COMPARING THE OUTCOMES OF URGENT START AND CONVENTIONAL START PERITONEAL DIALYSIS : A RETROSPECTIVE ANALYSIS FROM A TERTIARY CARE CENTRE IN SOUTH INDIA

Introduction:

As patient survival on long-term maintenance hemodialysis has continually improved in recent years, multiple vascular access failure necessitating urgent-start peritoneal dialysis (USPD) is becoming more commonplace. This study is aimed at examining the indications, complications, technique survival and mortality of patients who were initiated on urgent-start peritoneal dialysis in our centre. We further aimed to compare infective and non-infective complications, technique survival and patient survival between urgent-start and conventional-start peritoneal dialysis patients.

Methods:

The present study is a single-centre, retrospective, observational study, comparing the outcomes of patients with Urgent-Start Peritoneal Dialysis and Conventional-Start Peritoneal Dialysis(CSPD). All patients with End Stage Kidney Disease (ESKD) initiated on Chronic Peritoneal Dialysis from January 2019 to August 2023 were included. In the CSPD group, the exchanges were initiated 14 days after the catheter insertion and in the USPD group, the exchanges were initiated within 14 days of catheter insertion. The choice of Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD) was as per the treating Nephrologist’s discretion. The clinical profile and outcomes were compared between the two groups using appropriate statistical methods.

Results:

During the study period, 119 patients were initiated on chronic peritoneal dialysis, 94 (79%) on CSPD and 25 (21%) on USPD. The mean age of the patients was 42 (±2.8) years. Males represented 57.14% (n = 68) of the patients. Hypertension (69.75%, n = 83) was the most common comorbidity. The median follow-up time was 10 months (IQR: 5-18). The most common indication for USPD was multiple vascular access failure (72%, n=18). The incidence of PD peritonitis was similar in the CSPD and USPD groups (43.62%, n=41 vs 44%, n=11). The time to 1st episode of peritonitis did not differ significantly between the two groups (p = 0.85). Surgical complications occurred in 10.64% (n=10) and 4% (n=1) in the CSPD and USPD groups, respectively. Patient and technique survival at 12 months using Kaplan Meier survival analysis showed no significant difference between the two groups (p=0.34 and p=0.63, respectively).

Conclusions:

The surgical, mechanical, and infective complications were not significantly different between USPD and CSPD groups. Urgent Start PD is therefore a viable and safe mode of Renal Replacement Therapy.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.