Introduction:
Aim: Immediate Start Peritoneal Dialysis (ImSPD) for initiation of peritoneal dialysis(PD), so as to avoid initial central venous catheter (CVC) insertion and hemodialysis (HD).
Methods:
This was a single center, prospective, case controlled, intention to treat study. A total of 75 patients were enrolled between May 2023 to August 2024. Group A (35 patients- control group) underwent Tenckhoff PD catheter insertion by Surgeon and conventional initiation of Manual PD exchanges after 14 days with initial phase HD with CVC access . Patients in Group B (40 patients- study group) underwent percutaneous Tenckhoff PD catheter insertion by Nephrologist and Immediate start of Automated Peritoneal Dialysis (APD). APD cycles were short and small volume to avoid exit site leak. Conversion from APD to manual PD in study group after 10 days as per patient’s choice. Primary outcome was comparison of PD related complications. Technique survival at 90 days was the secondary outcome.
Results:
Baseline characteristics were the same in both groups .
The cost of PD catheter insertion was less in study group. (121 USD per patient
in study group vs 263 USD in the control group).Catheter Related Blood Stream Infection(CRBSI )was noted in 5 out of 35(14.2%) of control group patients undergoing initial HD with Central Venous Catheter (CVC) access . None of the paients in the Study group underwent initial HD.
Outcomes of PD : (Table 1). There were 2 episodes of exit site leaks (5%) in the study group compared to 3(5.7%) in the control group(p=0.5361). Catheter blockage at start was seen 14% of group A vs nil in group B (p=0.0605) . Peritonitis at 90 days was seen in 4(10%) in study group vs 3(8.5%) in control group( p=1.000). Technique survival at 90 days after catheter insertion was 32/35(91.4%) in group A and 38/40( 95% ) in group B (p=0.5362) . Primary and Secondary outcomes between both groups were comparable.
Conclusions:
Acceptance of PD as RRT is more if we avoid HD with CVC catheter insertion. Percutaneous PD catheter insertion by Nephrologist under local anesthesia helps avoid General anesthesia and Laparatomy for PD catheter insertion by Surgeon.
Immediate start PD can be done by Percutaneous PD insertion and and initial APD with small volume short cycles
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.