Introduction:
Peritoneal dialysis (PD) is an excellent modality of KRT but is used rarely at the initiation in ESKD patients throughout the world. A successful PD-first policy requires medical expertise, patient factors and their selection, support of dedicated staff and a well-designed patient training programme.
Methods:
This is a descriptive study to elucidate PD as a Standard of Care (SOC) 1st initiative in ESKD patients. Here we collected the data of patients who presented to us from Aug 2022 to Jul 2024, all selected patients being first time presented to us with ESKD with any of the standard KRT requiring indications from a single center in south India, described them in terms of basic epidemiology, presentation, urine and serum lab parameters, the type of catheters used, modality/ prescription and were followed up regularly.
Results:
A total of 33 adult patients were diagnosed to have ESKD and opted for PD as 1st choice of KRT during the study period. Among them 51.51 % (n- 17) were male population with mean age of presentation was 36.75 years. The same nephrologists performed percutaneous placement of soft PD catheter which includes Emergent Start PD (ESPD) 69.69% (n- 23), Urgent Start PD (USPD) 12.12% (n- 4), Immediate Start PD (ISPD) 12.12% (n- 4) and primary nonfunctioning in 6.06% (n- 2) for which Simultaneous Catheter Repositioning (SCR) was done later. All patients were managed initial 2 weeks with APD with low volume dwells based on the BMI and patient related factors and subsequently were converted to either CAPD 42.42% (n- 14) or continued with APD 57.57% (n-19) based on the patient’s choice. Bridge HD was considered in 2 patients for couple of sessions i/v/o acute pulmonary edema. The M.C co-morbidity was DM followed by HTN, M. C CKD etiology was DKD 46.20% f/b CIN. The mean Hb and S. Alb in PD patients were 12.08gms/ dl and 2.18 g/ dl respectively. The mean S. K levels were 3.36mmol/ L and over all there was good preservation of RRF in terms of preserved U.O, better nutritional stability and good quality of life. Currently we have 60. 60% of patients on PD (APD 42.42% n- 14, CAPD 18.18% n- 6), 12. 12% n- 4 on HD, 6.06% n- 2 underwent renal transplantation and 6.06% n- 2 expired due to CVD related events.
Conclusions:
PD first policy is no longer any contraindication rather has many advantages for initiation of RRT in selected patients after proper assessment. Barriers for PD first policy should be off-loaded. PD friendly government policies, economics, provider or healthcare professional education, modality-related factors, and patient-related factors should be overcomed and the implementation should be encouraged.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.