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Chronic peritoneal dialysis (PD) has been initiated in different modalities: urgent (US), early (ES) and planned (Plan) PD. Our aim was to assess whether PD initiation modality interferes in complications at 30 days, patient outcomes and technique survival at 180 days.
This is a single-center retrospective study that included incident adult patients starting PD between November/2016-July/2022. Exclusion criteria were incomplete data and patients with acute kidney injury or who underwent hemodialysis (HD) for more than 30 days. The subjects were divided into three groups: 1) US-PD: started PD with an urgent indication within 3 days after catheter implantation, without prior HD; 2) ES-PD: started within 14 days, including those who underwent urgent HD for up to 30 days; 3) Plan-PD: started PD after a 15-day break-in period, without prior HD. Complications and hospitalizations 30 days after PD initiation were compared and technique and patient survival at 180 days were evaluated.
Among 394 patients identified, 282 were included in this analysis. Mean age was 57.1±15.6 years old, most patients were men (56.7%) and considered themselves as white race (89.4%). Most common etiology for kidney disease was diabetes (42%). Most part of patients had arterial hypertension and diabetes as main comorbidities (91.8% and 52.5%). Regarding the onset of PD, 118 (41.8%) patients underwent US-PD, 117 (41.5%) ES-PD and 47 (16.7%) Plan-PD. In ES-PD, 86 (73.5%) patients had previously undergone HD and heart failure was more prevalent than in the other groups. The majority (55.3%) of catheters were implanted by Seldinger technique (ST), 29.1% laparotomy (LP) and 15.6% videolaparotomy (VLP). The catheter implantation technique differed between groups, with a higher percentage of implants by ST in the US-PD group (61.9%) and a higher frequency of LP in the ES-PD group (38.5%), p=0.042. The main complications were mechanical ones, such as catheter dysfunction (10.3%) and leakage (9.6%), the latter being more frequent in the ES-PD group and in LP procedures. Hospitalization at 30 days and patient survival at 180 days did not differ between groups. Technique survival was similar between groups (US-PD 83.9%, ES-PD 78.6% and Plan-PD 91.5% - p=0.132) in 180 days follow-up. The main reason for dropout was transfer to HD, which was more frequent in ES-PD (ES-PD 13.7% vs 5.1% US-PD vs 4.3% Plan-PD – p=0.030). Deaths within 180 days did not differ between the three groups (8.5% US-PD vs ES-PD 6% vs 0% Plan-PD – p=0.126).
Mechanical complications were the most common ones identified and the higher rates of leakage and transfer to HD in the early-start group may be related to patient characteristics. The technique and patient survival seem to be unrelated to the modality of PD initiation (urgent, early or planned) in the first 180 days after starting therapy.