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Peritoneal dialysis (PD) has become a well-established alternative to hemodialysis (HD) as the first-line renal replacement modality. During the COVID-19 pandemic, we generated a renal replacement therapy program with PD as the first option in acute and chronic patients. Patients admitted to urgent-onset PD continued ambulatory treatment
Retrospective cohort study of 43 adults who initiated urgent start PD between April 2021 and October 2022. Retention rates at 30, 60, six months and 365 days; development of noninfectious and infectious complications; modality failure and switch to hemodialysis; all-cause mortality; and the impact of this urgent start peritoneal dialysis unit on the total number of patients on peritoneal dialysis in our province were analyzed.
We analyzed 44 patients with urgent initiation of peritoneal dialysis. The characteristics of the studied population are summarized (Table 1). Retention in the modality was 88% at 30 days, 75% at 60 days, 61% at 6 months and 56% at one year (Figure 1). Total mortality 11 patients (25%). Causes: Covid-19 associated pneumonia 8 (16%), bacterial pneumonia 1 (2%), sudden cardiovascular death 1 (2%), treatment drop-off 1 (2%). Modality changes occurs in 7 patients (15%) due to lack of compliance and recurrent peritonitis. Mechanical and abdominal wall problems were observed in 7 patients, mostly symptomatic hernia. All of these patients required surgical repair and transition to automated peritoneal dialysis (Table 2). The rate of peritonitis was high at 0.8 episodes/patient/year, mostly due to staphylococcus aureus. One Aspergillus fungal peritonitis was recorded in a patient with leukemia. Three patients (6%) recovered kidney function.
The historical average of patients treated with peritoneal dialysis in the province of San Juan is 63±1. Since the operation of the urgent start unit, the average increased to 89±1, p<0.05 vs. prior years to 2021 (Figure 2).
In our studied population, urgent start peritoneal dialysis is an acceptable modality as acute replacement therapy, despite a higher frequency of complications than expected in scheduled start. It allows a sustainable modality in an acceptable proportion of patients with chronic kidney disease.