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Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors
Damin Xu1, Tianjiao Liu1, Jie Dong1
1Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University; and Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Beijing, PR China.
Insights
Urgent-start peritoneal dialysis (PD) is safe. Male sex and prior abdominal surgery increase the risk of abdominal wall complications in urgent-start PD patients.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Complications
Background:
- Mechanical complications are a significant concern in urgent-start peritoneal dialysis (PD) due to a shortened break-in period.
- Limited data exists on risk factors for these complications in urgent-start PD populations.
Purpose of the Study:
- To identify risk factors associated with mechanical complications in patients undergoing urgent-start PD.
- To evaluate the safety and practicability of urgent-start PD.
Main Methods:
- An observational cohort study was conducted.
- Data from 922 patients initiating PD within one week of catheter insertion (January 2003 to May 2013) were analyzed.
- Predictors included age, sex, surgical history, BMI, and laboratory values.
Main Results:
- The prevalence of abdominal wall complications was 4.8%, and catheter complications was 9.5%.
- Hernia (55%) and hydrothorax (25%) were the most common abdominal wall complications.
- Male sex (HR, 5.41) and history of abdominal surgery (HR, 2.34) were independently associated with increased risk of abdominal wall complications.
Conclusions:
- Urgent-start PD is a safe and feasible treatment option.
- Male sex and a history of abdominal surgery are identified as risk factors for abdominal wall complications in this population.
Background:
Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited.
Study Design:
Observational cohort study.
Setting & Participants:
All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013.
Predictors:
Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell.
Outcomes:
The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction.
Results:
922 patients on urgent-start PD therapy were enrolled (mean age, 59.1±15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; P<0.001) and history of abdominal surgery (HR, 2.34; 95% CI, 1.04-5.26; P=0.04) were independently associated with higher risk for developing abdominal wall complications.
Limitations:
As a cohort study, comparisons could not be established between urgent-start PD and conventional PD.
Conclusions:
Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications.
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