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Urgent-start peritoneal dialysis: Association with outcomes
Steph Karpinski1,2, Scott Sibbel1,2, Dena E Cohen1,2
1DaVita Clinical Research, Minneapolis, MN, USA.
Summary
Urgent-start peritoneal dialysis (USPD) shows lower hospitalization rates compared to in-centre hemodialysis with central venous catheters (ICHD-CVC) for end-stage kidney disease patients. This suggests USPD may be a beneficial option for those with limited pre-dialysis planning.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- Many end-stage kidney disease (ESKD) patients initiate dialysis without adequate pre-dialysis planning.
- In-centre hemodialysis via central venous catheter (ICHD-CVC) is the predominant initiation route.
- Urgent-start peritoneal dialysis (USPD) offers an alternative, allowing immediate dialysis catheter use.
Purpose of the Study:
- To compare hospitalization and mortality outcomes between USPD and ICHD-CVC initiation routes.
- To evaluate the effectiveness of USPD in patients with limited pre-dialysis planning.
Main Methods:
- Multicentre retrospective study of adult patients initiating dialysis in 2018.
- 1:1 matching of USPD patients to ICHD-CVC patients based on ESKD aetiology, race, diabetes, and insurance.
- Hospitalization and mortality tracked from initiation to June 30, 2019, with adjusted analyses for age and sex.
Main Results:
- USPD patients experienced a 24% lower hospitalization rate (1.21 admissions/pt-yr vs. 1.51 admissions/pt-yr).
- Adjusted incidence rate ratio for hospitalization was 0.76 (95% CI 0.65-0.88) favoring USPD.
- Mortality rates were similar, with a trend favoring USPD (0.08 vs. 0.11 deaths/pt-yr; adjusted hazard ratio 0.84, 95% CI 0.62-1.15).
Conclusions:
- USPD is associated with significantly lower hospitalization rates compared to ICHD-CVC.
- Widespread adoption of USPD may improve outcomes for ESKD patients initiating dialysis with limited planning.
- USPD represents a viable and potentially safer alternative for urgent dialysis initiation.
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