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Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes
George Tsihlis1,2, Kieren Pirabhahar3, Frederika Sciberras1
1Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia.
Insights
Early-start peritoneal dialysis (ESPD) within 14 days of catheter insertion shows similar complication rates to conventional-start PD, except for increased pericatheter leaks. This strategy is viable for kidney failure patients.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Peritoneal dialysis (PD) is increasingly initiated soon after catheter insertion.
- Limited data exists on the outcomes of this early-start strategy.
Purpose of the Study:
- To compare the outcomes of early-start PD (ESPD) and conventional-start PD (CSPD).
- To evaluate complications and transfer rates between ESPD and CSPD.
Main Methods:
- Retrospective observational study of 297 adult kidney failure patients initiating PD.
- ESPD was defined as PD commencement ≤14 days post-catheter insertion; CSPD was >14 days.
- Data collected on demographics, infectious and mechanical complications, and time to PD-related peritonitis or hemodialysis transfer.
Main Results:
- 130 patients (43.8%) underwent ESPD.
- ESPD was associated with significantly more pericatheter leaks (6.9% vs. 0.6%, P=0.003) compared to CSPD.
- No significant differences were observed in other complication episodes, PD-related peritonitis, or transfer to hemodialysis.
Conclusions:
- Early-start PD is associated with an increased risk of pericatheter leaks.
- Otherwise, ESPD demonstrates a comparable complication profile to conventional-start PD.
- Catheter insertion technique and prior hemodialysis did not impact outcomes.
Introduction:
Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy.
Methods:
This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at ≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value < 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis.
Results:
A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P = 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes.
Conclusion:
ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile.
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