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Unveiling the Intricacies: Exploring Stepwise Initiation of Peritoneal Dialysis in a Single-Center Setting
Ping-Kun Hsiao1, Wei-Je Wong2, Su-I Hsieh3,4
1Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111 Sec. 3, Xinlong Rd, Taipei 11696, Taiwan.
Insights
Stepwise Initiation of Peritoneal Dialysis (SIPD) may reduce infections and peritonitis compared to conventional PD, though catheter survival remains similar. Further research is needed to confirm these findings for chronic kidney disease patients.
Area of Science:
- Nephrology
- Medical Technology
Background:
- Chronic kidney disease (CKD) is a global health issue requiring effective renal replacement therapies.
- Peritoneal dialysis (PD) offers a home-based alternative to hemodialysis.
- The Stepwise Initiation of Peritoneal Dialysis (SIPD) method's efficacy and safety require further investigation.
Purpose of the Study:
- To compare the efficacy and safety of SIPD versus conventional PD (CPD).
- To evaluate complication rates and catheter survival between SIPD and CPD.
Main Methods:
- Retrospective analysis of 39 patients on SIPD and 78 on CPD.
- Matched for age and sex.
- Evaluation of surgical techniques, complications, infection rates, and catheter survival using statistical analysis.
Main Results:
- SIPD had a significantly longer break-in period (176 days vs. 27 days).
- CPD showed higher rates of late complications, including peritonitis.
- SIPD experienced fewer infection events (28 vs. 80, p=0.043), but catheter survival was not significantly different.
Conclusions:
- SIPD may decrease catheter-related infections and peritonitis incidence compared to CPD.
- An extended break-in period in SIPD might promote tissue healing and reduce biofilm formation.
- Further multi-center studies are recommended to validate these findings and assess economic impact.
Abstract:
Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. Materials and Methods: We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, t-test, and negative binomial regression. Results: The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, p = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. Conclusions: Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD.
