Urgent-Start Peritoneal Dialysis: Brazilian Experience

Author(s)

Alves, Camila Albuquerque ; Calice-Silva, Viviane ; Rufino, Elaine Mari ; Garms, Durval ; Ferreira, Helen Caroline ; Baptistella, Mariane ; Dias, Dayana Bitencourt ; Mendes, Marcela Lara ; Banin, Vanessa Burgini ; Ponce, Daniela

• Document type: Journal article
• Source: BLOOD PURIFICATION; v. 52, n. 6, p. 8-pg., 2023-06-08.

Abstract

Introduction: Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. Methods: This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. Results: Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 & PLUSMN; 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (p = 0.003) and exit site infection (p = 0.002) were identified as predictors of peritonitis, while mechanical complications (p = 0.004) and peritonitis (p < 0.001) were identified as predictors of technique failure and switching to HD. Age (p < 0.001), hospitalization (p = 0.012), and bacteremia (p = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. Conclusion: PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds. (AU)

• FAPESP's process: 19/02116-2 - Strategies to overcome an undertaking of peritoneal dialysis as an option of chronic replacing kidney therapy
• Grantee: Daniela Ponce
• Support Opportunities: Research Grants - Research in Public Policies