Researchers identify factors linked to complications in urgent-start peritoneal dialysis
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While researchers of this study found “limited complications” associated with urgent-start peritoneal dialysis, they identified several factors that may increase the risk for a variety of catheter-related complications, including leakage and peritonitis.
For patients who are not yet on dialysis but require renal replacement therapy within 2 weeks, urgent-start PD is a “feasible and well-tolerated alternative to hemodialysis,” according to José L. Hernández-Castillo, MD, of the National Autonomous University of Mexico, and colleagues.
“Adequate peritoneal catheter management is essential for the preservation of the peritoneal membrane function, thus permitting long-term PD management for CKD,” the researchers wrote. “However, urgent-start PD has shown an increased risk of leakage compared with routine or planned PD.”
With this in mind, Hernández-Castillo and colleagues sought to “identify the demographic and clinical characteristics of [end-stage renal disease] ESRD patients, as well as the presurgical, surgical and postsurgical factors associated with urgent-start PD complications.”
To do this, researchers conducted a retrospective cross-sectional observational study of 102 patients with ESRD who initiated renal replacement therapy with urgent-start PD (mean age, 56.2 years; 63.7% were men; 62.7% also had diabetes and hypertension).
Primary outcomes of the study were catheter leakage, dysfunction and peritonitis, though catheter removal, repositioning and mortality were also considered.
Researchers observed catheter leakage in 7.8% of the study population, catheter dysfunction in 26.5% and peritonitis in 13.7%. Catheter removal occurred in 5.9% of the study population and catheter repositioning occurred in 20.6%; 2.9% of patients died.
Results showed peritonitis was associated with younger age, higher creatinine levels upon hospital admission and heart failure.
In addition, researchers found patients with abdominal hernia were 7.5 times more likely to experience catheter leakage, and that catheter removal was associated with obesity and lower GFR.
“This study contributes to the existing urgent-start PD literature by providing evidence that true urgent-start PD with catheter opening within 72 hours has limited complications, making it a relatively safe option,” Hernández-Castillo and colleagues concluded of their findings. “However, larger prospective multicenter studies assessing these risk factors in urgent-start dialysis are needed.”
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