Urgent start peritoneal dialysis shows high survival rate in integrated health care system
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One year after patients initiated urgent start peritoneal dialysis in an integrated health care system, they experienced high survival and modality retention rates according to data published in Kidney Medicine.
Further, researchers suggest that urgent start PD should be considered an option in situations calling for unplanned initiation of dialysis.
“Urgent start PD has been shown to have a low incidence of complications including peritonitis, leaks, catheter malfunction, hospitalizations and modality failure, with favorable 90-day outcomes,” Sijie Zheng, MD, PhD, from the division of nephrology at Kaiser Permanente Medical Center in Oakland, California, and colleagues wrote. “The objectives of this study were to study the demographic and clinical characteristics in patients who were initiated on urgent start PD and to assess complications, survival rate and modality failure at defined time intervals.”
In a retrospective cohort study, researchers monitored 84 adult members of Kaiser Permanente Northern California who initiated urgent start PD between Jan. 1, 2011, and Dec. 12, 2014. Researchers measured the retention rates of patients at 30, 90 and 365 days using binomial proportions. Using the Kaplan-Meier method, researchers estimated cumulative incidence of all-cause mortality.
Less than 5% of the cohort experienced major complications and 6% experienced catheter malfunction. Peritonitis and exit site infections occurred in 20% of patients. In addition, 1 year after PD initiation, the total all-cause mortality was 9.7%. Analyses revealed retention rates of 98.8%, 91.3% and 80% at 30 days, 90 days and 365 days, respectively.
“Within an integrated health care system, urgent start PD was shown to be a safe, viable and sustainable treatment option. Given the recent executive order for increasing home dialysis incidence, urgent start PD should be more widely used for patients needing prompt and unplanned dialysis initiation,” Zheng and colleagues wrote. “It is unclear whether our results are generalizable to other health care systems, where delivery of care historically has been more fragmented. Ideally a prospective, multicenter randomized study should be performed to confirm the results.”
Perspective
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It was good to see how this study paid attention to how the PD catheters performed at 30, 60 and 90 days, because the last thing you want is a leaky catheter. Any technician can put a catheter in, but it takes an artist to make it work right. So, when you’re trying to optimize these patients’ PD starts in an unplanned manner, you have to align yourself with a good technician, whether that’s a surgeon or interventional radiologist. Therefore, it was good to see that this study was done in an integrated health care system. The context of an integrated health care system allows for a more seamless transition for the involved patients and providers. Everyone caring for the patient is on the same page, whereas in a real-world situation, that’s not always the case; as an example, sometimes a surgeon is at a different hospital or the available nephrologist isn’t comfortable with the PD start. Additionally, it was important that this study showed outcome complications that were similar to those in standard PD starts. Moving forward, I think we need more prospective pilot studies for unplanned dialysis with integrated processes to optimize these transitions in kidney care.
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