Abstract: TH-PO827

Urgent Start Dialysis: Peritoneal Dialysis versus Hemodialysis via a Central Venous Catheter

Session Information

  • Peritoneal Dialysis - I
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Bhalla, Neelam M., kaiser permanente, Hayward, California, United States
  • Arora, Neiha, The Permanente Medical Group, Oakland, California, United States
  • Darbinian, Jeanne A., Kaiser Permanente, Oakland, California, United States
  • Zheng, Sijie, The Permanente Medical Group, Oakland, California, United States
Background

Though underutilised in the US, PD is a safe and effective home modality of renal replacement therapy.One reason for under use of PD is the practice of initiating patients on HD via a central venous catheter (CVC) if they do not have a functional AVF/AVG. When compared with AVF/AVG, CVC use is associated with increased mortality. Recently, use of urgent start PD has gained interest since it decreases use of CVCs, while affording a mechanism of increased PD utilization. In this retrospective cohort study, we compared complications and outcomes between the two urgent start dialysis modalities.

Methods

We identified a subpopulation of KPNC members who met clinical criteria for being in urgent need of beginning PD or HD between 1/1/2011 and 12/31/2014. Urgent start HD patients were matched 3:1 with PD urgent starts on selected characteristics. Medical records of all cohort members were reviewed by three nephrologists. Complications and outcomes occurring after initiation of dialysis were compared between the modalities using Chi-square or Fisher exact tests.

Results

We compared 335 HD starts with 84 PD starts. There were no modality switches in the PD cohort; in HD start cases one changed to home HD and four to PD. Transferring to hospice accounted for 92% of modality terminations in HD; reasons in PD were psychosocial (43%); medical (28.6%); peritonitis (14.3%) and others (14.3%). Major complications were low in both groups (<5%), though rate of catheter malfunction was higher in HD (12.8% vs. 6.0%, p=0.09). There was a statistically significant difference in overall infectious complications between PD (20%: peritonitis -13%; exit site - 7%) and HD (9%: bacteremia - 7.2%; exit site - 1.8%, p<0.01). There were more deaths in the HD group (19.7% vs 7%, p=0.015). Furthermore a higher proportion of deaths was observed in patients with bacteremia compared with those who had peritonitis (25 vs. 16.7%). Pericatheter leaks developed in 7% of PD cases and in no HD patients.

Conclusion

Urgent PD start is a viable alternative to urgent HD start via CVC. Although infectious complications were higher in PD, peritonitis was associated with less mortality than bacteremia. Notably there is a high patient retention rate, leading to increased utilization of PD.

Funding

  • Private Foundation Support