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Kidney Week

Abstract: SA-PO691

Dialysis Modality in PD Patients Undergoing Laparoscopic Surgery

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Cho, Janis, Augusta University, Augusta, Georgia, United States
  • Waller, Jennifer L., Augusta University, Augusta, Georgia, United States
  • Kheda, Mufaddal F., Augusta University, Augusta, Georgia, United States
  • Baer, Stephanie L, Augusta VA Medical Center, Augusta, Georgia, United States
  • Colombo, Rhonda E., Augusta University, Augusta, Georgia, United States
  • Huber, Lu, Avera Medical Group Nephrology, Sioux Falls, South Dakota, United States
  • White, John Jason, Augusta University, Augusta, Georgia, United States
  • Plumb, Troy J., University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Nahman, N. Stanley, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
Background

Historically, PD patients requiring abdominal surgery required a change to hemodialysis (HD). Laparoscopic surgery (LPS) has been used for many abdominal procedures, but it is unclear if PD patients can undergo LPS and continue with PD. To address patterns of dialysis modality change in PD patients undergoing LPS, we queried the USRDS.

Methods

Incident PD patients from 2004 – 2011 (n=56,192) who underwent LPS were studied. Groups included: no interruption of PD(P); planned temporary (PT) HD then back to PD(PTHD-P); permanent switch (PS) to HD(PSHD); urgent temporary (UT) HD then back to PD(UTHD-PD); or urgent(U) HD with PS to HD(UHD-PSHD). Demographics and outcomes were determined. The relative risk (RR) of complications versus no interruption of PD (P) up to 3 months post-op were estimated.

Results

7298 PD patients had LPS, 45% women, 74% White, with mean+SD age 55+3 years, and time on dialysis of 16.6+1.9 months. Outcomes and group comparisons are shown in the table.
Continuing PD was the most common form of dialysis in PD patients undergoing LPS, had the lowest complication rate, and may represent the lowest-risk cohort for LPS. Planned switches to HD were better than urgent switches, and were likely applied to higher risk patients. Urgent switches that returned to PD had the highest complication rates for peritonitis, bacteremia, and wound infection, and may indicate cohorts of patients developing complications with or during LPS.

Conclusion

Continuing PD during laparoscopic surgery is common and appears safe. The need for urgent HD is uncommon, but if PD is resumed, it is associated with a higher risk of post-op complications. Risk stratification may help predict whether to switch dialysis modality in PD patients prior to LPS.

Dialysis Modalities Among PD Patients Undergoing LPS
VariablePTHD-PPSHDUTHD-PUHD-PSHDPp Value
N (%)2801 (27)1465 (19)250 (3.3)159 (2.1)3529 (47)NA
Final logistic regression model comparing switches to P (RR (95% CI))
LevelPeritonitisBacteremiaWound Infection
PTHD-P vs P1.98 (1.41 – 2.79)5.76 (4.44 – 7.47)2.72 (1.50 – 4.95)
PSHD vs P0.44 (0.24 – 0.81)1.48 (1.03 – 2.12)2.24 (1.14 – 4.42)
UTHD-P vs P5.64 (0.35 – 9.24)6.37 (4.15 – 9.79)6.05 (2.57 – 14.22)
UHD-PSHD vs P1.79 (0.71 – 4.53)4.50 (2.48 – 8.18)5.32 (1.76 – 16.03)