Abstract: SA-PO706
The Choice of Urgent-Start Peritoneal Dialysis versus Hemodialysis through a Tunneled Central Venous Catheter: A Single Center Experience in the United States
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
- Wang, Delin, Brown University, Providence, Rhode Island, United States
- Kerns, Eric S., Brown University, Providence, Rhode Island, United States
- Licht, Jonah, Brown University, Providence, Rhode Island, United States
- Hu, Susie L., Brown University, Providence, Rhode Island, United States
Background
Peritoneal dialysis (PD) has been underutilized for patients with unplanned need for initiation of renal replacement therapy compared to hemodialysis (HD) through a tunneled central venous catheter (CVC) in the United States.
Methods
We examined outcomes related to urgent start PD versus HD (with a tunneled CVC) in a retrospective cohort of 47 adults who required urgent dialysis initiation from January 2015 to December 2016. Those who are unstable with critical illness were excluded. In addition to baseline demographics and comorbidities, we compared dialysis access related complications and total number of procedures required related to dialysis modality selection. Comparisons were performed using t-test for linear variables, and chi-square test for categorical variables.
Results
28 patients had tunneled CVC placed for HD and 19 patients had PD catheter placed. Mean follow-up was 60 months for HD patients and 46 months for PD patients. The PD group was significantly younger, with less heart failure, more hypertension, and higher pre-dialysis serum creatinine (Table). 75% of patients who underwent HD with a tunneled CVC versus 47% who performed urgent start PD had any access related procedures.
Conclusion
The complication rate related to dialysis modality choice between urgent start PD and HD with a tunneled CVC is similar. There was a trend towards fewer procedures required for urgent start PD and should be more commonly considered for those requiring dialysis urgently.
Comparisons between urgent start PD and HD
| HD | PD | P-value | |
| Age (years) | 60 ± 15 | 46 ± 17 | 0.007 |
| Follow-up duration (months) | 60 | 46 | 0.85 |
| Potassium (mEq/L) | 4.8 ± 0.9 | 4.3 ± 0.7 | 0.05 |
| HCO3 (mEq/L) | 19 ± 4 | 18 ± 4 | 0.64 |
| BUN (mg/dL) | 97 ± 41 | 111 ± 38 | 0.25 |
| Creatinine (mg/dL) | 8.1 ± 4.7 | 12.0 ± 6.1 | 0.01 |
| Coronary artery disease (%) | 39 | 16 | 0.08 |
| Congestive heart failure (%) | 43 | 5 | 0.005 |
| Hypertension (%) | 89 | 95 | 0.01 |
| Diabetes mellitus (%) | 57 | 21 | 0.51 |
| Access-related procedures (%) | 75 | 47 | 0.05 |