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Kidney Week

Abstract: SA-PO740

Urgent-Start Peritoneal Dialysis in the Outpatient Setting in an Underserved Urban Area

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

  • Serrano, Andres, Mount Sinai Hospital, Chicago, Illinois, United States
  • Philip, Melby, Mount Sinai Hospital, Chicago, Illinois, United States
Background

Despite an increase in End-Stage Renal Disease (ESRD) incident cases selecting Peritoneal Dialysis (PD), the proportion of patients on PD remains below historical levels achieved in the 80s. There is an increased interest in urgent-start PD, as a way of increasing the number of patients on PD, and decreasing the number of patients initiating hemodialysis (HD) through a central venous catheter. However, implementing these programs could be challenging in a community hospital with scarce resources. Also, there is a great level of concern regarding complications at the moment dialysis is initiated. We are presenting our experience with a group of patients who had urgent-start PD.

Results

During a period of 8 years, a total of 81 patients initiated PD. Forty-three patients (53%) had an indication for urgent dialysis initiation, and they either decided in advance for PD or after education regarding RRT then decided for PD. The patients underwent laparoscopic PD catheter insertion, and within 14 days they initiated PD training at the dialysis clinic. During the time in training, they received low volume PD. Of the 43 patients, 21 patients (49%) presented through the ER with no history of kidney disease. The average age was 47.9 years, and the majority of patients were Hispanics (67%). In fourteen patients (33%) the etiology of ESRD was unknown. The average estimated GFR at dialysis initiation was 6 ml/min, and the average number of days between PD catheter insertion and PD initiation was 8 days. Seven patients required in-hospital temporary HD because of impending complications related to uremia, but once stable, they had the PD catheter placed and they initiated PD training as outpatient. Two patients started PD immediately in the hospital after the catheter was placed because of emergent dialysis needs and no HD access. In terms of complications, there were 2 mechanical complications (1 pericatheter leakage, 1 poor catheter flow) and one PD related peritonitis, compared to 0 mechanical complications and 3 PD related peritonitis in patients who started PD the traditional way.

Conclusion

Our experience shows that urgent-start PD is a safe alternative to initiate renal replacement therapy avoiding the use of long term central venous catheters. We also demonstrated that urgent-start PD can be done successfully in the outpatient setting.