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Kidney Week

Abstract: FR-PO521

Early Peritoneal Dialysis Start: Is There Room for More?

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ferrer, Francisco, CHMT - EPE, Torres Novas, Portugal
  • Abrantes, Ana rita, Centro Hospitalar Médio Tejo - EPE, Torres Novas, Portugal
  • Gonçalves, Hernâni Ricardo Martins, Centro Hospitalar do Medio Tejo, Torres Novas, Portugal
  • Lobos, Ana Vila, Centro Hospitalar do Médio Tejo, Lisbon, Portugal
Background

Despite educational care, a considerable number of End Stage Renal Disease (ESRD) patients present to Nephrology without a plan for dialysis and in the urgent need of it. Most of them could be suitable for Peritoneal Dialysis (PD), but concerns with PD access placement, makes hemodialysis (HD) through a central venous catheter as the only viable option. Early PD start (in the first 14 days after catheter placement) could be an option in this subset of patients and favor the increment of PD programs.
The purpose of our study was to demonstrate that early PD start could be a safe option for patients in the urgent need of dialysis.

Methods

Retrospective, single-center study, with 18 ESRD patients without a dialysis care plan, who started PD in the first 14 days after catheter placement (Early start group - ESG) and 34 patients who started PD after planned dialysis care (Late start group - LSG). For each group we collected demographic data, previous nephrology follow up, type of catheter placement and initial PD prescription. We also measured short-term (90-day) clinical outcomes (Kt/V, creatinine clearance, daily ultrafiltration (UF), hemoglobin, ferritin, parathyroid hormone, phosphorus, calcium and albumin), as well as PD related complications (peritonitis, exit-site infections, leaks and catheter dysfunction).

Results

Patients on ESG begun PD in about 4.9 days after catheter placement, mainly due to overhydration. These patients were predominantly of male gender (88 vs 59%, p= 0.025) and without previous follow-up by Nephrologist (67 vs 97%, p=0.001). Although there weren’t any differences in PD modality and type of catheter placement, exchange volumes were lower in the ESG (p=0.001). Short term outcomes were equal among groups, except for daily UF (higher in ESG; p= 0.013). Concerning mechanical complications, the number of leaks and episodes of catheter dysfunction were also similar, as well as the rate of infectious complications.

Conclusion

Despite being a single center study, with a small number of patients enrolled, our results demonstrate the safety and feasibility in beginning PD in patients with kidney failure, without a previous plan for renal replacement therapy. Early PD start in patients with the urgent need of dialysis could be an important step to improve PD worldwide, overcoming the initiation of HD through a catheter and its well known risks.