Abstract: FR-PO533
Early Start Peritoneal Dialysis: How to Increment This Modality?
Session Information
- Peritoneal Dialysis: Modality, Catheter, Infections
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Ferrer, Francisco, Centro Hospitalar Médio Tejo - EPE, Torres Novas, Portugal
- Abrantes, Ana rita, Centro Hospitalar Médio Tejo - EPE, Torres Novas, Portugal
- Gonçalves, Hernâni Ricardo Martins, Centro Hospitalar Médio Tejo - EPE, Torres Novas, Portugal
- Lobos, Ana Vila, Centro Hospitalar Médio Tejo - EPE, Torres Novas, Portugal
Background
Despite the increasing incidence of end-stage renal disease (ESRD), peritoneal dialysis (PD) is offered to a minor subset of patients. One way to increment PD rates is the early start of technique after catheter placement without the usual break in times but there are concerns with mechanical and infectious complications that could compromise PD outcomes. The aim of this study was to compare the outcomes and safety of early PD start, after 12 and 24 months.
Methods
Retrospective analysis performed in a single-center; 52 patients: 34 started PD after planning (late start group - LSG) and 18 in the first 14 days after catheter placement (early start group - ESG). Demographic data, comorbidities, Charlson comorbidity index (CCI) were collected. PD related complications and dropout cases were identified.
Results
ESG present a male predominance (88.2 vs 58.8%; p=0.025) and higher CCI (35.9 vs 59.4% estimated 10-year survival) with a significantly prevalance of cardiovascular diseases (p=0.03). Average time between catheter placement and PD starting in the ESG was 5 days. LSG stayed longer under PD (813 vs 555 days). Kidney transplantation was the main cause of dropout in the LSG group whereas in the ESG the causes were mechanical issues and death. First episode of peritonitis (FP) occurred earlier in the ESG (478 vs 831 days) but this difference was not statistically significant among the 2 groups. Unadjusted Kaplan-Meier estimated that the difference in dropout-free survival was statistically significant in bouth groups (p=0.006, long rank test). Multivariate analysis with Cox regression demonstrated that, even though the risk of dropout was higher during the first 12 months in the ESG (HR=5.503; p=0.014), this decreases after 24 months (HR=2.363; p=0.036) of PD. The frequency of dropout was higher in the ESG (77.1% versus 61.8%) but this difference was not significant (p=0.242). When comparing the frequency of dropout after excluding patients that were transplanted, results were similar.
Conclusion
Urgent-start PD can be a valid and safe alternative to hemodialysis via central venous catheter and should be offered to patients without contraindications. Other factors not related to the early start of technique (age and higher CCI), can have a negative impact on the morbidity and mortality of those patients influencing the outcomes of DP technique.