Kidney Week

Abstract: FR-OR105

Initiation of Peritoneal Dialysis in Patients with Cardiorenal Syndrome Reduces Subsequent Hospitalization

Session Information

• Peritoneal Dialysis: Innovations and Clinical Practice
  November 08, 2019 | Location: 147, Walter E. Washington Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Auguste, Bourne L.A, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Bourne L.A Auguste, MD, MS



Dr. Bourne Auguste is a nephrologist at Sunnybrook Health Sciences Centre and an Assistant Professor in Department of Medicine at the University of Toronto, in Toronto, Canada. His areas of research and clinical focus are quality improvement, patient safety and innovation. He currently has interests in developing innovative tools for home dialysis training and improving patient selection pathways for all forms of independent dialysis eligibility. Dr. Auguste has also taken an interest in acute peritoneal dialysis (PD) by using ultrasound-guided PD catheter insertions as a means to improve modality options and access for patients.

• Ibrahim, Ali Z., Toronto General Hospital, Toronto, Ontario, Canada

Ali Z. Ibrahim,

• Girsberger, Michael Yannik, Toronto General Hospital, Toronto, Ontario, Canada

Michael Yannik Girsberger,

• Abreu, Zita C., Toronto General Hospital, Toronto, Ontario, Canada

Zita C. Abreu,

• Agarwal, Arnav, University of Toronto, Toronto, Ontario, Canada

Arnav Agarwal,

• McQuillan, Rory F., University of Toronto, Toronto, Ontario, Canada

Rory F. McQuillan,

• Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada

Joanne M. Bargman,

Background

Inotropic dependence and diuretic resistance in patients with cardiorenal syndrome (CRS) leads to frequent hospitalizations and is associated with high mortality. Peritoneal dialysis (PD) offers a smoother hemodynamic profile with effective volume removal for these patients. There is little data on this approach in the North American literature. The aim of our study was to determine if volume overloaded CRS patients on maximal doses of diuretic therapy had reduced heart failure hospitalization following PD initiation.

Methods

We reviewed CRS patients receiving a bedside catheter and starting PD urgently within 2 weeks of insertion at the University Health Network from January 1, 2013 to December 31, 2018. Data for heart failure-related hospitalizations and length of stay 6 months before and after PD initiation was collected. Patients who died, switched to hemodialysis or were transferred to another facility within 6 months of starting PD were excluded from analysis of the hospitalization rates.

Results

We identified 31 CRS patients who had a beside PD catheter inserted. The average age of patients was 66.0 ± 13.0 years. There were 7 (22.6%) deaths and 4 (12.9%) transfers to other programs or hemodialysis within 6 months of catheter insertion. After exclusion, we analyzed the hospitalization and length of stay data for 20 patients. The hospitalization rate 6 months prior to PD initiation was 6.9 admissions per 1000 patient-days. This decreased to 2.5 admissions per 1000 patient-days after PD initiation (Figure 1). Additionally, there was also a striking reduction in the average length of stay (24.1 to 3.9 days; p= .001).

Conclusion

Volume overloaded CRS patients receiving maximal diuretic therapy have lower hospitalization rates and shorter stays after PD initiation. Adopting quality improvement strategies such as bedside PD catheter insertions can serve as a means to facilitate acute start dialysis in this population.