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Kidney Week

Abstract: PO1261

Urgent-Start Peritoneal Dialysis and Outcomes

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Karpinski, Steph, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Sibbel, Scott, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Cohen, Dena E., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Van Wyck, David B., DaVita Patient Safety Organization, Denver, Colorado, United States
  • Ghaffari, Arshia, University of Southern California, Los Angeles, California, United States
  • Schreiber, Martin J., DaVita Inc, Denver, Colorado, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Many patients start dialysis without adequate pre-dialysis planning, and generally initiate hemodialysis using a central venous catheter (HD-CVC). A minority utilize urgent start peritoneal dialysis (USPD), where a peritoneal dialysis catheter is placed and used for dialysis initiation without the usual 2-4 week waiting period. Few analyses have compared outcomes between patients utilizing these two dialysis initiation routes.

Methods

All data for this retrospective study were derived from deidentified electronic health records. Patients who initiated dialysis via HD-CVC during 2018 were matched 1:1 to patients who initiated dialysis using USPD during the same period on the basis of insurance type, etiology of end-stage kidney disease, race, and presence of diabetes. Hospitalization, mortality, and scores on the Kidney Disease Quality of Life (KDQOL) survey were evaluated from dialysis initiation through the first of death, transplant, loss to follow-up, or study end (30 June 2019). Outcomes were compared across exposure groups using models adjusted for age and sex.

Results

A total of 717 USPD patients were matched to HD-CVC patients. During follow-up (mean 1.2 ± 0.6 years in both groups), USPD patients were hospitalized at a rate of 1.21 admissions/patient-year (pt-yr), vs. 1.51 admissions/pt-yr for HD-CVC patients. This corresponded to a 24% lower rate of hospitalization among USPD patients (adjusted incidence rate ratio 0.76, 95% confidence interval [CI] 0.65 – 0.88). Mortality rates were likewise lower among USPD patients compared to HD-CVC patients (0.08 vs 0.11 deaths/pt-yr) although this trend did not achieve statistical significance (adjusted hazard ratio 0.84, 95% CI 0.62, 1.15). No differences were observed with respect to KDQOL scores.

Conclusion

Among patients with little to no predialysis planning, use of USPD is associated with a lower subsequent hospitalization rate and a trend towards lower mortality rate, compared to HD-CVC. In areas where facilities and clinical expertise exist, more widespread adoption of USPD may lead to better outcomes among patients with limited pre-dialysis planning.