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Kidney Week

Abstract: PO1268

Outcomes of Urgent-Start Peritoneal Dialysis in a Retrospective Cohort

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Matzumura Umemoto, Gonzalo, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • O Brien, Frank J., Washington University in Saint Louis, Saint Louis, Missouri, United States
Background

Peritoneal dialysis (PD) has shown to have early survival benefit and increased patient satisfaction when compared to in-center hemodialysis. Despite this, 87% of patients with End Stage Renal Disease (ESRD) start on hemodialysis, while only 10% of patients start RRT via peritoneal dialysis. The Advancing American Kidney Health Initiative was launched in July 2019, with the goal of having 80% of incident ESRD patients on a home modality or transplant by 2025. In this context, major changes will need to ensue so patients starting RRT can have increased access to home dialysis. Conventional start peritoneal dialysis requires the PD catheter to rest for several weeks after insertion prior to use. This limits the use of PD for patients that need to start RRT urgently. An alternative is urgent start PD where dialysis can be started as soon as 1 day after catheter insertion. There is growing evidence that urgent start PD is a safe and effective alternative to urgent start hemodialysis.

Methods

A retrospective analysis of patients that underwent urgent start peritoneal dialysis from 2013 to 2019 at the Washington University Home Modalities Dialysis Clinic was conducted. Complications (including catheter leak, catheter malfunction, infections and bleeding episodes), hospital admissions in the first 30 days after catheter placement and time patients remained on PD after urgent start were examined.

Results

41 patients were started on urgent PD during the study period. 12 patients (29%) were started as an inpatient and 29 patients (71%) as an outpatient. Median time from catheter placement to initiation of dialysis was 5 days. Major complications including peri-catheter leaks occurred in 3 patients (7.3%), catheter malfunction in 7 patients (17.1%), peritonitis within the first 4 weeks occurred in 3 patients (7.3%) and 2 patients (4.8%) developed an exit site infection. There was 1 patient that had a major bleeding event after catheter placement. 11 patients (27%) were admitted to the hospital within the first 30 days after urgent start PD. During the follow-up period, the median time patients were on PD after urgent start was 15.9 months, 16 patients (39.02%) transitioned to another form of RRT.

Conclusion

As has been demonstrated in previous studies urgent start PD remains a viable option for initiation of RRT and ensures increased access to home dialysis.