Abstract: PO0974
Immediate Start PD: A Single-Center Experience
Session Information
- Peritoneal Dialysis
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Giles, Harold E., Nephrology Associates, Birmingham, Alabama, United States
- Watson, Thomas H., Nephrology Associates, Birmingham, Alabama, United States
- Kraus, Michael A., Fresenius Kidney Care, Waltham, Massachusetts, United States
- Chatoth, Dinesh K., Fresenius Kidney Care, Waltham, Massachusetts, United States
- Herman, Melissa, Fresenius Kidney Care, Waltham, Massachusetts, United States
Background
Peritoneal Dialysis catheters are felt to require a healing time prior to initial use. Concern for increased risk of leak, has led many to use supine intermittent low volume exchanges (<1000 mL) initially for earlier start peritoneal dialysis. We undertook a study to prospectively monitor and track peritoneal dialysis complications when catheter use was early (prior to 14 days post placement) and the nephrologist chose to start with higher volume dialysate (>= 1000mL) without regard to maintaining a supine position. Higher volume dialysis with earlier initiation should allow for better PD clearances when clinically warranted and more salt and water removal compared to supine intermittent low volume exchanges.
Methods
In this single center prospective observational study, peritoneal dialysis catheters were placed laparoscopically ensuring tunneling through the abdominal rectus muscle with the deep cuff placed just within or below the rectus abdominal muscle. Purse strings sutures were only used at the surgeons’ discretion. Surgeons did undergo consistent education from two experienced surgeons prior to the study. Patients were included in the study if the nephrologist felt early start dialysis was indicated. Prescriptions were at the discretion of the nephrologist.
Results
Since January 2021, 23 PD catheters have been placed using this technique with only one adverse event. 8 patients (35%) initiated PD 24 – 72 hours post placement and 15 patients (65%) started dialysis between 73 hours and 2 weeks post catheter placement. All patients first exchanges were 1000 ml, and volumes were increased rapidly at the discretion of the nephrologist as patient condition warranted. In these 23 patients, 1 patient experienced a peritoneal leak which resolved with rest. That patient was in the > 72 hour group. No other catheter complications were noted.
Conclusion
In this single center observational study, peritoneal catheters placed laparoscopically with careful abdominal rectus tunnelling allowed for larger volume dialysis exchanges without concern for supine positioning or intermittent use. One leak was noted and no other complications for an acceptable leak rate of 4% in this small study. This study demonstrates that PD can be initiated sooner post dialysis and larger volumes are well tolerated.