Abstract: FR-PO502
The Impact of Urgent Start Peritoneal Dialysis on Patient Outcomes
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Lasky, Rachel A., Fresenius Medical Care, Waltham, Massachusetts, United States
- Chaudhuri, Sheetal, Fresenius Medical Care, Waltham, Massachusetts, United States
- Blankenship, Derek M., Fresenius Medical Care, Waltham, Massachusetts, United States
- Kraus, Michael A., Fresenius Medical Care, Waltham, Massachusetts, United States
- Sor, Murat, Azura Vascular Care, Malvern, Pennsylvania, United States
- Chatoth, Dinesh K., Fresenius Medical Care, Waltham, Massachusetts, United States
Background
In the last decade, there has been significant interest in urgent start PD (USPD), defined as use of PD catheter within 14 days of insertion, as a viable option for patients initiating dialysis. This strategy helps increase PD use in a population that typically would have started on HD. Studies have reported higher rate of pericatheter leaks, exit site infections and peritonitis in patients who started USPD compared to conventional starts at FKC clinics.
Methods
All FKC PD patients that had a peritoneal catheter placed at an outpatient surgical center or hospital between August 1, 2019 and August 31, 2021 were included. Unadjusted logistic regression was used to compare patients based on the number of days between catheter placement and the first PD treatment: urgent start (≤ 14 days) or conventional start (>14 days). Catheter leaks, peritonitis events, and exit site infections within the first 90 days following catheter placement were identified using electronic medical records. Patient dialysis treatment data were used to identify breaks in training treatments (three days or more between treatments) and back-up treatments.
Results
5,429 urgent start and 17,435 conventional start patients were included. Urgent start patients had 1.3 time the odds of peritonitis when compared to conventional start patients (2.5% vs 1.9%; p=0.01). Urgent start patients also had 2.5 times the odds to experience leaks (1.1% vs 0.4%; p<0.0001) and 1.5 times the odds to have a break in training treatment (p<0.0001). However, urgent start patients had 0.5 times the odds to have a back-up in-center treatment during training (p<0.0001). There was no significant difference between groups in exit site infections.
Conclusion
In this large incident PD cohort, while USPD patients were more likely to have peritonitis, pericatheter leaks and break in training treatments, rates of both complications in both groups are quite low. Interestingly, the leaks or mechanical complications associated with PD catheters in USPD patients did not result in significant HD backup treatments but were successfully managed with break in PD training treatments.
Funding
- Commercial Support –