Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis.
BACKGROUND
Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start.


METHODS
This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival.


RESULTS
A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups.


CONCLUSION
Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.
['See|Emily J|EJ|', 'Cho|Yeoungjee|Y|', 'Hawley|Carmel M|CM|', 'Jaffrey|Lauren R|LR|', 'Johnson|David W|DW|']
D000328:Adult D000368:Aged D016022:Case-Control Studies D002404:Catheterization D018572:Disease-Free Survival D005260:Female D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D010530:Peritoneal Dialysis D010538:Peritonitis D013997:Time Factors D016896:Treatment Outcome
urgent-start peritoneal dialysis peritonitis Complications technique survival end-stage kidney disease