February 04, 2022
1 min read
One year after patients initiated urgent start peritoneal dialysis in an integrated health care system, they experienced high survival and modality retention rates according to data published in Kidney Medicine.
Further, researchers suggest that urgent start PD should be considered an option in situations calling for unplanned initiation of dialysis.
“Urgent start PD has been shown to have a low incidence of complications including peritonitis, leaks, catheter malfunction, hospitalizations and modality failure, with favorable 90-day outcomes,” Sijie Zheng, MD, PhD, from the division of nephrology at Kaiser Permanente Medical Center in Oakland, California, and colleagues wrote. “The objectives of this study were to study the demographic and clinical characteristics in patients who were initiated on urgent start PD and to assess complications, survival rate and modality failure at defined time intervals.”
In a retrospective cohort study, researchers monitored 84 adult members of Kaiser Permanente Northern California who initiated urgent start PD between Jan. 1, 2011, and Dec. 12, 2014. Researchers measured the retention rates of patients at 30, 90 and 365 days using binomial proportions. Using the Kaplan-Meier method, researchers estimated cumulative incidence of all-cause mortality.
Less than 5% of the cohort experienced major complications and 6% experienced catheter malfunction. Peritonitis and exit site infections occurred in 20% of patients. In addition, 1 year after PD initiation, the total all-cause mortality was 9.7%. Analyses revealed retention rates of 98.8%, 91.3% and 80% at 30 days, 90 days and 365 days, respectively.
“Within an integrated health care system, urgent start PD was shown to be a safe, viable and sustainable treatment option. Given the recent executive order for increasing home dialysis incidence, urgent start PD should be more widely used for patients needing prompt and unplanned dialysis initiation,” Zheng and colleagues wrote. “It is unclear whether our results are generalizable to other health care systems, where delivery of care historically has been more fragmented. Ideally a prospective, multicenter randomized study should be performed to confirm the results.”