Urgent Start Peritoneal Dialysis: A Population-Based Cohort Study

Neelam M Bhalla; Neiha Arora; Jeanne A Darbinian; Sijie Zheng

doi:10.1016/j.xkme.2022.100414

Urgent Start Peritoneal Dialysis: A Population-Based Cohort Study

Kidney Med. 2022 Jan 21;4(3):100414. doi: 10.1016/j.xkme.2022.100414. eCollection 2022 Mar.

Authors

Neelam M Bhalla¹, Neiha Arora², Jeanne A Darbinian³, Sijie Zheng⁴

Affiliations

¹ Division of Nephrology, Kaiser Permanente Medical Center, Hayward, CA.
² Division of Nephrology, Kaiser Permanente Medical Center, Fremont, CA.
³ Division of Research, Kaiser Permanente Northern California, Oakland, CA.
⁴ Division of Nephrology, Kaiser Permanente Medical Center, Oakland, CA.

Abstract

Rationale & objective: It is a common practice to start patients in urgent need of dialysis on hemodialysis via a central venous catheter. Because central venous catheter use is associated with increased risk of infections, hospitalizations, and mortality, urgent start peritoneal dialysis (PD) increasingly represents a viable alternative. This study aimed to examine clinical outcomes, complications, mortality, and modality retention in patients who initiated urgent start PD.

Study design: Retrospective cohort study.

Setting and participants: Eighty-four adult members of a large integrated health care system who initiated urgent start PD between January 1, 2011, and December 31, 2014.

Exposure: Urgent start PD.

Outcomes: Retention rates at 30, 90, and 365 days; time to the development of noninfectious and infectious complications, modality failure, and all-cause mortality.

Analytical approach: Cumulative incidence of all-cause mortality was estimated using the Kaplan-Meier method. Retention rates for PD were computed using binomial proportions.

Results: Occurrence of major complications was less than 5%. Catheter malfunction occurred in 6% of cases; of those, catheter patency could be established in 80%. Infectious complications occurred in 20% of patients who initiated PD and included peritonitis and exit site infections. At 365 days after initiation, the cumulative incidence of all-cause mortality was 9.7% (95% CI, 4.7%-19.4%). PD retention rates were 98.8%, 91.3%, and 80.0% at 30 days, 90 days, and 1 year, respectively.

Limitations: Retrospective cohort design, a well-matched comparable group of urgent start hemodialysis patients could not be identified, small number of patients in a single integrated health care system, uncertain or limited generalizability of findings to other health care systems.

Conclusions: At 1 year after initiation, patients who initiated urgent start PD had high survival and modality retention rates. In unplanned initiation of dialysis, urgent start PD is a viable and sustainable option and should be considered in selected patients to optimize care.

Keywords: All-cause mortality; PD retention; modality failure; peritoneal dialysis; urgent start PD.