Prognosis of urgent initiation of peritoneal dialysis: a systematic review and meta-analysis

Ren Fail. 2024 Jan 30;46(1):2312533. doi: 10.1080/0886022X.2024.2312533. Epub 2024 Feb 23.

Abstract

Objectives: Currently, there is no consensus on the optimal timing for the initiation of peritoneal dialysis (PD) after catheter placement.

Design: Systematic review and meta-analysis.

Exact date of data collection: From inception till July 31, 2023.

Main outcome measures: To assess the outcomes and safety of unplanned PD initiation (<14/7 days after catheter insertion) in cohort studies.

Results: Fifteen studies involving 3054 participants were included. (1) The risk of unplanned initiation of leakage and Obstruction was no difference in both the break-in period (BI) <14 and BI < 7 groups. (2) Catheter displacement was more likely to occur in the emergency initiation group with BI < 7. (3) No significant differences were observed between the two groups regarding infectious complications. (4) There was no difference in transition to HD between patients with BI < 7 and BI < 14 d.

Conclusion: Infectious complications of unplanned initiation of peritoneal dialysis did not differ from planned initiation. Emergency initiation in the BI < 7 group had higher catheter displacement, but heterogeneity was higher. There were no differences in leakage or obstruction in either group. Catheter survival was the same for emergency initiation of peritoneal dialysis compared with planned initiation of peritoneal dialysis and did not increase the risk of conversion to hemodialysis.

Registration: This meta-analysis was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023431369).

Keywords: ESRD; Peritoneal dialysis; catheter; early-start; urgent start.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Cohort Studies
  • Humans
  • Kidney Failure, Chronic* / therapy
  • Peritoneal Dialysis*
  • Prognosis
  • Renal Dialysis

Grants and funding

This research was supported by the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China (Grant No. LHDMZ22H050001); the Construction of Key Projects by Zhejiang Provincial Ministry (Project No.WKJ-ZJ-2302); The Zhejiang Province Chinese Medicine Modernization Program (Project No. 2020ZX001); The Key Project of Scientific Research Foundation of Chinese Medicine (2022ZZ002); the ‘Pioneer’ and ‘Leading Goose’ R&D Program of Zhejiang (2022C03118; 2023C03075); The Key project of Basic Scientific Research Operating Funds of Hangzhou Medical College (KYZD202002); the General Project of the Medical and Health of Zhejiang Province (Grant Number 2021KY833): Zhejiang Province Health Department Project (2021KY490)