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Kidney Blood Press Res. 2018;43(6):1699-1705. doi: 10.1159/000495386. Epub 2018 Nov 23.

Early Start Peritoneal Dialysis: Technique Survival in Long-Term Follow-Up.

Author information

1
Department of Medicine, Renal Division, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazilbrunocaldin@hotmail.com.
2
Department of Medicine, Renal Division, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
3
Urology Division, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
4
Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.

Abstract

BACKGROUND/AIMS:

Peritoneal dialysis (PD) has gained interest over the last decade as a viable option for early start dialysis. It is still unknown if shorter break-in periods and less time for proper patient evaluation and training could influence technique survival in comparison to planned-start PD.

METHODS:

A prospective and observational study that compared technique survival in a cohort of patients who started either early or planned PD. Early start PD was defined as break-in period from 3 to 14 days with no previous nephrologist follow-up or patient training.

RESULTS:

A total of 154 patients were included (40 as early start PD), followed by a median time of 381 days. Comparing early vs. planned-start PD, groups were similar concerning age 56 (40; 70) vs. 48 (32; 63) years, p=0.071, body mass index (BMI) 23.3 ± 4.2 vs. 23.8 ± 4.0 kg/m2, p=0.567 and male gender (60 vs. 48%, p=0.201), respectively. Comparing early vs. planned-start groups, there were no differences regarding PD dropout for peritonitis (7.5 vs. 11.4%, p=0.764), catheter dysfunction (12.5 vs. 17.5%, p=0.619) and patient burnout (0 vs. 4.4%, p=0.328), respectively. Less patients in early start group quit PD for peritoneal membrane failure in comparison to planned-start group (2.5 vs. 16.7%, p=0.026). In multivariate cox-regression analysis, the only factors independently associated with technique failure were BMI> 25 kg/m² (p=0.033) and Diabetes Mellitus (p=0.013), whereas no differences regarding early vs. planned-PD start were observed (p=0.184).

CONCLUSION:

Despite the adverse scenario for initiating dialysis, early start PD had similar outcomes in comparison to planned-start PD in long-term follow-up.

KEYWORDS:

Acute peritoneal dialysis; Peritoneal dialysis; Unplanned peritoneal dialysis

PMID:
30472710
DOI:
10.1159/000495386
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