Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study

Autor: Kwan-Dun Wu, Yung-Ming Chen, Wen-Yi Li, Shih-Hua Lin, Shang-Jyh Hwang, Yi-Cheng Wang
Rok vydání: 2017
Předmět:
Male
Nephrology
Emergency Medical Services
medicine.medical_specialty
medicine.medical_treatment
Peritoneal dialysis
Population
Taiwan
030232 urology & nephrology
Long Term Adverse Effects
Kaplan-Meier Estimate
lcsh:RC870-923
Patient Care Planning
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Internal medicine
Central Venous Catheters
Humans
Medicine
Prospective Studies
030212 general & internal medicine
Mortality
education
Prospective cohort study
Dialysis
Aged
education.field_of_study
business.industry
Middle Aged
lcsh:Diseases of the genitourinary system. Urology
medicine.disease
Kidney Transplantation
Emergent-start
Outcome and Process Assessment
Health Care
Kidney Failure
Chronic
Female
Hemodialysis
business
Central venous catheter
Glomerular Filtration Rate
Research Article
Kidney disease
Zdroj: BMC Nephrology
BMC Nephrology, Vol 18, Iss 1, Pp 1-9 (2017)
ISSN: 1471-2369
Popis: Background The clinical consequences of starting chronic peritoneal dialysis (PD) after emergent dialysis via a temporary hemodialysis (HD) catheter has rarely been evaluated within a full spectrum of treated end-stage renal disease (ESRD). We investigated the longer-term outcomes of patients undergoing emergent-start PD in comparison with that of other practices of PD or HD in a prospective cohort of new-onset ESRD. Methods This was a 2-year prospective observational study. We enrolled 507 incident ESRD patients, among them 111 chose PD (43 planned-start, 68 emergent-start) and 396 chose HD (116 planned-start, 280 emergent-start) as the long-term dialysis modality. The logistic regression model was used to identify variables associated with emergent-start dialysis. The Kaplan–Meier survival analysis was used to determine patient survival and technique failure. The propensity score-adjusted Cox regression model was used to identify factors associated with patient outcomes. Results During the 2-year follow-up, we observed 5 (4.5%) deaths, 15 (13.5%) death-censored technique failures (transfer to HD) and 3 (2.7%) renal transplantations occurring in the PD population. Lack of predialysis education, lower predialysis estimated glomerular filtration rate and serum albumin were predictors of being assigned to emergent dialysis initiation. The emergent starters of PD displayed similar risks of patient survival, technique failure and overall hospitalization, compared with the planned-start counterparts. By contrast, the concurrent planned-start and emergent-start HD patients with an arteriovenous fistula or graft were protected from early overall death and access infection-related mortality, compared with the emergent HD starters using a central venous catheter. Conclusions In late-referred chronic kidney disease patients who have initiated emergent dialysis via a temporary HD catheter, post-initiation PD can be a safe and effective long-term treatment option. Nevertheless, due to the potential complications and cost concerns, such practice of PD initiation would better be replaced with a planned-start mode by employing more effective predialysis therapeutic education and timely catheter placement.
Databáze: OpenAIRE
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