February 04, 2022
1 minute read
Urgent Start Peritoneal Dialysis Shows High Survival Rate in Integrated Health Care System
Source/Disclosures
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Disclosures: Zheng does not report any relevant financial information.
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According to data published in Kidney medicine.
Additionally, the researchers suggest that urgent initiation of PD should be considered as an option in situations requiring unplanned initiation of dialysis.
“Urgent-start PD has been shown to have a low incidence of complications, including peritonitis, leaks, catheter dysfunction, hospitalizations, and modality failure, with favorable outcomes at 90 days,” sijie Zheng, MD, PhD, from the division of nephrology at Kaiser Permanente Medical Center in Oakland, Calif., and colleagues wrote. “The objectives of this study were to investigate demographic and clinical characteristics in patients who were initiated on urgent start PD and to assess complications, survival rate, and modality failure at time intervals defined.”
In a retrospective cohort study, researchers followed 84 adult members of Kaiser Permanente Northern California who entered urgent-start PD between January 1, 2011, and December 12, 2014. Researchers measured patient retention rates at 30 , 90 and 365 days using binomial proportions. Using the Kaplan-Meier method, the researchers estimated the 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 the onset of PD, the total all-cause mortality was 9.7%. The analyzes revealed retention rates of 98.8%, 91.3% and 80% at 30 days, 90 days and 365 days, respectively.
“Within an integrated healthcare system, urgent PD has proven to be a safe, viable and sustainable treatment option. Given the recent executive order to increase the incidence of home dialysis, urgent-start PD should be more widely used for patients requiring rapid and unplanned initiation of dialysis,” Zheng and colleagues wrote. “It is unclear whether our findings are generalizable to other health care systems, where the delivery of care has historically been more fragmented. Ideally, a prospective multicenter randomized study should be performed to confirm the results.
Perspective
Jose A. Morfin, MD, FASN
It was good to see how this study paid attention to the performance of DP catheters at 30, 60, and 90 days, because the last thing you want is a leaky catheter. Any technician can put a catheter in, but it takes an artist to make it work properly. So when you’re trying to optimize these patients’ PD starts in an unplanned way, you need to align yourself with a good technician, whether it’s a surgeon or an interventional radiologist. Therefore, it was good to see that this study was done in an integrated health care system. The context of an integrated health care system allows for a smoother transition for the patients and providers involved. Everyone caring for the patient is on the same page, whereas in a real situation this is not always the case; for example, sometimes a surgeon is in another hospital or the available nephrologist is not comfortable with starting PD. Additionally, it was important that this study showed outcome complications similar to those of standard PD debut. Going forward, I think we need more prospective pilot studies of unplanned dialysis with integrated processes to optimize these transitions in renal care.
Jose A. Morfin, MD, FASN
Nephrologist and Editorial Advisory Board Member of Nephrology News & Issues
University of California Davis Medical Center
Sacramento, California
Disclosures: Morfín does not report any relevant financial information.
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