P1193URGENT X EARLY START PERITONEAL DIALYSIS: PATIENTS´ PROFILE AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Viviane Calice-Siva ◽  
Helen Ferreira ◽  
Bruna Tonial ◽  
Izabel Ribeiro ◽  
Pedro Daudt ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Dropout Rate ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Early Start ◽  
Fill Volume ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims In the last ten years, peritoneal dialysis (PD) has been considered a safe option to start renal replacement therapy (RRT) in end-stage renal disease patients in need to start dialysis urgently. The definition applied to the Urgent Start PD (US-PD) varies widely worldwide. Recently, it was proposed that US-PD definition should be according to patients’ necessity of starting dialysis, considering “urgent start” when PD started up to 72 hours of catheter placement and “early start” PD when it is starts between 3 and 14 days after catheter placement. Considering this new definition, we aimed to compare demographical and clinical characteristics of patients´ that started PD therapy as urgent and early starts as well as 30-day complications, 6-month hospitalization and dropout rate. Method All adult patients that started PD therapy up to 14 days after catheter insertion in our institution between October 2016 and February 2019 were included in the analyses. Patients were placed on urgent-start (US-PD) group if therapy started until 72-h after catheter insertion or early-start (ES-PD) group if PD initiated between 3 and 14 days. Dialysis records were reviewed to obtain clinical and demographic data, fill volume prescribed for the first PD session, 30-days complications (leakage, bleeding, catheter tip migration and peritonitis) and 6-month hospitalization and dropout rate. Results In our study, 72 patients were analyzed (US-PD=52, ES-PD=20), mean age was 53.2 ± 15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications and 6-month hospitalization and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage (US-PD 6 (11%) x ES-PD 2(10%) patients). The most common cause of patient’s dropout was transfer to HD.Only patients from the US-PD group needed to switch to that modality (5 (10%)). Conclusion Almost three-quarters of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of PD when urgent dialysis is needed.

scholarly journals Urgent vs. early-start peritoneal dialysis: patients' profile and outcomes

2020 ◽  
Author(s):  
Viviane Calice-Silva ◽  
Bruna C. Tonial ◽  
Helen C. Ferreira ◽  
Fabiana B. Nerbass
Keyword(s):  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Dropout Rate ◽  
Catheter Insertion ◽  
Dialysis Patients ◽  
Short Term ◽  
Early Start ◽  
Fill Volume ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Introduction: Peritoneal dialysis (PD) has been considered a safe option of therapy in end-stage renal disease patients with urgent need of dialysis. Recently, it was proposed that Urgent-Start-PD (US-PD) be defined when PD starts within 72 hours after catheter placement and “early start” PD (ES-PD) when PD starts between 3 and 14 days after. We aimed to compare demographic and clinical characteristics between patients in US-PD and ES-PD as well as 30-day complications, 6-month hospitalization, and dropout rate. Methods: Adult patients starting PD within 14 days after catheter insertion (October/2016 - February/2019) were included and divided into US-PD group and ES-PD group based on the their PD initiation time. Clinical and demographic data, fill volume for the first PD session, 30-day complications, 6-month hospitalization, and dropout rate were assessed. Results: In our study, 72 patients were analyzed (US-PD=40, ES-PD=32) with mean age of 53.2±15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications, 6-month hospitalization, and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage. The most common cause of dropout was transfer to HD. Conclusion: Fifty five percent of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of urgent PD when needed.

scholarly journals An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

2019 ◽  
Vol 6 (5) ◽  
pp. 1802
Author(s):  
Anit Joseph K. ◽  
Vivek P. Sarma ◽  
Aravind C. S. ◽  
Sethunath S. ◽  
Sivakumar K. ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Image Guidance ◽  
Catheter Insertion ◽  
Dialysis Catheter ◽  
Hemodialysis Catheter ◽  
Stage Renal Disease ◽  
Operative Notes ◽  
End Stage

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

scholarly journals Comparing the Incidence of Catheter-Related Complications with Straight and Coiled Tenckhoff Catheters in Peritoneal Dialysis Patients—a Single-Center Prospective Randomized Trial

2015 ◽  
Vol 35 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Chu-Jun Ouyang ◽  
Feng-Xian Huang ◽  
Qiong-Qiong Yang ◽  
Zong-Pei Jiang ◽  
Wei Chen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Randomized Trial ◽  
Survival Rates ◽  
Prospective Randomized Trial ◽  
Primary Study ◽  
Catheter Survival ◽  
Catheter Dysfunction ◽  
Catheter Tip ◽  
Stage Renal Disease ◽  
End Stage

♦ObjectivesWe aimed to prospectively compare the incidence of catheter-related complications and catheter survival for straight (SCs) and coiled (CCs) Tenckhoff catheters in peritoneal dialysis (PD) patients.♦MethodsThis open prospective randomized trial recruited 189 PD patients with end-stage renal disease from the department of nephrology, The First Affiliated Hospital of Sun Yat-sen University from 6 November 2007 to 27 August 2008. The patients were randomized to a SC ( n = 99) or a CC ( n = 90) and were then followed for 2 years. All catheter placements were performed by two designated experienced nephrologists who used a standardized institutional placement protocol. The primary study outcomes were catheter-related complications and catheter survival at 1 and 2 years.♦ResultsWe observed no significant differences in clinical and demographic characteristics between the groups at baseline. The overall incidence of catheter dysfunction was higher in the CC group than in the SC group (17.8% vs 7.1%, p = 0.03), and most of the events occurred 4 weeks or more after the catheters were implanted. Catheter tip migration and omental wrapping were the most common causes of catheter dysfunction. Surgical catheter rescue was more common in patients with CCs than in patients with SCs (9 vs 3 patients respectively, p = 0.05). No significant differences were observed in other catheter-related complications, including dialysate leaks, hernias, and PD-related infections (peritonitis, exit-site, and tunnel infections). Catheter survival rates in the SC and CC groups were similar at 1 year (96.7% ± 1.9% vs 96.5% ± 2.0%, p = 0.98) and at 2 years (95.3% ± 2.3% vs 92.4% ± 3.6%, p = 0.76).♦ConclusionsThe incidence of PD catheter–related complications is probably higher with CCs than with SCs. The results of our study suggest that a SC is the better option to reduce subsequent catheter complications.

Peritoneal Dialysis Catheter Surgery Using Transversus Abdominis Plane Block

2017 ◽  
Vol 37 (4) ◽  
pp. 429-433 ◽  
Author(s):  
Dean Markic ◽  
Božidar Vujičić ◽  
Mladen Ivanovski ◽  
Kristian Krpina ◽  
Antun Gršković ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Transversus Abdominis ◽  
Peritoneal Dialysis Catheter ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Effective Technique ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

BackgroundPeritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block.MethodsIn the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015.ResultsThe TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications.ConclusionThe TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.

Immediate Initiation of CAPD following Percutaneous Catheter Placement without Break-in Procedure

2007 ◽  
Vol 27 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Young-Il Jo ◽  
Sug Kyun Shin ◽  
Jong-Ho Lee ◽  
Jong-Oh Song ◽  
Jung-Hwan Park
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Insertion ◽  
Catheter Placement ◽  
Exit Site Infection ◽  
Placement Method ◽  
Modified Method ◽  
Percutaneous Catheter ◽  
Catheter Malfunction ◽  
Severe Hemorrhage ◽  
Catheter Tip

Objective To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A prospective, observational clinical study. Setting Peritoneal dialysis (PD) units of two university-based hospitals. Patients and Methods This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD. Results Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period. Conclusion The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.

Outcomes of Simultaneous Peritoneal Dialysis and Arteriovenous Fistula Placement in End-Stage Renal Disease Patients

2017 ◽  
Vol 37 (6) ◽  
pp. 658-661 ◽  
Author(s):  
Nosratollah Nezakatgoo ◽  
Albert Ndzengue ◽  
Manhunath Ramaiah ◽  
Elvira O. Gosmanova
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Arteriovenous Fistula ◽  
End Stage Renal Disease ◽  
Catheter Insertion ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Peritoneal dialysis (PD) interruption requiring hemodialysis (HD) is not uncommon and its frequently abrupt nature prevents timely creation of permanent HD access and avoidance of central venous catheters (CVC). We retrospectively studied a cohort of 24 end-stage renal disease (ESRD) patients (mean age 50.7 years, 83.3% African-Americans, 58.3% females, time on dialysis interquartile range [IQR] 0 - 65 days) who had simultaneous PD catheter insertion and backup arteriovenous fistula (AVF) creation between January 1, 2012, and December 31, 2013. The primary outcome of interest was the percent of patients receiving HD through the backup AVF at the time of PD interruption. A median (IQR) for PD catheter use after its insertion was 10.5 (2 - 20) days. After the mean follow-up of 19.6 months, 12 patients remained on PD, 2 patients received a kidney transplant, and 1 patient died. The overall AVF patency was 66.7%. A total of 9 (37.5%) patients had PD interruption requiring permanent (8 patients) or temporary (1 patient) HD after the mean (standard deviation [SD]) follow-up of 12.3 (8.2) months. Arteriovenous fistula was used as the initial access in 4 patients, and in 3 patients the original AVF was used after additional surgical revision. Forty-four percent of patients with a backup AVF fistula avoided CVC at the time of PD interruption requiring HD. The simultaneous AVF creation at the time of PD catheter insertion reduced but did not fully eliminate CVC at the time of PD interruption. Larger studies are needed to evaluate the utility of a backup AVF in PD patients.

scholarly journals An Unusual Case of Recurrent Migration of the Peritoneal Dialysis Catheter into the Inguinal Hernia Sac

2021 ◽  
pp. 152-157
Author(s):  
Haruna Fukuzaki ◽  
Junichiro Nakata ◽  
Yuka Shirotani ◽  
Yuki Shimizu ◽  
Masayuki Maiguma ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Inguinal Hernia ◽  
Peritoneal Dialysis Catheter ◽  
Hernia Sac ◽  
First Case ◽  
Catheter Tip ◽  
Hernia Inguinal ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

We herein report the first case of a patient with recurrent migration of the peritoneal dialysis (PD) catheter into the inguinal hernia sac. A 58-year-old man suffered from end-stage renal disease due to polycystic kidney disease (PKD). A year before starting PD, a PD catheter was implanted with stepwise initiation of PD using the Moncrief-Popovich technique. He complained of drain failure and right inguinal swelling during the induction period and was diagnosed with right inguinal hernia. Further examination revealed that the PD catheter tip had migrated into the inguinal hernia sac. Although surgery was planned, the PD catheter tip spontaneously migrated back into the intra-peritoneal space. 14 months later, he noticed fill and drain failure again. Diagnosis was PD catheter dysfunction due to migration into the right inguinal hernia sac. PD was resumed without issues after repositioning of the PD catheter and repair of the inguinal hernia. Inguinal hernia is a frequent complication in PD patients, especially in those with PKD. Early diagnosis and treatment of hernia should be considered in PD patients.

Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience

2017 ◽  
Vol 38 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Haijiao Jin ◽  
Zhaohui Ni ◽  
Shan Mou ◽  
Renhua Lu ◽  
Wei Fang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Older Patients ◽  
Catheter Insertion ◽  
Dialysis Modality ◽  
Single Center ◽  
Short Term ◽  
Stage Renal Disease ◽  
End Stage

Background Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients. Methods This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups. Results A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], p = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 – 19.147], p = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, p = 0.915). Conclusion Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis.

Prevalence and Management of Hernias in Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Miguel Ángel García-Ureña ◽  
César Remón Rodríguez ◽  
Vicente Vega Ruiz ◽  
Francisco Javier Carnero Hernández ◽  
Evaristo Fernández-Ruiz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Local Anesthesia ◽  
Surgical Techniques ◽  
Catheter Insertion ◽  
University Hospital ◽  
Dialysis Patients ◽  
Tension Free ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Objectives The aim of this study was to assess the prevalence of hernias before and after the start of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal disease, and to evaluate the result of a proposed surgical treatment. Design Prospective observational study. Setting University hospital. Patients 122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients. Main Outcome Measures Finding of hernias; morbidity associated with catheter insertion and hernia repair; recurrence of hernias. Results 19 hernias were detected in 15 patients (12.3%) before they began CAPD; only 7 hernias were observed while on CAPD. Umbilical (61.5%) and inguinal (26.9%) hernias were the most common. Multiple hernias were detected in 4 patients. Simultaneous repair of hernia and catheter insertion was performed in patients with preexisting hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild postoperative complications were recorded: 3 seromas and 1 hematoma. No fluid leakage was found in our series. There were no long-term complications (infection or recurrence) related to the mesh. Conclusions 73% of hernias in peritoneal dialysis patients occur before starting dialysis. Hernia problems in these high-risk patients can be safely solved using a careful technique with application of tension-free hernioplasty. Most may be repaired under local anesthesia with simultaneous catheter insertion.

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