Peritoneal Dialysis First: PD Should Be Considered for Dialysis Initiation

A structured peritoneal dialysis (PD) initiation service provided by a dedicated team of nephrologists, interventionists, and PD nurses, taking patients through the stages of predialysis education and monitoring, dialysis catheter insertion, dialysis initiation, and follow-up in the immediate post-dialysis initiation period, can go a long way in expanding PD prevalence. The authors noticed a rapid expansion of their PD program following the introduction of such a service, and they share their experience in this article. A multidisciplinary team providing 1-stop coordinated care may help in alleviating the differences in patient selection criteria, minimize delays in PD catheter insertions, ensure timely initiation of dialysis, reduce the need to start dialysis urgently, actively identify and sort any teething issues, enhance patients’ confidence, and reduce technique failures.

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Timing of Peritoneal Dialysis Initiation and Mortality: Analysis of the Canadian Organ Replacement Registry

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2013.10.054 ◽

2014 ◽

Vol 63 (5) ◽

pp. 798-805 ◽

Cited By ~ 14

Author(s):

Arsh K. Jain ◽

Jessica M. Sontrop ◽

Jeffery Perl ◽

Peter G. Blake ◽

William F. Clark ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation ◽

Mortality Analysis ◽

Organ Replacement

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Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

Frontiers in Medicine ◽

10.3389/fmed.2021.775586 ◽

2022 ◽

Vol 8 ◽

Author(s):

Xueqin Wu ◽

Yong Zhong ◽

Ting Meng ◽

Joshua Daniel Ooi ◽

Peter J. Eggenhuizen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Patient Survival ◽

Dialysis Initiation ◽

Dialysis Modality ◽

Significant Difference ◽

Stage Renal Disease ◽

End Stage

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

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Better Quality of Life of Peritoneal Dialysis compared to Hemodialysis over a Two-year Period after Dialysis Initiation

Scientific Reports ◽

10.1038/s41598-019-46744-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Hee-Yeon Jung ◽

Yena Jeon ◽

Yeongwoo Park ◽

Yon Su Kim ◽

Shin-Wook Kang ◽

...

Keyword(s):

Quality Of Life ◽

Peritoneal Dialysis ◽

Dialysis Initiation

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How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Kidney360 ◽

10.34067/kid.0002392020 ◽

2020 ◽

Vol 1 (10) ◽

pp. 1163-1175

Author(s):

Nilum Rajora ◽

Shani Shastri ◽

Gulzar Pirwani ◽

Ramesh Saxena

Keyword(s):

Peritoneal Dialysis ◽

Cost Effective ◽

Cost Of Care ◽

Dialysis Initiation ◽

High Rate ◽

Center Staff ◽

Effective Option ◽

Poor Outcomes ◽

Unplanned Dialysis ◽

Improve Patient

In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter–related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.

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Increasing peritoneal dialysis initiation worldwide: ‘there are none so blind as those who will not see’

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa024 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1458-1461

Author(s):

Wim Van Biesen ◽

Norbert Lameire

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation

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Comorbidities in Chronic Pediatric Peritoneal Dialysis Patients: A Report of the International Pediatric Peritoneal Dialysis Network

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00124 ◽

2012 ◽

Vol 32 (4) ◽

pp. 410-418 ◽

Cited By ~ 28

Author(s):

Alicia M. Neu ◽

Anja Sander ◽

Dagmara Borzych–Dużałka ◽

Alan R. Watson ◽

Patricia G. Vallés ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Initiation ◽

Dialysis Patients ◽

Pediatric Dialysis ◽

Hospitalization Rates ◽

Ocular Abnormality ◽

International Pediatric ◽

The Impact ◽

Pediatric Dialysis Patients

Background, Objectives, and Methods Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality. Results Information on comorbidities was available for 1830 patients 0 – 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 – 80.9 months), and total follow-up time in the registry was 2095 patient–years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001). Conclusions Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple comorbidities were frequently reported among patients with a defined syndrome. Preliminary analysis suggests an association between comorbidity and poor outcome in those patients. As this powerful international registry matures, further multivariate analyses will be important to more clearly define the impact of comorbidities on hospital-ization rates and mortality in pediatric CPD patients.

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Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00046 ◽

2012 ◽

Vol 32 (6) ◽

pp. 595-604 ◽

Cited By ~ 20

Author(s):

David W. Johnson ◽

Muh Geot Wong ◽

Bruce A. Cooper ◽

Pauline Branley ◽

Liliana Bulfone ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Residual Renal Function ◽

Early Initiation ◽

Dialysis Initiation ◽

Early Start ◽

Initiation Of Dialysis ◽

Late Initiation ◽

Late Start ◽

The Ideal

♦ BackgroundSince the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early- compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.♦ MethodsAdults with an estimated glomerular filtration rate (eGFR) of 10 – 15 mL/min/1.73 m2who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 – 14 mL/min/1.73 m2(early start) or 5 – 7 mL/min/1.73 m2(late start). The primary outcome was all-cause mortality.♦ ResultsOf the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start ( n = 233) or late start ( n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 – 2.30 months] and 7.83 months (IQR: 5.83 – 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 – 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 – 0.82 episodes) per patient–year in the early-start group and 0.69 episodes (95% CI: 0.61 – 0.78 episodes) per patient–year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 – 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).♦ ConclusionEarly initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.

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