Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program

BackgroundMany patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area.MethodsIn this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting.ResultsThirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7 %) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0 – 13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3 %) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch.ConclusionsOur results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access.

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Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa

The Journal of Vascular Access ◽

10.5301/jva.5000695 ◽

2017 ◽

Vol 18 (1_suppl) ◽

pp. S41-S46 ◽

Cited By ~ 2

Author(s):

Maurizio Gallieni ◽

Antonino Giordano ◽

Anna Ricchiuto ◽

Davide Gobatti ◽

Maurizio Cariati

Keyword(s):

Peritoneal Dialysis ◽

End Stage Renal Disease ◽

Venous Catheter ◽

Infectious Complications ◽

Dialysis Access ◽

Central Venous ◽

Treatment Start ◽

Alternative Approach ◽

Stage Renal Disease ◽

End Stage

Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.

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MO706PATIENTS AND CENTER-RELATED FACTORS IN PERIOTONEAL CHOICE IN INCIDENT PATIENTS: A REGIONAL EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0028 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Vincenzo Antonio Panuccio ◽

Giovanna Parlongo ◽

Rocco Tripepi ◽

Giovanni Luigi Tripepi ◽

Paola Cianfrone ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Venous Catheter ◽

Dialysis Access ◽

Related Factors ◽

Early Referral ◽

Dialysis Treatment ◽

Outpatient Program ◽

Dialytic Modality ◽

Late Referral

Abstract Background and Aims Effective outpatient organization is essential in the management of patients with chronic kidney disease. Although peritoneal dialysis (PD) has many advantages it is still not popular. Method The aim of this study was to evaluate patient and center-related factors that affect the final choice of peritoneal dialysis (PD) versus hemodialysis (HD) in the Calabrian region (Italy). We analyzed 2 annual regional surveys performed by nephrologists (2017 and 2018) in incident dialysis patients. Collected factors included: early and late referral to the dialysis program, pre-dialysis participation in outpatient visits, first dialysis access [peritoneal catheter (PC), central venous catheter (CVC), arteriovenous fistula (AVF)], final dialysis treatment (HD or PD) and the care giver. Results The study sample included 296 incident patients (63% males) aged 66±15 years. Time to referral influenced the type of first dialysis access. Among patients with early referral, 35% initiated dialysis by a PC, 34% by AVF and 31% by CVC, while among those with late referral, only 5% started dialysis by a PC, 15% by AVF, and the majority (80%) by CVC (P<0.001). Time to referral was also associated with pre-dialysis visits (34%, 33% and 34% versus 5%, 22% and 73%, respectively, P<0.001). When evaluating clinical suitability for treatment modality, 54% of early referrals and 45% of late referrals were eligible for PD. The choice of dialytic modality was again related to time to referral: 38% with early referral chose PD compared to 15% of those with late referral (P<0.001). Furthermore, in patients who participated in the pre-dialysis program, 38% started PD versus 11% of patients that did not participate (P<0.001). The role of the caregiver remains uncertain. Conclusion These data confirm that a more attentive and dedicated organization of the pre-dialysis outpatient program would contribute to a greater expansion of the peritoneal dialysis program.

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Peritoneal Dialysis as an Urgent-Start Option for Incident Patients on Chronic Renal Replacement Therapy: World Experience and Review of Literature

Blood Purification ◽

10.1159/000506505 ◽

2020 ◽

Vol 49 (6) ◽

pp. 652-657 ◽

Cited By ~ 1

Author(s):

Dayana Bittencourt Dias ◽

Marcela Lara Mendes ◽

Camila Albuquerque Alves ◽

Jacqueline Teixeira Caramori ◽

Daniela Ponce

Keyword(s):

Peritoneal Dialysis ◽

Observational Studies ◽

Bloodstream Infections ◽

Venous Catheter ◽

Cost Effective ◽

Initial Time ◽

Dialysis Access ◽

Review Of Literature ◽

Collective Experience ◽

Cost Effective Alternative

Chronic kidney disease is a significant problem of public health worldwide, and up to 60% of patients start dialysis in an unplanned manner without a definitive dialysis access. Recently, peritoneal dialysis (PD) has emerged as an alternative to unplanned chronic dialytic method, and the world collective experience shows that PD can be an efficient, safe, and cost-effective alternative with comparable outcomes to the planned PD and urgent-start hemodialysis (HD). More importantly, as compared to urgent-start HD using a central venous catheter, urgent-start PD has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related mechanical complications, and need for dialysis catheter reinsertions during the initial time of the therapy. An integrative review was conducted on PD urgent start compared to HD urgent start and to planned PD, identifying its potential advantages and limitations. Literature search was performed within multiple databases, and observational studies on clinical experience with urgent PD were reviewed and appraised.

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Urgent-Start Peritoneal Dialysis: The First Year of Brazilian Experience

Blood Purification ◽

10.1159/000478970 ◽

2017 ◽

Vol 44 (4) ◽

pp. 283-287 ◽

Cited By ~ 11

Author(s):

Dayana Bitencourt Dias ◽

Marcela Lara Mendes ◽

Vanessa Burgugi Banin ◽

Pasqual Barretti ◽

Daniela Ponce

Keyword(s):

Peritoneal Dialysis ◽

Survival Rates ◽

High Volume ◽

Infectious Complications ◽

Chronic Patients ◽

Safe Alternative ◽

Dialysis Unit ◽

Technique Survival ◽

Stage Renal Disease ◽

End Stage

Background: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. Methods: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (<72 h) PD catheter placement. After hospital discharge, patients were treated with intermittent PD on alternate days in a dialysis unit until family training was provided. Results: Fifty-one patients fulfilling the following criteria were included: age was 62.1 ± 15 years, with diabetes as the main etiology of end-stage renal disease (39%), and uremia as the main dialysis indication (76%). Metabolic and fluid controls were achieved after 3 sessions of HVPD, and patients remained in intermittent PD for 23.2 ± 7.2 days. Mechanical complications occurred in 25.7% and peritonitis rate was 0.5 episode/patient-year. In the first 6 months, technique and patients survival rates were 86 and 82.4% respectively. Conclusion: The PD modality was a feasible and safe alternative to hemodialysis in the urgent-start dialysis.

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Brazilian dialysis survey 2019

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2020-0161 ◽

2021 ◽

Author(s):

Precil Diego Miranda de Menezes Neves ◽

Ricardo de Castro Cintra Sesso ◽

Fernando Saldanha Thomé ◽

Jocemir Ronaldo Lugon ◽

Marcelo Mazza Nascimento

Keyword(s):

Peritoneal Dialysis ◽

Venous Catheter ◽

Serum Levels ◽

Absolute Number ◽

Incidence Rates ◽

Red Blood Cell Transfusion ◽

Dialysis Access ◽

Online Questionnaire ◽

Dialysis Treatment ◽

Number Of Patients

Abstract Introduction: National data on chronic dialysis treatment are essential for the development of health policies that aim to improve the treatment of patients. Objective: To present data from the Brazilian Dialysis Survey 2019, promoted by the Brazilian Society of Nephrology. Methods: Data collection from dialysis units in the country through a completed online questionnaire for 2019. Results: 314 (39%) centers responded the questionnaire. In July 2019, the estimated total number of patients on dialysis was 139,691. Estimates of the prevalence and incidence rates of patients undergoing dialysis treatment per million of the population (pmp) were 665 and 218, respectively, with mean annual increases of 25 pmp and 14 pmp for prevalence and incidence, respectively. The annual gross mortality rate was 18.2%. Of the prevalent patients, 93.2% were on hemodialysis and 6.8% on peritoneal dialysis; and 33,015 (23.6%) on the waiting list for transplantation. 55% of THE centers offered treatment with peritoneal dialysis. Venous catheters were used as access in 24.8% of THE patients on hemodialysis. 17% of the patients had K ≥ 6.0mEq/L; 2.5% required red blood cell transfusion in July 2019 and 10.8% of the patients had serum levels of 25-OH vitamin D < 20 ng/mL. Conclusion: The absolute number of patients, the incidence and prevalence rates in dialysis in the country continue to increase, as well as the percentage of patients using venous catheter as dialysis access. There was an increase in the number of patients on the list for transplantation and a tendency to reduce gross mortality.

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Peritoneal Dialysis Access: Prospective Randomized Comparison of the Swan Neck and Tenckhoffcatheters

Peritoneal Dialysis International ◽

10.1177/089686089501500412 ◽

1995 ◽

Vol 15 (4) ◽

pp. 353-356 ◽

Cited By ~ 53

Author(s):

Björn H. Eklund ◽

Eero O. Honkanen ◽

Aino-Riitta Kala ◽

Lauri E. Kyllönen

Keyword(s):

Peritoneal Dialysis ◽

Infectious Complications ◽

University Hospital ◽

Dialysis Access ◽

Exit Site ◽

Peritoneal Catheter ◽

Catheter Survival ◽

Catheter Migration ◽

The Impact ◽

To Receive

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit -site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital, serving a population of 1.2 million. Patients Forty consecutive patients requiring their first dialysis catheter for future CAPD were randomized to receive either a two-cuff permanently bent Swan neck catheter or a two-cuff straight Tenckhoff catheter. The skin exit was downward-directed in the Swan neck group and upward-directed in the Tenckhoff group. Results Dialysate leak, catheter migration, or tunnel infection did not occur in any of the patients. Three outer cuff extrusions needing cuff shaving occurred, all in the Tenckhoffgroup(p =0.1). No significant differences could be demonstrated in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications, and equally good results were obtained with both catheter types studied.

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Dialysis Access, Infections, and Hospitalisations in Unplanned Dialysis Start Patients: Results from the Options Study

The International Journal of Artificial Organs ◽

10.5301/ijao.5000557 ◽

2017 ◽

Vol 40 (2) ◽

pp. 48-59 ◽

Cited By ~ 6

Author(s):

Anna Machowska ◽

Mark D. Alscher ◽

Satyanarayana Reddy Vanga ◽

Michael Koch ◽

Michael Aarup ◽

...

Keyword(s):

Healthcare Utilisation ◽

Venous Catheter ◽

Infectious Complications ◽

Fistula Formation ◽

Study Patient ◽

Dialysis Access ◽

Av Fistula ◽

Technique Survival ◽

Start Ups ◽

Unplanned Dialysis

Introduction Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients. Methods In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation. Results 72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI, 0.17-0.68) and cardiac failure, OR = 0.31(CI, 0.13–0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11–0.79) and those who received AVF, OR = 0.11 (CI, 0.03–0.38), had significantly lower odds of death. Discussion UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.

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Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfz053 ◽

2019 ◽

Vol 13 (2) ◽

pp. 166-171

Author(s):

Delin Wang ◽

Nathan Calabro-Kailukaitis ◽

Mahmoud Mowafy ◽

Eric S Kerns ◽

Khetisuda Suvarnasuddhi ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Retrospective Cohort ◽

Venous Catheter ◽

Dialysis Access ◽

Dialysis Patients ◽

Central Venous ◽

The Usa ◽

The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average >1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P < 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

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An alternative approach for complicated prosthetic aortic valve endocarditis

Surgical Case Reports ◽

10.1186/s40792-021-01195-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Dimos Karangelis ◽

Argyris Krommydas ◽

Fotios A. Mitropoulos

Keyword(s):

Surgical Treatment ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Pericardial Patch ◽

Safe Alternative ◽

Case Presentation ◽

Prosthetic Aortic Valve ◽

Alternative Approach ◽

Sutureless Valve ◽

Valve Implantation

Abstract Background Surgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands. Case presentation Herein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient underwent removal of the dehisced prosthetic valve, radical annular debridement, reconstruction of the aortomitral curtain with a pericardial patch as a patch exclusion technique and implantation of a sutureless valve. Conclusion Patch exclusion technique, followed by sutureless valve implantation, might represent a feasible and safe alternative for the surgical treatment of complicated PVE.

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