Abstract

Purpose

Immediate-start peritoneal dialysis (PD) has emerged as a strategy for patients in need of urgent dialysis. However, the ideal timing for initiating this procedure remains uncertain. In this study, we aimed to compare complications and outcomes between immediate-start PD and conventional-start PD.

Methods

We performed a two-center retrospective cohort study between 1 January 2015 and 31 May 2020. Patients who underwent PD were divided into immediate-start PD (without break-in period) and conventional-start PD group (break-in period within at least 14 days). The primary outcomes were the incidence of the mechanical complications and infectious complication. The secondary outcomes were technique failure and patient survival.

Results

A total of 209 patients (106 in the immediate-start PD group and 103 in the conventional-start PD group) were included. Immediate-start PD had significantly lower catheter malfunction or migration rate compare with conventional-start PD (2.8% vs. 15.5%, p = 0.003) but comparable rates of dialysate leaks, pleuroperitoneal leaks, and hemoperitoneum. Infectious complications (exit-site infection and peritonitis) were similar between groups. Technique survival was comparable (7.5% vs. 4.8%, p = 0.22), while immediate-start PD exhibited lower mortality rates (0.9% vs. 13.6%, p = 0.001).

Conclusion

Immediate-start PD appears to be a viable option for patients in need of urgent dialysis, with reduced catheter complications and comparable infectious complications and technique survival when compared to conventional-start PD.

中文翻译：

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无磨合期立即启动腹膜透析与常规启动腹膜透析的比较：两中心回顾性审核

摘要

目的

立即开始腹膜透析（PD）已成为需要紧急透析的患者的一种策略。然而，启动这一程序的理想时机仍不确定。在本研究中，我们的目的是比较立即开始 PD 和常规开始 PD 的并发症和结果。

方法

我们于2015年1月1日至2020年5月31日进行了一项两中心回顾性队列研究。将接受PD的患者分为立即启动PD组（无磨合期）和常规启动PD组（磨合期至少在14 天）。主要结局是机械并发症和感染并发症的发生率。次要结果是技术失败和患者生存。

结果

总共纳入 209 名患者（立即开始 PD 组 106 名，常规开始 PD 组 103 名）。与传统启动 PD 相比，立即启动 PD 的导管故障或迁移率显着降低（2.8% vs. 15.5%，p  = 0.003），但透析液渗漏、胸腹膜渗漏和腹腔积血的发生率相当。各组之间的感染并发症（出口部位感染和腹膜炎）相似。技术生存率相当（7.5% vs. 4.8%，p  = 0.22），而立即开始 PD 的死亡率较低（0.9% vs. 13.6%，p  = 0.001）。

结论

对于需要紧急透析的患者来说，立即开始腹膜透析似乎是一个可行的选择，与传统开始腹膜透析相比，导管并发症减少，感染并发症和技术生存率相当。