MO718: Urgent, Early and Planned Start Peritoneal Dialysis—Does the Initiation Modality Matter to Patient's Outcomes?
Authors: Sevignani Gabriela , Bagio Giovanna , Tosin Camila , Sumnienski Bertoldi Gustavo , Ferreira Helen , Calice-Silva Viviane 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Peritoneal dialysis (PD) has been used as a renal replacement therapy for end-stage kidney disease patients in different initiation patterns: urgent, early and planned start PD. The indication of PD initiation is mainly based on the presence or not of signs and symptoms that would indicate dialysis urgent initiation and in the possibility of patients receive pre-dialysis when they would plan RRT initiation when necessary. Our aim was to evaluate if the PD initiation modality interfere in patients’ 30- and 180-day outcomes and in the technique survival.

METHOD
This is a single-center retrospective study that included incident adult patients starting PD between October 2016 and March 2021. Exclusion criteria were: (i) have done previously PD, (ii) patients younger &lt; 18 years old and (iii) missing data related to main outcomes analysed. US-PD group was considered those incident patients starting therapy with some urgent indication and within 3 days after Tenckhoff catheter implantation, ES-PD group was those patients who had previously received urgent hemodialysis (HD) and started PD between 3 and 14 days and, Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Complications and hospitalization due to all cause were compared 30 and 180 days from PD initiation. Technique survival during the first 180 days on PD were assessed by Kaplan–Meier curves.

RESULTS
During the period mentioned earlier 280 patients started PD. In these analyses 201 patients were included. Mean age was 58.4 ± 15.2 years old, most part of patients were female (51.7%) and considered themselves as white race (92%). The most common etiology for kidney disease was diabetes (32%). Most part of patients had arterial hypertension and diabetes as main comorbidities (88.6% and 48.3%). Considering the PD initiation, 62 (30.8%) patients started PD urgently, 84 (41.8%) patients had an earlier start and 55 (27.4%) started PD planned. Patients have similar characteristics regarding demographics, comorbidities, and cause of renal disease. Patients in the ES-PD group had higher prevalence of heart failure and coronary arterial disease compared to the others (P = 0.03 and 0.08, respectively). Regarding complications in the first 30 days on PD, the most common complication was mechanical ones such as leakage and catheter tip migration and the incidence of these did not differ from PD initiation modalities. The US and ES-PD groups presented a greater incidence of hospitalization events in the first 30 days compared with the Plan-PD group [8 (13.6%) events US-PD, 16 (19.3%) ES-PD and 1 (0.5%) Plan-PD—P = 0.04], most part of them not related to PD. Complication and hospitalization events were similar in all groups in 180 days on therapy. Patients on the ES-PD group had a higher percentage of transfer to HD during the first 180 days. Technique survival was similar between groups (US-PD 85.2%, ES-PD 77.1% and Plan-PD 88.7%—log-rank P = 0.18) in 180 days follow-up (Fig. 1). Death and transfer to HD were the most common causes for dropout, mainly in the ES-PD group [9 (10.7% deaths and 12 (14.3%) transfer to HD].

CONCLUSION
The study demonstrates similar complications after 30 days PD initiation regardless of type of PD initiation, greater hospitalization events in the ES-PD group after 30 days, which can be related to the patients’ characteristics. Similar complications, hospitalizations, and technique survival after 180 days on PD we found for both groups.