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Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD.

Methods

This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival.

Results

A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p  = 0.70) and catheter readjustment (1.5% vs. 2.5%; p  = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25–1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29–7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89–4.31) and patient survival (HR 1.46, 95% CI 0.44–4.87) were comparable between the two groups.

Conclusion

Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.

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Acknowledgements

The authors gratefully acknowledge the contributions of peritoneal dialysis nurses and physicians from Singapore General Hospital.

Funding

No funding support for this study.

Author information

Authors and Affiliations

  1. Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore

    Chee Chin Phang, Marjorie Wai Yin Foo, Sin Yan Wu, Mathini Jayaballa, Riece Koniman, Choong Meng Chan, Elizabeth Ley Oei & Htay Htay

  2. Princess Alexandra Hospital, Brisbane, Australia

    David W. Johnson

  3. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia

    David W. Johnson

  4. Translational Research Institute, Brisbane, Australia

    David W. Johnson

  5. Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan City, Australia

    David W. Johnson

  6. Health Services Research Centre (HSRC), Singapore Health Services (SingHealth), Singapore, Singapore

    Ying Hao

  7. Department of General Surgery, Singapore General Hospital, Singapore, Singapore

    Tze Tec Chong

Authors
  1. Chee Chin Phang
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  2. Marjorie Wai Yin Foo
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  9. Elizabeth Ley Oei
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  11. Htay Htay
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Corresponding author

Correspondence to Htay Htay.

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Conflict of interest

Marjorie WY Foo has received consultancy fees and travel sponsorships from AWAK Technologies Pte Ltd, travel sponsorships from Baxter Healthcare and grants from National Medical Research Council. David Johnson has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca and AWAK, speaker’s honoraria and travel sponsorships from ONO, and travel sponsorships from Amgen. Htay Htay has received research grant from Johnson & Johnson Pte Ltd, SingHealth Pte Ltd and consultancy fees and travel sponsorships from AWAK Technologies Pte Ltd. She has also received speaker’s honoraria and travel sponsorships from Baxter Healthcare. The other authors have no financial conflicts of interest to declare.

Ethical approval

Centralised Institutional Review Board (CIRB) was consulted for approval. The study was granted exemption by CIRB given that the study was conducted for a quality improvement (QI) initiative project to monitor the effect of the new practice on the outcomes (CRBI ref number: 2018/2925).

Informed consent

The waiver of informed consent was granted from CIRB as the study was conducted for a quality improvement project and was a retrospective non-interventional study.

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Phang, C.C., Foo, M.W.Y., Johnson, D.W. et al. Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience. Int Urol Nephrol 53, 583–590 (2021). https://doi.org/10.1007/s11255-020-02630-8

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  • DOI: https://doi.org/10.1007/s11255-020-02630-8

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