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Unplanned vs. planned peritoneal dialysis as initial therapy for dialysis patients in chronic kidney replacement therapy

  • Nephrology - Original Paper
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Abstract

Aim

To compare infectious and mechanical complications, technique failure and mortality of a planned PD vs. an unplanned PD program.

Design

It was a prospective observational study that included chronic kidney disease (CKD) patients who started PD according to medical recommendation: group1—planned and group 2—unplanned PD.

Methods

This study evaluated patients who started planned and unplanned PD programs in a teaching hospital from July 2014 to December 2017.

Results

A total of 58 patients were included in the planned PD group and 113 in the unplanned PD group. There was difference between the two groups in leak and hospital admissions, that were more frequent in the unplanned PD group. Periods free from exite site infection, peritonitis and mechanical complications were longer in the planned group. Cox regression analysis identified age and the lowest albumin value as factors associated with mechanical complications; peritonitis indicated the presence of ESI and mechanical complications; the change to HD was associated with a younger age, mechanical complications, diabetes mellitus (DM) and peritonitis. The factors associated with death were age and lower values of albumin. After 48 months, the growth of the PD program was 252%.

Conclusion

The technique survival and patient mortality in unplanned PD was similar to planned PD, while the period marked by the absence of complications related to PD was longer in the planned PD group. In the Cox regression, unplanned PD was not identified as risk factor for death, transition to HD or complications related to therapy, while age and lower albumin values were predictors of negative outcomes.

Impact

Unplanned PD is not risk factor for death and complications related to PD and can be an option to unplanned HD.

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Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo, 2019/02116-2.

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Authors and Affiliations

  1. Botucatu School of Medicine, University of Sao Paulo State, Avenue Mario Rubens Montenegro, PO 18600000, Botucatu, SP, Brazil

    Marcela Lara Mendes, Camila Albuquerque Alves, Laudilene Cristina Rebello Marinho, Dayana Bitencourt Dias & Daniela Ponce

Authors
  1. Marcela Lara Mendes
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  2. Camila Albuquerque Alves
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  3. Laudilene Cristina Rebello Marinho
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  4. Dayana Bitencourt Dias
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  5. Daniela Ponce
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Contributions

MLM, CAA, DBD, DP: made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; MLM, DP: involved in drafting the manuscript or revising it critically for important intellectual content; MLM, CAA, LCRM, DBD, DP: given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content; MLM, DP: agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Daniela Ponce.

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Conflict of interest

No conflict of interest was declared by the authors.

Ethical approval

The basic ethical principles of the guidelines and regulatory standards for research on human beings were followed in this study. This research project was approved by the Human Research Ethics Committee from Botucatu School of Medicine (protocol CAAE-55140116.3.0000.5411).

Informed consent

All the patients gave written informed consent in accordance with the Declaration of Helsinki.

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Mendes, M.L., Alves, C.A., Marinho, L.C.R. et al. Unplanned vs. planned peritoneal dialysis as initial therapy for dialysis patients in chronic kidney replacement therapy. Int Urol Nephrol 54, 1417–1425 (2022). https://doi.org/10.1007/s11255-021-03029-9

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  • DOI: https://doi.org/10.1007/s11255-021-03029-9

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