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Implementation of urgent start peritoneal dialysis reduces hemodialysis catheter use and hospital stay in patients with unplanned dialysis start.
Kidney Blood Press. Res. 44, 1383-1391 (2019)
Background: Unplanned start of renal replacement therapy is common in patients with end-stage renal disease and often accomplished by hemodialysis (HD) using a central venous catheter (CVC). Urgent start using peritoneal dialysis (PD) could be an alternative for some of the patients; however, this requires a hospital-based PD center that offers a structured urgent start PD (usPD) program. Methods: In this prospective study, we describe the implementation of an usPD program at our university hospital by structuring the process from presentation to PD catheter implantation and start of PD within a few days. For clinical validation, we compared the patient flow before (2013-2015) and after (2016-2018) availability of usPD. Results: In the 3 years before the availability of usPD, 14% (n = 12) of incident PD patients (n = 87) presented in an unplanned situation and were initially treated with HD using a CVC. In the 3 years after implementation of the usPD program, 18% (n = 18) of all incident PD patients (n = 103) presented in an unplanned situation of whom n = 12 (12%) were treated with usPD and n = 6 (6%) with initial HD. usPD significantly reduced the use of HD by 57% (p = 0.0005). Hospital stay was similar in patients treated with usPD (median 9 days) compared to those with elective PD (8 days), and significantly lower than in patients with initial HD (26 days, p = 0.0056). Conclusions: Implementation of an usPD program reduces HD catheter use and hospital stay in the unplanned situation.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Dialysis ; Urgent Start ; Peritoneal Dialysis ; Unplanned ; Hemodialysis Catheter ; Hospital Stay; Early Mortality; Initiation; Patterns; Outcomes; Access
ISSN (print) / ISBN
1420-4096
e-ISSN
1423-0143
Journal
Kidney & Blood Pressure Research
Quellenangaben
Volume: 44,
Issue: 6,
Pages: 1383-1391
Publisher
Karger
Publishing Place
Allschwilerstrasse 10, Ch-4009 Basel, Switzerland
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Reviewing status
Peer reviewed