OUTCOMES OF EARLY AND CONVENTIONAL COMMENCEMENT OF PERITONEAL DIALYSIS
GEORGE TSIHLIS1, KEIREN PIRABHAHAR2, FREDERIKA SCIBERRAS1, MARYANN NICDAO1, LARAINE AW1, ALVIE AGOO1, VINCENT LEE1,3,4, LUKAS KAIRAITIS1,2, KAMAL SUD1,5,6, JAN SWINNEN3,7,8, KATRINA CHAU1,2, 1Western Renal Services (Western Sydney and Nepean Blue Mountains Local Health Districts), Sydney, New South Wales, Australia2Blacktown and Mount Druitt Clinical School, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia3Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia4The Westmead Institute for Medical Research, Westmead, New South Wales, Australia5Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia6Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, New South Wales, Australia7Médecins Sans Frontières, Sydney, New South Wales, Australia8Department of Vascular Surgery, Westmead Hospital, Westmead, New South Wales, Australia
Abstract
Aim: To compare outcomes of early-start (≤14 days) and conventional-start (>14 days) peritoneal dialysis (PD) after catheter insertion.
Background: Internationally, there is increasing PD commencement within the recommended two week break-in period. Studies are warranted to evaluate outcomes of this strategy within Australia.
Methods: All patients within Western Renal Services initiating PD through a new catheter, inserted laparoscopically or by Seldinger technique, between August 2019-August 2022, were included in this retrospective observational study. This cohort included incident PD patients, either with or without bridging haemodialysis, and patients resuming PD following catheter replacement. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using ANOVA and Chi-square testing. A p value <0.05 was considered significant with Bonferroni correction performed where relevant.
Results: 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking early-start PD. Most patients had laparoscopically inserted catheters (65.3%), and 65 (22.0%) patients had bridging haemodialysis. Compared with conventional-start PD, patients with early-start PD were younger (56.6 vs. 60.3 years, p=0.049), required inpatient care (42.3% vs. 28.7%, p=0.02) and underwent Seldinger catheter insertion (51.5% vs. 21.6%, p<0.01). Patients with early-start PD had a higher incidence of pericatheter leaks (6.9% vs. 0.6%, p<0.01) and similar incidence of peritonitis (30% vs. 34.1%, p=0.5), PD catheter insertion-related peritonitis (3.8% vs. 8.4%, p=0.1), and exit site infection (26.2% vs. 27.5%, p=0.8). Complication rates were similar between PD catheters inserted laparoscopically as compared to Seldinger technique, and patients who had or did not have bridging haemodialysis.
Conclusions: Early-start PD is associated with higher pericatheter leak rates than conventional-start PD, with an otherwise similar complication profile.
Biography
George Tsihlis is a Nephrology Advanced Trainee, working in the Western Sydney Renal Service. He completed his MBBS at Monash University, and his basic physician training in the Western Sydney Local Health District. He is currently based at Westmead Hospital, complementing his clinical practice with active roles in BPT education and research. His interests in the field include general nephrology, peritoneal dialysis and renal obstetric medicine.