The importance of a Peritoneal Dialysis-first policy in long term outcomes

Authors

  • Ana Luisa Correia Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal Author https://orcid.org/0000-0002-9228-341X
  • Pedro Almiro e Castro Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal Author
  • Filipe Mira Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal Author
  • Sofia Cerqueira Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal Author
  • Maria Guedes Marques Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal Author
  • Pedro Maia Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal Author
  • Rui Alves Nephrology Department, Hospitais da Universidade de Coimbra, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal Author

Keywords:

Hemodialysis, Home, Kidney Failure, Chronic/therapy, Outpatient Clinics, Hospital, Peritoneal Dialysis, Treatment Outcome

Abstract

Introduction: A significant part of peritoneal dialysis (PD) patients begins renal replacement therapy (RRT) through hemodialysis (HD) before transitioning to PD. We aim to evaluate the impact of an initial period on HD before transitioning to PD on the outcomes.
Material and Methods: We conducted a retrospective cohort study including the prevalent PD patients between January 2017 and December 2019. Demographic and clinical data were collected at the time of PD start and one and two years after. Patients were divided in two groups, “PD‐first” group and “HD‐first” group, for comparison.
Results: Seventy‐eight PD patients were included, mostly male (66.7%; n=52), with a mean age of 52.2±14.3 years. Thirty‐three patients (42.3%) initiated RRT with intermittent HD and switched to PD after a median time of 3 months. We found no difference between “HD‐first” and “PD‐first” groups regarding demographic data, prevalence of comorbidities or renal disease etiology. At the moment of PD start and one and two years later patients on the “HD‐first” had a signif‐ icant lower volume of residual diuresis and of residual kidney function (RKF). At one and two‐years follow‐up “HD‐first” group also needed a higher number of antihypertensive drugs, had lower weekly Kt/V and a higher number of episodes of peritonitis. Patients in the “HD‐first” group also had significantly more cardiovascular events after two years.
Conclusion: A period in HD prior to PD seems to precipitate a faster reduction of RKF and dialysis efficacy. We reinforce the importance of promoting the start of PD‐first and urgent‐start PD programs.

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References

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Published

11-03-2024

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Original Article

How to Cite

The importance of a Peritoneal Dialysis-first policy in long term outcomes. (2024). Portuguese Kidney Journal, 38(1), 30-34. https://pkj.spnefro.pt/index.php/journal/article/view/29

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