The importance of a Peritoneal Dialysis-first policy in long term outcomes
Keywords:
Hemodialysis, Home, Kidney Failure, Chronic/therapy, Outpatient Clinics, Hospital, Peritoneal Dialysis, Treatment OutcomeAbstract
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
Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT on behalf of the NECOSAD Study Group. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 2002; 62:1046–53
Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, Fenton S. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant 2012; 27:3568–75
Vonesh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int 2006; 70:S3–11
Nessim SJ, Bargman JM, Jassal SV, Oliver MJ, Na Y, Perl J. The impact of transfer from hemodialysis on peritoneal dialysis technique survival. Perit Dial Int 2015; 35(3):297-305
Legendrea B, Lobbedeza T, Couchoudc C, Lassallec M, Kazesc I, Lanota A, Boyera A, Béchade C. Switch from Hemodialysis to Peritoneal Dialysis: Does the Time Spent on Hemodialysis Impact Outcomes in Peritoneal Dialysis? Am J Nephrol 2022; 53:542–551
Chidambaram M, Bargman JM, Quinn RR, Austin PC, Hux JE, Laupacis A. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011; 31:565–73
Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol 2012; 7:612–18
Mujais S, Story K. Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts. Kidney Int Suppl 2006; (103):S21–6
Tavares J., Silva F., Lima A., et al. Urgent-Start Peritoneal Dialysis – a viable option? A case report and literature review. Port J Nephrol Hypert 2020; 34(2):110-115
Dias DB, Mendes ML, Caramori JT, Dos Reis PF, Ponce D. Urgent-start dialysis: comparison of complications and outcomes between peritoneal dialysis and haemodialysis. Perit Dial Int 2021; 41:244–252
Parapiboon W, Sangsuk J, Nopsopon T, Pitsawong W, Tatiyanupanwong S, Kanjanabuch T, Johnson DW. Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure. Kidney Int Rep 2022 Jun 11;7(8):1866-1877
Shamy OE. Does Temporary Hemodialysis Before Peritoneal Dialysis Initiation Affect Patient Outcomes? Kidney Int Rep 2022; 7,1734–1736
Jin H, Fang W, Zhu M, Yu Z, Fang Y, Yan H, Zhang M, Wang Q, Che X, Xie Y, Huang J, Hu C, Zhang H, Mou S, Ni Z. Urgent-start peritoneal dialysis and hemodialysis in ESRD patients: complications and outcomes. PLoSOne 2016; 11:e0166181
Zhang L, Cao T, Li Z, Wen Q, Lin J, Zhang X, Guo Q, Yang X, Yu X, Mao H. Clinical outcomes of peritoneal dialysis patients transferred from hemodialysis: a matched case–control study. Perit Dial Int 2012; 33:259–66
Liberek T, Renke M, Skonieczny B, Kotewicz K, Kowalewska J, Chmielewski M, Kot J, Lichodziejewska-Niemierko M, Rutkowski B. Therapy outcome in peritoneal dialysis patients transferred from haemodialysis. Nephrol Dial Transplant 2009; 24:2889–94
Lee Y, Okuda Y, Sy J, Kim SR, Obi Y, Kovesdy CP, Rhee CM, Streja E, Kalantar-Zadeh K. Ultrafiltration Rate Effects Declines in Residual Kidney Function in Hemodialysis Patients. Am J Nephrol 2019; 50(6):481–488
Obi Y, Streja E, Rhee CM, Ravel V, et al. Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study. Am J Kidney Dis 2016; 68(2):256-265
Nessim SJ, Bargman JM, Austin PC, Nisenbaum R, Jassal SV. Predictors of peritonitis in patients on peritoneal dialysis: results of a large, prospective Canadian database. Clin J Am Soc Nephrol 2009; 4:1195–200
Chidambaram M, Bargman JM, Quinn RR, Austin PC, Hux JE, Laupacis A. Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011; 31:565–73
Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol 2012; 7:612–18
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol 2009; 4:1925–31
McIntyre CW, Burton JO, Selby NM, Leccisotti L, Korsheed S, Baker CS, et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol 2008; 3:19–26
Ahmadmehrabi S, Tang WHW. Hemodialysis-induced cardiovascular disease. Semin Dial 2018; 31: 258– 267
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Copyright (c) 2024 Ana Luisa Correia, Pedro Almiro e Castro, Filipe Mira, Sofia Cerqueira, Maria Guedes Marques, Pedro Maia, Rui Alves (Author)
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