The importance of a Peritoneal Dialysis-first policy in long term outcomes
DOI:
https://doi.org/10.71749/pkj.29Keywords:
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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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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