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2015 ; 35
(6
): 622-4
Nephropedia Template TP
gab.com Text
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English Wikipedia
Unplanned Start on Peritoneal Dialysis Right after PD Catheter Implantation for
Older People with End-Stage Renal Disease
#MMPMID26702001
Povlsen JV
; Sørensen AB
; Ivarsen P
Perit Dial Int
2015[Nov]; 35
(6
): 622-4
PMID26702001
show ga
Unplanned start on dialysis remains a major problem for the dialysis community
worldwide. Late-referred patients with end-stage renal disease (ESRD) and urgent
need for dialysis are overrepresented among older people. These patients are
particularly likely to be started on in-center hemodialysis (HD), with a
temporary vascular access known to be associated with excess mortality and
increased risks of potentially lethal complications such as bacteremia and
central venous thrombosis or stenosis.The present paper describes in detail our
program for unplanned start on automated peritoneal dialysis (APD) right after PD
catheter implantation and summarizes our experiences with the program so far.
Compared with planned start on PD after at least 2 weeks of break-in between PD
catheter implantation and initiation of dialysis, unplanned start may be
associated with a slight increased risk of mechanical complications but
apparently no detrimental effect on mortality, peritonitis-free survival, or PD
technique survival.In our opinion and experience, the risk of serious
complications associated with the implantation and immediate use of a PD catheter
is less than the risk of complications associated with unplanned start on HD with
a temporary central venous catheter (CVC). Unplanned start on APD is a gentle,
safe, and feasible alternative to unplanned start on HD with a temporary CVC that
is also valid for the late-referred older patient with ESRD and urgent need for
dialysis.