Urgent-Start Peritoneal Dialysis Reduces Infections, Boosts Survival Rates

Dallas, TX – A protocol for urgent-start peritoneal dialysis results in less blood stream infections and appears to reduce mortality when compared to urgent-start hemodialysis, according to research presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings in Dallas, TX.

Most patients who present with end-stage renal disease in the emergency room are given urgent-start hemodialysis with a central venous catheter. However, researchers at the University of Southern California hypothesized that allowing patients the option of starting with peritoneal dialysis (PD) could improve long-range outcomes.

“In general, the overall outcomes for urgent-start PD patients are no different than patients who start planned PD or planned hemodialysis (HD)” said lead researcher Arshia Ghaffari, DO, Assistant Clinical Professor of Medicine at the Keck School of Medicine of USC Division of Nephrology. “We were also pleased to see we didn’t see a higher rate of complications, such as peritonitis, that we thought we might have in these urgent-start PD patients.”

The research is based on 161 dialysis patients, of which 46 were urgent-start PD patients. Those who had urgent-start hemodialysis with a central venous catheter had a 43% higher hospitalization rate, 4 times higher adjusted rate of catheter-related bacteremia, and 66% higher number of dialysis access procedures compared to urgent-start PD patients. It appeared that the urgent-start PD patient had a lower rate of mortality and technique failure as well.

“I work at a county hospital where I regularly see patients crashing into dialysis without a plan,” said Dr. Ghaffari. “Previously, almost all were placed on hemodialysis because there is a better developed infrastructure for that modality, but this research shows that urgent-start dialysis patients should be given a choice for their treatment.”

Urgent-start PD patients had similar rates of infection and hospitalization when compared to patients who had planned to go on hemodialysis or peritoneal dialysis.

“Many studies indicate better clinical outcomes for those on PD, and many PD patients report feeling better and having more energy for daily tasks,” said Kerry Willis, PhD, Chief Scientific Officer, National Kidney Foundation. “This new protocol appears to offer ESRD patients a safer dialysis choice, even in an urgent-start situation. It would be great to see this study replicated in other centers.”

 

The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families, and tens of millions of Americans at risk. For more information, visit www.kidney.org.