Botucatu School of Medicine, 67785UNESP, Sao Paulo, Brazil.
Perit Dial Int. 2021 Mar;41(2):244-252. doi: 10.1177/0896860820915021. Epub 2020 Mar 30.
Few studies have evaluated the viability and outcomes between peritoneal dialysis (PD) and haemodialysis (HD) in urgent-start renal replacement therapy (RRT). This study aimed to compare infectious and mechanical complications related to urgent-start PD and HD. Secondary outcomes were to identify risk factors for complications and mortality related to urgent-start dialysis.
A quasi-experimental study with incident patients receiving PD and HD in a Brazilian university hospital, between July 2014 and December 2017. Subjects included individuals with final-stage chronic kidney disease who required immediate RRT, that is, HD through central venous catheter or PD in which the catheter was implanted by a nephrologist and utilized for 72 h, without previous training. Patients with PD were subjected, initially, to high-volume PD for metabolic compensation. After hospital discharge, they remained in intermittent PD in the dialysis unit until training was completed. Mechanical and infectious complications were compared, as well as the recovery of renal function and survival.
In total, 93 patients were included in PD and 91 in HD. PD and HD groups were similar regarding age (58 ± 17 vs. 60 ± 15 years; = 0.49), frequency of diabetes mellitus (37.6% vs. 50.5%; = 0.10), other comorbidities (74.1% vs. 71.4%; = 0.67) and biochemical parameters at the beginning of RRT, that is, creatinine (9.1 ± 4.1 vs. 8.0 ± 2.8; = 0.09), serum albumin (3.1 ± 0.6 vs. 3.3 ± 0.6; = 0.06) and haemoglobin (9.5 ± 1.8 vs. 9.8 ± 2.0; = 0.44). After a minimum follow-up period of 180 days and a maximum follow-up period of 2 years, there was no difference regarding mechanical complications (24.7% vs. 37.4%; = 0.06) or bacteraemia (15.0% vs. 24.0%; = 0.11); however, there was a difference regarding infection of the exit site (25.8% vs. 39.5%; = 0.04) and diuresis maintenance [700 (0-1500) vs. 0 (0-500); < 0.001], with better results in the PD group. There was better phosphorus control at 180 days in the PD group (62.4% vs. 41.8%; = 0.008), with a lower requirement for phosphate binder usage (28% vs. 55%; < 0.001), erythropoietin (18.3% vs. 49.5%; < 0.001) and anti-hypertensives (11.8% vs. 30.8%; = 0.003). Time to death was similar between groups. In the multivariate analysis, PD was a predictor of renal function recovery [odds ratio: 3.95 (1.01-15.4)].
PD is a viable and safe alternative to HD in a scenario of urgent-start RRT with complication rates and outcomes similar to those of HD, highlighting the results regarding renal function recovery.
很少有研究评估紧急开始肾脏替代治疗（RRT）中腹膜透析（PD）和血液透析（HD）的存活率和结果。本研究旨在比较紧急开始 PD 和 HD 相关的感染和机械并发症。次要结局是确定与紧急开始透析相关的并发症和死亡率的危险因素。
这是一项在巴西一所大学医院进行的准实验研究，纳入了 2014 年 7 月至 2017 年 12 月期间接受 PD 和 HD 的新发病例患者。研究对象包括需要立即进行 RRT 的终末期慢性肾脏病患者，即通过中心静脉导管进行 HD 或 PD，其中导管由肾脏病专家植入并使用 72 小时，无需事先培训。PD 患者最初接受高容量 PD 以进行代谢补偿。出院后，他们在透析病房继续间歇性 PD，直到完成培训。比较了机械和感染并发症，以及肾功能恢复和存活率。
共纳入 93 例 PD 患者和 91 例 HD 患者。PD 和 HD 组在年龄（58±17 岁 vs. 60±15 岁；=0.49）、糖尿病患病率（37.6% vs. 50.5%；=0.10）、其他合并症（74.1% vs. 71.4%；=0.67）和 RRT 开始时的生化参数方面相似，即肌酐（9.1±4.1 vs. 8.0±2.8；=0.09）、血清白蛋白（3.1±0.6 vs. 3.3±0.6；=0.06）和血红蛋白（9.5±1.8 vs. 9.8±2.0；=0.44）。在最低随访期 180 天和最长随访期 2 年之后，机械并发症（24.7% vs. 37.4%；=0.06）或菌血症（15.0% vs. 24.0%；=0.11）无差异；然而，出口部位感染（25.8% vs. 39.5%；=0.04）和利尿维持[700（0-1500）vs. 0（0-500）；<0.001]存在差异，PD 组结果更好。PD 组在 180 天时磷控制更好（62.4% vs. 41.8%；=0.008），需要使用磷酸盐结合剂的比例更低（28% vs. 55%；<0.001）、红细胞生成素（18.3% vs. 49.5%；<0.001）和抗高血压药（11.8% vs. 30.8%；=0.003）更少。两组的死亡时间相似。多变量分析显示，PD 是肾功能恢复的预测因素[比值比：3.95（1.01-15.4）]。
PD 是紧急开始 RRT 的一种可行且安全的替代方法，其并发症发生率和结果与 HD 相似，突出了肾功能恢复的结果。
