Phang Chee Chin, Foo Marjorie Wai Yin, Johnson David W, Wu Sin Yan, Hao Ying, Jayaballa Mathini, Koniman Riece, Chan Choong Meng, Oei Elizabeth Ley, Chong Tze Tec, Htay Htay
Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
Princess Alexandra Hospital, Brisbane, Australia.
Int Urol Nephrol. 2021 Mar;53(3):583-590. doi: 10.1007/s11255-020-02630-8. Epub 2020 Sep 7.
There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD.
This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival.
A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups.
Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.
终末期肾病患者对紧急开始腹膜透析（PD）的兴趣日益增加，以避免使用中心静脉导管及其并发症。本研究旨在比较紧急开始腹膜透析（定义为在腹膜透析导管插入后2周内开始腹膜透析）与传统开始腹膜透析的临床结局。
这是一项对2017年1月至2018年2月期间新加坡总医院所有新发病例腹膜透析患者的单中心回顾性队列研究。主要结局是透析液渗漏。次要结局包括导管故障、导管调整、出口处感染、腹膜炎、技术生存率和患者生存率。
共纳入187例新发病例腹膜透析患者。其中，66例（35%）开始紧急开始腹膜透析。紧急开始腹膜透析组的透析液渗漏明显高于传统开始腹膜透析组（7.6%对0.8%；p = 0.02），而两组之间的导管故障（4.5%对3.3%；p = 0.70）和导管调整（1.5%对2.5%；p = 1.00）相当。出口处感染相当（发病率风险比（IRR）：0.66，95%置信区间（CI）0.25 - 1.74），而紧急开始腹膜透析组的腹膜炎明显高于传统开始腹膜透析组（发病率风险比（IRR）3.10，95%置信区间（CI）1.29 - 7.44）。紧急开始腹膜透析时首次发生腹膜炎的时间，尤其是革兰氏阳性腹膜炎的时间明显更短。两组之间的技术生存率（风险比（HR）1.95，95% CI 0.89 - 4.31）和患者生存率（HR 1.46，95% CI 0.44 - 4.87）相当。
与传统开始腹膜透析相比，紧急开始腹膜透析与透析液渗漏和腹膜炎的风险较高相关，但技术生存率和患者生存率相当。
