Hernández-Castillo José L, Balderas-Juárez Joana, Jiménez-Zarazúa Omar, Guerrero-Toriz Karen, Loeza-Uribe Michelle P, Tenorio-Aguirre Erika K, Mendoza-García Jesús G, Mondragón Jaime D
Facultad de Medicina, Unidad de Posgrado, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Department of Internal Medicine, Hospital General Dr. Manuel Gea González, Mexico City, Mexico.
Kidney Int Rep. 2020 Jul 26;5(10):1722-1728. doi: 10.1016/j.ekir.2020.07.025. eCollection 2020 Oct.
Urgent-start peritoneal dialysis (PD) in patients with newly diagnosed end-stage renal disease (ESRD) is a well-tolerated alternative to hemodialysis (HD). The primary aim of this study was to identify the demographic and clinical characteristics of ESRD patients, as well as the presurgical, surgical, and postsurgical factors associated with urgent-start PD complications.
A retrospective cross-sectional observational study was performed on 102 patients with ESRD who merited urgent-start PD from January 2015 to June 2019. The primary clinical outcome measures were catheter leakage, dysfunction, and peritonitis, whereas the secondary outcomes were catheter removal, repositioning, and death. Statistical inferences were made with the χ or Fisher's exact test and independent samples tests.
One hundred two subjects (65 men, 63.7%) 56.2 ± 15.1 years old were included in this study; 64 of the subjects had diabetes and hypertension (62.7%). Catheter leakage occurred in 8 patients (7.8%), catheter dysfunction in 27 patients (26.5%), and peritonitis in 14 patients (13.7%); meanwhile, catheter removal occurred in 6 patients (5.9%), catheter repositioning in 21 patients (20.6%), and death in 3 patients (2.9%). Peritonitis was associated with younger age (i.e., 47.0 ± 16.8 vs. 57.6 ± 14.4 years; = 0.014; 95% confidence interval [CI]: 2.2-19.1; odds ratio [OR] 0.96; = 0.018; 95% CI: 0.92-099), higher creatinine levels upon admission (i.e., 20.2 ± 9.8 vs. 14.1 ± 8.3; = 0.014; 95% CI: -10.9 to -1.2), and heart failure (OR 4.79; = 0.043; 95% CI: 1.05-21.88). Patients with abdominal hernia were 7.5 times more likely to have their catheter leak (OR 7.5; = 0.036; 95% CI: 1.14-49.54) Catheter removal was associated with obesity (i.e., body mass index [BMI] of 31.6 ± 4.1 vs. 25.9 ± 4.9; = 0.007; 95% CI: -9.8 to -1.6; OR 1.26; = 0.013; 95% CI: 1.05-1.51) and Modification of Diet in Renal Disease glomerular filtration rate (MDRD-GFR) (i.e., 2.5 ± 0.6 vs. 3.7 ± 2.3; = 0.003; 95% CI: 0.5-1.9).
Peritonitis was associated with younger age, higher creatinine levels upon admission, and heart failure; meanwhile, catheter removal was linked to obesity and lower glomerular filtration rate. Compared with previous reports, our study included patients in which PD was initiated shortly after catheter insertion, making the intervention a true urgent-start PD. This study contributes to the existing urgent-start PD literature by providing evidence that urgent-start PD with catheter opening within 72 hours has limited complications, making it a relatively safe option.
新诊断的终末期肾病（ESRD）患者进行紧急开始的腹膜透析（PD）是一种耐受性良好的血液透析（HD）替代方案。本研究的主要目的是确定ESRD患者的人口统计学和临床特征，以及与紧急开始的PD并发症相关的术前、术中和术后因素。
对2015年1月至2019年6月期间适合紧急开始PD的102例ESRD患者进行了一项回顾性横断面观察研究。主要临床结局指标为导管渗漏、功能障碍和腹膜炎，次要结局为导管拔除、重新定位和死亡。采用χ²检验或Fisher精确检验以及独立样本t检验进行统计推断。
本研究纳入了102名受试者（65名男性，占63.7%），年龄为56.2±15.1岁；其中64名受试者患有糖尿病和高血压（占62.7%）。8例患者（7.8%）发生导管渗漏，27例患者（26.5%）发生导管功能障碍，14例患者（13.7%）发生腹膜炎；同时，6例患者（5.9%）进行了导管拔除，21例患者（20.6%）进行了导管重新定位，3例患者（2.9%）死亡。腹膜炎与年龄较小（即47.0±16.8岁对57.6±14.4岁；P=0.014；95%置信区间[CI]：2.2 - 19.1；优势比[OR]0.96；P=0.018；95%CI：0.92 - 0.99）、入院时肌酐水平较高（即20.2±9.8对14.1±8.3；P=0.014；95%CI：-10.9至-1.2）以及心力衰竭（OR 4.79；P=0.043；95%CI：1.05 - 21.88）相关。有腹疝的患者导管渗漏的可能性高7.5倍（OR 7.5；P=0.036；95%CI：1.14 - 49.54）。导管拔除与肥胖（即体重指数[BMI]为31.6±4.1对25.9±4.9；P=0.007；95%CI：-9.8至-
