School of Nursing, Fudan University, Shanghai, China.
Department of Nursing, Huashan Hospital Affiliated to Fudan University, Shanghai, China,
Blood Purif. 2021;50(2):161-173. doi: 10.1159/000510550. Epub 2020 Oct 29.
The best timing of peritoneal dialysis (PD) initiation after catheter implantation is still controversial. It is necessary to explore whether there exists a waiting period to minimize the risk of complications.
A systematic review and meta-analysis were searched in multiple electronic databases published from inception to February 29, 2020, to identify cohort studies for evaluating the outcome and safety of unplanned-start PD (<14 days after catheter insertion). Risks of bias across studies were evaluated using Newcastle-Ottawa Quality Assessment Scale.
Fourteen cohort studies with a total of 2,401 patients were enrolled. We found that early-start PD was associated with higher prevalence of leaks (RR: 2.67, 95% CI, 1.55-4.61) and omental wrap (RR: 3.28, 95% CI, 1.14-9.39). Furthermore, patients of unplanned-start PD in APD group have higher risk of leaks, while those in CAPD group have a higher risk of leaks, omental wrap, and catheter malposition. In shorter break-in period (BI) group, the risk of suffering from catheter obstruction and malposition was higher for patients who started dialysis within 7 days after the surgery than for patients within 7-14 days. No significant differences were found in peritonitis (RR: 1.00; 95% CI, 0.78-1.27) and exit-site infections (RR: 1.12; 95% CI, 0.72-1.75). However, shorter BI was associated with higher risk of mortality and transition to hemodialysis (HD) while worsen early technical survival, with pooled RR of 2.14 (95% CI, 1.52-3.02), 1.42 (95% CI, 1.09-1.85) and 0.95 (95% CI, 0.92-0.99), respectively.
Evidence suggests that patients receiving unplanned-start PD may have higher risks of mechanical complications, transition to HD, and even mortality rate while worsening early technical survival, which may not be associated with infectious complications. Rigorous studies are required to be performed.
腹膜透析（PD）置管后开始的最佳时间仍存在争议。有必要探讨是否存在等待期以最大程度地降低并发症的风险。
系统检索了多个电子数据库，检索时间从建库至 2020 年 2 月 29 日，以确定评估计划外 PD（导管插入后<14 天）的结局和安全性的队列研究。使用纽卡斯尔-渥太华质量评估量表评估研究间的偏倚风险。
共纳入 14 项队列研究，总计 2401 例患者。我们发现早期 PD 与更高的渗漏发生率（RR：2.67，95%CI，1.55-4.61）和网膜包裹（RR：3.28，95%CI，1.14-9.39）相关。此外，APD 组中计划外 PD 的患者渗漏风险较高，而 CAPD 组中渗漏、网膜包裹和导管位置不当的风险较高。在较短的磨合期（BI）组中，手术后 7 天内开始透析的患者发生导管阻塞和位置不当的风险高于手术后 7-14 天内开始透析的患者。在腹膜炎（RR：1.00；95%CI，0.78-1.27）和出口部位感染（RR：1.12；95%CI，0.72-1.75）方面未发现显著差异。然而，较短的 BI 与更高的死亡率和向血液透析（HD）的转换风险相关，同时早期技术生存率恶化，汇总 RR 分别为 2.14（95%CI，1.52-3.02）、1.42（95%CI，1.09-1.85）和 0.95（95%CI，0.92-0.99）。
有证据表明，接受计划外 PD 的患者可能存在更高的机械并发症风险、向 HD 转换的风险，甚至死亡率，同时早期技术生存率恶化，这可能与感染并发症无关。需要进行严格的研究。
