Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China.
Semin Dial. 2024 May-Jun;37(3):200-210. doi: 10.1111/sdi.13198. Epub 2024 Mar 13.
The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of associated complications in individuals with chronic kidney disease (CKD). The goal of this study was to evaluate the effects of unplanned/urgent-start PD versus conventional-start PD in this cohort of patients. Electronic search of MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was done from inception until July 2023 for studies reporting outcomes of unplanned/urgent-start and conventional-start PD in CKD patients. Outcomes of interest included mechanical complications, post-procedure infections, mortality, and transfer to hemodialysis. Heterogeneity, publication bias, and the influence of individual studies on the pooled odds ratio (OR) with 95% confidence interval (CI) were evaluated. Twenty-seven studies were finally included in the review. The overall risk of post-procedure infectious was comparable for both PD initiation methods (OR: 1.05; 95% CI: 0.83-1.34). Similarly, the risks for peritonitis and exit site infections did not differ significantly. However, urgent-start PD correlated with a significantly higher risk of overall mechanical complications (OR: 1.70; 95% CI: 1.23-2.34). Specifically, the risk for leaks was notably higher (OR: 2.47; 95% CI: 1.67-3.65) in the urgent-start group compared to the conventional-start PD group. Urgent-start PD correlated with significantly increased mortality rates (OR: 1.83; 95% CI: 1.39-2.41). There was no difference in the likelihood of technique survival and transfer to hemodialysis. Both urgent-start and conventional-start PD correlated with similar risks of overall infectious complications. Urgent-start PD resulted in significantly increased risks of mechanical complications and mortality. Our findings emphasize the need for meticulous planning and consideration when opting for PD initiation.
腹膜透析（PD）启动的时机，无论是常规启动（计划）还是紧急启动（非计划），可能会影响 PD 的结果以及慢性肾脏病（CKD）患者相关并发症的发生率。本研究的目的是评估在这组患者中，非计划/紧急启动 PD 与常规启动 PD 的效果。通过 MEDLINE（通过 PubMed）、EMBASE、Cochrane 对照试验中心注册库（CENTRAL）和 Scopus 数据库进行电子检索，检索时间从开始到 2023 年 7 月，以检索报告 CKD 患者非计划/紧急启动和常规启动 PD 结果的研究。感兴趣的结果包括机械并发症、术后感染、死亡率和转血液透析。评估了异质性、发表偏倚以及个别研究对合并优势比（OR）及其 95%置信区间（CI）的影响。最终有 27 项研究纳入综述。两种 PD 启动方法的术后感染总风险相当（OR：1.05；95%CI：0.83-1.34）。同样，腹膜炎和出口部位感染的风险也没有显著差异。然而，紧急启动 PD 与整体机械并发症的风险显著增加相关（OR：1.70；95%CI：1.23-2.34）。具体而言，紧急启动组的漏出风险明显更高（OR：2.47；95%CI：1.67-3.65），明显高于常规启动 PD 组。紧急启动 PD 与死亡率显著增加相关（OR：1.83；95%CI：1.39-2.41）。技术存活率和转血液透析的可能性没有差异。紧急启动和常规启动 PD 均与整体感染并发症的风险相似。紧急启动 PD 导致机械并发症和死亡率的风险显著增加。我们的研究结果强调，在选择 PD 启动时需要进行精心的计划和考虑。
