García-García Guillermo, Ibarra-Estrada Miguel, Perl Jeffrey, Madero Magdalena, Murguía-Soto César, Hernández-Morales Karla, Camacho-Guerrero Jahir R, Pérez-Venegas Miguel A, Carmona-Morales Edgar J, Oseguera-Gonzalez Alexa N, Franco-Garcia Martha K, Chávez-Alonso Gael, García-Peña María F, Gómez-Fregoso Juan A, Navarro-Blackaller Guillermo, Alcantar-Vallin M Luz, Abundis-Mora Gabriela, Medina-González Ramón, Martínez Gallardo-González Alejandro, Chávez-Iñiguez Jonathan S
University of Guadalajara Health Sciences Center, Guadalajara, Mexico.
Intensive Care Unit, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.
Kidney360. 2025 Jul 22;6(8):1373-1383. doi: 10.34067/KID.0000000863.
In severe and late-stage uremia, hemodialysis is often the preferred modality on the basis of the rationale that it can address complications within a few hours. Patients with symptomatic ESKD who urgently start peritoneal dialysis and hemodialysis were associated with similar mortality rates, correction of uremia, and technique survival.
Urgent start peritoneal dialysis (PD) may be often avoided due to concerns of efficacy and unfavorable clinical outcomes among those with severe and symptomatic kidney failure. We sought to evaluate mortality risks and other clinical outcomes in individuals starting PD versus hemodialysis urgently, restricted to those with symptomatic and advanced kidney failure.
In this prospective single-center cohort, all adult individuals who were dialysis-naïve and consecutively hospitalized with severe and symptomatic kidney failure (defined as a urea value >300 mg/dl) were eligible. The primary outcome was 90-day mortality between those starting PD and hemodialysis. Secondary outcomes were to describe changes in biochemical parameters (potassium, sodium, and bicarbonate), ability to remain on the initial dialysis modality, fluid removal, and PD and hemodialysis access complications.
Between May 2022 and 2024, 120 received PD and 103 received hemodialysis with 73% being male with a median age of 43 years and a median serum urea of 360 mg/dl (interquartile range, 321–420). Mortality at 90 days was 29.1% for hemodialysis and 20.8% for PD died with an adjusted risk of death (adjusted hazard ratio of 1.26; 95% confidence interval [CI], 0.73 to 2.18). The urea value decreased more than 50% in both techniques (95% CI, −14.8 to 43.9; = 0.10) within the first 7 days, with similar trends for serum potassium and bicarbonate. The total ultrafiltrate was greater by 1.2 L in the hemodialysis patients compared with PD patients ( = 0.005). Catheter dysfunction was lower in patients who received hemodialysis compared with those on PD (13.6% versus 26.7% ([95% CI, 2.7 to 23.5; = 0.01]). By 90 days, 5.5% of patients in the hemodialysis group were switched to PD, and 10.5% of patients in the PD group were switched to hemodialysis, but this difference was not significant (95% CI, −3.5 to 13.6; = 0.27).
Among individuals with severe and symptomatic kidney failure outcomes were similar between urgent start hemodialysis and PD. Further studies are necessary to confirm these results.
在重度和晚期尿毒症中，基于血液透析能在数小时内解决并发症这一原理，它通常是首选的治疗方式。有症状的终末期肾病患者紧急开始腹膜透析和血液透析，其死亡率、尿毒症的纠正情况及技术生存率相似。
由于担心疗效以及严重且有症状的肾衰竭患者临床结局不佳，紧急开始腹膜透析（PD）常常被避免。我们试图评估紧急开始腹膜透析与血液透析的个体的死亡风险及其他临床结局，研究对象限于有症状的晚期肾衰竭患者。
在这个前瞻性单中心队列研究中，所有未接受过透析且因严重且有症状的肾衰竭（定义为尿素值>300mg/dl）而连续住院的成年个体均符合条件。主要结局是开始腹膜透析和血液透析的患者90天死亡率。次要结局是描述生化参数（钾、钠和碳酸氢盐）的变化、维持初始透析方式的能力、液体清除情况以及腹膜透析和血液透析通路并发症。
在2022年5月至2024年期间，120例接受腹膜透析，103例接受血液透析，73%为男性，中位年龄43岁，中位血清尿素为360mg/dl（四分位间距，321 - 420）。血液透析组90天死亡率为29.1%，腹膜透析组为20.8%，调整后的死亡风险（调整后的风险比为1.26；95%置信区间[CI]，0.73至2.18）。在最初7天内，两种技术的尿素值均下降超过50%（95%CI，-14.8至43.9；P = 0.10），血清钾和碳酸氢盐也有类似趋势。血液透析患者的总超滤量比腹膜透析患者多1.2L（P = 0.005）。接受血液透析的患者导管功能障碍发生率低于腹膜透析患者（13.6%对26.7%[95%CI，2.7至23.5；P = 0.01]）。到90天时，血液透析组5.5%的患者转为腹膜透析，腹膜透析组10.5%的患者转为血液透析，但差异无统计学意义（95%CI，-3.5至13.6；P = 0.27）。
在有严重且有症状的肾衰竭患者中，紧急开始血液透析和腹膜透析的结局相似。需要进一步研究来证实这些结果。
