Urgent-start Peritoneal dialysis, a challenge for the nephrologist

Palacios-Guillén A. · Revista Medica Herediana (2022) · DOI: 10.20453/rmh.v33i4.4409

Resumen

The peritoneal dialysis (PD) is a less use but cost-effective therapy. Urgent-start PD is defined as the therapy initiation for incident patients immediately after or before two weeks of inserting a catheter for chronic PD in patients with chronic renal failure with an indication of urgent dialysis, compared with the conventional initiation after two weeks. The objective of this study was to review the actual data about urgent-start PD. PubMed, the Cochrane Library and SciELO were reviewed. Twelve articles published up to 31th October of 2021 were included. Data showed that fewer patients were admitted to PD and even fewer in urgent start PD. There was not a significant difference that justified the delay to use the implanted catheter, avoiding hemodialysis in urgent situations. A metanalysis with 16 studies (2953 patients) concluded that urgent start PD compared with conventional initiation did not increase all-cause mortality (RR 1.49, IC 95%: 0.87 a 2.53); 7 cohort studies (RR 1.89, IC 95%: 1.07 a 3.3); 1 case-control study (RR 0.90, IC 95%: 0.27 a 3.02). Another metanalysis with 6 studies (1242 patients) reported low certainty in mortality (RR: 1.25, IC 95%: 0.92 a 1.69; I2=0%, p=0.99), mechanical complications with leaking (RR: 6.72, IC 95%: 2.11 a 21.32; I2=0%, p=0.60) with no differences in infectious complications (RR: 1.36, IC 95%: 0.90 a 2.05, p=0.14). We conclude that there is no difference in survival of both, patients and catheter between urgent and conventional PD. Nephrologist should consider urgent onset DP as an alternative in patients who require urgent dialysis.

Instituciones: Universidad Peruana Cayetano Heredia