Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes

BackgroundSeveral studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients.MethodsIn this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups.ResultsOur study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate.ConclusionIn an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need for dialysis.背景 多项研究表明，对于终末期肾病（end-stage renal disease, ESRD）患者而言，紧急启动腹膜透析（peritoneal dialysis, PD）是血液透析（hemodialysis, HD）的可行替代方案，但目前尚未直接评估透析方式对紧急启动透析患者结局的影响，尤其是对短期并发症的影响。本研究旨在比较紧急启动透析的ESRD患者采用PD与HD的并发症及结局。 方法 本项回顾性研究纳入2013年1月至2014年12月期间，在单中心紧急启动透析且未预先建立功能性血管通路或腹膜透析导管的终末期肾病患者。根据患者所采用的透析方式（PD与HD）进行分组。所有患者均在导管置入后至少随访30天（随访截至2016年1月）。比较两组患者的透析相关并发症与患者生存率。 结果 本研究共纳入178例患者（其中男性占56.2%），PD组与HD组分别有96例和82例患者。与HD组患者相比，PD组患者合并心血管疾病的比例更高，心力衰竭发生率更低，血清钾、血红蛋白、血清白蛋白、血清前白蛋白水平更高，而脑钠肽水平更低。两组患者在性别、年龄、糖皮质激素使用情况、早期肾内科转诊率、原发性肾脏疾病患病率、合并症患病率及其他实验室指标方面均无显著差异。初始30天内，HD组患者的透析相关并发症发生率显著高于PD组；HD组患者菌血症发生概率亦显著高于PD组。血液透析是短期（30天）透析相关并发症的独立预测因素。两组患者的生存率无显著差异。 结论 在经验丰富的医疗中心中，对于急需透析的终末期肾病患者，腹膜透析是血液透析安全且可行的替代透析方案。