Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Advance CKD Stage V in Surin Hospital: A Randomized Controlled Study During the Years 2019-2024
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Abstract
BACKGROUND: At present, most patients with end-stage kidney disease require urgent initiation of renal replacement therapy. The majority begin dialysis with a temporary hemodialysis catheter, which carries a high risk of complications. In recent years, there has been an increasing trend toward urgent-start peritoneal dialysis (PD), however, comparative data regarding its safety and outcomes remain limited. Therefore, this study aimed to provide additional evidence in this area.
OBJECTIVES: To compare technique survival outcomes between Urgent-Start Peritoneal Dialysis (PD) versus Urgent-Start Hemodialysis (HD), and to evaluate secondary outcomes including patient survival and complications.
METHODS: This was an open-label randomized controlled trial conducted in patients with end-stage kidney disease at Surin Hospital between 2019 and 2024. A total of 210 patients were randomized to either the urgent-start HD or the urgent-start PD group (105 patients per group) and followed up at 6 weeks and 52 weeks.
RESULTS: The technique survival rate at 6 weeks was 92% in HD group versus 93% in PD group. At 52 weeks, the technique survival rate was 69% versus 66%, showing no significant difference (p>0.05). Six-week mortality was higher in the HD group compared with the PD group (6% vs. 0%), with statistical significance (p=0.029), while 52 weeks mortality did not differ significantly between the two groups (p=0.88).
CONCLUSIONS: Urgent-start peritoneal dialysis demonstrated higher short-term patient survival compared with urgent-start temporary hemodialysis, particularly within the first 6 weeks. Technique survival and overall patient survival at 52 weeks were not significantly different between the two modalities.
Thaiclinicaltrials.org number, TCTR20251016002
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References
Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, et al. US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2020;75(1 Suppl 1):A6-A7.
Hole B, Caskey F, Evans K, Fluck R, Kumwenda M, Steenkamp R, et al. UK renal registry 19th annual report: chapter 12 multisite dialysis access audit in England, Northern Ireland and Wales in 2015 and 2014 PD one year follow-up: national and centre-specific analyses. Nephron 2017;137 Suppl 1:269-96.
Perl J, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 2011;22:1113-21.
Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Patterns and predictors of early mortality in incident hemodialysis patients: new insights. Am J Nephrol 2012;35:548-58.
Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, et al. Dialysis initiation, modality choice, access, and prescription: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney Int 2019;96:37-47.
Chiu M, Jain AK, Blake PG. Truly urgent "urgent-start" peritoneal dialysis. Kidney Int Rep 2020;5:1625-6.
Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CM, Cho Y. Urgent-start peritoneal dialysis versus haemodialysis for people with chronic kidney disease. Cochrane Database Syst Rev [Internet]. 2021 [cited 2023 June 15];1(1):CD012899. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8092642/pdf/CD012899.pdf
Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CM, Cho Y. Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease. Cochrane Database Syst Rev [Internet]. 2020[cited 2023 June 15];12(12):CD012913. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8094169/pdf/CD012913.pdf
Zang XJ, Yang B, Du X, Mei CL. Urgent-start peritoneal dialysis and patient outcomes: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2019;23:2158-66.
Dias DB, Mendes ML, Caramori JT, Falbo Dos Reis P, Ponce D. Urgent-start dialysis: comparison of complications and outcomes between peritoneal dialysis and haemodialysis. Perit Dial Int 2021;41:244-52.
Chuengsaman P, Kasemsup V. PD first policy: Thailand's response to the challenge of meeting the needs of patients with end-stage renal disease. Semin Nephrol 2017;37:287-95.
Parapiboon W, Sangsuk J, Nopsopon T, Pitsawong W, Tatiyanupanwong S, Kanjanabuch T, et al. Randomized study of urgent-start peritoneal dialysis versus urgent-start temporary hemodialysis in patients transitioning to kidney failure. Kidney Int Rep 2022;7:1866-77.
Jin H, Fang W, Zhu M, Yu Z, Fang Y, Yan H, et al. Urgent-start peritoneal dialysis and hemodialysis in ESRD patients: complications and outcomes. PLoS One [Internet]. 2016 [cited 2023 June 20];11(11):e0166181. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5100934/pdf/pone.0166181.pdf
Koch M, Kohnle M, Trapp R, Haastert B, Rump LC, Aker S. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 2012;27:375-80.
Xie D, Zhou J, Cao X, Zhang Q, Sun Y, Tang L, et al. Percutaneous insertion of peritoneal dialysis catheter is a safe and effective technique irrespective of BMI. BMC Nephrol [Internet]. 2020 [cited 2023 June 20];21(1):199. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7249625/pdf/12882_2020_Article_1850.pdf
