Different Modes Of Urgent-start Automatic Peritoneal Dialysis After Catheter Insertion:A Controlled Study

Background:Peritoneal dialysis(peritoneal dialysis,PD)is one of the important modes of renal replacement therapy in uremia patients.When compared to hemodialysis,PD has its irreplaceable advantage in the protection of residual renal function,reduce the incidence of cardiovascular events,long-term survival.Automated peritoneal dialysis(APD)is the treatment employing a mechanical device to assist the delivery and drainage of dialysate as a substitute of the manual operation in patients with end-stage renal disease(ESRD).It has been reported that APD may have several advantages over traditional continuous ambulatory peritoneal dialysis(CAPD)including less incidence of peritonitis and hospitalization.Undergoing APD have a considerable amount of work,family,and social activities,while recent study found no difference in overall mortality and technical failure compared to CAPD.Thus,APD is proposed as an alternative to CAPD in all patients suitable for PD.In the developing countries,it is very often to see an ESRD patient who needs renal replace treatment immediately at his/her first hospital admission.Thus,acute catheter insertion was applied usually in such a situation and urgent-start PD therapy is required during the specific interval immediately post-surgery.Urgent-start PD may lead to complications such as peritonitis,and dialysate fluid leaks due to an increased intra-abdominal pressure.Performing APD in the supine position has been shown to reduce the intra-abdominal pressure than the upright position in CAPD.Therefore,APD is considered rather optimal in who needs urgent-start PD.Low-volume tidal peritoneal dialysis(TPD)and intermittent peritoneal dialysis(IPD)are common modes of APD used in clinical practice,especially after emergent catheter insertion.Given the consistently increasing trend towards APD usage,understanding the potential complications of TPD and IPD using mechanical devices in the population initiating dialysis is essential.Objective : The present study is designed to compare the differences in incidence of complications between the low-volume TPD and IPD modes in ESRD patients initiating urgent-start APD.To evaluate the safety of low-volume TPD and IPD in ESRD patients initiating APD after an acute catheter insertion.Methods:From May 2011 to May 2013,49 patients were enrolled and 27 patients received low-volume TPD treatment whereas 22 patients underwent low-volume IPD right after Tenckhoff catheter insertion at the Nephrology department of Guangdong General People's Hospital.The incidence of complications during the 14-day APD treatment was observed.After APD treatment,all the patients were transferred to continuous ambulatory peritoneal dialysis(CAPD)and followed up for 2 years.Results : The IPD group demonstrated a significantly high incidence of catheter-related complications(omental wrapping 27.3% vs 0 and suction pain 18.2% vs 0)than the TPD group after adjusting for age,gender,baseline diabetes,systolic blood pressure,body mass index,and the experience of the operators.However,the short duration of APD treatment with either IPD or TPD mode did not affect the long-time technical survival.Conclusions : In patients immediately after catheter insertion,low-volume TPD mode demonstrated a lower incidence of catheter-related complications compared to IPD.TPD is a preferable APD mode for this specific population.