Clinical Study Of Urgent-start Peritoneal Dialysis On End Stage Renal Diseases

End stage renal disease(ESRD)has become a heavy burden to public health worldwide.According to the 2018 United States Renal Data System(USRDS)report,the crude incidence of ESRD diagnoses was 388 per million/ year.Surprisingly,even with regular nephrology followup,more than 60% new diagnosed ESRD patients do not have plans when they begin renal replacement therapy.Hence,starting dialysis in an unplanned manner is a common occurrence.Urgent initial dialysis is a common and important problem all over the world,accounting for 30%-50% of initial dialysis patients.Over 80% of patients who initiated hemodialysis(HD)started using central venous catheter(CVC)is the main starting dialysis form in urgent initial dialysis worldwide.Meanwhile,CVC is independently associated with increased mortality and high rates of bacteremia,central venous stenosis,thrombosis and other complications,which is not conducive to the long-term prognosis of patients.The European best practice guide(EBPG)and the(ISPD)guidelines of the International Peritoneal Dialysis Association recommend that catheterization should be inserted at least two weeks before the start of PD(PD).However,it is unrealistic for these unplanned ESRD dialysis patients to wait two weeks.Urgent initiation Peritoneal Dialysis(Urgent-start PD)is an effective way to start PD quickly after catheterization.It can avoid the increased risk of catheter-related complications in CVC.The prognosis of ESRD patients was improved and the treatment procedure was simplified.Therefore,in recent years,growing evidence shows that urgent start dialysis is a safe and effective urgent dialysis modewith wide range of application prospects.In this paper,the comparison of different urgent-start dialysis methods was made.1.Whether Urgent-start PD is the preferred alternative therapy for ESRD patients.A retrospective study was conducted on all ESRD patients who met the requirements of PD treatment from January 1,2002 to December 31,2011,in the Department of Kidney,Shanghai Chang zheng Hospital and Shanghai Song jiang District Central Hospital.All the patients were followed up from the date of catheterization until the patient withdrew from abdominal dialysis,transferred to other centers,transplants,died,lost or until the end of the study.The demographic indexes,clinical biochemical indexes and residual renal function before dialysis were collected.The follows were also recorded: the date of catheterization,the date of onset of abdominal dialysis,the outcome,the time of prognosis,the causes of prognosis,the occurrence and risk factors of catheter dysfunction events,the patency rate of catheter function,the occurrence of peritonitis 1 year after operation,the adequacy of peritoneal dialysis,etc.2.Evaluating the safety and feasibility of urgent-start PD and urgent-start HD in patients with ESRD patients.A retrospective study was conducted on all ESRD patients who needed dialysis within 14 days and had no permanent dialysis access in the Department of Kidney,Shanghai Changzheng Hospital and the Department of Kidney,Shanghai Songjiang District Central Hospital from January 1,2012 to December 31,2015.ESRD patients undergoing dialysis were divided into Urgent-start PD group and Urgent-start HD group.All patients were followed up until death,transplantation,loss of follow-up,or until the end of the study.The age,sex,primary disease,complications,residual renal function and clinical biochemical indexes before dialysis were counted.The complications related to dialysis within 30 days after catheterization were compared between the emergency initiation PD group and the emergency initiation HD group.The incidence of dialysis related complications and bacteremia and the survival rate of the two groups were compared.Comparison of health economics and dialysis adequacy between the two groups of patients.3.Exploring the safety and feasibility of urgent-start dialysisfor ESRD patients from urgent-start APD to long-term peritoneal dialysis.This study was a prospective,randomized,controlled clinical trial with a proportion of 1:1.All ESRD patients who needed dialysis treatment within 2 weeks and who did not have a permanent dialysis pathway from February 1,2016 to January 31,2017,were enrolled in the trial.These patients were randomly divided into two groups.According to the urgent initial dialysis method,the patients with ESRD were divided into APD-CAPD group: PD catheterization group,APD as urgent starting mode after 2 weeks of CAPD treatment;HD-CAPD group: CVC catheterization for HD treatment,three times a week after HD,PD catheterization,PD catheterization for 2 weeks before CAPD treatment.All patients were followed up to patient death,missing visit or to the study termination date.The age,sex,primary disease,complications,residual renal function and clinical biochemical indexes before dialysis were counted in APD-CAPD group and HD-CAPD group.The technical survival rate,infection incidence,survival rate and residual renal function of the two groups were compared after 14 days of transition to CAPD.This study verified that Urgent-start PD can be used as the first choice of urgent initial replacement therapy for ESRD patients.1.For patients who need urgent dialysis for reasons such as late referrals,clinicians can start dialysis treatment within a short period of time after catheterization according to the specific situation.Using PD as the short-and long-term incidence of catheter failure,as well as other catheter-related complications(such as intestinal perforation,severe bleeding,early infection and abdominal wall complications),which are very low and have a high catheter patency rate.Urgent-start PD is not an independent risk factor for technical failure and death in patients with dialysis.Age is an independent risk factor related to catheter failure.Male sex,diabetic nephropathy and low albumin level are independent risk factors for abdominal wall complications.Urgent-start PD is feasible as a safe and effective emergency initial dialysis method.2.As an urgent initial dialysis method for ESRD patients,compared with HD,dialysis related complications occurred within 30 days after catheterization,less dialysis related complications and bacteremia,higher survival rate and significant cost saving in health economics.For PD patients with different onset within 2 weeks,there is no difference in the occurrence and dialysis adequacy of peritonitis.Urgent-start PD is a safe and effective way to replace the urgent initial dialysis of Urgent-start HD.3.The urgent start mode of ESRD patients in need of urgent dialysis from urgent-start APD to CAPD is beneficial to the protection of residual kidney function.It is safe,feasible and has a good application prospect for urgent start dialysis treatment at the beginning of APD.