How to start the late referred ESRD patient urgently on chronic APD
Department of Renal Medicine C, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
Correspondence and offprint requests to: Johan V. Povlsen, MD, Department of Renal Medicine C, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark. Email: vpj{at}sks.aaa.dk
Background. Peritoneal dialysis (PD) has become a well-established complementary alternative to haemodialysis (HD) as first-line renal replacement modality. At our department, 
50% of the end-stage renal disease patients are started urgently on chronic dialysis due to late referral or unexpected deterioration of residual renal function. These patients—although suitable for PD—were previously started on HD via a temporary central venous catheter. Since January 2000, patients have been offered urgent start on chronic PD right after PD-catheter insertion by open surgery.
Methods. Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (<24 h) PD catheter placement and comparing short-term (3 months) outcome measures and dialysis-related complications between a group of patients started acutely on chronic PD and a non-matched group of patients with a planned start on chronic PD.
Results. The number and type of infectious complications were equal in both the groups. The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P < 0.05). Consequently, the need for surgical replacement of catheters was also significantly higher in the study group (P < 0.02). With death and transplantation being the censored events, there was no difference in short-term PD technique survival rates between the two groups [39/45 (86.7%) vs 45/50 (90.0%)].
Conclusions. The PD modality may be a feasible, safe and complementary alternative to HD not only in the chronic, but also in the acute setting. The concept of acute start on chronic PD may be an yet another tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy.