Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study

Detalhes bibliográficos
Autor(a) principal: Hangai, Kellen Thayanne
Data de Publicação: 2022
Outros Autores: Pecoits-Filho, Roberto, Blake, Peter G., da Silva, Daniela Peruzzo, Barretti, Pasqual [UNESP], de Moraes, Thyago Proença
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.3389/fmed.2022.717385
http://hdl.handle.net/11449/249449
Resumo: Background: Patients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure. Methods: This is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model. Results: We included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models. Conclusion: Unplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.
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spelling Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort studyBRAZPDearly-start dialysisperitoneal dialysisunplanned peritoneal dialysisurgent-start dialysisBackground: Patients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure. Methods: This is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model. Results: We included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models. Conclusion: Unplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR)Division of Nephrology University of Western OntarioDivision of Nephrology Department of Internal Medicine Universidade Estadual Paulista (UNESP)Division of Nephrology Department of Internal Medicine Universidade Estadual Paulista (UNESP)Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR)University of Western OntarioUniversidade Estadual Paulista (UNESP)Hangai, Kellen ThayannePecoits-Filho, RobertoBlake, Peter G.da Silva, Daniela PeruzzoBarretti, Pasqual [UNESP]de Moraes, Thyago Proença2023-07-29T15:41:41Z2023-07-29T15:41:41Z2022-11-23info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://dx.doi.org/10.3389/fmed.2022.717385Frontiers in Medicine, v. 9.2296-858Xhttp://hdl.handle.net/11449/24944910.3389/fmed.2022.7173852-s2.0-85143499757Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengFrontiers in Medicineinfo:eu-repo/semantics/openAccess2024-08-14T17:37:05Zoai:repositorio.unesp.br:11449/249449Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-14T17:37:05Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
title Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
spellingShingle Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
Hangai, Kellen Thayanne
BRAZPD
early-start dialysis
peritoneal dialysis
unplanned peritoneal dialysis
urgent-start dialysis
title_short Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
title_full Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
title_fullStr Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
title_full_unstemmed Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
title_sort Impact of unplanned peritoneal dialysis start on patients' outcomes—A multicenter cohort study
author Hangai, Kellen Thayanne
author_facet Hangai, Kellen Thayanne
Pecoits-Filho, Roberto
Blake, Peter G.
da Silva, Daniela Peruzzo
Barretti, Pasqual [UNESP]
de Moraes, Thyago Proença
author_role author
author2 Pecoits-Filho, Roberto
Blake, Peter G.
da Silva, Daniela Peruzzo
Barretti, Pasqual [UNESP]
de Moraes, Thyago Proença
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Programa de Pós- Graduação em Ciências da Saúde-Pontifícia Universidade Católica do Paraná (PUCPR)
University of Western Ontario
Universidade Estadual Paulista (UNESP)
dc.contributor.author.fl_str_mv Hangai, Kellen Thayanne
Pecoits-Filho, Roberto
Blake, Peter G.
da Silva, Daniela Peruzzo
Barretti, Pasqual [UNESP]
de Moraes, Thyago Proença
dc.subject.por.fl_str_mv BRAZPD
early-start dialysis
peritoneal dialysis
unplanned peritoneal dialysis
urgent-start dialysis
topic BRAZPD
early-start dialysis
peritoneal dialysis
unplanned peritoneal dialysis
urgent-start dialysis
description Background: Patients with end-stage kidney disease (ESKD) who start unplanned dialysis therapy are more likely to be treated with hemodialysis (HD) using a central venous catheter, which has been associated with a greater risk of infections and other complications, as well as with a higher long-term risk of death. Urgent-start PD is an alternative that has been suggested as an option for starting dialysis in these cases, with potentially better patient outcomes. However, the definition of urgent-start PD is not homogeneous, and no study, to our knowledge, has compared clinical outcomes among urgent start, early start, and conventional start of PD. In this study, we aimed to compare these types of initiation of dialysis therapy in terms of a composite outcome of patient survival and technique failure. Methods: This is a retrospective, multicenter, cohort study, involving data from 122 PD clinics in Brazil. We used the following: Urgent-start groups refer to patients who initiated PD within 72 h after the PD catheter insertion; early-start groups are those starting PD from 72 h to 2 weeks after the catheter insertion; and conventional-start groups are those who used the PD catheter after 2 weeks from its insertion. We analyzed the composite endpoint of all causes of patient's mortality and technique failure (within the initial 90 days of PD therapy) using the following three different statistical models: multivariate Cox, Fine and Gay competing risk, and a multilevel model. Results: We included 509 patients with valid data across 68 PD clinics. There were 38 primary outcomes, comprising 25 deaths and 13 technique failures, with a total follow-up time of 1,393.3 months. Urgent-start PD had no association with the composite endpoint in all three models. Conclusion: Unplanned PD seems to be a safe and feasible option for treatment for patients with non-dialysis ESKD in urgent need of dialysis.
publishDate 2022
dc.date.none.fl_str_mv 2022-11-23
2023-07-29T15:41:41Z
2023-07-29T15:41:41Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.3389/fmed.2022.717385
Frontiers in Medicine, v. 9.
2296-858X
http://hdl.handle.net/11449/249449
10.3389/fmed.2022.717385
2-s2.0-85143499757
url http://dx.doi.org/10.3389/fmed.2022.717385
http://hdl.handle.net/11449/249449
identifier_str_mv Frontiers in Medicine, v. 9.
2296-858X
10.3389/fmed.2022.717385
2-s2.0-85143499757
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Frontiers in Medicine
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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