Automated peritoneal dialysis with shortened break-in periods in urgent-start scenarios: A retrospective cohort study.

Abstract

Background: End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy. Urgent-start peritoneal dialysis (PD) has emerged as a viable alternative to hemodialysis particularly in resource-limited settings. However, concerns remain regarding catheter-related complications associated with early initiation of PD. Automated PD (APD) offers enhanced flexibility and fluid management, but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.

Aim: To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.

Methods: This was a single center, observational study that included 62 patients with end-stage kidney disease who required urgent-start dialysis, underwent PD catheter placement, and received APD. Patients were stratified based on catheter opening time (< 12 hours vs > 12 hours). Catheter-related complications, biochemical parameters, and dialysis efficacy were analyzed.

Results: The median catheter opening time was 11 h (interquartile range: 8-14 hours). No significant differences in catheter-related complications were observed between groups (P > 0.05). Catheter dysfunction, migration, leakage, and replacement occurred in 14.5%, 9.7%, 12.9%, and 11.3% of patients, respectively. APD led to significant reductions in serum creatinine, blood urea nitrogen, urea, phosphorus, and potassium (P < 0.05), alongside correction of metabolic acidosis. No cases of peritonitis or hemoperitoneum were observed.

Conclusion: Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.