Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors

Background Mechanical complications are of particular concern in urgent-start peritoneal dialysis (PD) because of the shorter break-in period. However, risk factors have been reported inconsistently and data in urgent-start PD populations are limited. Study Design Observational cohort study. Setting & Participants All patients treated with urgent-start PD, defined as PD therapy initiated within 1 week after catheter insertion, January 2003 to May 2013. Predictors Age, sex, abdominal surgery history, body mass index, hemoglobin level, albumin level, C-reactive protein level, break-in period (period between catheter insertion and PD therapy initiation), dialysate exchange volume, and use of overnight dwell. Outcomes The presence of mechanical complications related to abdominal wall or catheter, including hernia, hydrothorax, hydrocele, subcutaneous leak, pericatheter leak, catheter malposition, omental wrap, and obstruction. Results 922 patients on urgent-start PD therapy were enrolled (mean age, 59.1 ± 15.0 [SD] years). Prevalences of abdominal wall and catheter complications were 4.8% and 9.5%, respectively. The most common abdominal wall complication was hernia (55%), followed by hydrothorax (25%). On adjustment, male sex (HR, 5.41; 95% CI, 2.15-13.59; P < 0.001) and history of abdominal surgery (HR, 2.34; 95% CI, 1.04-5.26; P = 0.04) were independently associated with higher risk for developing abdominal wall complications. Limitations As a cohort study, comparisons could not be established between urgent-start PD and conventional PD. Conclusions Urgent-start PD is a safe and practicable approach. Male sex and history of abdominal surgery could contribute to the development of abdominal wall complications.