Prognosis of urgent initiation of peritoneal dialysis: a systematic review and meta-analysis

Abstract

Objectives

Currently, there is no consensus on the optimal timing for the initiation of peritoneal dialysis (PD) after catheter placement.

Design

Systematic review and meta-analysis.

Exact date of data collection

From inception till July 31, 2023.

Main outcome measures

To assess the outcomes and safety of unplanned PD initiation (<14/7 days after catheter insertion) in cohort studies.

Results

Fifteen studies involving 3054 participants were included. (1) The risk of unplanned initiation of leakage and Obstruction was no difference in both the break-in period (BI) <14 and BI < 7 groups. (2) Catheter displacement was more likely to occur in the emergency initiation group with BI < 7. (3) No significant differences were observed between the two groups regarding infectious complications. (4) There was no difference in transition to HD between patients with BI < 7 and BI < 14 d.

Conclusion

Infectious complications of unplanned initiation of peritoneal dialysis did not differ from planned initiation. Emergency initiation in the BI < 7 group had higher catheter displacement, but heterogeneity was higher. There were no differences in leakage or obstruction in either group. Catheter survival was the same for emergency initiation of peritoneal dialysis compared with planned initiation of peritoneal dialysis and did not increase the risk of conversion to hemodialysis.

Registration

This meta-analysis was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023431369)

Keywords:

• Peritoneal dialysis
• ESRD
• early-start
• urgent start
• catheter

Acknowledgements

We would like to thank all those involved in the work.

Authors contributions

Ji H and Baoqiao W drafted and revised the manuscript and collected data. Yue Z and Limiao D help to screen the literature and collect data. Yueming L drafted and revised the manuscript and designed the tables/figures, Juan J drafted and revised the manuscript. Qiang H initiated the collaboration, as well as directed, drafted, and revised the manuscript.

Ethics statement

An ethics statement is not applicable because this study is based exclusively on published literature.

Disclosure statement

No potential conflict of interest was reported by the author(s)

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Additional information

Funding

This research was supported by the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China (Grant No. LHDMZ22H050001); the Construction of Key Projects by Zhejiang Provincial Ministry (Project No.WKJ-ZJ-2302); The Zhejiang Province Chinese Medicine Modernization Program (Project No. 2020ZX001); The Key Project of Scientific Research Foundation of Chinese Medicine (2022ZZ002); the ‘Pioneer’ and ‘Leading Goose’ R&D Program of Zhejiang (2022C03118; 2023C03075); The Key project of Basic Scientific Research Operating Funds of Hangzhou Medical College (KYZD202002); the General Project of the Medical and Health of Zhejiang Province (Grant Number 2021KY833): Zhejiang Province Health Department Project (2021KY490)