Success of Instant-Start Life-Saving Peritoneal Dialysis in Patients with EndStage Vascular Access Failure: Time to Rescue Patients

Abstract

Background: This study aimed at evaluation of the visibility of instant-start, life-saving peritoneal dialysis in dialysis patients with End Stage Vascular Access Failure (ESVAF) in addition to complications and outcome of this dialysis modality. Methods: This is a prospective observational study from June 2015 throughout July 2018. Urgent two-cuff curled Tenckhoff PD catheters were inserted percutaneously within few hours by expert nephrology team. Twenty-three dialysis ESVAF patients who presented acutely to our hospital were included in the study. Results: Dialysis was initiated within 2 hours (range: 1-3 h) from presentation in all patients. Adequate metabolic and volume control was achieved after 4 sessions of PD. Mechanical complications occurred in 25.1%. The main mechanical complications were minor peri-catheter leakage (13%) and catheter tip migration (8.7%). One patient had omental wrap which necessitated catheter replacement. Exit-Site Infection (ESI) occurred in 13%, tunnel infection in 0% and peritonitis in 13% of patients. Peritonitis rate was 0.142 episode/patient-year. After 6 months, catheter and patient survival rates were 87.0% and 91.3% respectively. Conclusion: The instant-start PD modality was a life-saving, feasible and safe alternative to hemodialysis in patients with ESVAF.