A Randomized Controlled Trial to Determine the Appropriate Time to Initiate Peritoneal Dialysis after Insertion of Catheter (Timely PD Study)
| العنوان: | A Randomized Controlled Trial to Determine the Appropriate Time to Initiate Peritoneal Dialysis after Insertion of Catheter (Timely PD Study) |
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| المؤلفون: | George John, Nicola Williams, Barry O’Loughlin, Kavitha Ramanathan, Thin Han, Lakshmanan Jeyaseelan, Edward Yeoh, Helen Healy, Dwarakanathan Ranganathan |
| المصدر: | Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis. 37:420-428 |
| بيانات النشر: | SAGE Publications, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, Anastomotic Leak, Peritonitis, Catheterization, Time-to-Treatment, Peritoneal dialysis, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, 030212 general & internal medicine, Dialysis, Aged, Intention-to-treat analysis, Catheter insertion, business.industry, General Medicine, Middle Aged, Surgery, Catheter, Nephrology, Catheter-Related Infections, Inclusion and exclusion criteria, Kidney Failure, Chronic, Female, Hemodialysis, business, Peritoneal Dialysis |
| الوصف: | Background The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter insertion is unclear. If dialysis is started too soon after insertion, dialysate leaks and infection could occur. However, by starting PD earlier, morbidity and costs can be reduced through lesser hemodialysis requirements. This is the first randomized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion. Methods All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial. Participants were randomized to 1 of 3 groups. Group 1 (G1) commenced PD at 1 week, group 2 (G2) at 2 weeks and group 3 (G3) at 4 weeks after PD catheter insertion. These groups were stratified by hospital and the presence of diabetes. Primary outcomes were the incidence of peritoneal fluid leaks or PD-related infection during the 4 weeks after commencement of PD. Results In total 122 participants were recruited, 39, 42, and 41 randomized to G1, G2, and G3, respectively. The primary outcome catheter leak was significantly higher in G1 (28.2%) compared with G3 (2.4%, p = 0.001) but not compared with G2 (9.5%, p = 0.044), based on intention to treat analysis. These differences were even more marked when analyzed with per protocol method: G1 had a significantly higher percentage (32.4 %) compared with G3 (3.3%, p = 0.003) but not compared with G2 (10.5%, p = 0.040). Event percentages of leak were statistically higher in G1 and occurred significantly earlier compared with other groups ( p = 0.002). Amongst diabetics, technique failure was significantly higher (28.6%) in G3 compared with 0% in G1 and 7.1% in G2 ( p = 0.036) and earlier in G3 at 163.2 days vs 176.8 and 175.8 ( p = 0.037) for G1 and G2, respectively. Conclusion Leaks were higher in participants commencing PD at 1 week after catheter insertion compared with the other 2 groups, and technique failure was higher in diabetics starting PD at 4 weeks. |
| تدمد: | 1718-4304 0896-8608 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5697b39baf1a6a24db9ab077e91cdf8bTest https://doi.org/10.3747/pdi.2016.00066Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....5697b39baf1a6a24db9ab077e91cdf8b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 17184304 08968608 |
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