Objectives To investigate the complications and survival of elderly patients with end-stage renal disease (ESRD) who received urgent-start peritoneal dialysis (USPD) or urgent-start haemodialysis (USHD), and to explore the value of peritoneal dialysis (PD) as the emergent dialysis method for elderly patients with ESRD.
Design Retrospective cohort study.
Setting Two tertiary care hospitals in Shanghai, China.
Participants Chinese patients (n=542) >65 years of age with estimated glomerular filtration rate ≤15 mL/min/m2 who received urgent-start dialysis between 1 January 2005 and 31 December 2015, and with at least 3 months of treatment. Patients who converted to other dialysis methods, regardless of the initial dialysis method, were excluded, as well as those with comorbidities that could significantly affect their dialysis outcomes.
Primary and secondary outcome measures Dialysis-related complications and survival were compared. Patients were followed until death, stopped PD, transfer to other dialysis centres, loss to follow-up or 31 December 2016.
Results There were 309 patients in the USPD group and 233 in the USHD group. The rate of dialysis-related complications within 30 days after catheter implantation was significantly lower in the USPD group compared with the USHD group (4.5% vs 10.7%, p=0.031). The 6-month and 1, 2 and 3-year survival rates were 95.3%, 91.4%, 86.6% and 64.8% in the USPD group, and 92.2%, 85.7%, 70.2% and 57.8% in the USHD group, respectively (p=0.023). The multivariable Cox regression analysis showed that USHD (HR=2.220, 95% CI 1.298 to 3.790; p=0.004), age (HR=1.025, 95% CI 1.013 to 1.043, p<0.001) and hypokalaemia (HR=0.678, 95% CI 0.487 to 0.970; p=0.032) were independently associated with death.
Conclusions USPD was associated with slightly better survival compared with USHD. USPD was associated with fewer complications and better survival than USHD in elderly patients with ESRD.
- peritoneal dialysis
- end-stage renal disease
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Contributors XZ, XD, LL and CM carried out the studies, participated in collecting data and drafted the manuscript. LL and CM performed the statistical analysis and participated in its design. All authors read and approved the final manuscript.
Funding This study was supported by the Shanghai Top Priority Key Clinical Disciplines Construction Project (2017ZZ02009; 2017ZZ02009), the National Key Research and Development Program of China (2016YFC0901502), the Shanghai Science and Technology Commission Foundation (15411971200) and the Shanghai Integration of Chinese and Western Medicine Foundation (SH201737).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the ethics committees of the Shanghai Changzheng Hospital and Songjiang District Central Hospital (No 2019SL005).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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