Peritoneal dialysis for the un Peritoneal dialysis for the un-planned planned Peritoneal dialysis for the un Peritoneal dialysis for the un-planned planned dialysis starter dialysis starter Th Lobbedez Th Lobbedez Nephrology Department Nephrology Department Nephrology Department Nephrology Department CHU Caen, France CHU Caen, France Antalya 2010 Antalya 2010
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Peritoneal dialysis for the un Peritoneal dialysis for the un-planned
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Peritoneal dialysis for the unPeritoneal dialysis for the un--planned planned Peritoneal dialysis for the unPeritoneal dialysis for the un--planned planned
dialysis starterdialysis starter
Th LobbedezTh Lobbedez
Nephrology DepartmentNephrology DepartmentNephrology DepartmentNephrology Department
CHU Caen, FranceCHU Caen, France
Antalya 2010Antalya 2010
DefinitionDefinition
�� UnUn--plannedplanned dialysisdialysis starterstarter:: aa patientpatient whowho startsstartshaemodialysishaemodialysis urgentlyurgently throughthrough aa temporarytemporaryhaemodialysishaemodialysis urgentlyurgently throughthrough aa temporarytemporarycathetercatheter
Dialysis modality in the late referred patientsDialysis modality in the late referred patients
100%
Dialysis modality according to the referral pattern[EPIREL, 502 incident dialysis patients in Lorraine]
79% 81%86%
98%
30%
40%
50%
60%
70%
80%
90%
100%HD
PD
0%
10%
20%
30%
>12 mo 12-4 mo 4-1 mo < 1mo
[M Kessler Am J Kid Dis 2003; 42:474-485]
PD is underused in the late referred patientsPD is underused in the late referred patients
�� Why PD is not used in late referred patients ?Why PD is not used in late referred patients ?�� Why PD is not used in late referred patients ?Why PD is not used in late referred patients ?
�� Medical decision ?Medical decision ?
�� Result of PD in late referred patients ?Result of PD in late referred patients ?
�� Lack of patients education and information ?Lack of patients education and information ?
Common pathway for the late referred patientsCommon pathway for the late referred patients
Haemodialysis initiation
[Temporary catheter ]2-3 weeks
[Temporary catheter ]
Chronic haemodialysis
[Tunneled catheter]
2-3 weeks
3-6 months
High risk period
Chronic haemodialysis
[Fistula or graft]
Catheter utilization in haemodialysis patientsCatheter utilization in haemodialysis patients
100%
Reasons for the tunneled catheters utilization[Single centre. 108 Tunneled catheters. 458 HD patients. US]
19%
29%
43%
30%
40%
50%
60%
70%
80%
90%
100%
“Impossibility to use PD ?”
19%
9%
0%
10%
20%
30%
No options Immature Scheduled Refusal
[T Lee, Am J Kidney Disease 2005; 46:501-508]
The unThe un--scheduled dialysis initiation in Spainscheduled dialysis initiation in Spain
100%
Education regarding dialysis modality
in un-planned dialysis starter
24%
76%
30%
40%
50%
60%
70%
80%
90%
100%Educated
Non educated
24%
0%
10%
20%
30%
Scheduled Un-scheduled
[ B Marron, Nephrol Dial Transplant 2006; 21 S2: 51-55]
How peritoneal dialysis can help to deal How peritoneal dialysis can help to deal
with unwith un--planned dialysis starter ?planned dialysis starter ?
PD: a possibility to act against the HD PD: a possibility to act against the HD
catheter utilizationcatheter utilization
Haemodialysis initiation 2-3 weeks
Acute start APD
Haemodialysis initiation
[Temporary catheter ]
Chronic haemodialysis
[Tunneled catheter]
2-3 weeks
3-6 months
Early transfer to PD
Chronic haemodialysis
[Fistula or graft]
Late transfer to PD
The acute start on PD procedure for the The acute start on PD procedure for the
late referred patients starting dialysislate referred patients starting dialysis
The acute start APD for late referred patientsThe acute start APD for late referred patients
�� TheThe possibilitypossibility forfor thethe patientpatient toto makemake aa choicechoice
ContraContra--indications for the acute startindications for the acute start
�� These patients were considered as contraindicated These patients were considered as contraindicated
for acute PD and started on haemodialysisfor acute PD and started on haemodialysisfor acute PD and started on haemodialysisfor acute PD and started on haemodialysis