What are the guidelines for initiating peritoneal dialysis (PD) on the same day as surgery?

From the Guidelines

Initiating peritoneal dialysis (PD) on the same day as surgery is not recommended, and it is advised to wait 10 days to 2 weeks after catheter placement to start PD, as suggested by the guidelines 1. When considering the initiation of PD, several factors must be taken into account to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. The guidelines provided emphasize the importance of waiting for an appropriate period after catheter placement before starting PD. This waiting period allows for the reduction of potential complications such as leakage, infection, or catheter malfunction.

Key Considerations for Initiating PD

• Waiting period: The recommendation to wait 10 days to 2 weeks after catheter placement is crucial for minimizing the risk of early complications 1.
• Patient assessment: Before initiating PD, it is essential to assess the patient's residual kidney function, lifestyle, and other factors that may influence the dialysis prescription 1.
• Dialysis prescription: The initial dialysis prescription should be tailored to the individual patient, considering factors such as body surface area, residual kidney function, and lifestyle constraints 1.

Recommendations for PD Initiation

• If PD must be started sooner than the recommended waiting period, low-volume, supine dialysis should be considered 1.
• Baseline assessments, including 24-hour urine collection for urea and creatinine clearance, should be performed to guide the dialysis prescription 1.
• Patient education on the individualized nature of their dialysis prescription and the potential need for future adjustments is crucial 1.

By following these guidelines and considering the individual patient's needs and circumstances, healthcare providers can optimize the initiation of peritoneal dialysis, minimizing risks and improving outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Guidelines for Initiating Peritoneal Dialysis on the Same Day as Surgery

• The feasibility of initiating peritoneal dialysis (PD) on the same day as surgery has been explored in several studies 2, 3, 4.
• A study published in 1999 found that laparoscopic placement of a peritoneal dialysis catheter and starting PD on the same day was a viable option, with no complications reported in 11 patients 2.
• A 2022 study found that early-start PD, defined as initiating PD within 48 hours of catheter insertion, was not associated with an increased incidence of mechanical or infectious complications 3.
• Another 2022 study found that initiating PD within 24 hours of catheter insertion was not associated with increased mechanical complications, infectious complications, or technique failures 4.
• The guidelines for initiating PD on the same day as surgery may include:
  • Using low dwell volumes (e.g. 500 mL) in a recumbent position to minimize complications 3
  • Gradually incrementing the PD prescription over 10 days to minimize complications 3
  • Ensuring precise positioning of the catheter in the pelvis using laparoscopy 2
  • Using a preperitoneal local anesthesia technique and sedation for patients who are not fit for general anesthesia 5

Key Considerations

• The decision to initiate PD on the same day as surgery should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
• Patients should be closely monitored for any signs of complications, such as catheter obstruction, leakage, or infection.
• The use of laparoscopy and preperitoneal local anesthesia technique may help to minimize complications and improve patient outcomes 2, 5.