Using manual exchanges for an urgent-start peritoneal dialysis program

Background: Urgent-start peritoneal dialysis (USPD) was designed to avoid temporary hemodialysis initiation with a hemodialysis catheter. In these patients, PD is initiated within 2 weeks of catheter placement, but typically these prescriptions utilize automated peritoneal dialysis (APD) with a cycler. Manual exchanges have not been reported previously for USPD. We hypothesize that using multiple, low-volume manual exchanges, patients will have similar rates of peritonitis, exit-site infection (ESI), pericatheter leaks and discontinuation of PD in the first 3 months after initiation. Methods: This retrospective study included patients who initiated PD in our unit from May 2014 until August 2016 using our USPD protocol. Patients with a body surface area <1.7m(2) used 750mL dwell volumes and those >1.7m(2) used 1000 mL dwell volumes during the first 7 days. Dwell times were 2-2.5h for two to three exchanges per day. After 7 days of successful therapy, the dwell volumes were doubled. All patients were maintained on furosemide 160 mg twice daily. Results: There were 20 patients enrolled in our USPD program. Our rates of peritonitis, ESI, pericatheter leak and discontinuation of PD were 5%, 0%, 5% and 5%, respectively. Conclusions: Manual exchange during USPD is a viable modality with similar results as APD. Using manual exchanges allows patients to be more ambulatory during the day when they are not dwelling, allows nurses to evaluate the amount of ultrafiltration and effluent characteristics and allows for training in manual exchanges as well.