Bastida-Castro LA, Martínez-Cuautle J, Corredor-Nassar MJ, Reyes-Torres BE, Alonso-Lobato SI, Balderas-Juarez J, Salinas-Ramirez MA, Hernandez-Castillo JL, Martínez-Sánchez FD. Automated peritoneal dialysis with shortened break-in periods in urgent-start scenarios: A retrospective cohort study. World J Nephrol 2025; 14(3): 107177 [DOI: 10.5527/wjn.v14.i3.107177]
Corresponding Author of This Article
Froylan David Martínez-Sánchez, MD, Professor, Department of Internal Medicine, Hospital General Dr. Manuel Gea Gonzalez, Calz. de Tlalpan 4800, Belisario Domínguez Secc 16, Tlalpan., Mexico 4800, Mexico. froylan.martinez@comunidad.unam.mx
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Sep 25, 2025; 14(3): 107177 Published online Sep 25, 2025. doi: 10.5527/wjn.v14.i3.107177
Automated peritoneal dialysis with shortened break-in periods in urgent-start scenarios: A retrospective cohort study
Luis A Bastida-Castro, Jimena Martínez-Cuautle, Maria Juliana Corredor-Nassar, Bruno Eduardo Reyes-Torres, Salma Ivette Alonso-Lobato, Joana Balderas-Juarez, Mauricio A Salinas-Ramirez, Jose L Hernandez-Castillo, Froylan David Martínez-Sánchez
Luis A Bastida-Castro, Maria Juliana Corredor-Nassar, Bruno Eduardo Reyes-Torres, Froylan David Martínez-Sánchez, Department of Internal Medicine, Hospital General Dr. Manuel Gea Gonzalez, Mexico 14080, Mexico
Jimena Martínez-Cuautle, Salma Ivette Alonso-Lobato, Joana Balderas-Juarez, Mauricio A Salinas-Ramirez, Jose L Hernandez-Castillo, Department of Nephrology, Hospital General Dr. Manuel Gea Gonzalez, Mexico 14080, Mexico
Froylan David Martínez-Sánchez, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico 04360, Mexico
Author contributions: Bastida-Castro LA, Martínez-Sánchez FD, Salinas-Ramírez MA, and Balderas-Juarez J contributed to the conceptualization of the project; Martínez-Sánchez FD edited the final draft of the manuscript; Hernández-Castillo JL and Salinas-Ramírez MA placed all the peritoneal dialysis catheters; Martínez-Cuautle J, Reyes-Torres BE, Corredor-Nassar MJ, and Alonso-Lobato SI collected the data from the patients and contributed to the discussion section; Martínez-Sánchez FD and Balderas-Juarez J are the guarantors of this work and as such had full access to all the data in the study and take responsibility for the integrity and accuracy of the data analysis.
Institutional review board statement: The Institutional Review Board of HGDMGG provided approval for this study (IRB No. 14-69-2024).
Informed consent statement: Written informed consent was waived for the present retrospective study as per the approval granted in the first Extraordinary Session of the Research and Ethics Committee of the HGDMGG held on August 9, 2024 (Approval Number: 14-69-2024).
Conflict-of-interest statement: The authors declare no competing interests.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Data sharing statement: All data and materials are available from the corresponding author and will be made available at a reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Froylan David Martínez-Sánchez, MD, Professor, Department of Internal Medicine, Hospital General Dr. Manuel Gea Gonzalez, Calz. de Tlalpan 4800, Belisario Domínguez Secc 16, Tlalpan., Mexico 4800, Mexico. froylan.martinez@comunidad.unam.mx
Received: March 18, 2025 Revised: April 9, 2025 Accepted: May 7, 2025 Published online: September 25, 2025 Processing time: 184 Days and 4.6 Hours
Abstract
BACKGROUND
End-stage kidney disease is a growing global health burden with many patients requiring urgent kidney replacement therapy. Urgent-start peritoneal dialysis (PD) has emerged as a viable alternative to hemodialysis particularly in resource-limited settings. However, concerns remain regarding catheter-related complications associated with early initiation of PD. Automated PD (APD) offers enhanced flexibility and fluid management, but evidence regarding its safety and outcomes in urgent-start scenarios with shortened break-in periods is limited.
AIM
To evaluate the clinical outcomes and biochemical changes associated with urgent-start APD with a shortened break-in period.
METHODS
This was a single center, observational study that included 62 patients with end-stage kidney disease who required urgent-start dialysis, underwent PD catheter placement, and received APD. Patients were stratified based on catheter opening time (< 12 hours vs > 12 hours). Catheter-related complications, biochemical parameters, and dialysis efficacy were analyzed.
RESULTS
The median catheter opening time was 11 h (interquartile range: 8-14 hours). No significant differences in catheter-related complications were observed between groups (P > 0.05). Catheter dysfunction, migration, leakage, and replacement occurred in 14.5%, 9.7%, 12.9%, and 11.3% of patients, respectively. APD led to significant reductions in serum creatinine, blood urea nitrogen, urea, phosphorus, and potassium (P < 0.05), alongside correction of metabolic acidosis. No cases of peritonitis or hemoperitoneum were observed.
CONCLUSION
Urgent-start APD with shortened break-in appears safe with low complication rates and improved biochemical outcomes.
Core Tip: Urgent-start peritoneal dialysis (PD) with a shortened break-in period is increasingly recognized as a safe and effective alternative to hemodialysis in patients with end-stage kidney disease requiring immediate kidney replacement therapy. This study evaluated the clinical outcomes and biochemical changes associated with automated PD (APD) initiated within ≤ 12 hours of catheter placement. Our findings demonstrated low complication rates, significant metabolic improvements, and potential cost benefits, supporting the expansion of urgent-start PD with APD as a feasible and resource-efficient strategy for urgent dialysis initiation.
