Objective: To evaluate actual risk of complications and 1-year catheter survival of immediate full-volume 2000-mL dialysate exchange after peritoneal catheter implantation.
Design and setting: A prospective randomized comparative study in a university hospital kidney center.
Patients: The study included 59 end-stage renal disease patients entering into a continuous ambulatory peritoneal dialysis program between January 1996 and December 1997.
Interventions: In group 1 (n = 21), exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days. In group 2 (n = 38), full-volume exchange per 6 hours was performed from the day of catheter implantation. Bed rest with minimal activity was recommended for the first 3 days in both groups.
Main outcome measures: Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss were observed for 1 year.
Results: After straight Tenckhoff catheter implantation, pericatheter dialysate leaks occurred in 9.5% of group 1 and in 10.5% of group 2 patients (no significance, NS). Within 1 month of implantation, the incidences of tunnel or exit-site infection, catheter malposition, and outflow failure were not significantly different between the two groups. Abdominal discomfort was noted in 2 patients from group 2. Peritonitis occurred in 9.5% and 5.3% (NS) within 2 weeks of catheter implantation, and in 14.3% and 10.5% (NS) after more than 2 weeks in group 1 and group 2, respectively. Early catheter loss within 1 month occurred in 4.8% of patients in group 1 and 5.3% in group 2 (NS). The causes of loss were persistent leakage in group 1, and persistent leakage combined with tunnel infection and outflow failure in group 2. The duration of hospitalization from the day of catheter insertion to discharge was definitely shorter in group 2 compared to group 1 (9.9 +/-0.6 days vs 15.0 +/- 0.8 days, p < 0.001). For 1-year follow-up, the frequencies of peritonitis were 0.062 +/- 0.015/patient-month in group 1 and 0.076 +/- 0.018/patient-month in group 2 (NS). The actual 1-year catheter survival was 85.7% in group 1 and 84.2% in group 2 (NS).
Conclusions: One-year catheter survival after immediate full-volume peritoneal dialysis exchange was 84.2%. This study did not show any evidence that immediate full-volume exchange causes more short- or long-term complications compared to the stepwise volume increment method.