Randomised Controlled Trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter to minimise complications in end stage renal disease patients (Timely Peritoneal dialysis study)

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The planned study targets patients with end stage kidney disease who choose peritoneal dialysis for maintenance therapy. Current practice at the Royal Brisbane and Women's Hospital is to wait four weeks after a Teckhoff catheter is placed before starting peritoneal dialysis . The literature lacks evidence of the optimal interval between peritoneal catheter insertion and start up of dialysis. Consequently practice varies. They too support delayed use but do not test different delay intervals and can not tell us the optimal time. A few recent studies reported a very low leak incidence after using catheter 1 week post insertion , attributed to a tight catheter securing. Any delay in starting PD results in temporary haemodialysis in patients who require immediate dailysis. Temporary haemodialysis requires a central venous access with attendant risk of complications. Temporary haemodialysis is more expensive than peritoneal dialysis . Therefore guidelines bodies, such as CARI (Caring for Australasians with Renal Impairment,), European Dialysis and Transplant Association-European Renal Association and International Society for Peritoneal Dialysis suggest a two week delay. They can can only publish suggestions based on the weak body of evidence, or lack thereof. CARI suggests randomised control trial as there is insufficient evidence for this to be a “guideline’’. The primary objective of this study is to determine the safest and shortest time interval between surgical placement of a Tenckhoff catheter and starting dialysis. The hypothesis is that there is no difference in complication rates between one, two and four week time intervals. If equivalence is proven between one, two and four week time intervals, we could justifiably change practice. Benefits for future patients include shorter exposure to haemodialysis treatments and their complications and shorter duration of haemodialysis catheter placement and its complications. If the results show more complications in the one or two week time interval groups, then we would encourage re-visiting the guidelines. catheter placement and its complications.