Preoperative Switch to Hemodialysis from Peritoneal Dialysis

There are few data available regarding the associations among individuals on chronic peritoneal dialysis between preoperative transfer to hemodialysis and postoperative outcomes. Yuyang Zhang, MD, and colleagues conducted a retrospective cohort study to examine whether preoperative hemodialysis would influence surgical outcomes in peritoneal dialysis patients undergoing major surgeries. Results were reported online in Frontiers in Surgery [doi.org/10.3389/fsurg.2022.1056908].

The researchers screened all peritoneal dialysis patients who underwent major surgeries from January 1, 2007, to December 31, 2020, at Peking University First Hospital (Beijing, China). Major surgery was defined as surgical procedures under general, lumbar, or epidural anesthesia, with more than an overnight hospital stay. Exclusion criteria were age less than 18 years, dialysis duration less than 3 months, and undergoing renal implantation surgeries or procedures exclusively aimed at placing or removing peritoneal catheters. Eligible patients were categorized as either hemodialysis or peritoneal dialysis based on preoperative dialysis status.

The overall cohort included 105 patients receiving chronic peritoneal dialysis. Of those, 65 continued on peritoneal dialysis and 40 switched to hemodialysis preoperatively. Patients in the preoperative hemodialysis group were significantly more likely to develop postoperative hyperkalemia. In addition, the total complication rates were numerically higher in the preoperative hemodialysis group.

Following adjustment, the two groups were similar in the incidence of postoperative hyperkalemia or any other postoperative complication rates. The two groups were also similar in long-term survival.

“It does not seem indispensable for peritoneal dialysis patients to switch to temporary hemodialysis before major surgeries,” the researchers said.