We Use Permcaths Instead of Peritoneal Catheters for Acute Kidney Injury and Urgent-Start Dialysis

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Public Health

Background:

• Severe acute kidney injury requiring dialysis (AKI-D) and advanced chronic kidney disease (CKD) present significant challenges in nephrology.
• Hemodialysis (HD) via central venous catheter is the predominant method for initiating dialysis in these urgent situations.
• Peritoneal dialysis (PD) is underutilized despite evidence suggesting its comparable efficacy and patient benefits.

Purpose of the Study:

• To evaluate the current practice patterns for initiating dialysis in AKI-D and advanced CKD.
• To highlight the underutilization of peritoneal dialysis (PD) in urgent-start scenarios.
• To question the reflexive reliance on central venous catheters for hemodialysis.

Main Methods:

• Review of current clinical practices and literature regarding dialysis initiation.
• Analysis of factors contributing to the underutilization of PD.
• Discussion of the implications for patient care and healthcare systems.

Main Results:

• Central venous catheter for HD is the most common approach for both AKI-D and urgent CKD dialysis initiation.
• PD is technically simpler, requires less infrastructure, and is more cost-effective than HD.
• Healthcare system structure, hospital logistics, and training influence the choice of dialysis modality.

Conclusions:

• The nephrology community may be underserving patients by not routinely offering PD for AKI and urgent-start situations.
• Re-evaluating current practices to include PD more frequently in urgent dialysis initiation is warranted.
• Optimizing PD utilization could benefit patients and the healthcare system.