Peritoneal dialysis as initial dialysis modality: a viable option for late-presenting end-stage renal disease

Late-presenting end-stage renal disease is a significant problem worldwide. Up to 70% of patients start dialysis in an unplanned manner without a definitive dialysis access in place. Haemodialysis via a central venous catheter is the default modality for the majority of such patients, and peritoneal dialysis is usually not considered as a feasible option. However, in the recent years, some reports on urgent-start peritoneal dialysis in the late-presenting end-stage renal disease have been published. The collective experience shows that PD can be a safe, efficient and cost-effective alternative to haemodialysis in late-presenting end-stage renal disease with comparable outcomes to the conventional peritoneal dialysis and urgent-start haemodialysis. More importantly, as compared to urgent-start haemodialysis via a central venous catheter, urgent-start peritoneal dialysis has significantly fewer incidences of catheter-related bloodstream infections, dialysis-related complications and need for dialysis catheter re-insertions during the initial phase of the therapy. This article examines the rationale and feasibility for starting peritoneal dialysis urgently in late-presenting end-stage renal disease patients and reviews the literature to compare the urgent-start peritoneal dialysis with conventional peritoneal dialysis and urgent-start haemodialysis.