[Urgent-start PD: a viable approach].

Area of Science:

• Nephrology
• Renal Replacement Therapy

Background:

• Peritoneal dialysis (PD) is underutilized globally, with only 10% of dialysis patients using it.
• Many patients with end-stage renal disease (ESRD) initiate dialysis late without a clear plan, often requiring central venous catheters (CVCs) for hemodialysis (HD), which increases mortality and infection risks.

Purpose of the Study:

• To evaluate the efficacy and safety of urgent-start peritoneal dialysis (UPD) as an alternative to late initiation of renal replacement therapy.
• To explore strategies for optimizing UPD outcomes and increasing its adoption.

Main Methods:

• Review of urgent-start peritoneal dialysis (UPD) and early-start peritoneal dialysis (EPD) approaches.
• Analysis of patient selection, catheter placement, staff education, and specific procedural techniques (e.g., modified insertion, low-volume exchanges).
• Comparison of UPD/EPD outcomes with conventional PD and urgent-start HD via CVC.

Main Results:

• UPD is a viable option for patients presenting late for dialysis, offering an alternative to CVC-based urgent-start HD.
• Optimized patient selection, catheter placement, and staff training are crucial for successful UPD.
• UPD/EPD demonstrate comparable mortality, PD survival, and infectious complication rates to conventional PD, while being safer and more cost-effective than urgent-start HD with CVCs.

Conclusions:

• Urgent-start peritoneal dialysis is an underused but effective modality that can increase PD utilization.
• UPD offers a safe, cost-effective alternative to urgent-start hemodialysis, reducing CVC-related complications.
• Implementing UPD requires careful patient selection, appropriate techniques, and adequate staff preparedness.