How To Build a Successful Urgent-Start Peritoneal Dialysis Program

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Modalities

Background:

• In-center hemodialysis (HD) is the primary treatment for end-stage kidney disease (ESKD), often initiated urgently via central venous catheters (CVCs).
• CVCs in urgent HD are linked to adverse outcomes, increased costs, and infection risks, further highlighted by the COVID-19 pandemic.
• Late-presenting ESKD patients frequently require urgent dialysis initiation, posing challenges for safe and effective treatment commencement.

Purpose of the Study:

• To evaluate the safety, efficacy, and cost-effectiveness of urgent-start peritoneal dialysis (USPD) for patients with late-presenting ESKD.
• To present USPD as a viable alternative to urgent-start HD with CVCs.
• To advocate for the implementation of USPD programs to improve patient outcomes and increase PD utilization.

Main Methods:

• USPD involves placing a peritoneal dialysis (PD) catheter and initiating PD within two weeks, often in a recumbent position with low fill volumes.
• Eligibility criteria include an intact peritoneal cavity and a stable home environment.
• Coordination between nephrologists, surgeons, and PD center staff is crucial for timely catheter placement and PD initiation.

Main Results:

• USPD is a safe option, with outcomes comparable to planned PD initiations.
• Mechanical PD catheter complications are minimal and manageable conservatively.
• USPD avoids the high rates of catheter-related infections and bacteremia associated with urgent-start HD.

Conclusions:

• Urgent-start PD is a safe, cost-effective, and viable option for unplanned dialysis initiation in late-presenting ESKD patients.
• USPD mitigates infection risks, particularly relevant in the context of pandemics.
• Implementing robust USPD programs requires strong infrastructure and interdisciplinary care coordination to enhance PD use, reduce costs, and improve patient outcomes.