Outcomes of pediatric urgent-start peritoneal dialysis: a single-center experience from Jordan

Urgent-start peritoneal dialysis (USPD) provides kidney replacement therapy (KRT) for children with acute kidney injury (AKI) or stage 5 chronic kidney disease (CKD) requiring dialysis. Pediatric data from resource-limited settings remain limited.

We retrospectively described 18 children who underwent USPD at a tertiary center in Jordan between January 2022 and December 2024. USPD was defined as initiation of peritoneal dialysis (PD) within 14 days of catheter insertion. Early complications occurred within 14 days of the first PD exchange, and late complications thereafter.

Sixteen children had AKI, and two had stage 5 CKD. Etiologies were hemolytic uremic syndrome (6/18, 33.3%) and acute tubular necrosis (4/18, 22.2%). Thirteen (72.2%) initiated PD within 24 h: five at 4-12 h and eight at 24 h. Six developed early complications: a leak on 4/18 (22.2%) and an exit-site infection on 2/18 (11.1%), without overlap. Five developed late complications. Peritonitis affected 4/18 (22.2%) and accounted for five episodes; other late events included a leak in two children, an exit-site complication in one, and catheter obstruction in one, with overlapping categories. At one year, 9/16 children with AKI (56.3%) were no longer receiving dialysis, 3/16 (18.8%) remained on PD, and 4/16 (25.0%) had died. Of the two children with stage 5 CKD, one remained on hemodialysis, and one was dialysis-free after transplantation.

This descriptive, single-center experience on USPD delivery, complications, and one-year outcomes. The small sample, absence of a comparator group, and heterogeneity preclude conclusions about safety, timing effects, or predictors.