Introduction: Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. Methods: This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. Results: Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 ± 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (p = 0.003) and exit site infection (p = 0.002) were identified as predictors of peritonitis, while mechanical complications (p = 0.004) and peritonitis (p < 0.001) were identified as predictors of technique failure and switching to HD. Age (p < 0.001), hospitalization (p = 0.012), and bacteremia (p = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. Conclusion: PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds.

1.
Ivarsen P, Povlsen JV. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis? Nephrol Dial Transplant. 2013;0:1–6.
2.
Koch M, Kohnle M, Trapp R, Haastert B, Rump LC, Aker S. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant. 2012;27(1):375–80.
3.
Lobbedez T, Lecouf A, Ficheux M, Henri P, Hurault de Ligny B, Ryckelynck JP. Of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience. Nephrol Dial Transpl. 2008;23(10):3290–4.
4.
Nissenson AR, Prichard SS, Cheng IK, Gokal R, Kubota M, Maiorca R, et al. Nonmedical factors that impact on ESRD modality selection. Kidney Int Suppl. 1993;40:S120–7.
5.
Dias DB, Mendes ML, Caramori JT, Falbo Dos Reis P, Ponce D. Urgent-start dialysis: comparison of complications and outcomes between peritoneal dialysis and haemodialysis. Perit Dial Int. 2021;41(2):244–52.
6.
Guo A, Mujais S. Patient and technique survival on peritoneal dialysis in the United States: evaluation in large incident cohorts. Kidney Int. 2003;88. S3–12.
7.
Wang AM, Lai KN. Theimportanceofresidualrenal function in dialysis patients. Kidney Int. 2006;69(10):1726–32.
8.
Brazilian society of nephrology [homepage on the internet]. São Paulo: Census of the Brazilian Society of Nephrology. 2005 [updated 2014 Aug 04; cited 2014 Sep 06]. Available from: www.sbn.org.br.
9.
Brazilian society of nephrology [homepage on the internet]. São Paulo: Census of the Brazilian Society of Nephrology. 2011 [updated 2014 Aug 04; cited 2014 Sep 06]. Available from: www.sbn.org.br.
10.
Brazilian society of nephrology [homepage on the internet]. São Paulo: Census of the Brazilian Society of Nephrology. 2016 [updated 2017 Aug 28; cited 2017 Ago 28]. Available from: www.sbn.org.br.
11.
Chaudhary K, Sangha H, Khanna R. Peritoneal dialysis first: rationale. Clin J Am Soc Nephrol. 2011;6(2):447–56.
12.
Sood MM, Tangri N, Hiebert B, Kappel J, Dart A, Levin A, et al. Geographic and facility-level variation in the use of peritoneal dialysis in Canada: a cohort study. CMAJ Open. 2014;2(1):36–E44.
13.
Vonesh EF, Snyder JJ, Foley RN, Collins A. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int. 2006;70:S3–S11.
14.
Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transpl. 2002;17(1):112–7.
15.
Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, Krediet RT, et al. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis. J Am Soc Nephrol. 2003;14(11):2851–60.
16.
Abensur H. How to explain the low penetration of peritoneal dialysis in Brazil. J Bras Nefrol. 2014;36(3):269–70.
17.
Pajek J. Overcoming the underutilisation of peritoneal dialysis. Biomed Res Int. 2015;2015:431092.
18.
Klarenbach SW, Tonelli M, Chui B, Manns BJ. Economic evaluation of dialysis therapies. Nat Rev Nephrol. 2014;10(11):644–52.
19.
Atapour A, Eshaghian A, Taheri D, Dolatkhah S. Hemodialysis versus peritoneal dialysis, which is cost-effective? Saudi J Kidney Dis Transpl. 2015 Sep;26(5):962–5.
20.
Perl J, Wald R, McFarlane P, Bargman JM, Vonesh E, Na Y, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol. 2011;22(6):1113–21.
21.
Casaretto A, Rosario R, Kotzker WR, Pagan-Rosario Y, Groenhoff C, Guest S. Urgent-start peritoneal dialysis: report from a U.S. private nephrology practice. Adv Perit Dial. 2012;28:102–5.
22.
Gabriel DP, Nascimento GVR, Caramori JT, Martim LC, Barretti P, Balbi AL. Peritoneal dialysis in acute renal failure. Ren Fail. 2006;28(6):451–6.
23.
Sirivongs D, Praderm L, Chan-on C. Experiences on bedside Tenckhoff catheter implantation. J Med Assoc Thai. 2011;94(Suppl 4):S58–63.
24.
Li PKT, Szeto CC, Piraino B, Bernardini J, Figueiredo AE, Gupta A, et al. Peritoneal dialysis-related infections recommendations: 2010 update. Perit Dial Int. 2010;30(4):393–423.
25.
Blake PG, Jain AK. Urgent start peritoneal dialysis defining what it is and why it matters. Clin J Am Soc Nephrol. 2018;13(8):1278–9.
26.
Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, et al. United States Renal Data System. 2014 USRDS annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis. 2015 Jul;66(1 Suppl 1):Svii, S1–305.
27.
Radhakrishnan J, Remuzzi G, Saran R, Williams DE, Rios-Burrows N, Powe N, et al. Taming the chronic kidney disease epidemic: a global view of surveillance efforts. Kidney Int. 2014;86(2):246–50.
28.
Alkatheeri AMA, Blake PG, Gray D, Jain AK. Success of Urgent-Start peritoneal dialysis in a large Canadian renal program. Perit Dial Int. 2016;36(2):171–6.
29.
Povlsen JV, Sorensen AB, Ivarsen P. Unplanned start on peritoneal dialysis right after PD catheter implantation for older people with end stage renal disease. Perit Dial Int. 2015;35(6):622–4.
30.
Jin H, Fang W, Zhu M, Yu Z, Fang Y, Yan H, et al. Urgent-start peritoneal dialysis and hemodialysis in ESRD patients: complications and outcomes. PLoS One. 2016;11(11):e0166181.
31.
Xu D, Liu T, Dong J. Urgent-start peritoneal dialysis complications: prevalence and risk factors. Am J Kidney Dis. 2017;70(1):102–10.
32.
Javaid MM, Lee E, Khan BA, Subramanian S. Description of an urgent-start peritoneal dialysis program in Singapore. Perit Dial Int. 2017;37(5):500–2.
33.
Ghaffari A, Kumar V, Guest S. Infrastructure requirements for an urgent-start peritoneal dialysis program. Perit Dial Int. 2013;33(6):611–7.
34.
Dias DB, Banin V, Mendes ML, Barretti P, Ponce D. Peritoneal dialysis can be an option for unplanned chronic dialysis: initial results from a developing country. Int Urol Nephrol. 2016;48(6):901–6.
35.
Ding X, Gao W, Guo Y, Cai Q, Bai Y. Comparison of mortality and complications between urgent-start peritoneal dialysis and urgent-start hemodialysis: a systematic review and meta-analysis. Semin Dial. 2022 May;35(3):207–14.
36.
Bittencourt Dias D, Mendes ML, Alves CA, Caramori JT, Ponce D. Peritoneal dialysis as an urgent-start option for incident patients on chronic renal replacement therapy: world experience and review of literature. Blood Purif. 2020;49(6):652–7.
37.
Szeto CC, Li PKT, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD catheter-related infection recommendations: 2017 update. Perit Dial Int. 2017;37(2):141–54.
38.
Figueiredo AE, Bernardini J, Bowes E, Hiramatsu M, Price V, Su C, et al. A syllabus for teaching peritoneal dialysis to patients and caregivers. Perit Dial Int. 2016;36(6):592–605.
39.
Figueiredo AE, Moraes TP, Bernardini J, Poli-de-Figueiredo CE, Barretti P, Olandoski M, et al. Impact of patient training patterns on peritonitis rates in a large national cohort study. Nephrol Dial Transplant. 2015;30(1):137–42.
40.
Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo A, et al. ISPD Guideline/Peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int. 2016 Sep 10;36(5):481–508.
41.
Hsiung JT, Kleine CE, Naderi N, Park C, Soohoo M, Moradi H, et al. Association of pre-end-stage renal disease serum albumin with post-EndStage renal disease outcomes among patients transitioning to dialysis. J Ren Nutr. 2019 Jan 11;29(4):310–21. pii: S1051-2276.
You do not currently have access to this content.