Urgent-start peritoneal dialysis
- Arshia Ghaffari, DO, MA, MBA
Arshia Ghaffari, DO, MA, MBA
- Assistant Professor Clinical Medicine, Division of Nephrology
- Keck School of Medicine, University of Southern California
Urgent-start peritoneal dialysis is the term used to describe the practice of initiating peritoneal dialysis soon after peritoneal dialysis catheter placement among patients with newly discovered end-stage renal disease (ESRD). Urgent-start peritoneal dialysis is useful because it circumvents the need for temporary hemodialysis. Since more than 50 percent of all new dialysis patients do not have a dialysis plan when diagnosed with ESRD, urgent-start peritoneal dialysis may increase the number of patients who utilize peritoneal dialysis for renal replacement therapy since it provides peritoneal dialysis as a modality option from the start.
The practice of urgent-start dialysis requires developments of protocols, policies, and procedures to help implement the approach in a timely, efficient, and safe method.
This review discusses an approach to urgent-start peritoneal dialysis. Different types of peritoneal dialysis and peritoneal dialysis dosing are discussed elsewhere. (See "Choosing a modality for chronic peritoneal dialysis" and "Prescribing and assessing adequate peritoneal dialysis".)
Urgent-start peritoneal dialysis is defined as initiation of peritoneal dialysis in patients with newly diagnosed end-stage renal disease (ESRD) who are not yet on dialysis and who require dialysis initiation less than two weeks after peritoneal dialysis catheter placement, but do not require emergent dialysis. Indications for emergent dialysis include hyperkalemia, volume overload, or marked uremia (see 'Contraindications' below). Urgent-start peritoneal dialysis is generally reserved for patients who have no plan for dialysis modality, but are considered good candidates for peritoneal dialysis.
Peritoneal dialysis is a type of dialysis that patients typically perform at home, after the patient (or family) receives appropriate training. Occasionally, peritoneal dialysis may be temporarily performed in a dialysis center to assist a patient who is unable to perform dialysis at home due to temporary disability or lack of adequate support at home, or to provide dialysis to a patient who has not yet completed peritoneal dialysis training.
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- SETTING UP AN URGENT-START PERITONEAL DIALYSIS PROGRAM
- Rapid catheter placement
- Staff education
- Administrative support
- Identifying appropriate candidates
- Development of protocols
- INITIAL PRESCRIPTION
- CLINICAL PATHWAY TO URGENT-START PERITONEAL DIALYSIS
- BARRIERS TO URGENT START
- SUMMARY AND RECOMMENDATIONS