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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- USRDS 2012 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. USRDS; Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, US Renal Data System, Bethesda, MD, 2012.
- Ghaffari A, Kalantar-Zadeh K, Lee J, et al. PD First: peritoneal dialysis as the default transition to dialysis therapy. Semin Dial 2013; 26:706.
- Jo YI, Shin SK, Lee JH, et al. Immediate initiation of CAPD following percutaneous catheter placement without break-in procedure. Perit Dial Int 2007; 27:179.
- Povlsen JV, Ivarsen P. How to start the late referred ESRD patient urgently on chronic APD. Nephrol Dial Transplant 2006; 21 Suppl 2:ii56.
- Lobbedez T, Lecouf A, Ficheux M, et al. Is rapid initiation of peritoneal dialysis feasible in unplanned dialysis patients? A single-centre experience. Nephrol Dial Transplant 2008; 23:3290.
- Song JH, Kim GA, Lee SW, Kim MJ. Clinical outcomes of immediate full-volume exchange one year after peritoneal catheter implantation for CAPD. Perit Dial Int 2000; 20:194.
- Banli O, Altun H, Oztemel A. Early start of CAPD with the Seldinger technique. Perit Dial Int 2005; 25:556.
- Yang YF, Wang HJ, Yeh CC, et al. Early initiation of continuous ambulatory peritoneal dialysis in patients undergoing surgical implantation of Tenckhoff catheters. Perit Dial Int 2011; 31:551.
- Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int 2005; 68:311.
- Perl J, Wald R, McFarlane P, et al. Hemodialysis vascular access modifies the association between dialysis modality and survival. J Am Soc Nephrol 2011; 22:1113.
- Ivarsen P, Povlsen JV. Can peritoneal dialysis be applied for unplanned initiation of chronic dialysis? Nephrol Dial Transplant 2014; 29:2201.
- Ghaffari A. Urgent-start peritoneal dialysis: a quality improvement report. Am J Kidney Dis 2012; 59:400.
- See EJ, Cho Y, Hawley CM, et al. EARLY AND LATE PATIENT OUTCOMES IN URGENT-START PERITONEAL DIALYSIS. Perit Dial Int 2016.
- Xu D, Liu T, Dong J. Urgent-Start Peritoneal Dialysis Complications: Prevalence and Risk Factors. Am J Kidney Dis 2017; 70:102.
- Alkatheeri AM, Blake PG, Gray D, Jain AK. Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program. Perit Dial Int 2016; 36:171.
- Jin H, Fang W, Zhu M, et al. Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes. PLoS One 2016; 11:e0166181.
- Casaretto A, Rosario R, Kotzker WR, et al. Urgent-start peritoneal dialysis: report from a U.S. private nephrology practice. Adv Perit Dial 2012; 28:102.
- Masseur A, Guest S, Kumar V. Early technique success after initiation of treatment with urgent-start peritoneal dialysis. Adv Perit Dial 2014; 30:36.
- Koch M, Kohnle M, Trapp R, et al. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 2012; 27:375.
- Ghaffari A, Kumar V, Guest S. Infrastructure requirements for an urgent-start peritoneal dialysis program. Perit Dial Int 2013; 33:611.
- 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