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Review
. 2014 Mar;63(3):390-5.
doi: 10.1053/j.ajkd.2013.09.018. Epub 2013 Nov 15.

Urgent-start peritoneal dialysis: a chance for a new beginning

Rohini Arramreddy  1 , Sijie Zheng  2 , Anjali B Saxena  3 , Scott E Liebman  4 , Leslie Wong  5
Affiliations
Review

Urgent-start peritoneal dialysis: a chance for a new beginning

Rohini Arramreddy et al. Am J Kidney Dis. 2014 Mar.

Abstract

Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm.

Keywords: Peritoneal dialysis; acute peritoneal dialysis; acute-start peritoneal dialysis; late end-stage renal disease (ESRD) referral; urgent peritoneal dialysis; urgent-start peritoneal dialysis.

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Figures

Figure 1
Figure 1
Key elements of a successful urgent-start peritoneal dialysis program.
See this image and copyright information in PMC

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