Urgent-start peritoneal dialysis: a chance for a new beginning.
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.
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Satellite Healthcare, Inc, San Jose, CA. Electronic address: arramreddyr@satellitehealth.com.
Rohini
R
Arramreddy
Department of Nephrology, The Permanente Medical Group, Oakland, CA.
Sijie
S
Zheng
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Department of Nephrology, Santa Clara Valley Medical Center, San Jose, CA.
Anjali B
AB
Saxena
Department of Nephrology, University of Rochester Medical Center, Rochester, NY.
Scott E
SE
Liebman
Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA; Satellite Healthcare, Inc, San Jose, CA.
Leslie
L
Wong
D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D013997:Time Factors
Peritoneal dialysis; acute peritoneal dialysis; acute-start peritoneal dialysis; late end-stage renal disease (ESRD) referral; urgent peritoneal dialysis; urgent-start peritoneal dialysis