title: Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis.
abstract: BACKGROUND
  Significant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start.
  
  
  METHODS
  This single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival.
  
  
  RESULTS
  A total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes (p< 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%,p= 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%,p= 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups.
  
  
  CONCLUSIONS
  Compared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: See
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Yeoungjee
authors.initials: Y
authors.lastname: Cho
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Jaffrey
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia david.johnson2@health.qld.gov.au.|School of Medicine, The University of Queensland, Brisbane, Australia.|Translational Research Institute, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; end-stage kidney disease; peritoneal dialysis; peritonitis; technique survival; urgent-start