Urgent-start peritoneal dialysis (PD) is safer than urgent-start hemodialysis (HD), according to investigators.

In a trial, investigators randomly assigned 207 patients requiring urgent-start dialysis to unplanned PD or HD. Due to Thailand’s “PD first” policy, urgent-start HD was considered as a temporary bridge to maintenance PD.

Urgent-start PD had a lower composite complication rate than urgent-start HD at 6 weeks (19% vs 37%) and reduced the risk for complications by 48%, Watanyu Parapiboon, MD, of Maharat Nakhonratchasima Hospital in Thailand and colleagues reported in Kidney International Reports. Results were driven by a reduction in dialysis-related complications (4% vs 24%), particularly intradialytic hypotension and dialysis disequilibrium syndrome episodes in the first week of urgent-start HD. The urgent-start peritoneal dialysis and hemodialysis groups had no meaningful differences in complications related to surgery, catheters, or infections over 6 weeks. The urgent-start peritoneal dialysis and hemodialysis groups also had no significant differences in patient survival (5% vs 4%) and technique survival rates (93% vs 91%) at 6 weeks.

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“Urgent start PD strategy is a viable option for patients transitioning from kidney failure to dialysis,” according to Dr Parapiboon’s team. “In the setting where PD is the final modality of choice, urgent start PD is safe, requiring only a single operation and avoiding temporary [central venous catheter], leading to fewer overall complications than urgent-start temporary HD during the transition period.”

Challenges of using urgent-start PD included catheter flow restriction and leakage around the catheter, the investigators noted. The study protocol mandated laxative use to reduce constipation before and after PD catheter insertion. Nephrologists were experienced in performing PD catheter insertion and had standardized preoperative and postoperative protocols. Most patients had normal-range body mass index.

Among the study’s limitations, the investigators could not determine whether urgent-start PD better preserved residual kidney function or led to fewer bleeding complications compared with urgent-start temporary HD.

The investigators said “urgent start PD is one of the essential keys to increasing home dialysis utilization and promoting patient-centered healthcare in the next decade.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Parapiboon W, Sangsuk J, Nopsopon T, et al. Randomized study of urgent-start peritoneal dialysis vs urgent-start temporary hemodialysis in patients transitioning to kidney failure. Kidney Int Rep. Published online June 10, 2022. doi:10.1016/j.ekir.2022.05.032