<b><i>Introduction:</i></b> Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. <b><i>Methods:</i></b> This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. <b><i>Results:</i></b> Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 ± 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (<i>p</i> = 0.003) and exit site infection (<i>p</i> = 0.002) were identified as predictors of peritonitis, while mechanical complications (<i>p</i> = 0.004) and peritonitis (<i>p</i> < 0.001) were identified as predictors of technique failure and switching to HD. Age (<i>p</i> < 0.001), hospitalization (<i>p</i> = 0.012), and bacteremia (<i>p</i> = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. <b><i>Conclusion:</i></b> PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds.
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