Urgent-start peritoneal dialysis versus haemodialysis for people with chronic kidney disease

Randomized Study of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Temporary Hemodialysis in Patients Transitioning to Kidney Failure

“… 18 The meta-analysis conducted by Htay et al. 7 also found that HD initiated with CVC may increase the risk of catheter-related bacteremia. Infectious complications represent a major cause of morbidity and mortality in dialysis patients.…”

“… 7 Nevertheless, all of the included studies in the meta-analysis were observational in nature, including 3 prospective cohorts and 4 retrospective designed studies, thereby reducing the certainty of evidence. 7 Recently, a quasi-experimental study involving 93 Brazilian participants with advanced CKD who required immediate dialysis demonstrated comparable outcomes and complications between both modalities. 14 In the present study, we sought to evaluate the efficiency and complications of both modalities in a randomized controlled trial fashion.…”

“…5,6 Usually, these patients are treated with urgent-start HD with a central venous catheter (CVC). [1][2][3]7,8 Several factors contributing to the apparent preference for urgent-start temporary HD over urgent-start PD include the following: (i) HD catheter placement is a routine procedure, whereas the availability of experienced clinicians who are willing and able to place PD catheters at short notice is more limited; 9,10 (ii) nephrology training in PD has been suboptimal compared with HD; 7,10,11 and (iii) financial incentives have historically favored in-center HD. 10 Urgent-start PD, which is generally defined as an initiation of PD during the break-in period (within 14 days postcatheter insertion), 12,13 has been an important strategy to promote home dialysis.…”

“…Moreover, PD requires a lower infrastructure setup and offers annual cost savings. 7 A Cochrane systematic review and meta-analysis of studies involving 991 participants demonstrated that urgent-start PD might reduce the risk of bloodstream infection compared with HD initiated with CVC, but had uncertain effects on the risks of infection-related and catheter-related complications, technique survival, and patient survival. 7 Nevertheless, all of the included studies in the meta-analysis were observational in nature, including 3 prospective cohorts and 4 retrospective designed studies, thereby reducing the certainty of evidence.…”

“…7 A Cochrane systematic review and meta-analysis of studies involving 991 participants demonstrated that urgent-start PD might reduce the risk of bloodstream infection compared with HD initiated with CVC, but had uncertain effects on the risks of infection-related and catheter-related complications, technique survival, and patient survival. 7 Nevertheless, all of the included studies in the meta-analysis were observational in nature, including 3 prospective cohorts and 4 retrospective designed studies, thereby reducing the certainty of evidence. 7 Recently, a quasi-experimental study involving 93 Brazilian participants with advanced CKD who required immediate dialysis demonstrated comparable outcomes and complications between both modalities.…”