Urgent start PD

UNLABELLED: ♦ BACKGROUND: Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ METHODS: In this prospective observational study, we report on our experience in a single academic center...

Urgent-start peritoneal dialysis (PD) refers to the initiation of dialysis soon after a PD catheter placement and is a treatment option available to the late-referred patient with advanced kidney disease. This article reviews nursing aspects of urgent-start PD and can serve as a guide for this evolving clinical pathway that can provide renal replacement therapy for a critical segment of the population with Stage 5 chronic kidney disease who require renal replacement therapy.

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BACKGROUND AND OBJECTIVES: The effect of in-hospital education on the adoption of home dialysis (peritoneal dialysis [PD] and home hemodialysis [HHD]) after an unplanned dialysis start is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Clinical demographics of consecutive patients acutely initiating hemodialysis (HD) from January 2005 to December 2009 were abstracted using institutional electronic records. All patients received multimedia chronic kidney disease education by the same advanced care nurse practitioner before discharge from the hospital...

In the United States, interest has recently been renewed in the more urgent initiation of peritoneal dialysis (PD) to avoid temporary vascular access catheters in appropriate patients presenting late in the course of their kidney disease. Urgent-start PD programs have been established across the country, requiring new infrastructure and processes of care. Less is known about early technique success after urgent initiation of PD. In this report, we describe 90-day technique success and causes of hospitalization in 81 patients initiating PD in our urgent-start pathway...

Late referral of patients with chronic kidney disease (CKD) and unforeseeable deterioration of residual renal function in known CKD patients remain a major problem leading to the need of unplanned start on chronic dialysis without a mature access for dialysis. In most centres worldwide, these patients are started on haemodialysis (HD) using a temporary tunnelled central venous catheter (CVC) for access. However, during the last decade, increasing clinical experience with unplanned start on peritoneal dialysis (PD) right after PD catheter implantation has been published...

Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement...

Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization...

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...

BACKGROUND AND OBJECTIVES: The role of peritoneal dialysis in the management of AKI is not well defined, although it remains frequently used, especially in low-resource settings. A systematic review was performed to describe outcomes in AKI treated with peritoneal dialysis and compare peritoneal dialysis with extracorporeal blood purification, such as continuous or intermittent hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, CINAHL, and Central Register of Controlled Trials were searched in July of 2012...

Urgent-start peritoneal dialysis (PD) can be defined as initiation of PD within 2 weeks of catheter insertion. Urgent-start PD can be offered to patients who are referred late to a nephrologist and who would typically be initiated on hemodialysis with a temporary vascular access. An urgent-start PD capability requires expedited options education, catheter placement, unique change in the PD unit infrastructure, and new processes of care. This report describes the urgent-start PD program established by a nephrology private practice in the United States...

BACKGROUND: Compared with hemodialysis, peritoneal dialysis (PD) is a cost-effective and patient-centered option with an early survival advantage, yet only 7% of patients with end-stage renal disease in the United States receive PD. PD underutilization is due in part to nephrologists' unfamiliarity with directly starting PD in patients who present with kidney failure requiring urgent initiation of dialysis. DESIGN: Quality improvement report. SETTING & PARTICIPANTS: Single-center study whereby 18 patients who presented urgently with chronic kidney disease stage 5 without a plan for dialysis modality were offered PD as the initial modality of dialysis...

The present paper describes a program for an unplanned start on assisted automated peritoneal dialysis for late referred patients with chronic kidney disease stage V and urgent need for initiation of dialysis. Using a standard prescription for 12 h overnight APD right after PD catheter placement, analysis of our data showed that unplanned start on APD has no detrimental effects on patients, combined patient and technique, peritonitis-free survivals or the risk of infectious complications, while the risk of mechanical complications and the need of replacement of displaced or malfunctioning PD catheters may be increased...

BACKGROUND: Peritoneal dialysis (PD) has become a well-established complementary alternative to haemodialysis (HD) as first-line renal replacement modality. At our department, approximately 50% of the end-stage renal disease patients are started urgently on chronic dialysis due to late referral or unexpected deterioration of residual renal function. These patients--although suitable for PD--were previously started on HD via a temporary central venous catheter. Since January 2000, patients have been offered urgent start on chronic PD right after PD-catheter insertion by open surgery...