The Impact of Urgent-Start Peritoneal Dialysis on Related Peritonitis, Mechanical Complications, and Hospitalization Rate in Qatar

Background: Urgent start Peritoneal dialysis by starting PD 48 hrs. after catheter insertions is a safe , efficient with a significant reduction in bacteremia comparing to HD in acute unplanned dialysis settings. Methods: We identified CKD-5 patients during ED visits as either having an earlier plan for PD as a dialysis modality or having no plan. Emergency and urgency need to start dailysis was evaluated . We created an Urgent Start PD pathway for those patients without the emergency need to start or who had an emergency need and became stable after starting HD through a temporary dialysis catheter (review attached Clinical pathway). We enrolled twenty-four patients (14 % of all PD patients) from October 2022 till April 2024, all of them were started on APD as the PD model, the final PD model was decided after completing both APD and CAPD training. Body surface area was the main factor that affected APD Prescription (duration, number of cycles, fill volume). PD-related peritonitis, mechanical complications and hospitalization rates were estimated till April 2024. Results: PD-related peritonitis rate is significantly reduced (Zero episodes) compared with Conventional starting PD (0.26 episodes/patient/year) with no ED visit related to PD complications. One patient developed a small inguinal hernia that was conservatively managed without surgical intervention. Conclusion: In this limited observation, Urgent start PD seems to be associated with decreased PD-related peritonitis rate and hospitalization rate with minor resolved incidence of mechanical complications. A larger number of patients and a longer duration are needed to generalize the findings of these observations.