The Study of Efficacy and Safety of Automated PD in Urgent Start Dialysis
The Study of Efficacy and Safety of Automated PD in Urgent Start Dialysis
This is a multi-center, controlled clinical trial study. The purpose of this study is to
 examine the efficacy and safety of automated peritoneal dialysis as compared with
 intermittent haemodialysis for ESRD patients with indications for urgent start dialysis.
Hemodialysis（HD） and peritoneal dialysis (PD) are both the main methods to treat with
 end-stage renal disease (ESRD) uremia patients. The first 3-month mortality and
 hospitalization rate of new dialysis patient is much higher than that of regular dialysis's.
 So it is very important to set up dialysis pathway and from inducing dialysis into regular
 dialysis smoothly. But in the global 50-70%, more than 70% of the patients in China can not
 establish the dialysis pathway in advance according to the plan. With the common, a temporary
 deep venous catheter would be used first, then the fistula established later, as the final
 transition for hemodialysis. Urgent peritoneal dialysis can be established 24 hours after the
 establishment of permanent access dialysis, simply and easily, it can protect the residual
 kidney function; reduce treatment costs, hemodynamic stability, no anticoagulant is its
 unique advantages, At the same time, also avoid the temporary deep venous pathway prone to
 local bleeding, infection, venous thrombosis, central venous stenosis, direct impact on the
 future of the mature of fistula , or transplanted kidney vascular conditions. Automatic
 peritoneal dialysis (APD) in the treatment of urgent dialysis patients can save more manpower
 and resources, and improve the efficiency of peritoneal dialysis. The study on the efficacy
 and safety of urgent dialysis lacks the precisely designed multi-center, prospective and
 controlled clinical trial, and APD only induces 3 days, it is difficult to really reflect the
 safety and effectiveness of APD. Therefore, it is of great practical significance to study
 the difference of safety, efficacy and cost-effectiveness between urgent PD and HD in a
 prospective, control and multicenter clinical trial. 206 ESRD uremia patients will involve in
 this multi-center, prospective and controlled clinical trial, the mode of urgent dialysis
 will choose by patient guided by nephrologist, the HD group will receive the standard
 traditional treatment: from induction HD to regular HD. The PD group will receive the APD
 daily. All patient will be monitor the physiological and biochemical marker for 14 day, and
 all adverse events and dead within 90days will collected to evaluated the safety, efficacy of
 the two urgent dialysis modes.
Inclusion Criteria:

 -  CKD(chronic kidney disease)-5 stage patient whose eGFR（CKD-EPI（chronic kidney
 disease-epidemiology collaboration））<15 ml/min/1.73m2,occured uremic symptoms or
 volume overload need of renal replacement therapy(RRT) within 14 days .

 -  Prolonged RRT access is not available.

 -  No dialysis treatment was given within 1 months.

 -  The vital signs are stable and tolerable in peritoneal dialysis catheterization or
 central venous catheterization.

 -  Able to understand the whole process of the trial, voluntarily participate in and sign
 informed consent.

 Exclusion Criteria:

 -  Maintenance RRT alraedy.

 -  Serious metabolic disorders ( hyperkalemia and acidosis) cause significant changes in
 electrocardiogram or other emergency indications to RRT within 24 hours.

 -  Hypertensive emergencies(diastolic blood pressure>130mmHg)

 -  Severe respiratory, circulatory or hepatic failure requires instrumental support or
 vasoactive drugs to maintain vital signs.

 -  High catabolic state eg. severe inflammation or trauma

 -  Absolute contraindication of peritoneal dialysis such as recent abdominal surgery
 (<1month), multiple abdominal surgeries.

 -  Absolute contraindication for hemodialysis such as hemodynamic instability (systolic
 blood pressure <80mmHg).

 -  Pregnant.

 -  Expected to survive for less than 1 years.

 -  Plan for kidney transplantation within 3 months.