Urgent-start Peritoneal Dialysis in ESRD Patients：A Multi-center Study
Urgent-start Peritoneal Dialysis in ESRD Patients：A Multi-center Study
Within the last decade, urgent-start peritoneal dialysis(PD) has gained considerable interest
 amongst nephrologists. Several publications have provided assurances that urgent-start PD is
 indeed feasible and can serve patients well; however, most of the studies have small sample
 sizes, retrospective design, and the impact of the urgent-start dialysis modality on outcome,
 especially on short-term complications, has not been directly evaluated. Therefore, we
 started this multi-centered, prospective, interventional study compared the dialysis-related
 complications and survival rate directly between urgent-start PD and HD groups with a large
 sample to determine the feasibility and safety of urgent-start PD as an alternate initial
 modality of dialysis for patients who require urgent initiation of dialysis therapy.
The prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is on the
 rise worldwide. Moreover, many patients who progress to ESRD, even with regular nephrology
 follow-up, do not have a distinct plan at the time of initiating dialysis therapy, resulting
 in an urgent need for dialysis. Urgent-start dialysis refers to urgent initiation of dialysis
 for ESRD patients with no pre-established functional vascular access or peritoneal dialysis
 (PD) catheter. Hemodialysis (HD) is preferred in most centers with a high rate of central
 venous catheter (CVC) use at the time of initiating dialysis among HD patients. There is a
 significantly increased risk of infectious complications, thrombosis, and other complications
 associated with CVC use which negatively affects patient prognosis. Within the last decade,
 urgent-start PD has gained considerable interest amongst nephrologists. Several publications
 have provided assurances that urgent-start PD is indeed feasible and can serve patients well;
 however, most of the studies have small sample sizes, and the impact of the urgent-start
 dialysis modality on outcome, especially on short-term complications, has not been directly
 evaluated. Therefore, we conducted this multicenter, prospective, randomized clinical trial
 to compare the dialysis-related complications and survival rate directly between urgent-start
 PD and HD groups with a large sample to determine the feasibility and safety of urgent-start
 PD as an alternate initial modality of dialysis for patients who require urgent initiation of
 dialysis therapy.
Inclusion Criteria:

 -  ESRD patients who need urgent-start dialysis(Urgent-start dialysis is defined as ESRD
 patients who required initiation of dialysis in 2 weeks without pre-established
 functional vascular access or a PD catheter.)

 -  patients who signs a informed consent form

 Exclusion Criteria:

 -  patients with severe volume overload with pulmonary edema

 -  patients with hyperkalemia (>6.5 mmol/L)

 -  patients with uremia encephalopathy

 -  patients with severe risk of bleeding or hemorrhagic disease

 -  patients with severe hepatic failure

 -  patients with contraindications of PD including extensive peritoneal fibrosis
 adhesion, severe skin disease, extensive abdominal infection or extensive abdominal
 burns, uncorrectable mechanical problems such as herniation of the umbilicus,
 herniation of the abdomen, bifida of the bladder, valgus of the peritoneum, peritoneal
 cavity and chest leakage

 -  patients with Intracranial hemorrhage or increased intracranial pressure

 -  patients with uncorrectable shock

 -  patients who cannot establish a vascular access

 -  patients with malignancy

 -  patients with mental disorder

 -  patients with pregnancy or lactation

 -  patients who are not suitable for inclusion in this study determined by reseachers