Introduction: Urgent-start peritoneal dialysis (US-PD) has been proposed as a safe modality of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients with an indication for emergency dialysis initiation. We aimed to compare the characteristics, 30-day complications, and clinical outcomes of US-PD and planned peritoneal dialysis (Plan-PD) patients over the first year of therapy. Methods: This was a single-center retrospective study that included incident adult patients followed for up to one year. US-PD was considered when incident patients started therapy within 7 days after Tenckhoff catheter implantation. Plan-PD group consisted of patients who started therapy after the breaking period (15 days). Mechanical and infectious complications were compared 30 days from PD initiation. Hospitalization and technique failure during the first 12 months on PD were assessed by Kaplan-Meier curves and the determinants were calculated by Cox regression models. Results: All patients starting PD between October/2016 and November/2019 who fulfilled the inclusion criteria were analyzed. We evaluated 137 patients (70 in the US-PD x 67 Plan-PD). The main complications in the first 30 days were catheter tip migration (7.5% Plan-PD x 4.3% US-PD - p= 0.49) and leakage (4.5% Plan-PD x 5.7% US-PD - p=0.74). Most catheters were placed using the Seldinger technique. The main cause of dropout was death in US-PD patients (15.7%) and transfer to HD in Plan-PD patients (13.4%). The occurrence of complications in the first 30 days was the only risk factor for dropout (OR = 2.9; 95% CI 1.1-7.5, p = 0.03). Hospitalization rates and technique survival were similar in both groups. Conclusion: The lack of significant differences in patients’ outcomes between groups reinforces that PD is a safe and applicable dialysis method in patients who need immediate dialysis.

ABSTRACT Introduction: Peritoneal dialysis (PD) has been considered a safe option of therapy in end-stage renal disease patients with urgent need of dialysis. Recently, it was proposed that Urgent-Start-PD (US-PD) be defined when PD starts within 72 hours after catheter placement and “early start” PD (ES-PD) when PD starts between 3 and 14 days after. We aimed to compare demographic and clinical characteristics between patients in US-PD and ES-PD as well as 30-day complications, 6-month hospitalization, and dropout rate. Methods: Adult patients starting PD within 14 days after catheter insertion (October/2016 - February/2019) were included and divided into US-PD group and ES-PD group based on the their PD initiation time. Clinical and demographic data, fill volume for the first PD session, 30-day complications, 6-month hospitalization, and dropout rate were assessed. Results: In our study, 72 patients were analyzed (US-PD=40, ES-PD=32) with mean age of 53.2±15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications, 6-month hospitalization, and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage. The most common cause of dropout was transfer to HD. Conclusion: Fifty five percent of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of urgent PD when needed.

<b><i>Introduction:</i></b> Unplanned peritoneal dialysis (PD) is an important option for chronic kidney disease (CKD) patients requiring kidney replacement therapy urgently as it offers the convenience of home-based therapy. The objective of this study was to assess the Brazilian urgent-start PD program in three different dialysis centers where there is shortage of hemodialysis (HD) beds. <b><i>Methods:</i></b> This prospective, multicentric cohort study included incident patients with stage 5 CKD and no permanent vascular access established who started urgent PD between July 2014 and July 2020 in three different hospitals. Urgent-start PD was defined as initiation of treatment up to 72 h after catheter placement. Patients were followed up from catheter insertion and assessed according to mechanical and infectious complications related to PD, patients, and technique survival. <b><i>Results:</i></b> Over 6 years, 370 patients were included in all three study centers. Mean patient age was 57.8 ± 16.32 years. Diabetic kidney disease was the main underlying condition (35.1%) and uremia was the main cause for dialysis indication (81.1%). Concerning complications related to PD, 24.3% had mechanical complications, 27.3% had peritonitis, 28.01% had technique failure, and 17.8% died. On logistic regression, hospitalization (<i>p</i> = 0.003) and exit site infection (<i>p</i> = 0.002) were identified as predictors of peritonitis, while mechanical complications (<i>p</i> = 0.004) and peritonitis (<i>p</i> &#x3c; 0.001) were identified as predictors of technique failure and switching to HD. Age (<i>p</i> &#x3c; 0.001), hospitalization (<i>p</i> = 0.012), and bacteremia (<i>p</i> = 0.021) were observed to predict death. The number of patients on PD increased at least 140% in all three participating centers. <b><i>Conclusion:</i></b> PD is a feasible option for patients starting dialysis in an unplanned manner and may be a useful tool for reducing shortage of HD beds.

We aimed to report the case of a 37 years old woman, caucasian, who got pregnant after seven months of dialysis initiation and had a full-term weeks successful delivery. We also reviewed and presented the reported cases of peritoneal dialysis pregnancies in the last 6 years. The patient started renal replacement therapy due to focal segmental glomerulosclerosis and chronic tubular nephritis. In the same year, she got pregnant and started pre-maternal care in the high-risk pregnancy program. Peritoneal dialysis prescription was adjusted according to the patient’s tolerance and laboratory parameters. No complications occurred during the first and second trimester. In the first quarter of the third trimester, an antihypertensive drug was initiated for maintenance of blood pressure. She delivered a healthy baby via spontaneous vaginal at 39 weeks. Birth was induced due to the advanced pregnancy time and the risk of worsening arterial pressure. Our experience showed that peritoneal dialysis is a viable option during pregnancy according to the patient's residual renal function and promotes a successful pregnancy period with the correct adaptations on peritoneal dialysis prescription. Collaboration and support amongst family, nephrologist and gynecologist doctors, multidisciplinary team and the patient are crucial to ensure treatment quality and successful outcomes.