Outcomes of Initiating Peritoneal Dialysis versus Hemodialysis in Severe, Symptomatic Kidney Failure.

KEY POINTS

In severe and late-stage uremia, hemodialysis is often the preferred modality on the basis of the rationale that it can address complications within a few hours. Patients with symptomatic ESKD who urgently start peritoneal dialysis and hemodialysis were associated with similar mortality rates, correction of uremia, and technique survival.

BACKGROUND

Urgent start peritoneal dialysis (PD) may be often avoided due to concerns of efficacy and unfavorable clinical outcomes among those with severe and symptomatic kidney failure. We sought to evaluate mortality risks and other clinical outcomes in individuals starting PD versus hemodialysis urgently, restricted to those with symptomatic and advanced kidney failure.

METHODS

In this prospective single-center cohort, all adult individuals who were dialysis-naïve and consecutively hospitalized with severe and symptomatic kidney failure (defined as a urea value >300 mg/dl) were eligible. The primary outcome was 90-day mortality between those starting PD and hemodialysis. Secondary outcomes were to describe changes in biochemical parameters (potassium, sodium, and bicarbonate), ability to remain on the initial dialysis modality, fluid removal, and PD and hemodialysis access complications.

RESULTS

Between May 2022 and 2024, 120 received PD and 103 received hemodialysis with 73% being male with a median age of 43 years and a median serum urea of 360 mg/dl (interquartile range, 321–420). Mortality at 90 days was 29.1% for hemodialysis and 20.8% for PD died with an adjusted risk of death (adjusted hazard ratio of 1.26; 95% confidence interval [CI], 0.73 to 2.18). The urea value decreased more than 50% in both techniques (95% CI, −14.8 to 43.9; = 0.10) within the first 7 days, with similar trends for serum potassium and bicarbonate. The total ultrafiltrate was greater by 1.2 L in the hemodialysis patients compared with PD patients ( = 0.005). Catheter dysfunction was lower in patients who received hemodialysis compared with those on PD (13.6% versus 26.7% ([95% CI, 2.7 to 23.5; = 0.01]). By 90 days, 5.5% of patients in the hemodialysis group were switched to PD, and 10.5% of patients in the PD group were switched to hemodialysis, but this difference was not significant (95% CI, −3.5 to 13.6; = 0.27).

CONCLUSIONS

Among individuals with severe and symptomatic kidney failure outcomes were similar between urgent start hemodialysis and PD. Further studies are necessary to confirm these results.