Urgent-start peritoneal dialysis for patients with end-stage renal disease. A health technology assessment

Objective:To analyze the available evidence on the relevant clinical and economic aspects of urgent-start peritoneal dialysis (US-PD) compared to urgent-start hemodialysis (US-HD).Material and methods: Rapid systematic review with searches in: Medline, Embase, Cochrane Library and Clinicaltrials.gov.The included studies were evaluated with quality tools.Relative risk (RR) was summarized, and meta-analysis of results was performed, when possible.Results: 1,303 articles were identified, 939 were screened by title and abstract, 29 were evaluated in full-text and 16 were selected.A total of 2,179 patients participated in the selected studies, 1,087 in the US-PD group, 915 in the US-HD group, and 177 in the PD after US-HD group.US-PD has beneficial effects, such as reducing one-year mortality (RR, 0.69; 95%CI: 0.51-0.92).There is no evidence to suggest US-PD increases the risk of complications in unplanned dialysis.On the contrary, there is an association between the practice of US-PD and a lower risk of undesirable outcomes compared to HD with a central venous catheter.Limited and heterogeneous economic evidence suggests that there is no incremental impact on costs.Conclusions: US-PD can be an effective, safe and accessible option for urgent initiation of dialysis in patients with chronic kidney disease who require unplanned initiation of dialysis.