Would you initiate urgent start peritoneal dialysis for a patient with uremic symptoms who plans to pursue long-term hemodialysis but currently lacks an AV access, to avoid using a temporary dialysis catheter until they can obtain a functioning AV access?

Interesting question.

My answer is no. Although generally I prefer PD, I would not go that route in this case.

An AVF could be created now, and it may be ready to use in 2-3 months.

Although a PD catheter could potentially be inserted and used even within the next 48 hours, the patient will need to ...

I wouldn’t unless I believe they might remain on PD. The initial few months of PD are the most resource-intensive, so transitioning to HD during that period could strain the program’s resources. From the patient’s perspective, learning PD for a few months only to transition to something entirely dif...

I would not do urgent PD in this patient. If the patient has had education and is known to want to do in-center HD, then I would follow the patient's wishes. Would assume that the patient had a reason not to choose PD to start with.

I think while the intentions are good, avoiding a CVC is always a good idea, this is just getting a bit too cute and a PD catheter being placed and coming in for urgent start training and then having supplies delivered, etc, is way too much.