Abstract: 【Abstract】Objective To investigate the efficiency, complications and long- term prognosis of urgentstart automated peritoneal dialysis (urgent-APD). Methods This retrospective study enrolled 16 urgent-APD patients treated in Peking Union Medical College Hospital from March 1996 to December 31, 2017. In addition, we randomly chose 32 peritoneal dialysis (PD) patients who matched the urgent- start APD patients in age, gender and dialysis time from 187 urgent-start intermittent peritoneal dialysis (urgent-IPD) and 464 conventional- start PD patients. The efficiency, mechanical and infectious complications, technique survival and patient survival were compared between the groups. Results There were no differences in baseline characteristics between the groups except that the period from catheter insertion to PD initiation was shorter in urgent-APD patients than in conventional- start PD patients (5 days vs. 15 days, P＜0.001). After PD initiation for one month, the mean daily ultrafiltration volume was greater in urgent-APD patients than in urgent-IPD patients (730ml vs. 125ml, P=0.010). After PD initiation for 3 months, weekly Kt/V was lower in urgent-APD patients than in conventional- start PD patients (2.10±0.22 vs. 2.70±0.63, P=0.001), and weekly creatinine clearance rate (Ccr) and residual glomerular filtration rate (rGFR) were comparable between urgent-APD, urgent-IPD and conventional-start PD patients. In the first 180 days after PD initiation, there were no differences in peritonitis- free survival, technique survival, and mechanical and infectious complications between urgent-APD, urgent-IPD and conventional-start PD patients. In urgent-APD patients, the 6-month, one- and 3-year survival rates were 85.1%, 69.6% and 60.9% respectively. Multivariate Cox hazard model showed that urgent-APD was not the independent risk factor for mortality (P=0.804 and 0.173, compared to urgent-IPD and conventional-start PD patients respectively). Conclusions Urgent-start APD has comparable efficiency, incidence of complications, technique survival and patient survival with urgent-start IPD and conventional-start PD. Therefore, urgent-start APD can be used as an alternative in the patients with urgent dialysis indication.

Key words: urgent-start dialysis, automated peritoneal dialysis, complication, survival analysis