Outcomes of Initiating Peritoneal Dialysis versus Hemodialysis in Severe, Symptomatic Kidney Failure
Bibliographic record
Abstract
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; P = 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 ( P = 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; P = 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; P = 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".