These patients are particularly likely to be started on in-center hemodialysis (HD), with a temporary vascular access known to be associated with excess mortality and increased risks of potentially lethal complications such as bacteremia and central venous thrombosis or stenosis.The present paper describes in detail our program for unplanned start on automated peritoneal dialysis (APD) right after PD catheter implantation and summarizes our experiences with the program so far. Late-referred patients with end-stage renal disease (ESRD) and urgent need for dialysis are overrepresented among older people. Unplanned start on dialysis remains a major problem for the dialysis community worldwide.
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