In this prospective cohort of patients with severe and symptomatic ESKD requiring an urgent start of HD or PD owing to uremic syndrome, both modalities offer similar outcomes in terms of mortality, correction of uremia, and technical survival. Authors found that the urgent start of PD is feasible and effective in the short- and long-term compared to HD. Suggesting that the reluctance to use PD as the initial modality in these urgent scenarios requires further consideration and ongoing evaluation.