Peritoneal dialysis discontinuation: to the root of the problem

Abstract

As the global burden of chronic kidney disease continues to increase, the use of peritoneal dialysis is often advocated as the preferred initial dialysis modality. Observational studies suggest a survival advantage for peritoneal dialysis over hemodialysis for the initial 2–3 years of dialysis. Peritoneal dialysis has been associated with better graft survival after kidney transplantation and has a reduced cost burden compared to hemodialysis. However, several medical and non-medical reasons may limit access to peritoneal dialysis, and less than 20% of patients with end-stage kidney disease are treated with peritoneal dialysis worldwide. In this narrative review, we sought to summarize the recent medical literature on risk factors for peritoneal dialysis discontinuation, distinguishing the early and the late phase after peritoneal dialysis initiation. Although the definition of clinically relevant outcomes varies among studies, we observed that center size, older age, and the presence of many comorbidities are risk factors associated with peritoneal dialysis discontinuation, regardless of the phase after peritoneal dialysis initiation. On the contrary, poor technique training and late referral to nephrology care, as opposed to the need for a caregiver, patient burnout and frequent hospitalizations, are related to early and late peritoneal dialysis drop-out, respectively. The aim of the review is to provide an overview of the most relevant parameters to be considered when advising patients in the selection of the most appropriate dialysis modality and in the clinical management of peritoneal dialysis patients. In addition, we wish to provide the readers with a critical appraisal of current literature and a call for a consensus on the definition of clinically relevant outcomes in peritoneal dialysis to better address patients' needs. Graphical abstract

A rare case of successful treatment of peritoneal dialysis patient with Serratia marcescens peritonitis without catheter removal: case report and literature review

“…Peritoneal dialysis-related peritonitis is the most common infectious complication in peritoneal dialysis patients, manifesting mainly as abdominal pain, fever, nausea and vomiting ( Kokubu et al., 2020 ), It may lead to serious consequences such as dialysis failure, spread of infection and even death. A common reason for conversion to hemodialysis during peritoneal dialysis is that a single severe episode of peritonitis or multiple episodes of peritonitis often result in decreased peritoneal ultrafiltration capacity ( Szeto and Li, 2019 ; Khan, 2023 ; Piarulli et al., 2023 ). Gram-positive cocci such as Staphylococcus and Enterococcus and multi-drug resistant bacteria are the common pathogens of peritonitis.…”