Predictors and Outcomes of Transfers from Peritoneal Dialysis to Hemodialysis

Association of Peritonitis with Hemodialysis Catheter Dependence after Modality Switch

“…Other common etiologies of PD modality switch include ultrafiltration failure, patient fatigue from daily PD procedure, development of omental wrap, technical issues, or worsening quality of life. Peritonitis preceded the switch in 48% of our study cohort, similar to the rate reported in two previous studies (35%-42%) (1,6). Whereas technique failure typically entails a permanent switch to HD, patients with peritonitis are frequently expected to resume PD.…”

“…In this study, patients who remained catheter dependent at 6 months after the PD to HD switch had greater mortality in the subsequent year compared with those using a permanent vascular access. Similarly, an Australian/New Zealand cohort study reported that, among patients switching from PD to HD, those who commenced HD with a permanent vascular access had superior survival than those who commenced with a catheter (6). These findings highlight the urgent need to develop programs and strategies to optimize vascular access planning in patients transitioning from PD to HD.…”

“…Pulliam et al (1) observed in a large United States dialysis chain that, at 90 days after the switch to HD, 78% used a catheter. Lam et al (6) reported from an Australian/New Zealand cohort that 76% of these patients used a dialysis catheter as their initial access at the time of switch to HD.…”

Association between causes of peritoneal dialysis technique failure and all-cause mortality

“…Peritonitis continues to be one of the most important risk factors for PD technique failure 4 , and contributes to almost 50% of death-censored PD technique failure in Australia, with similar observations being reported in other countries 5 – 7 . In an analysis of the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry of 6639 incident PD patients, 10% of patients who had experienced peritonitis died within 30 days of peritonitis 8 , with similar findings corroborated in other studies 9 .…”

Characteristics Associated With Peritoneal Dialysis Technique Failure: Are We Asking the Right Questions?

“…In a retrospective assessment of HD-PD transfer in Australia, only 25% of all transfers were thought to be potentially predictable, leaving the remaining three-quarters unpredictable (but perhaps not necessarily unpreventable). 3 PD patients acutely transferred to HD face various hazards. First, they often perceive this transition as a failure, as highlighted by the commonly used term "PD technique failure."…”