Vascular Access Planning in Peritoneal Dialysis Patients

Abstract

Peritoneal dialysis (PD) is a well-established renal replacement therapy for end-stage renal disease patients. Nonetheless, on an annual basis, at least 10% of patients shift from PD to hemodialysis for a variety of reasons. Thus the issue of vascular access creation needs to be addressed for this small but significant group of patients. Despite the relatively consistent number of dropouts, the creation of an arteriovenous fistula prior to transfer remains suboptimal, and variable from center to center. Literature for this specific area is poor and dated. Guidelines seem to suggest vascular access creation in high-risk failure patients, but they have no detailed criteria to select patients that would likely fail PD and therefore take advantage of a backup access. There is a need to better understand and predict patients that require conversion to hemodialysis to develop a plan that focuses on wellness and maximum quality of life in the lifecycle of PD patients. This review addresses the issue of vascular access planning in adult PD patients, presents the available literature on the topic and the current guidelines and recommendations, and describes a research agenda to guide decision making in clinical practice.

Peritoneal Dialysis and Mortality, Kidney Transplant, and Transition to Hemodialysis: Trends From 1996-2015 in the United States

“…The high use of venous catheters is associated with increased risk for infection and poorer outcomes, 32 underscoring the benefit of early recognition of a trajectory pointed toward transition to HD that can allow for appropriate vascular access planning. 33 Despite certain limitations, studies have demonstrated that routine placement of prophylactic fistulas in PD patients is not successful or justifiable 34 , 35 , 36 , 37 , 38 given their low use and high failure rate when their use is eventually attempted. Improving the ability to predict who may require a transition could enable more patients to benefit from the advantages of an established arteriovenous fistula close to the time of transition to HD, potentially saving them from a tunneled catheter.…”

Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…55 Hence, time-dependent surveillance of effective clearances and ultrafiltration volumes are necessary in patients on PD. Predictive models are needed to identify peritoneal dialysis patients that require transition preparation such as education and vascular access creation, 56,57 particularly to support home hemodialysis when appropriate.…”

Current guidelines in peritoneal dialysis – Part I

“…On an annual basis, at least 10 20% of end stage renal disease patients switch from PD to HD. This conversion should be planned, and it is particularly important to proceed with the creation of a vascular access in these patients 53 . The policy of providing backup fistula in all patients at the time of PD treatment start allowing emergency access for hemodialysis was not successful.…”