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Perit Dial Int 27(Supplement_3): 18- 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical Experience

Transfer to Peritoneal Dialysis Due to Vascular Access Complications

L. Solá, O. Noboa, G. Fleitas, R. Laborda and V. Quintero

Hospital Maciel, Montevideo, Uruguay

Objective: As a consequence of late referral, almost 80% of the patients (pts) have their first dialysis performed through a central venous catheter. Recent reports have shown the advantage of transferring hemodialysis pts with infective endocarditis to peritoneal dialysis (PD). This indication may be extended to pts with bacteremia related to vascular access (VA) infection. PD might also be indicated as a "bridge" when thrombosis of a permanent VA occurs. Our aim is to analyze the outcomes of pts transferred to PD due to VA complications. Methods: Descriptive retrospective analysis of pts transferred to PD due to VA complications (1/6/2004–28/2/2007). Data recorded were demographic data, nephropathy, cause of transfer to PD, catheter implantation technique, time to initiation of PD, complications, technique and patient survival in the first 90 days. Results: Were transferred to PD 26 pts due to VA complications. Mean age 56±17 years, 11 females. 23 (88.5%) have been on HD and 3 starting dialysis. In 14 (53.8%) transfer was due to a VA infection (permanent VA in 7, central venous catheter in 6, and 1 pacemaker), and in 12 due to VA thrombosis. Catheter implantation technique was surgical (20) or by puncture (6). Median time to PD initiation was 3 days (range 0–34). All started with automated PD. Assisted PD was permanently performed in 15 pts (58%), by nurses at the hospital in 7. Complications in the first 90 days were: mechanical in 7 pts (27%): 2 abdominal wall hematomas, 2 insertion-site leaks, 2 catheters malfunction, 1 hydrothorax, and 1 bowel perforation. One pt (3.8%) presented peritonitis. Catheter was removed in 4 pts. At the end of the period 16 pts (61%) remained in PD, in 14 due to patient's choice and in 2 due to impossibility to perform a new VA; 6 pts returned to HD and 4 pts died. In 2 cases, death was related to initial infection, in 1 a disseminated neoplasm, and 1 as a consequence of gram-negative peritonitis. Conclusions: Transfer to PD is a safe alternative in the treatment VA complications of HD pts. PD must be considered when infective VA complications occur. Further studies comparing outcomes of pts with VA complications maintained in HD or PD are required.






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