Format

Send to

Choose Destination
Perit Dial Int. 2018 Jul-Aug;38(4):271-277. doi: 10.3747/pdi.2017.00180. Epub 2018 Jun 6.

Planning Vascular Access in Peritoneal Dialysis-Defining High-Risk Patients.

Author information

1
Nephrology Department, Centro Hospitalar de São João, Porto, Portugal ferreihugo@gmail.com.
2
Nephrology Department, Centro Hospitalar de São João, Porto, Portugal.
3
Faculty of Medicine, University of Porto, Porto, Portugal.
4
Nephrology and Infectious Diseases Research and Development Group, INEB-(I3S), Porto, Portugal.

Abstract

BACKGROUND:

Peritoneal dialysis (PD) is an effective renal replacement technique. However, every year a considerable number of patients are transferred to hemodialysis (HD). Our aim was to identify those at risk, in order to place an arteriovenous fistula (AVF).

METHODS:

Case-control study enrolling all prevalent patients in 2014 and 2015 in our clinic. Groups: 72 case patients who were transferred definitively to HD, 111 control patients (remaining on PD, transplanted, recovered renal function, or deceased).

RESULTS:

A total of 183 patients were eligible, with a mean age of 55.2 ± 14.8 years, 56.3% male, 31.1% diabetic, and 49.7% on continuous ambulatory PD. The mean follow-up time was 42.1 ± 25.6 months. Eighty-five patients had an AVF. The groups differed in diabetic nephropathy etiology, and in some PD-related characteristics (Kt/V, creatinine clearance, residual renal function, mean ultrafiltration, natriuretic peptide, peritonitis, hospitalizations, and hypervolemia). In multivariate analysis, Kt/V < 1.7 (odds ratio [OR] 3.00, 95% confidence interval [CI]: 1.20 - 7.50], albumin < 35 g/L (OR 4.03, 95% CI: 1.26 - 12.92), number of hospitalizations 1 to 3 (OR 2.74, 95% CI: 1.15 - 6.53) and 4 or more (OR 10.48, 95% CI: 3.62 - 30.36), and 2 or more peritonitis episodes (OR 2.50, 95% CI: 1.03 - 6.07) were predictors of PD transfer to HD. In those patients who were transferred to HD, 34 initiated HD by AVF, 2 needed a catheter due to a non-functioning AVF, and 36 did not have an AVF needing catheter placement.

CONCLUSIONS:

Low Kt/V, low albumin, higher number of hospitalizations, and peritonitis were factors associated with PD transfer to HD, probably indicative of a high-risk PD population where arteriovenous access should be weighed.

KEYWORDS:

Arteriovenous fistula; hemodialysis

PMID:
29875179
DOI:
10.3747/pdi.2017.00180
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center