It is commonly thought that there are higher rates of failure and death in patients who transfer from hemodialysis (HD) to peritoneal dialysis (PD). The risk of failure and death is higher within the initial year after the switch to PD. Several mechanisms have been proposed such as more rapid loss of residual renal function and more frequent presence of co-morbidities responsible for impossibility to continue HD. The latter factor may make more vulnerable the patients switched to PD
In the present study the impact of transfer from HD to PD on survival and dialysis efficiency has been evaluated in patients unable to continue HD treatment because of vascular access exhaustion.
Patients switched to PD from HD were selected amongst patients followed-up by a single nephrology unit. The mean cause of switch was vascular access exhaustion. Clinical history and biochemistry were recorded at baseline and during follow-up. Dialysis efficiency was evaluated as for standard clinical practice methods. Fatal and not fatal events were registered.
Amongst n.65 patients n. 12 patients were evaluated. These patients had been swithched from HD to PD because because of vascular access exhaustion. Clinical characteristics were: Gender (m/f):7/5; mean age (years): 57±7 SD, mean vintage of HD (years): 8.2±7.1, vintage range of PD (years): 1-7, Continuous tidal peritoneal dialysis: N. 9, Continuous ambulatory peritoneal dialysis: N. 3. KT/V markedly improved during PD compared to value registered during the final period of HD treatments. Two patients were transplanted; one patient died because of cerebrovascular event not correlated to PD treatment.
The data of present study suggest that efficiency of PD is maintained even in patients who had been switched from HD. The higher mortality rate that has been reported by Others during the first year from the switch has not been confirmed by our long-term follow-up.
