From Chronic Hemodialysis to Peritoneal Dialysis: Between Informed Choice and Vascular Access Constraint

Abstract

Introduction: The transfer from hemodialysis (HD) to peritoneal dialysis (PD) may result from either a rescue strategy in cases of vascular access exhaustion or a planned, patient-centered transition. The impact of the context and timing of this transfer on prognosis remains insufficiently documented. Methods: We conducted a retrospective, single-center, descriptive and analytical study including patients treated with HD for at least 3 months and subsequently transferred to PD, provided that they had completed at least six months of follow-up on PD. Demographic, biological, adequacy parameters, complications, and survival data were analyzed. Patients were divided according to the indication for transfer: vascular access failure versus patient choice. Results: Among 257 patients followed on PD, 31 were included. The mean age at initiation of PD was 46.5 ± 17.6 years, with a male-to-female ratio of 0.94. Transfer to PD was motivated by patient choice in 51.6% of cases and by vascular access failure in 48.4%. The median duration of HD before transfer was significantly longer in the vascular access exhaustion group (p = 0.015). These patients also presented with hypoalbuminemia, more severe anemia, and significantly lower residual renal function at PD initiation (p = 0.008, p = 0.019, and p = 0.004, respectively). Peritoneal leaks were more frequent in this group (p = 0.025). Overall mortality was significantly higher in the vascular access failure group (p = 0.007), with lower overall survival (p = 0.016), but no significant difference in technique survival. Conclusion: The prognosis following transfer from HD to PD appears to be strongly associated with the patient’s clinical status at the time of transition. Vascular access exhaustion may be a marker of advanced vulnerability and is associated with increased mortality. These findings underscore the importance of timely transfer, before the loss of residual renal function and exhaustion of vascular access options.