Healthy arm with good vascular access

Preserve Vascular Access

Initiating Dialysis with PD preserves vascular access and eliminates the risk of HD access infections and complications1

  • A PD Catheter may be established and may be used within 24 hours for treatment2
  • 35% of AV fistulas fail to mature resulting in the need for CVC3
  • Unlike PD catheters, fistulas are irreversible, with body image implications 
  • Percutaneous catheter insertion can support timely access to PD4
  • Practices incorporating nephrologist-led percutaneous catheter insertion are shown to have an increase in the number of patients using PD4-9
Image of a doctor shaking hands with a patient

Reduced access related infections & hospitalization rates for PD vs ICHD

Challenges of HD vascular access

  • Infectious complications of vascular access are one of the major causes of morbidity and mortality in HD patients10 
  • HD vascular access is implicated as the source of bacteremia in 48-73% of patients with CVC as the highest source of infection11 
  • The use of CVCs has been clearly implicated in an increased risk of mortality and infection rates1

PD offers: 

  • Reduced risk of access complications, hospitalization and infection12,13,15,16 
    • The rate of hospitalization due to vascular access complications is higher than peritonitis-related hospitalization17
  • Reduced number and risk of invasive interventions and associated complications12-16

Hospitalization rates in adult ESKD patients

Craph showing Adjusted cause-specific hospitalization rates in adult ESKD patients 2011-2021

Related Pages

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PD is the ideal bridge to kidney transplant associated with favorable post-transplant outcomes

Bridge to Transplant

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Peritonitis prevention strategies in PD

Reduce Infection and Hospitalization Rates
References

  1. Almasri JM, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg. 2016;64(1):236-243.

  2. Schreiber Jr MJ. Changing Landscape for Peritoneal Dialysis: Optimizing Utilization. Semin Dial. 2017;30(2):149-157.

  3. Voorzaat BM, et al. Arteriovenous Fistula Maturation Failure in a Large Cohort of Hemodialysis Patients in the Netherlands. World J Surg. 2018;42(6)1895–1903. 

  4. Perl J, et al. Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study. Nephrol Dial Transplant. 2015;30(2):301–309. 

  5. Rao A, et al. UK Renal Registry 18th Annual Report: Chapter 11 2014 multisite dialysis access audit in England, Northern Ireland and Wales and 2013 PD one year follow-up: national and centre-specific analyses. Nephron. 2016;132(1):253-278. 

  6. Leong Goh B, et al. Does Peritoneal Dialysis Catheter Insertion by Interventional Nephrologists Enhance Peritoneal Dialysis Penetration? Semin Dial.2008;21(6):561-566. 

  7. Ng EK, et al. Multicenter Analysis on the Impact of Nephrologist-Initiated Catheter Insertion Program on Peritoneal Dialysis Penetration. Semin Dial. 2012;25(5):569-573. 

  8. Asif A, et al. Does catheter insertion by nephrologists improve peritoneal dialysis utilization? A multicenter analysis. Semin Dial. 2005;18(2):157-160. 

  9. Ros-Ruiz S, et al. The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience. Nefrologia. 2016;36(1):19-23.

  10. Suzuki M, et al. Bacteremia in hemodialysis patients. World J Nephrol. 2016;5(6):489-496

  11. Nassar GM, Ayus JC. Infectious complications of the hemodialysis access. Kidney Int. 2001;60(1):1-13

  12. Huijbregts HJ, et al. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol. 2008;3(3):714-719.

  13. Maya ID, et al. Outcomes of brachiocephalic fistulas, transposed brachiobasilic fistulas, and upper arm grafts. Clin J Am Soc Nephrol. 2009;4(1):86-92.

  14. Fokou M, et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg. 2012;26(5):680- 684.  

  15. Oliver MJ, et al. Choosing peritoneal dialysis reduces the risk of invasive access interventions. Nephrol Dial Transplant. 2012;27(2):810-816.  

  16. Coentrao L, et al. Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study. BMC Nephrol. 2012;13(1):1-7. 

  17. United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States: End Stage Renal Disease: Chapter 5. Hospitalization. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.