Clinical outcome after transfer from peritoneal dialysis to hemodialysis

Guidelines for the clinical care and management of intra-abdominal complications in patients transferred from peritoneal dialysis (PD) to hemodialysis (HD) are not well established. In this study, we analyzed the indications for transfer, presence of abdominal complications, and clinical outcome on HD of 26 patients who were followed up between 1996 and 2004. Laboratory and radiology data for the patients (computerized tomographic and ultrasonographic examinations performed during the transfer and annually thereafter) were collected retrospectively. The indications for transfer from PD to HD were peritonitis (19%), mechanical problems (39%), and ultrafiltration failure (42%). At the time of transfer, 11 patients had no intra-abdominal complications, 8 had intra-abdominal loculated fluid collection, and 7 had intra-abdominal free fluid. One year after transfer, intra-abdominal fluid collection was observed in 6 patients, 3 of whom received percutaneous drainage. Patients who had intra-abdominal complications at the time of transfer exhibited significantly lower albumin (p < 0.01), higher levels of C-reactive protein (p < 0.02), and erythropoietin resistance at the time of transfer (p < 0.0001). During the first year after transfer, we observed a tendency toward an increase in albumin and a decrease in C-reactive protein level in the group that had complications, and yet nutritional interventions were still necessary in that group. A high ratio of intra-abdominal problems, which have adverse nutritional and inflammatory impacts, are seen after patients are transferred from peritoneal dialysis.