Transitions to and from peritoneal dialysis: Your questions answered

Modality transitions are very common in patients undergoing peritoneal dialysis (PD); they can either occur before the initiation of PD, following its termination, or as a temporary interruption during PD treatment. Transfers to and from facility hemodialysis represent the majority of these transitions. In addition to their impact on the quality of life of patients and their caregivers, modality transitions are often linked with hospitalizations, mortality, and increased health expenditures. Yet, some of these transfers are unavoidable and should be considered as part of the "dialysis life plan" for patients receiving PD. In this review, we will present the epidemiology, risk factors, and clinical impacts of the most frequent transitions that PD patients experience. We will also discuss strategies to optimize the outcomes of patients undergoing modality transfers. Finally, we will review the evidence underlying the integrated home dialysis paradigm, in which patients transition from PD to home hemodialysis.