Favorable Rates of Technical Success and Reintervention for Peritoneal Dialysis Compared to Hemodialysis

This study sought to evaluate technical outcomes of surgery for hemodialysis (HD) versus peritoneal dialysis (PD), and to assess the potential impact of early HD access creation.

Retrospective review was conducted of all adult patients undergoing PD catheter placement or arterial-venous fistula/graft creation for initial dialysis access at a single center, January 2018-August 2023. Outcomes were assessed for patients undergoing PD versus HD, along with the association between time to first use of an arteriovenous (AV) fistula/graft and time to failure.

During the study period, 271 patients underwent creation of an AV fistula/graft with 229 (85%) initiating HD, of which 180 (79%) successfully utilized their fistula/graft. A total of 76 patients underwent placement of a PD catheter with 74 (97%) initiating PD, of which 70 (95%) successfully utilized their PD catheter. Median time from initial surgery to first successful use of dialysis access was 92 days for AV fistulas/grafts, versus 25 days for PD catheters (P < 0.001). Among patients who successfully accessed their AV fistula/graft or PD catheter, a significant difference was observed in rates of reintervention (HD 70% versus PD 44%, P < 0.001). Median time from initial surgery to reintervention was 166 days for AV fistulas/grafts, compared to 331 days for PD catheters (P = 0.026). No association was observed between time from fistula/graft creation to first use and time from first use to failure (P = 0.84).

Significant differences in technical outcomes exist between HD and PD, while early creation of HD access may not be associated with length of useable access life.