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Access problems plague both peritoneal dialysis and hemodialysis
1Department of Medicine, University of Missouri, Columbia.
Insights
Dialysis access complications are significant for both peritoneal dialysis and hemodialysis. While peritoneal dialysis may have more frequent access issues, hemodialysis access complications are often more severe, leading to higher risks of infection and sepsis.
Area of Science:
- Nephrology
- Medical Technology
- Patient Safety
Background:
- Chronic kidney disease management necessitates long-term dialysis therapies, including peritoneal dialysis (PD) and center hemodialysis (HD).
- Both PD and HD rely on transcutaneous access, posing substantial costs and complication risks.
- Access-related complications significantly impact the safety and acceptability of these life-sustaining treatments.
Purpose of the Study:
- To compare the complication rates and severity between vascular access in hemodialysis and peritoneal access in peritoneal dialysis.
- To evaluate the clinical and economic implications of access-related issues in both chronic dialysis modalities.
Main Methods:
- Comparative analysis of complication data from existing studies on PD and HD access.
- Review of reported rates for exit site infections, peritonitis, and blood access clotting.
- Assessment of treatment modalities and outcomes, including hospitalization and surgical interventions.
Main Results:
- Exit site infections (PD) and blood access clotting (HD) present comparable complication frequencies.
- Peritoneal dialysis access complications, though potentially more frequent overall, are often managed outpatient.
- Hemodialysis vascular access complications carry a higher risk of bacteremia, sepsis, and necessitate surgical revision.
Conclusions:
- Both PD and HD face significant access challenges that require ongoing efforts for improvement.
- Reducing access complications can enhance the overall safety and patient acceptance of both dialysis modalities.
- Understanding the differential severity of access complications is crucial for optimizing patient care in chronic dialysis.
Abstract:
Both chronic peritoneal dialysis and center hemodialysis require a transcutaneous access. Costs of maintaining access to the bloodstream and the costs of maintaining access to the peritoneal cavity are substantial for both therapies. Complication rates for blood access clotting and exit site infection may be similar. Exit site infections can often be treated on an outpatient basis. Clotted blood access devices frequently need surgical revision. Peritonitis can in some instances be related to access (excluding internal sources for peritonitis), but with newer devices these rates can be as low as 0.5 episodes per patient year or lower. Thus, the sum of exit site infection rates and peritonitis rates may give totals approaching one episode per patient year. If clotted access incident rates are near half of this, as the recently quoted study suggests, then overall access complications may be more common in peritoneal dialysis. However, the outpatient treatment of most episodes of peritonitis and the outpatient treatment of many if not most episodes of exit site infection implies a lower level of severity than a clotted access device requiring hospitalization and surgical revision. Also of note, bacteremia is a rare complication of exit site infection and peritonitis. In contract, bacteremia and sepsis occur in a high percentage of patients with an infected blood access. Thus, both chronic peritoneal dialysis and chronic hemodialysis continue to be plagued by access problems. Efforts to decrease these problems if successful can result in increased acceptability and safety of both therapies.
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