title: Vascular access planning in peritoneal dialysis patients.
abstract: Peritoneal dialysis (PD) is a well-established renal replacement therapy for end-stage renal disease patients. Nonetheless, on an annual basis, at least 10% of patients shift from PD to hemodialysis for a variety of reasons. Thus the issue of vascular access creation needs to be addressed for this small but significant group of patients. Despite the relatively consistent number of dropouts, the creation of an arteriovenous fistula prior to transfer remains suboptimal, and variable from center to center. Literature for this specific area is poor and dated. Guidelines seem to suggest vascular access creation in high-risk failure patients, but they have no detailed criteria to select patients that would likely fail PD and therefore take advantage of a backup access. There is a need to better understand and predict patients that require conversion to hemodialysis to develop a plan that focuses on wellness and maximum quality of life in the lifecycle of PD patients. This review addresses the issue of vascular access planning in adult PD patients, presents the available literature on the topic and the current guidelines and recommendations, and describes a research agenda to guide decision making in clinical practice.
authors.affiliation: Nephrology and Dialysis Unit, San Paolo Hospital, University of Milan, Italy. giusychiarelli@yahoo.it
authors.forename: Giusy
authors.initials: G
authors.lastname: Chiarelli
authors.forename: Monica
authors.initials: M
authors.lastname: Beaulieu
authors.forename: Mario
authors.initials: M
authors.lastname: Cozzolino
authors.forename: Suneet
authors.initials: S
authors.lastname: Singh
authors.forename: Mercedeh
authors.initials: M
authors.lastname: Kiaii
authors.forename: Paul
authors.initials: P
authors.lastname: Taylor
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Diego
authors.initials: D
authors.lastname: Brancaccio
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000592:standards; D003266:Continuity of Patient Care; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000628:therapy; D018579:Patient Selection; D010530:Peritoneal Dialysis; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011788:Quality of Life; D012042:Registries; D006435:Renal Dialysis; D017211:Treatment Failure