title: [Reason for "choosing" peritoneal dialysis: exhaustion of vascular access for hemodialysis?].
abstract: BACKGROUND
  Little is known about the prognosis of patients beginning peritoneal dialysis (PD) as their last alternative.
  
  
  OBJECTIVE
  To describe the clinical-demographic profile of patients switching from hemodialysis (HD) to PD, due to exhaustion of the HD vascular access, and the occurrence of peritonitis among them.
  
  
  METHODS
  Review of the medical records of all patients in the PD program of the Hospital Roberto Santos in the city of Salvador, state of Bahia, Brazil.
  
  
  RESULTS
  The study comprised 22 patients (median age, 47.9 years), 54.5% of whom were men, 84.2%, black or mulattoes, and 68.2% originated from the inner Bahia state. Peritoneal dialysis was the initial modality of renal substitutive therapy (RST) in only four of those patients. The remaining 18 patients began RST through HD, mainly on an emergency basis and by using double-lumen catheter (DLC). In a median of 7.7 months on HD, most patients (64.7%) used four or more DLCs. In only 7/18 (39%) patients, the switch from HD to PD was based on the patient';s choice; in most cases, 11/18 (61%), the reason for switching to PD was exhaustion of HD vascular access. Peritonitis was more frequent in patients switching to PD due to exhaustion of HD vascular access than in the rest of the group.
  
  
  CONCLUSIONS
  Initiating RST on an emergency basis through HD and using DLC may lead to a fast exhaustion of vascular access, leaving PD as the only viable option. This inadequate mode of patient "selection" for PD is associated with a higher risk for peritonitis.
authors: Departamento de Medicina, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Brazil.
authors: Paulo Novis
authors: PN
authors: Rocha
authors: Mila
authors: M
authors: Sallenave
authors: Verena
authors: V
authors: Casqueiro
authors: Bolivar
authors: B
authors: Campelo Neto
authors: Sérgio
authors: S
authors: Presídio
mesh_terms: D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D006435:Renal Dialysis; D012189:Retrospective Studies