title: Is transition between peritoneal dialysis and hemodialysis really a gradual process?
abstract: BACKGROUND
  Transfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD.
  
  
  METHODS
  All patients in 4 centers of Basse-Normandie who had been treated with PD for more than 90 days and who were permanently transferred to HD between 1 January 2005 and 31 December 2009 were retrospectively reviewed. The rate of unplanned HD start was evaluated.
  
  
  RESULTS
  In the 60 patients (39 men, 21 women) included in the study, median score on the Charlson comorbidity index at PD initiation was 5 [interquartile range (IQR): 3 - 7], median age at HD initiation was 62 years (IQR: 54 - 76 years), and median duration on PD was 22 months (IQR: 12 - 36 months). Among the 60 patients, 37 had an unplanned HD initiation. Peritonitis was the most frequent cause of unplanned HD start (n = 20), and dialysis inadequacy (n = 11), the main cause of planned HD start. During the transition period, all patients were hospitalized. Median duration of hospitalization was 4.5 days (IQR: 0 - 25.5 days). Within 2 months after HD initiation, 9 patients died. Two months after starting HD, 6 of the remaining 51 patients were being treated in a self-care HD unit and only 23 patients had a mature fistula.
  
  
  CONCLUSIONS
  Unplanned HD start is a common problem in patients transferred from PD. Further studies are needed to improve the rate of planned HD start in PD patients transferred to HD.
authors.affiliation: Nephrology Department, CHU Clemenceau, Caen, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Boissinot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Landru
authors.forename: Eric
authors.initials: E
authors.lastname: Cardineau
authors.forename: Elie
authors.initials: E
authors.lastname: Zagdoun
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ryckelycnk
authors.forename: Thierry
authors.initials: T
authors.lastname: Lobbedez
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000209:etiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: Technique failure; transition