title: Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa.
abstract: ABSTRACTHemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.
authors.affiliation: Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo, Milan, Department of Clinical and Biomedical Sciences, "Luigi Sacco", University of Milan, Milan - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.affiliation: Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo, Milan, Department of Clinical and Biomedical Sciences, "Luigi Sacco", University of Milan, Milan - Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo, Milan, Department of Clinical and Biomedical Sciences, "Luigi Sacco", University of Milan, Milan - Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ricchiuto
authors.affiliation: Department of Surgery, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo, Milan - Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gobatti
authors.affiliation: Department of Diagnostic Sciences, Division of Radiology and Interventional Radiology, Ospedale San Carlo Borromeo - ASST Santi Paolo e Carlo, Milan - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cariati
mesh_terms: D000465:Algorithms; D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization; D002405:Catheterization, Central Venous; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome