LAUSR

This study was carried out to ascertain the 6 month survival of patients who were transferred from hemodialysis to peritoneal dialysis due to poor vascular access at tertiary care facility in Pakistan. PD remains an under-utilized and unpopular modality of renal replacement therapy. One of the major reasons for its unpopularity remains poor patient selection. Furthermore PD is used as a last resort when AV access for HD becomes impossible in Pakistan. This study was carried out over a 4 year period. All patients transferred from hemodialysis onto peritoneal dialysis were included in the study. A total of 23 patients of Pakistani decent were switched to peritoneal dialysis from hemodialysis because of poor AV access. All patients included in the study had undergone venograms and consultation with vascular surgeons to confirm that AV access henceforth was inadequate for hemodialysis to continue. After placement of the peritoneal dialysis catheter a 2 week rest period was given to each patient before CAPD was initiated. The 6 month survival of each patient from the point of being transferred to CAPD was noted. The mean age of patients included in the study was 58 years. 80% of the participants were known to have diabetes mellitus. 15 out of the 23 patients included in the study died within 6 months of starting peritoneal dialysis. 12 out of the 23 patients included had difficulties in achieving either required ultrafiltration or KT/V despite ensuring correct catheter placement and following standard CAPD good practices. Patients being switched from hemodialysis to CAPD due to poor AV access carry a greater than 50% 6 month mortality rate. In a country where PD struggles to gain popularity, we need to be very selective in starting patients on this modality with a realization that PD cannot be kept as a last resort rather should be advocated as the first choice therapy. Only then can the true benefits of PD be exhibited.