Potential causes of underutilization and transfer to HD
| Modality related |
| infections |
| peritonitis |
| tunnel infection, exit-site infections |
| inadequate dialysis |
| unable to meet clearance targets (Kt/V or creatinine clearance) |
| ultrafiltration failure |
| inability to achieve dry weight |
| persistent volume overload |
| mechanical problems |
| catheter problems |
| infections |
| mechanical complications |
| System related |
| lack of infrastructure |
| lack of patient modality education/training |
| transfer to a facility where PD is unavailable |
| center effect |
| provider expertise |
| physician reimbursement |
| ownership of dialysis facility |
| Patient related |
| patient burnout |
| social reasons, family, age, occupation, etc. |
| geography: distance to travel |
| loss of RRF |
| malnutrition/excess protein loss |
| diabetic complications: severe neuropathy, blindness |
| abdominal surgeries or development of hernia |
| respiratory problems, chronic cough |
| stroke or severe illness limiting manual dexterity |