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 |