Table 1.

Potential causes of underutilization and transfer to HD

Modality related
        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
        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