SS21 - Investigation of Technical Success and Reintervention Rates of Hemodialysis versus Peritoneal Dialysis: Is Peritoneal Dialysis an Underutilized Modality?

Objectives: Hemodialysis (HD) is the predominant dialysis modality utilized in the United States, compared to the primary alternative of peritoneal dialysis (PD). Choice of dialysis modality is informed by patient preference, comorbidities, anatomy, and logistical considerations. However, patients may not be fully aware of the relative rates of timely dialysis access use, as well as potential need for surgical reintervention, when deciding between HD and PD. This study sought to evaluate the effectiveness of each modality for timely initiation of dialysis, as well as to compare the need for surgical reintervention, with the goal of improving patient and surgeon knowledge regarding dialysis modality selection.

Methods: Retrospective chart review was performed for all patients >18 years old undergoing surgical placement of either a PD catheter or AV fistula/graft for initial dialysis access at a single independent academic medical center from January 1, 2018, through December 31, 2022. Clinical and demographic characteristics of patients undergoing HD versus PD were compared using Pearson Chi-squared and Wilcoxon rank sum tests. Kaplan-Meier survival analysis and the log-rank test were used to compare time to surgical reintervention for dialysis access by modality.

Results: During the study period, 347 patients underwent initial dialysis access surgery: 271 underwent creation of an AV fistula/graft and 76 underwent placement of a PD catheter (Table I). Among patients who initiated dialysis, 80% of those who chose HD successfully used their initial AV fistula/graft, while 92% of PD patients used their initial PD catheter. Time from surgery to first use of dialysis access was significantly shorter for patients on PD (median 25 days) compared with HD (median 92 days) (Table II, p< 0.001). Among HD patients, 49% required surgical reintervention to maintain dialysis access, compared with 44% of PD patients (p=0.5). The Kaplan-Meier analysis did not demonstrate a statistically significant difference in time to reintervention between PD and HD (p=0.086). However, among patients requiring surgical reintervention, the time from successful first use of dialysis access to reintervention was significantly different between HD (median 101 days) and PD (median 312 days) (p < 0.001).

Conclusions: Significant differences exist between HD and PD in the time from access use to reintervention. Vascular Surgeons who can provide comprehensive information regarding the relative advantages and disadvantages of surgical access for both PD and HD are uniquely equipped to counsel patients regarding potential outcomes.