Peritoneal dialysis (PD) is a well-established renal re- placement therapy for end-stage renal disease patients. Nonetheless, on an annual basis, at least 10% of patients shift from PD to hemodialysis for a variety of reasons. Thus the issue of vascular access creation needs to be addressed for this small but significant group of patients. Despite the relatively consistent number of dropouts, the creation of an arteriovenous fistula prior to transfer remains subopti- mal, and variable from center to center. Literature for this specific area is poor and dated. Guidelines seem to suggest vascular access creation in high-risk failure patients, but they have no detailed criteria to select patients that would likely fail PD and therefore take advantage of a backup ac- cess. There is a need to better understand and predict pa- tients that require conversion to hemodialysis to develop a plan that focuses on wellness and maximum quality of life in the lifecycle of PD patients. This review addresses the issue of vascular access planning in adult PD patients, pre- sents the available literature on the topic and the current guidelines and recommendations, and describes a research agenda to guide decision making in clinical practice. Perit Dial Int 2008; 28:585–590 www.PDIConnect.com KEY WORDS: Renal replacement therapy; vascular ac- cess; dropout; technique failure; arteriovenous fistula. P eritoneal dialysis (PD) is well established worldwide as a renal replacement therapy in end-stage renal dis- Peritoneal Dialysis International, Vol. 28, pp. 585–590 Printed in Canada. All rights reserved. 0896-8608/08 $3.00 + .00 Copyright © 2008 International Society for Peritoneal Dialysis 585 VASCULAR ACCESS PLANNING IN PERITONEAL DIALYSIS PATIENTS Giusy Chiarelli, 1,2 Monica Beaulieu, 2 Mario Cozzolino, 1 Suneet Singh, 2 Mercedeh Kiaii, 2 Paul Taylor, 2 Adeera Levin, 2 Diego Brancaccio, 1 and Maurizio Gallieni 1 Nephrology and Dialysis Unit, 1 San Paolo Hospital, University of Milan, Italy; Division of Nephrology, 2 University of British Columbia, Vancouver, British Columbia, Canada Correspondence to: G. Chiarelli, Renal Division, San Paolo Hospital, Via Di Rudini 8, 20142 Milan, Italy. giusychiarelli@yahoo.it Received 20 September 2007; accepted 18 April 2008. ease patients. However, many PD patients require con- version to hemodialysis (HD) for a variety of reasons, such as repeated infections, inadequate dialysis due to loss of residual renal function, and deterioration of peri- toneal membrane function. There is a need to better un- derstand and predict those patients that require conversion to HD, especially with respect to the creation of vascular access for HD. Given the known benefit of arteriovenous fistulas (AVFs) versus other types of vas- cular accesses on outcomes in HD, it is important that patients needing to convert from PD to HD have a ma- ture AVF at the time of conversion. Peritoneal dialysis and HD should not be seen as com- petitive but as complementary methods in an “integrated care concept” of the same renal replacement therapy program (1,2). Thus, a comprehensive and multidisci- plinary approach is required to develop a plan that fo- cuses on wellness and maximum quality of life at different stages in the lifecycle of PD patients (3). The focus of this review is to increase awareness of the need for vascular access planning in adult PD patients, describe what is and is not known about this topic, and describe a research agenda that will help guide future decision making to improve the outcomes of patients. VASCULAR ACCESS PLANNING IN PD PATIENTS: IS IT WORTH IT? Data from the British Columbia Renal Agency data- base, Canada, highlights the need for vascular access planning in PD patients. In 2006, 853 patients were on CONTROVERSIES IN PERITONEAL DIALYSIS by on May 18, 2011 www.pdiconnect.com Downloaded from