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Kidney Week

Abstract: PO0975

Converting ESKD Patients on Peritoneal Dialysis to Hemodialysis Post Cardiac Surgery: A Necessity or Comfort

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Bassil, Elias, Cleveland Clinic, Cleveland, Ohio, United States
  • Matta, Milad, Cleveland Clinic, Cleveland, Ohio, United States
  • Liaqat, Aimen, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Fawaz, Adam, Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Taliercio, Jonathan J., Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Calle, Juan C., Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
  • Harb, Serge C., Cleveland Clinic, Cleveland, Ohio, United States
  • Elgharably, Haytham, Cleveland Clinic, Cleveland, Ohio, United States
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Daou, Remy, Universite Saint-Joseph, Beirut, Lebanon
  • Mehdi, Ali, Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio, United States
Background

End-stage kidney disease (EKSD) patients on peritoneal dialysis (PD) undergoing cardiac surgery are sometimes converted to hemodialysis (HD) post-surgery. The reasons for this conversion are not well defined in the literature. We sought to examine the reasons cited for converting PD patients to HD post operatively after undergoing major cardiac surgery.

Methods

We examined ESKD patients on PD undergoing cardiac surgery from 2009-2019 using an electronic health records (EHR)-based Cardio-Thoracic Surgery (CTS) registry at the Cleveland Clinic. We identified PD patients who were converted to HD perioperatively. We reviewed the EHR to identify the main causes for conversion.

Results

62 ESKD patients on PD undergoing major cardiac surgery were identified. 16 patients, representing more than a quarter, were converted to HD post operatively. Out of those converted, 31.25% were converted for absolute indications (18.75% for PD catheter malfunction, 6.25% for gadolinium exposure and 6.25% for concern of pericardio-peritoneal communication). 68.75% were converted for less clear and relative indications (25% based on clinician preference, 43.75% for hemodynamic instability or requiring vasopressors). Results are displayed in (Table 1).

Conclusion

A small percentage of PD patients are converted to HD for absolute indications. Most patients are converted based on relative indications including lack of familiarity with PD and hemodynamic instability. As the number of ESKD patients on PD is expected to increase, a better understanding of the outcomes of PD patients post cardiac surgery is needed. In addition, more education is urgently needed to increase the comfort of practitioners managing PD patients in special situations that might be amenable to prescription alterations without premature transition to hemodialysis.

Table 1