From vascular access exhaustion to peritoneal dialysis: a life-saving change in strategy

Introduction: Vascular access exhaustion is a critical situation in chronic hemodialysis patients and may compromise the continuation of renal replacement therapy. In this context, salvage peritoneal dialysis represents a valuable alternative. Methods: This retrospective, monocentric, descriptive, and analytical study was conducted at Ibn Sina University Hospital in Rabat between 2006 and 2025. Among 257 patients treated with peritoneal dialysis, 21 had vascular access exhaustion; 15 patients were finally analyzed after exclusion of incomplete files. Results: The mean age was 47.1 ± 15.4 years, and the median duration on hemodialysis before transfer was 49 months [36–168]. Urgent or early peritoneal dialysis initiation occurred in 60% of cases. Automated peritoneal dialysis was used in 66.7% of patients. Significant improvement was observed in hemoglobin, phosphatemia, and bicarbonate levels, with overall preservation of dialysis adequacy. Mechanical complications were frequent, especially catheter migration (53.3%) and pericatheter leaks (40%). Nevertheless, technique retention reached 80%, with a median technique survival of 24 months [16.5–34]. Overall mortality remained high (73.3%), mainly related to cardiovascular and infectious comorbidities. Conclusion: Salvage peritoneal dialysis is an effective and realistic strategy in patients with vascular access exhaustion, but earlier identification of at-risk patients could improve outcomes.