Clinical Outcomes of Patients with ESKD and Multiple Access Failure Who Shifted from Hemodialysis to Peritoneal Dialysis at a Tertiary Kidney Center in the Philippines

Background: End stage kidney disease (ESKD) has been a significant public health burden affecting patients world wide. Hemodialysis (HD) and peritoneal dialysis (PD) are different but valuable modalities of renal replacement therapy for patients with end stage kidney disease. Reliable permanent vascular access is a fundamental tool in providing adequate and effective hemodialysis. This study aimed to determine the clinical outcomes of ESKD patients diagnosed with multiple access failure (MAF) who shifted from HD to PD at a tertiary referral renal center in the Philippines. Methods: This retrospective cross sectional study was conducted from January 2019 to December 2022 through medical records chart review and hospital database of all multiple access failure patients who were shifted from HD to PD and were observed for one year. Results: The study showed that patients with multiple access failure had a 48% occurrence of technique survival within one year of shifting. PD associated infection and PD related complication had an almost equal occurrence comprising 27% and 26% respectively. The presence of PD associated infection (24%, P value 0.0008) and PD related mechanical complication (22%, P value 0.0064) were significantly associated with hospitalization while technique survival was significantly associated with less mortality (45%, P value 0.0001). Conclusion: Hospitalization within one year was prevalent among ESKD patients with multiple access failure and was significantly associated with PD associated infection and PD related mechanical complication. Catheter survival within one year was significantly associated with less mortality. This study revealed that despite the high mortality for MAF patients, transitioning to PD offers a life-saving option, providing additional years of survival. Funding: Private Foundation Support