Resumption of Peritoneal Dialysis After a Long Period on Hemodialysis Due to Vascular Access Exhaustion

Introduction: Vascular access exhaustion in hemodialysis (HD) patients represents one of the most challenging and limiting complications to the continuation of renal replacement therapy especially in those patients with a prior history of peritoneal dialysis who required a modality switch to HD. In this context, the reinitiation of peritoneal dialysis (PD) can be a viable alternative lifesaving to patients without functional vascular access (AV). Case Description: C1: Female 44 years old. Starts on PD in 2019. later migrates to HD due to relapsing peritonitis. She has a history of five failed AV(Infection/Dysfunction), 1 thrombosed fistula. C2: Female 29 years old. Starts PD in 2019, later migrates to HD due to catheter dysfunction. She has a history of 9 AV with complications requiring removal (Infection/Dysfunction), In 2023, she returned to PD. C3: Male 35 years old Initially on PD, he switches to HD due to early dysfunction. History of 8 AV and 2 thrombosed fistulas. Return to PD. Patient without complications. C4: Female 43 years old. She has a history of 7 failed AV. She was switched to peritoneal dialysis (PD) in 2022. Case 5: Male 35 years old. Initially on PD, he switched to HD due to early dysfunction. He has a history of 8 AV and 2 thrombosed fistulas, return to PD. Discussion: PD can be a viable, effective, and sometimes the only available alternative for patients with exhausted AV. Its use as rescue therapy is underrepresented in both the literature and clinical practice. Our case series demonstrates that, despite severe comorbidities and complex medical histories, transitioning or returning to PD can be achieved with good functional outcomes and without major immediate technical complications.