Peritoneal dialysis catheter dysfunction: when can the catheter be rescued?

PURPOSE OF REVIEW: Peritoneal dialysis (PD) catheter dysfunction is frequently treated as a generic access failure, although the appropriate response depends on the underlying mechanism. This review summarizes a practical, mechanism-directed approach to reversible medical causes, image-guided salvage, surgical revision, and catheter replacement. RECENT FINDINGS: Recent guidelines and reviews support early exclusion of infection and acute abdominal pathology, deliberate treatment of constipation and fibrin, and early abdominal radiography when flow is impaired. Catheterography and fluoroscopic manipulation can restore selected migrated or partially obstructed catheters. Still, immediate technical success does not ensure durable function when omental wrap, adhesions, fixed kinking, or unfavorable catheter geometry is present. Observational series also support same-session removal and reinsertion for noninfectious mechanical failure and for narrowly selected infection-related indications. Laparoscopic revision remains the definitive treatment for structural abnormalities. SUMMARY: A successful PD access program requires a written rescue pathway that quickly transitions from reversible causes to mechanism-specific interventions. The meaningful outcome is not radiographic catheter position alone, but rapid return to the prescribed PD regimen while minimizing temporary hemodialysis exposure, repeated emergency visits, and avoidable technique failure.