Which scenario would indicate switching from PD to in-center hemodialysis?

Which scenario would indicate switching from PD to in-center hemodialysis?

• A. Occasional mild abdominal discomfort during exchanges.
• B. Patient prefers in-center treatment for convenience.
• C. Chronic kidney function has improved.
• D. Recurrent or refractory peritonitis with catheter issues, nonresolving inadequate clearance, or intra-abdominal conditions that preclude PD.

Answer: (D)

The situation where treatment must be switched occurs when PD can no longer be performed safely or effectively because the peritoneal membrane or the abdominal cavity is compromised. Recurrent or refractory peritonitis, especially with catheter problems, damages the peritoneal membrane and the access itself, leading to ongoing infection and poor dialysis clearance. If clearance remains inadequate despite proper PD technique, the body isn’t receiving enough toxin and fluid removal. And intra-abdominal conditions that prevent proper dialysate flow or pose risk with PD—such as adhesions, obstruction, or other abdominal issues—make continuing PD unsafe or impractical. In these scenarios, switching to in-center hemodialysis provides reliable, controlled toxin and fluid removal with a vascular access, without depending on the peritoneum. Other options don’t fit as well because mild abdominal discomfort during exchanges can often be managed without stopping PD, a patient choosing in-center treatment for convenience is a personal preference rather than a medical contraindication, and improvement in kidney function would reduce or eliminate the need for dialysis rather than necessitate a switch.

The situation where treatment must be switched occurs when PD can no longer be performed safely or effectively because the peritoneal membrane or the abdominal cavity is compromised. Recurrent or refractory peritonitis, especially with catheter problems, damages the peritoneal membrane and the access itself, leading to ongoing infection and poor dialysis clearance. If clearance remains inadequate despite proper PD technique, the body isn’t receiving enough toxin and fluid removal. And intra-abdominal conditions that prevent proper dialysate flow or pose risk with PD—such as adhesions, obstruction, or other abdominal issues—make continuing PD unsafe or impractical. In these scenarios, switching to in-center hemodialysis provides reliable, controlled toxin and fluid removal with a vascular access, without depending on the peritoneum.

Other options don’t fit as well because mild abdominal discomfort during exchanges can often be managed without stopping PD, a patient choosing in-center treatment for convenience is a personal preference rather than a medical contraindication, and improvement in kidney function would reduce or eliminate the need for dialysis rather than necessitate a switch.