SILVA, Cristina et al. Peritoneal dialysis in patients with vascular access problems. []. , 28, 2, pp.119-125. ISSN 0872-0169.

^len^aVascular access problems are an important cause of compulsory transfer to peritoneal dialysis. Surprisingly, little is known about the effect of these transfers on peritoneal dialysis adequacy, patient or technique survival. We have analysed retrospectively a cohort of 75 patients treated at the Peritoneal Dialysis Unit of Centro Hospitalar Lisboa Norte - Hospital de Santa Maria during the year 2011. ‘Vascular access problems’ were defined clinically. Patient characteristics, peritoneal dialysis features and survival were compared between patients with (group 1, n = 14) and without vascular access problems (group 2, n = 61). In group 1, significantly more patients were Black and had been transferred from haemodialysis, with a considerably longer time spent on this technique. These patients were more likely to be anuric, with an inferior daily total fluid removal, lower renal and total creatinine clearance, and poorer Kt/V for urea. Peritoneal clearance and peritoneal membrane transport type did not differ between groups. Group 1 had a considerably higher exit site infection and peritonitis rate, and a lower albumin level. No significant differences were observed in unadjusted patient or technique survival between the two study groups. In the Cox multiple regression model, only a higher total creatinine clearance significantly and positively influenced the technique survival. In conclusion, the prevalence of vascular access problems of the Peritoneal Dialysis Unit was 18.7% and it justified 78.6% of transfers from the Haemodialysis Unit. These were not the ideal patients for peritoneal dialysis. Nonetheless, our data suggest that the outcome (patient and technique survival) of patients with mandatory transfer to peritoneal dialysis because of vascular access problems is similar to that achieved in patients without vascular access problems. Total creatinine clearance appeared as an independent protective factor of technique survival^lpt^aOs problemas de acesso vasculares sao uma causa importante de transferencia obrigatoria para dialise peritoneal. Surpreendentemente, pouco e conhecido sobre os efeitos destas transferencias na adequação da dialise peritoneal, sobrevida do paciente ou da tecnica. Analisamos retrospetivamente um grupo de 75 pacientes tratados na Unidade de Dialise Peritoneal do Centro Hospitalar Lisboa Norte - Hospital de Santa Maria no ano 2011. Os ‘problemas de acesso vascular’ foram definidos clinicamente. As caracteristicas e sobrevida dos pacientes foi comparada entre os doentes com (grupo 1, n = 14) e sem problemas de acesso vascular (grupo 2, n = 61). No grupo 1 havia um numero maior de doentes de raca negra e transferidos de hemodialise, com um tempo dispendido nesta tecnica consideravelmente superior. Estes doentes eram mais propensos a anuria, menor remocao total de fluidos/dia, menor depuracao de creatinina renal e total, e inferior Kt/V da ureia. A depuracao de creatinina peritoneal e o tipo de transportador de membrana peritoneal nao divergiu entre os grupos. As taxas de infeccao do orificio de saida e peritonite foram superiores no grupo 1, a albuminemia era menor nestes doentes. Nao se verificaram diferencas na sobrevida dos doentes ou tecnica (metodo >Kaplan-Meier). No modelo de regressao >Cox, apenas valores superiores de depuracao de creatinina total influenciaram de forma significativa e positiva a sobrevida da tecnica. Em conclusao, na Unidade a prevalencia de problemas de acesso vascular foi 18.7%, e isso justificou 78.6% das transferencias da Unidade de Hemodialise. Estes nao seriam os doentes ideais para dialise peritoneal. No entanto, os dados sugerem que a sobrevida (paciente e tecnica) de doentes com transferência obrigatoria para dialise peritoneal por problemas de acesso vascular e similar a de doentes sem problemas de acesso vascular. A depuracao de creatinina total surgiu como fator protetor independente da sobrevida da tecnica

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