Which scenario would prompt switching from PD to hemodialysis due to ultrafiltration failure?

• A. Continue PD but increase dialysis dose without evaluating UF
• B. Switch to hemodialysis due to ultrafiltration failure with edema and hypervolemia
• C. Treat with diuretics and continue PD
• D. Ignore edema and continue PD

Answer: (B)

When ultrafiltration in PD fails, the peritoneal membrane can’t remove enough fluid, so the person becomes fluid-overloaded. If edema and signs of hypervolemia persist despite optimizing the PD prescription, continuing with PD won’t correct the volume overload. Switching to hemodialysis is the best move because HD can remove excess fluid more reliably and rapidly, helping restore and control the patient’s fluid status.

Increasing the PD dose without addressing UF won’t fix the underlying problem and can worsen membrane stress; diuretics may help only if there’s still some residual kidney function and won’t resolve UF-related fluid buildup by themselves; ignoring the edema isn’t safe and won’t protect the patient from cardiovascular risks.