Which scenario would prompt switching from PD to hemodialysis?

• A. Recurrent severe peritonitis with catheter failure
• B. Adequate ultrafiltration with edema and hypervolemia
• C. Stable catheter function
• D. Patient choice to continue PD

Answer: (A)

The scenario that would prompt switching from PD to hemodialysis centers on ongoing problems with the PD access and the peritoneal membrane itself. Recurrent severe peritonitis together with catheter failure means the PD method can no longer be performed safely or effectively. Peritonitis causes inflammation and damage to the peritoneal membrane, which can reduce or destroy its ability to do dialysis, and catheter failure means exchanges can’t be performed reliably. When the PD system can’t be trusted to remove waste and excess fluid, or the infection risks become unmanageable, switching to hemodialysis provides a safer, more reliable way to achieve clearance and fluid control without depending on the peritoneal membrane or the PD catheter.

In contrast, adequate ultrafiltration with edema, stable catheter function, or patient preference to stay on PD do not indicate a failure of the PD system. If PD is still functioning and delivering the needed dialysis, there’s no compelling reason to switch.