There are no pre-determined reasons for transferring patients to hemodialysis. The most common reason why patients transfer to HD is secondary to peritonitis, followed by catheter-related problems. Inability to achieve adequate clearances or fluid removal and continued non-adherence are additional reasons to transfer patients to HD but are relatively uncommon.

If there is a reason to transfer a patient to HD, it is important to plan for HD vascular access – of course, this can not be done in the acute setting (like non-resolution of peritonitis).

Having said that, most PD patients don’t need to transfer to HD. Hence, planning for each patient to transfer to HD is not necessary and placement of a vascular access in every PD patient not recommended. it is also important to ensure that all units monitor the rates of transfer to HD for their patient population and implement continuous quality improvement to reduce risk for transfer – the risk for transfer is very center dependent with some units have a much lower need to transfer their patients to HD than others