Although a comparison of PD to HD for patients with severe heart failure has not been published, there are several reports of successful PD performance in subjects with severe heart failure. Extensive peripheral or central venous occlusive disease prohibits surgical placement of some types of hemodialysis access. Manifestations of severe ischemia, even gangrene, of the hands follow placement of vascular access in the same wrist or forearm in a few patients with severe peripheral vascular disease, particularly diabetics. 131 Marginal vascular beds are at risk for ischemia or reduced perfusion during hypotension, which is frequent in some HD patients. Over a period of time, vascular accesses fail and revisions are no longer able to restore adequate blood flow.
Home hemodialysis requires an assistant.
The decision to initiate PD rather than HD in children is influenced by a variety of factors. Regular school attendance by children of all ages can best be achieved with a home dialysis procedure. Finally, renal replacement therapy can also best be provided by PD when the child lives a long distance from a pediatric ESRD center. PD efficiency relies on effective peritoneal blood flow, dialysate flow, sufficient peritoneal surface area, and permeability to allow adequate solute and fluid removal. The optimal performance of PD requires certain physical and intellectual capabilities of the patient or caregiver.