# Peritoneal Dialysis As Salvage Therapy in a High-Risk Patient With Failed Hemodialysis Access: A Case Report

## TL;DR

A high-risk patient with failed hemodialysis access successfully switched to peritoneal dialysis, showing it can be a viable rescue therapy.

## Contribution

Demonstrates peritoneal dialysis as a salvage option in patients with no remaining hemodialysis access and prior abdominal surgeries.

## Key findings

- The patient achieved full clinical recovery after switching to peritoneal dialysis.
- Initial catheter malposition was surgically corrected, enabling successful PD initiation.
- The case supports reconsidering PD for high-risk patients with exhausted vascular access.

## Abstract

Peritoneal dialysis (PD) is often contraindicated in patients with extensive prior abdominal surgeries due to the risk of adhesions, catheter malposition, and poor dialysis efficacy. We present a complex case of a 64-year-old male with end-stage kidney disease (ESKD) who experienced repeated arteriovenous fistula (AVF) thromboses and multiple catheter-related bloodstream infections, ultimately exhausting all viable vascular access sites for hemodialysis (HD). Despite prior abdominal surgeries, the patient underwent successful PD catheter insertion following femoral catheter-related sepsis and fungemia. Although initial PD catheter malposition was observed, it was corrected surgically, and PD was initiated, leading to full clinical recovery. This case highlights the potential role of PD as a rescue therapy, even in patients with relative contraindications and no remaining HD access options. It underscores the importance of reconsidering the feasibility of PD in high-risk patients when vascular access is no longer available.