From transfer to transition: review and proposition of the SFNDT dialysis Commission

Abstract

Over the course of their disease, patients with chronic kidney disease (CKD) will be treated by several kidney replacement therapy (KRT) modalities. The transitions between KRT modalities can be experienced as traumatic by patients, and are associated with an increased morbidity and mortality, notably when they are not anticipated. Planning these transition phases could reduce the psychological trauma induced by the transfer, as well as reduce the risk of morbidity and mortality. However, the lack of a clear definition of a transfer, and the lack of criteria enabling the identification of patients at risk of transfer, prevents the anticipation of these transition phases at high risk for patients. We here discuss the various possible causes and risk factors of transfer from peritoneal dialysis (PD) to hemodialysis as well as transfer from hemodialysis to PD. The dialysis Commission of the Société francophone de néphrologie, dialyse et transplantation (SFNDT) makes some proposals to improve transition phases, such as the identification of patients at risk, specific PD programs for unplanned PD start, transition unit and hybrid therapy.