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Case Reports
. 2025 Jun 24;17(6):e86681.
doi: 10.7759/cureus.86681. eCollection 2025 Jun.

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

Selena Gajić  1 , Marko Baralic  1   2 , Ana Bontic  3   2 , Aleksandar Sic  4 , Aleksandra Kezic  3   2
Affiliations
Case Reports

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

Selena Gajić et al. Cureus. .

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.

Keywords: bacteriemia; central venous catheter infection; end-stage kidney disease; hd (hemodialysis); hemodialysis access; peritoneal dialysis (pd).

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee of The University Clinical Center of Serbia issued approval No. 890/8. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Anterior-posterior view chest X-ray showing right-sided pneumonia with pleural effusion (black arrow).
Figure 2
Figure 2. Native X-ray of the abdomen showing the PC (red arrow) and infected Hickman CVC (black arrow).
PC: Peritoneal catheter; CVC: Central venous catheter.
Figure 3
Figure 3. Anterior-posterior view chest X-ray showing regression of pneumonia.
See this image and copyright information in PMC

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