Abstract
Sustainable vascular or peritoneal access for dialysis is very important for patients undergoing dialysis therapy, and access trouble is occasionally involved with unexpected occurrence of complications. Once access trouble occurs, dialysis therapy might be discontinued and be followed by a life-threatening state of patients with end-stage kidney disease. Bacterial infection, massive bleeding, and thrombosis in patients undergoing hemodialysis and acute infectious peritonitis and chronic encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis are important clinical issues. Preemptive kidney transplantation prior to dialysis has several advantages over transplantation after exposure to dialysis therapy. One of the notable advantages is the lack of necessity of dialysis access, which avoids access operations before transplantation. However, some transplant recipients may need short-term dialysis therapy due to the unexpected progression of chronic renal dysfunction. Dialysis access is required in a short preoperative period for preconditioning. The selection of renal replacement therapy without complications in a short-term dialysis before transplant surgery is important for the success of kidney transplantation. Appropriate preparation of short-term dialysis therapy and access is a key to success of preemptive kidney transplantation.
Highlights
Preemptive kidney transplantation (PEKT) is defined as transplantation prior to dialysis therapy
We especially focus on the dialysis access related to PEKT in the optimal modality selection
Both dialysis accesses cannot be used for dialysis therapy immediately after the access operation, and the access removal operation has a greater burden compared to the removal of tunneled cuffed catheter (TCC)
Summary
Preemptive kidney transplantation (PEKT) is defined as transplantation prior to dialysis therapy. Some transplant recipients need short-term dialysis therapy for preconditioning due to the unexpected progression of renal dysfunction. Such cases include the PEKT criteria and require dialysis access for hemodialysis (HD) or peritoneal dialysis (PD). The appropriate selection of short-term dialysis modality is important for preconditioning of PEKT with preventing dialysis access-related complications. The selection of renal replacement therapy (RRT) is important because it avoids complications related to dialysis access. Optimal modality selection of RRT is very important for improving life expectancy and maintaining good quality of life in patients with end-stage kidney disease (ESKD). Appropriate selection of dialysis access is one of the most important issues in the treatment of RRT. We especially focus on the dialysis access related to PEKT in the optimal modality selection
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