Kidney Week 2025 Annual Meeting-Choosing the Optimal Dialysis Modality for Difficult Situations

Video Transcription

Video Summary

The session opens with housekeeping notes (disclosures, recording, evaluations) before four talks on dialysis modality decisions in complex patients.<br /><br />Dr. Yoshi Obi discusses severe obesity in end-stage kidney disease and its impact on peritoneal dialysis (PD), hemodialysis (HD), and transplant access. Obesity increases PD challenges including glucose absorption (promoting weight gain and worsening diabetes), higher catheter-related infections, and mechanical issues, but PD can still be safe and durable with proper catheter placement, laparoscopic techniques (e.g., omentopexy), and careful interpretation of adequacy metrics (Kt/V may be falsely low because body water is overestimated). Obese patients have higher hospitalization and HD transfer rates and lower transplant rates, yet PD is not more lethal than HD. HD poses major vascular access difficulties in obesity. Because obesity blocks waitlisting, weight-loss strategies—especially GLP-1 receptor agonists and modern bariatric surgery (preferably sleeve gastrectomy)—can improve transplant eligibility and survival, best delivered via multidisciplinary care.<br /><br />Dr. Manju Karela-Timura presents a framework for dialysis decisions in patients with cognitive impairment: identify and grade impairment (screening tools like MoCA), distinguish delirium (often reversible/uremic) from dementia (progressive, often vascular/neurodegenerative), link mechanism to dialysis physiology, incorporate patient context/caregiver support, and use scenario planning. Evidence suggests HD-related hypotension and cerebral hypoperfusion may worsen brain ischemia and white-matter injury; interventions like cool dialysate may help select vulnerable patients.<br /><br />Dr. Rukshana Shroff reviews failing kidney transplants in children. Graft half-life is limited, adolescents are high-risk, and glomerular diseases recur and drive early failure. Planning early for retransplant and preserving vascular access are critical; PD and HD have comparable outcomes post-failure, with potential advantages of hemodiafiltration for inflammation, cardiovascular markers, growth, and quality of life.<br /><br />Dr. Joanne Bargman argues PD is often well-suited for cardiorenal syndrome and severe heart failure (including LVAD patients) due to gentle continuous ultrafiltration, better hemodynamic tolerance, and lower bacteremia risk, with consistent reductions in hospitalizations and improved functional status despite limited RCT evidence.

Asset Subtitle

Moderator(s): Scott Liebman, Raj Munshi

Presentation(s):

Severe Obesity: Hemodialysis, Peritoneal Dialysis, and How? - Yoshitsugu Obi
Patient with Cognitive Impairment: Hemodialysis or Peritoneal Dialysis? - Manjula Kurella Tamura
Recurrent Kidney Disease Post-Transplant in a Child: Which Dialysis Modality? - Rukshana Shroff
Severe Heart Failure: Is Peritoneal Dialysis the Optimal Dialysis Modality? - Joanne Bargman

Meta Tag

Date 11/6/2025

Pathway 1 Dialysis

Pathway 2 Hypertension and Cardiorenal Disorders

Session ID 507060

Keywords

dialysis modality selection

peritoneal dialysis in obesity

hemodialysis vascular access challenges

end-stage kidney disease obesity

PD catheter placement laparoscopic omentopexy

Kt/V adequacy interpretation in obesity

GLP-1 receptor agonists weight loss

bariatric surgery sleeve gastrectomy

transplant waitlisting barriers obesity

cognitive impairment in dialysis patients

MoCA screening tool

delirium versus dementia in ESKD

intradialytic hypotension cerebral hypoperfusion

failing pediatric kidney transplant retransplant planning

peritoneal dialysis for cardiorenal syndrome heart failure