Supplementary Material for: Conversion From Intermittent Hemodialysis to Peritoneal dialysis in metastatic Catheter-Related Blood Stream Infection

Of all complications from Central Venous Catheters (CVC) in End-Stage Renal Disease [ESRD] patients, Catheter-Related Blood Stream Infection [CRBSI] is one of the most devastating consequences. The option of catheter salvage is not an effective measure with metastatic infections. However, in patients with severe vasculopathy and/or near end-stage vascular disease, preservation of the venous access should be given utmost importance as the luxury of utilizing another vascular site is markedly limited. Providing adequate renal replacement therapy in this group of patients can be remarkably challenging for Nephrologists. We are presenting an ESRD patient with advanced vascular disease who developed metastatic catheter-related bloodstream infection (CRBSI) with worsening uremia who was successfully converted from Intermittent hemodialysis [IHD] to Peritoneal dialysis [P.D]. Our rationale was to minimize repeated intravascular procedures coupled with the presence of another intravascular device. This has led to a complete resolution of persistent bacteremia, with a steady improvement in the uremic state. Conversion from IHD to PD for persistent bacteremia with metastatic complications was seldom addressed in literature. In the absence of a significant contraindication to PD, it can be considered as a valid alternative possibility in order to interrupt this viscous cycle especially in vasculopathic patients.

在终末期肾病（End-Stage Renal Disease, ESRD）患者的中心静脉导管（Central Venous Catheters, CVC）相关并发症中，导管相关血流感染（Catheter-Related Blood Stream Infection, CRBSI）是最具破坏性的结局之一。针对合并转移性感染的患者，导管挽救并非有效的干预措施。然而，对于存在严重血管病变和/或接近终末期血管病变的患者，应将血管通路的保留置于极高优先级，因为可选用的其他血管通路位点已极度有限。为这类患者提供充分的肾脏替代治疗，对肾病科医师而言往往极具挑战性。
本文报告1例伴进展性尿毒症的晚期血管病变终末期肾病患者，其发生了转移性导管相关血流感染（CRBSI），最终成功将其治疗方案从间歇性血液透析（Intermittent hemodialysis, IHD）转换为腹膜透析（Peritoneal dialysis, PD）。我们的治疗思路为尽可能减少重复血管内操作，同时避免额外置入血管内装置。该干预使患者的持续性菌血症完全缓解，尿毒症状态稳步改善。
针对伴转移性并发症的持续性菌血症患者，由间歇性血液透析转换为腹膜透析的诊疗策略在现有文献中鲜有报道。若无腹膜透析的明确禁忌证，该方案可作为打破这一恶性循环的有效替代选择，尤其适用于合并血管病变的患者。