Access problems plague both peritoneal dialysis and hemodialysis.

Both chronic peritoneal dialysis and center hemodialysis require a transcutaneous access. Costs of maintaining access to the bloodstream and the costs of maintaining access to the peritoneal cavity are substantial for both therapies. Complication rates for blood access clotting and exit site infection may be similar. Exit site infections can often be treated on an outpatient basis. Clotted blood access devices frequently need surgical revision. Peritonitis can in some instances be related to access (excluding internal sources for peritonitis), but with newer devices these rates can be as low as 0.5 episodes per patient year or lower. Thus, the sum of exit site infection rates and peritonitis rates may give totals approaching one episode per patient year. If clotted access incident rates are near half of this, as the recently quoted study suggests, then overall access complications may be more common in peritoneal dialysis. However, the outpatient treatment of most episodes of peritonitis and the outpatient treatment of many if not most episodes of exit site infection implies a lower level of severity than a clotted access device requiring hospitalization and surgical revision. Also of note, bacteremia is a rare complication of exit site infection and peritonitis. In contract, bacteremia and sepsis occur in a high percentage of patients with an infected blood access. Thus, both chronic peritoneal dialysis and chronic hemodialysis continue to be plagued by access problems. Efforts to decrease these problems if successful can result in increased acceptability and safety of both therapies.