Evaluating Transfers to Hemodialysis in BC - PWR (Jan 2026)

Dr. Tobias Siemens and Dr. Suneet Singh present their talk, “Evaluating Transfers to Hemodialysis in BC: A Comparative Analysis Across Health Authorities and Recommendations for Data Quality Improvement,” as part of BC Renal and UBC’s province-wide rounds. 0:03:20 - Introduction Dr. Siemens begins by emphasizing that chronic kidney disease (CKD) is a growing global health burden, driving significant increases in mortality. He notes that hemodialysis (HD) and peritoneal dialysis (PD) are generally considered equivalent therapies, but highlights a number of additional benefits associated with PD (e.g., lower costs, more personal freedom for patients). Nevertheless, PD is still underutilized. 0:10:49 – Evaluating Transfers to HD in BC Dr. Siemens discusses reasons why a patient may be transferred from PD to HD (e.g., peritonitis, hernia, social issues, unexpected catheter infections, geography, etc.), and provides an overview of an analysis of 197 such patients in BC. Among those transferred, most had diabetic kidney disease and very few had ADPKD. Notably, there were significant regional variations, and patients in the Northern Health Authority were particularly likely to transfer from PD to HD. Also, the reason behind the transfers was not recorded in PROMIS for 27 percent of cases. Dr. Siemens highlights data on mortality of patients who switched from PD to HD, noting a significant portion passed away within the first 3 months of transferring. 0:29:00 – Discussion Dr. Siemens discusses the rate and cause of transfers to HD in BC. 30% transferred to HD after 2 years on PD. Infection-related is the main reason for transfer. He focuses on data from Abbotsford, which suggest that psychosocial reasons and abdominal complications was significant. 0:32:50 – Vascular access He then talks about vascular access at the time of transition, noting that 91% of patients transferred with CVC, which was associated with reduced survival (selection bias may may a role). He questions whether there are key risk factors we are missing and points to an analysis, where no specific risk factor was identified. 0:36:45 – Modality transfer and deaths Dr. Siemens notes that only 2% of patients were transferred to home hemodialysis (HHD). He empshizes the huge portion of people who died after transferring to HD, and discusses whether providers should be better balancing end of life needs of patients. 0:39:15 – Regional differences Dr. Siemens then discusses the regional differences between Health Authorities, and why northern regions experienced disproportional rates of transfers from PD to HD (e.g., less lab work to detect peritonitis). 0:41:55 – Summary and Q&A Dr. Siemens provides an overview of key points before taking questions from the audience with Dr. Singh.