Mission P(D)-possible: Enabling Peritoneal Dialysis in Situations Formerly Thought to Be Impossible, Eight Inspiring Cases

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Introduction: Tom Cruise currently tries for the seventh time to do the impossible in "Dead Reckoning". We try to do the same in PD, an underutilized form of kidney replacement therapy (KRT). In this abstract we present an inspiring collection of 8 individual cases, in which, despite co-diseases currently thought to be contraindications for PD, this treatment modality could successfully implemented. Case Description: In 2023, 81 PD catheters were implanted at our center, cahnging the view on "contraindications" to PD.PD despite major abdominal surgery including subtotal colectomy and hemicolectomy as well as comtinuation of PD despite colostomy are reported. Further, a patient with ADPKD and liver cysts who undergoes PD with adequate dialysis effectiveness for almost 5 years, despite rejecting unilateral nephrectomy challanged our view about contriaindications for PD. Moreover, Calciphylaxis (CUA) often considered a contraindication for continuing PD, can successfully be managed with intensified PD and administration of sodium thiosulfate. Frequently anuria is viewed as a contraindication to PD, a view we do not share in general. In cases intellectual disability, hemodialysis is often preferred, however, there are cases in which PD can be carried out successfully such as in trisomy 21. Missing arms are a drastic obstacle to carrying out PD. This hurdle could also be solved through technical assistance and interprofessional collaboration, as was the case with our patient with amelia due to thalidomide embryopathy (Figure 1). Discussion: It will not be before 2025 that Tom Cruise will accomplish a mission impossible again. Meanwhile interprofessional teams worldwide will do the impossible many times by enabling PD in those patients who have chosen this form of KRT, focussing on patient-centered outcomes.Patient with Contergan induced dysmelia connecting himself to a PD cycler (consent on file).

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