When do you refer for peritoneal dialysis catheter placement in a patient with advanced chronic kidney disease who does not currently have dialysis needs but does have a progressive decline in eGFR?

At what point do you refer a patient with advanced CKD and progressive eGFR decline for peritoneal dialysis catheter placement?

• Early, when dialysis is not yet imminent, accepting the need for ongoing catheter care such as weekly flushes
• When eGFR reaches a threshold at which dialysis is expected within a few months
• I use the Moncrief-Popovich technique, placing and embedding the catheter subcutaneously early and externalizing it when dialysis is needed
• I delay referral until dialysis is urgently needed, accepting the risk of temporary hemodialysis via tunneled catheter if PD catheter placement is not feasible in time
• Other