Complications of Peritoneal Dialysis Catheters: Early and Late

Primary Malfunction of a Peritoneal Dialysis Catheter Due to Encasement in an Encapsulating Sheath

Obstruction of the catheter is one of the potentially serious complications of peritoneal dialysis. Dislocation of the tip of the catheter, intraluminal fibrin formation, and omental wrapping are among the most common etiologies of peritoneal dialysis catheter malfunction that necessitate correction. Here we present a rare case of primary malfunction of a newly placed catheter in which multiple attempts to restore the patency by minimally invasive procedures were unsuccessful. Laparoscopy revealed a thick encapsulating sheath around the entire length of the catheter as the etiology of complete obstruction, without involvement of other intra-abdominal structures. The sheath was opened and the catheter was pulled out in its entirety. There was no intraluminal or orifice obstruction and it subsequently functioned perfectly.

Transection versus infection: acute appendicitis in a peritoneal dialysis patient presenting as catheter dysfunction and discontinuity on X-ray

Acute appendicitis in peritoneal dialysis patients generally presents as abdominal pain and cloudy dialysate. We report a case of acute appendicitis in a peritoneal dialysis patient that presented as poor dialysate fluid drainage and an abnormal abdominal X-ray showing breakage in the continuity of the catheter. Catheter dysfunction in this case was caused by acute appendicitis leading to the formation of adhesions with peritoneal dialysis catheter trapped in it. This resulted in radiological appearance of catheter breakage, although catheter itself was intact. Clinicians should be aware of this rare presentation of acute appendicitis-poor drain alarm and radiological appearance of catheter discontinuity.

Intensive Versus Minimal Standard Dosage for Peritoneal Dialysis in Acute Kidney Injury: A Randomized Pilot Study

BACKGROUND

Dosage for peritoneal dialysis (PD) in acute kidney injury (AKI) is controversial. This study aims to find benefits and risks of intensive versus minimal standard dosage of PD in AKI.

METHODS

In a tertiary-hospital, 93 AKI patients who required PD between May 2015 and January 2016 were enrolled in a randomized, open-label controlled study. Patients were randomized to intensive group (> 30 L) and minimal standard group (< 20 L) of PD volume per day for the first 2 consecutive days. The primary outcome was in-hospital mortality. The secondary outcomes were peritonitis rate, dialysis dependence, and PD leakage.

RESULTS

Seventy-five patients were analyzed (intensive PD n = 39; minimal standard PD n = 36). Mean age was 60 years. Most patients were in critical care (72% unstable hemodynamic, mean APACHE II score 26.2). Kt/V delivery per session was 0.61 and 0.38 in intensive and minimal standard PD dosage for the first 2 consecutive sessions. According to intention-to-treat analysis, the in-hospital mortality rate of intensive PD dosage was not significantly different from the minimal standard PD dosage (79% vs 63%, relative risk [RR] 1.11, 95% confidence interval [CI] 0.80 to 1.51, p = 0.13). The dialysis dependence rate and PD leakage were not significantly different between the 2 groups. The rate of PD peritonitis was slightly higher in the intensive PD dosage group (15.3% vs 8.3%, p = 0.34).

CONCLUSION

Among AKI patients who required PD, there was no significant difference in in-hospital mortality between intensive and minimal standard PD dosage.

Salvage of a totally occluded peritoneal dialysis catheter by laparoscopic milking

Mechanical problems of the Peritoneal Dialysis (PD) catheter remain a significant cause of temporary or even permanent transfer to hemodialysis. Until recently, the most popular approach was to remove the problematic PD catheter than to try to salvage it. We report a case of severe (two-way) PD catheter obstruction that appeared after spontaneous hemoperitoneum and did not resolve with multiple conservative measures. However, it was successfully salvaged by laparoscopic surgery and milking of a big intraluminal clot.

Abdominal pseudocysts following peritoneal dialysis-associated peritonitis: a report of 3 cases

Common complications of peritoneal dialysis are peritonitis, leakages, hernias, catheter dislocation, and loss of ultrafiltration. We describe 3 cases of abdominal pseudocysts with progressive difficulty instilling and draining peritoneal dialysis fluid. The 3 patients had been treated with peritoneal dialysis for 1, 2, and 6 years. Two patients had experienced previous episodes of peritonitis and 1 had signs of peritonitis when the pseudocyst was first detected. In all 3 patients, ultrasound and computed tomographic scans, obtained because of progressive decreases in solute clearance, showed dialysate entrapped in a cyst that enclosed the inner tip of the Tenckhoff catheter. The cyst was resected in 2 patients, and the Tenckhoff catheter was removed in 1 patient. Histologic samples were not suggestive of encapsulating peritoneal sclerosis. Abdominal pseudocysts are a rare complication after peritoneal dialysis therapy, but are reported in 1% of patients with ventriculoperitoneal shunts. The outcome of our described patients was good, although they had to be switched to hemodialysis therapy.