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Cheng XBJ, Bargman J. Complications of Peritoneal Dialysis Part I: Mechanical Complications. Clin J Am Soc Nephrol 2024; 19:784-790. [PMID: 38190178 PMCID: PMC11168815 DOI: 10.2215/cjn.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. However, it can be associated with unexpected interruptions to or discontinuation of therapy. Timely diagnosis and resolution are required to minimize preventable modality change to hemodialysis. This review covers mechanical complications, including leaks, PD hydrothorax, hernias, dialysate flow problems, PD-related pain, and changes in respiratory mechanics. Most mechanical complications occur early, either as a result of PD catheter insertion or the introduction of dialysate and consequent increased intra-abdominal pressure. Late mechanical complications can also occur and may require different treatment.
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Affiliation(s)
- Xin Bo Justin Cheng
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
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Ria P, Garritano S, Martella V, De Pascalis A, Zito A, Napoli M, Spampinato M, D’Ugo S. Preservation of Peritoneal Dialysis in Liver Surgery with Robotic Technique: A Case Report. Case Rep Nephrol Dial 2024; 14:15-19. [PMID: 38298244 PMCID: PMC10830135 DOI: 10.1159/000536139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction During the last year, the features of peritoneal dialysis patients have changed, and the cases in which there is a need to perform abdominal surgery are growing. Reports of abdominal surgery in patients who are able to continue peritoneal dialysis are increasing. The minimally invasive techniques represent the preferred and safest approach. Such techniques are associated with reduced hospitalization time, less invasiveness, peritoneal integrity preservation, and reduced intra-abdominal inflammation due to regenerative processes. Case Presentation In this case report, we present a case of major abdominal surgery, in the form of hepatic metastasectomy, performed with the robotic-assisted technique, which allowed catheter and intracorporeal dialysis preservation. The patient showed a strong determination to continue with peritoneal dialysis as long as possible. During the switch to hemodialysis, he performed prophylactic antibiotic therapy to preserve the peritoneal catheter, and the patient was instructed to have a reduced water intake, avoiding excessive ultrafiltration potentially deteriorating the residual renal function. Special care was also taken to avoid any nephrotoxic drug. The peritoneal treatment was restarted after 3 weeks with low volume exchange for the first 10 days, and the pre-surgery dialysis volumes were then re-established. After surgery, the patient showed adequate clearance of solutes and ultrafiltration similar to the preoperative period. The patient did not encounter any wound complications. Conclusion Robotic surgery represents a further aid in peritoneal dialysis preservation after abdominal surgery. A detailed communication with the patient before performing this kind of procedure and a strong will to preserve the peritoneal method are essential.
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Affiliation(s)
- Paolo Ria
- Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | - Vilma Martella
- Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio De Pascalis
- Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Anna Zito
- Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy
| | - Marcello Napoli
- Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | - Stefano D’Ugo
- HPB and General Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
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Inoki Y, Nishi K, Osaka K, Kaneda T, Akiyama M, Sato M, Ogura M, Kamei K. Postoperative management and complications after abdominal surgery in children receiving peritoneal dialysis. Pediatr Nephrol 2023; 38:3427-3434. [PMID: 37148341 DOI: 10.1007/s00467-023-06009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Patients on peritoneal dialysis (PD) may develop PD-related complications that necessitate abdominal surgery. However, when to resume PD and how to prescribe PD fluid after surgery in pediatric patients are unknown. METHODS Patients on PD who underwent small-incision abdominal surgery between May 2006 and October 2021 were included in this retrospective observational study. The complications after surgery and characteristics of patients with PD fluid leakage were analyzed. RESULTS Thirty-four patients were included. They underwent 45 surgical procedures, including 23 inguinal hernia repairs, 17 PD catheter repositioning or omentectomy, and 5 others. The median time to resume PD was 1.0 (IQR, 1.0-3.0) days, and the median PD exchange volume at the initiation of PD after surgery was 25 (IQR, 20-30) ml/kg/cycle. PD-related peritonitis occurred in two patients after omentectomy and one after inguinal hernia repair. There was no PD fluid leakage or hernia recurrence among the 22 patients who had a hernia repair. Peritoneal leakage occurred in 3 of the 17 patients who had PD catheter repositioning or an omentectomy and was treated conservatively. No patients who resumed PD 3 days after small-incision abdominal surgery with less than half of PD volume had fluid leakage. CONCLUSIONS Our findings demonstrated that PD could be resumed within 48 h of inguinal hernia repair with no PD fluid leakage or hernia recurrence in pediatric patients. In addition, resuming PD 3 days after a laparoscopic procedure with less than half of the usual dialysate volume might reduce the risk of PD fluid leakage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
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Tangirala S, Devi U, Kumar T, Balakrishnan U, Amboiram P. Clinical Profile, Outcomes, and Complications in Neonates Undergoing Peritoneal Dialysis in a Tertiary Neonatal Care Unit - An Observational Study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:337-342. [PMID: 37417188 DOI: 10.4103/1319-2442.379034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Peritoneal dialysis (PD) is the most common form of renal replacement therapy in neonates and there is a lot of heterogeneity in patient selection and outcomes across the various units. This study aimed to assess the indications, complications, and outcomes in terms of survival of PD. This is a retrospective study of 23 neonates who underwent acute PD at a tertiary care neonatal unit between August 2016 and July 2021. A cross-sectional poll was also conducted among the doctors who have been in the unit for the past 10 years regarding their experience in PD. The baseline, clinical, biochemical parameters, outcomes, and complications were analyzed. All statistical analyses were performed using the IBM SPSS Statistics version 23.0 software. The mean (±standard deviation) gestational age and birth weights of neonates were 32.6 ± 4 weeks and 1743 ± 922 g, respectively. Six (26%) babies had extremely low birth weight, five (22%) very low birth weight (VLBW), and seven (30%) low birth weight. The indications were acute kidney injury [17/23 (74%)], fluid overload [3/23 (17%)], suspected inborn errors of metabolism [2/23 (9%)] and hypernatremia [1/23 (4%)]. A pigtail catheter (74%) was used in most of them. Catheter block was noticed in four babies and peritonitis in two neonates. We did not encounter any complications during the procedure, and PD appears to be practicable across all gestational ages and birth weights.
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Affiliation(s)
- Susmitha Tangirala
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Usha Devi
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Thinesh Kumar
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Lew SQ, Khan AA, Rieders B, Agrawal ST. Haemoperitoneum after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of a pancreatic lesion in a peritoneal dialysis patient. BMJ Case Rep 2020; 13:13/11/e236573. [PMID: 33148597 DOI: 10.1136/bcr-2020-236573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Haemoperitoneum was observed in a peritoneal dialysis (PD) patient after undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-FNA was performed to evaluate a pancreatic cyst seen on a prekidney transplant evaluation abdominal CT scan. Haemoperitoneum cleared with a PD exchange. In this case report, we discuss aetiologies for bleeding risks in patients with chronic kidney disease and focus on haemoperitoneum in patients receiving PD. We will also explore treatment options to minimise bleeding associated with an abdominal procedure such as EUS-FNA.
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Affiliation(s)
- Susie Q Lew
- Medicine, George Washington University, Washington, District of Columbia, USA
| | - Ali A Khan
- Medicine, George Washington University, Washington, District of Columbia, USA
| | - Brandon Rieders
- Medicine, George Washington University, Washington, District of Columbia, USA
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Laparoscopic proctectomy for rectal cancer in an automated peritoneal dialysis patient: A case report. Int J Surg Case Rep 2020; 74:19-22. [PMID: 32771935 PMCID: PMC7415625 DOI: 10.1016/j.ijscr.2020.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022] Open
Abstract
This is the first case report of laparoscopic proctectomy in a patient on peritoneal dialysis (PD). It may be safe for PD patients to continue to maintain PD after laparoscopic rectum resection without the need for temporary hemodialysis transition. The patient’s surgical wound healed well and renal function recovered to the same as before. The peritoneal dialysis adjustment program is beneficial to patient. This case report reflects the treatment of patients in multiple disciplines together, and reflects the advantages of the multidisciplinary diagnosis and treatment model.
Introduction There is little evidence to support the safety of peritoneal dialysis (PD) in restarting immediately after abdominal surgery. It is also unclear whether early recovery of PD in minimally invasive abdominal surgery reduces the risk of complications. This is the first case report of laparoscopic proctectomy in a patient on PD. Presentation of case A 66-year-old female patient with end-stage renal disease underwent daily automated peritoneal dialysis. Colonoscopy in the patient suggested rectal cancer. After laparoscopic rectum resection, restart PD on post-operative day 2. Two weeks after the operation, the patient's surgical wound healed well and renal function recovered to the same as before, and the original PD plan was maintained without obvious discomfort. Discussion Multiple other case reports have shown that PD has been safely resumed after various operations. However, PD patients undergoing abdominal surgery may cause serious complications. Maybe the peritoneal dialysis restores immediately after surgery should consider some conditions. Conclusion We think that it may be safe for PD patients to continue to maintain PD after laparoscopic rectum resection without the need for temporary hemodialysis transition. More cases will be collected in the future to consolidate this conclusion and provide reference for the diagnosis and treatment of similar cases in the future.
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Ahmad M, Wallace EL, Jain G. Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success? ACTA ACUST UNITED AC 2020; 1:569-579. [DOI: 10.34067/kid.0000662019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.
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Abstract
Patients receiving peritoneal dialysis (PD) encounter an increased risk for infection, bleeding, and PD fluid leakage after abdominal surgery. These complications may affect the future use of PD. Appropriate patient preparation may mitigate complications. Certain complications or procedures allow patients to remain on PD while others require transition to hemodialysis. We review the etiology and management of infection, bleeding, and PD fluid leakage associated with abdominal surgery as well as the relationship of specific abdominal procedures to continuing PD.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
| | - Ashté Collins
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
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Lew SQ, Khan AA, Rieders B, Agrawal ST. Successful use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on a pancreatic lesion in a peritoneal dialysis patient without interrupting treatment. Perit Dial Int 2020; 40:230-232. [PMID: 32063184 DOI: 10.1177/0896860819893579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), a well-established minimally invasive gastrointestinal procedure, has been used to diagnose and stage cancers of the pancreas. We describe the successful use of EUS-FNA in a peritoneal dialysis (PD) patient to evaluate a pancreatic cyst. The patient continued on PD immediately after the procedure without using hemodialysis. The patient did not experience any complication such as infection, bleeding, or peritoneal fluid leakage.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, George Washington University, DC, USA
| | - Ali A Khan
- Department of Medicine, George Washington University, DC, USA
| | - Brandon Rieders
- Division of Gastroenterology, George Washington University, DC, USA
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Silverstein WK, Teshima C, Jolly S, Perl J. Don't Interrupt! A Case Report of Continuing Peritoneal Dialysis After Endoscopic Gastric Tumor Resection. Can J Kidney Health Dis 2019; 6:2054358119887147. [PMID: 31723433 PMCID: PMC6836299 DOI: 10.1177/2054358119887147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/27/2019] [Indexed: 01/13/2023] Open
Abstract
Rationale: The evidence supporting the safety of restarting peritoneal dialysis (PD) immediately after abdominal surgery and interventions is scant. In particular, there are no reported cases characterizing periprocedural management of PD for patients undergoing endoscopic submucosal dissection for gastric intramucosal tumor removal. Presenting concerns of the patient: A 66-year-old female with end-stage kidney disease secondary to diabetic nephropathy, currently on nocturnal automatic PD, presented with new iron-deficiency anemia. Workup revealed an intramucosal gastric lesion proximal to the pylorus, without surrounding lymph node involvement. Endoscopic submucosal dissection was performed with en bloc endoscopic resection of a 5-cm, partially flat, partially sessile mass along the posterior wall and lesser curvature of the gastric antrum. Pathology revealed low-grade dysplasia without features of malignancy. There was no evidence of hemorrhage or leak post-dissection. Diagnoses: The clinical presentation was consistent with an uncomplicated endoscopic submucosal dissection. Interventions: Peritoneal dialysis was held for 48 hours and restarted thereafter with no complications. The patient did not require bridging with hemodialysis. Outcomes: The patient had an uncomplicated post-endoscopic course, with no subsequent episodes of PD-associated peritonitis after at least 6-month follow-up. Novel finding: This is the first reported case of PD reinitiation after endoscopic submucosal dissection of a gastric tumor.
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Affiliation(s)
| | - Christopher Teshima
- Department of Medicine, University of Toronto, ON, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, ON, Canada
| | - Simran Jolly
- Clinical Research Solutions, Miamisburg, OH, USA
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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