Peritoneal Dialysis Complications

Complications
1. Peritonitis and Catheter-Related Infections: Peritonitis is thought to occur most often by touch contamination, but may also occur in the setting of a catheter exit site or tunnel infection. Patients with peritonitis usually present with cloudy peritoneal fluid and abdominal pain. Infections due to gram-positive cocci (Staphylococcus epidermidis and Staphylococcus aureus) tend to be most common (60–70% episodes) compared to infections with gram-negative bacteria (15–25%) or fungi (2–3%). Treatment should be continued for a total of 2 weeks, while more severe infections due to S aureus, pseudomonas, or multiple gram-negative organisms should be treated for 3 weeks. Patients should be taught to perform routine exitsite care in order to prevent catheter infections. Daily cleansing with antibacterial soap and water is recommended by most centers. The daily application of mupirocin or gentamicin cream to the exit site has been shown to be effective in reducing catheter infections and related peritonitis.

2. Mechanical Complications such as hernia, scrotal or labial edema.

3. Encapsulating Peritoneal Sclerosis: a rare but serious condition characterized by extensive intraperitoneal fibrosis and encasement of bowel loops.

4. Ultrafiltration Failure

5. Metabolic Complications

Indications for peritoneal dialysis catheter removal:
1. Refractory peritonitis: failure to respond to appropriate antibiotics within 5 days

2. Fungal peritonitis

3. Relapsing peritonitis

4. Peritonitis in the setting of severe exit site or tunnel infection

5. Peritonitis due to multiple enteric organisms in the setting of a surgical abdomen

Dietary modifications:
A protein intake of at least 1.2 g/kg is recommended for PD patients.

National Kidney Foundation has great handbook. To view please Click Here
For information on nutrition and peritoneal dialysis please Click Here

Ardavan Mashhadian D.O.
Nephrologist
1400 S Grand Ave Suite 615, Los Angeles, CA 90015
(213) 537-0328

Types of Peritoneal Dialysis

Types of Peritoneal Dialysis
1. Continuous Ambulatory Peritoneal Dialysis: In CAPD dialysis solution is constantly present in the abdomen, typically being exchanged four to fives times per day, 7 days per week. The dialysis fluid is exchanged manually by the patient using the force of gravity to drain and fill the abdomen.

2. Automated Peritoneal Dialysis: In APD a cycler machine automatically exchanges fluid into and out of the abdomen for the patient. The cycler draws dialysis solution from larger bags (usually 5 L), which it warms to the desired temperature. The patient usually spends between 8 and 10 hours a night on the cycler, disconnects from the cycler in the morning after a final fill is delivered, and then is free to go about daily activities.

3. Intermittent Peritoneal Dialysis: IPD is a form of PD that is usually performed in a hospital or in a dialysis center. It is usually reserved for patients with acute renal failure or end-stage renal failure and sometimes for patients immediately after catheter placement who are uremic and need more urgent dialysis.

Not all patients' peritoneal membranes transport solute at the same rate. In clinical practice, a patient's peritoneal membrane transport characteristics can be determined by measuring the creatinine equilibration curve and the glucose absorption curve during a standardized peritoneal equilibration test (PET). Patients are classified principally into one of four transport categories: high, high-average, low-average, and low. High transporters tend to do better on regimens that have frequent, short duration dwells, such as APD, whereas low transporters tend to do better on regimens with longer duration dwells, such as CAPD. Average transporters are generally able to do well on a variety of PD regimens.


National Kidney Foundation has great handbook. To view please Click Here
For information on nutrition and peritoneal dialysis please Click Here

Ardavan Mashhadian D.O.
Nephrologist
1400 S Grand Ave Suite 615, Los Angeles, CA 90015
(213) 537-0328

Peritoneal Dialysis Indications and Contraindications

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Peritoneal dialysis (PD) PD is a form of dialysis in which a dialysis solution is instilled in the peritoneal cavity, periodically drained, and exchanged with fresh solution through a single, indwelling peritoneal catheter. It is a established form of renal replacement therapy that is used around the world. United States Renal Data System (USRDS) data from 1998 to 2002 indicate that the prevalent PD population decreased by 3.5% per year, with only 8% of prevalent dialysis patients being treated with PD in 2002. In contrast to the experience in the United States, the prevalent number of patients with end-stage renal disease receiving PD has exceeded 60% in other countries, such as in Mexico and Hong Kong. The cause for these differences is likely multifactorial and is related to access to PD, physician expertise, patient mix, and reimbursement.

Indications:
1. PD continues to be the preferred dialysis modality for infants and young children

2. Patients with severe hemodynamic instability on hemodialysis

3. Patients with difficult vascular access

Contraindications:
1. The one absolute contraindication to chronic PD is an unsuitable peritoneum due to the presence of extensive adhesions, fibrosis, or malignancy.

2. Abdominal hernias

3. Presence of colostomy, ileostomy, nephrostomy, or ileal conduit

4. Recurrent chronic backache with preexisting disc disease

5. Severe psychological and social problems

6. Severe diverticular disease of the colon

7. Severe neurologic disease, movement disorder, or severe arthritis preventing self care. (caregivers can be trained to perform the peritoneal dialysis)

8. Severe chronic obstructive pulmonary disease

9. Malnutrition

Studies investigating differences in patient mortality between PD and hemodialysis (HD) have been conflicting. Most reports have shown no significant difference in survival between PD and non-diabetic HD patients.



National Kidney Foundation has great handbook. To view please Click Here
For information on nutrition and peritoneal dialysis please Click Here

Ardavan Mashhadian D.O.
Nephrologist
1400 S Grand Ave Suite 615, Los Angeles, CA 90015
(213) 537-0328