Noninfectious Complications Of Peritoneal Dialysis Research Articles

Peritoneal dialysis related non-infectious complications: Asingle-center experience over 20 years.

Non-infectious complications of peritoneal dialysis (NICPD) are common and could be an important cause of technical failure, especially in the early period of peritoneal dialysis (PD) initiation. NICPD are also center- and provider-dependent. This study aimed to investigate the frequency, etiology, and associated outcomes of NICPD in a single center over a period of 20 years. Data were retrospectively collected in 262 patients who were initiated on PD between April 2001 and April 2021. Inclusion criteria were age 18 years or older and a minimum follow-up period of 3 months. Patients were grouped according to the reason of NICPD: catheter-related, increased intra-abdominal pressure-related, metabolic, and other complications. There were 142 females and 120 males in the study, with a mean age of 44±16.9 years. The mean time on PD was 52.6±40 months. During the follow-up period, 185 (71%) patients experienced 382 NICPD episodes. 26 patients (9.9%) were switched to maintenance hemodialysis (HD) due to NICPD. Outflow failure was the most common NICPD (n=97). It was also the most common reason for catheter revision (n=23) and PD discontinuation (n=12). Catheter intervention was required in 32 patients (12.2%). Prior HD treatment and male gender were independent risk factors for NICPD and catheter-related complications (OR 2.076; p=0.037; OR: 1.797, p=0.042, respectively). Early-start PD was associated with a lower risk for NICPD development (OR: 0.393, p=0.013). In this select cohort of PD patients, we found that NICPD are common and outflow failure is the most common cause of NICPD. NICPD are associated with major complications requiring catheter removal or transfer to in-center HD. Early recognition and appropriate management of NICPD are essential to prolonging time on PD in end-stage renal disease patients.

Non-infectious complications of peritoneal dialysis and peritoneal scintigraphy

Peritoneal dialysis (PD) is an alternative to hemodialysis that is indicated in patients with chronic end-stage disease. It has many advantages, but also complications such as dialysate leaks around the catheter insertion site, in the abdominal wall or in the pleural cavity, inguinoscrotal hernia and even intra-abdominal fluid collection.
 Peritoneal scintigraphy is a simple, non-invasive, low-irradiation examination, without the risk of allergy, that allows both diagnosing and locating these complications because it allows acquiring images at the time of infusion, as well as remotely and after drainage of the dialysate. Tomoscintigraphy coupled with scanner SPECT / CT (Single Photon Emission Computed Tomography / Computed Tomography) can also help narrow the diagnosis.
 The objective of this article is to clarify the value of peritoneal scintigraphy in the diagnosis of non-infectious complications of peritoneal dialysis, the conditions for performing the examination and the potential indications, as illustrated by a few cases.

Infectious and Non-infectious Complications of Peritoneal Dialysis in Children

Despite the many advantages of peritoneal dialysis (PD) in children with endstage renal disease, there exist redoubtable complications of PD that should be overcome. To prevent and manage these complications, a multidisciplinary team should provide support highly tailored for each child and family, based on the standardized practice guidelines for the management of pediatric PD. In this review, we summarize the clinical manifestations and management of several complications of PD. Key words: Peritoneal dialysis; End-stage renal disease; Complication

Evaluation of non-infectious complications of peritoneal dialysis in children: a multicenter study.

Peritoneal dialysis (PD) is the most common kidney replacement therapy in children. Complications associated with PD affect treatment success and sustainability. The aim of this study was to investigate the frequency of PD-related non-infectious complications and the predisposing factors. Retrospective data from 11 centers in Turkey between 1998 and 2018 was collected. Non-infectious complications of peritoneal dialysis (NICPD), except metabolic ones, in pediatric patients with regular follow-up of at least 3months were evaluated. A total of 275 patients were included. The median age at onset of PD and median duration of PD were 9.1 (IQR, 2.5-13.2) and 7.6 (IQR, 2.8-11.9) years, respectively. A total of 159 (57.8%) patients encountered 302 NICPD within the observation period of 862 patient-years. The most common NIPCD was catheter dysfunction (n = 71, 23.5%). At least one catheter revision was performed in 77 patients (28.0%). Longer PD duration and presence of swan neck tunnel were associated with the development of NICPD (OR 1.191; 95% CI 1.079-1.315, p = 0.001 and OR 1.580; 95% CI 0.660-0.883, p = 0.048, respectively). Peritoneal dialysis was discontinued in 145 patients; 46 of whom (16.7%) switched to hemodialysis. The frequency of patients who were transferred to hemodialysis due to NICPD was 15.2%. Peritoneal dialysis-related non-infectious complications may lead to discontinuation of therapy. Presence of swan neck tunnel and long duration of PD increased the rate of NICPD. Careful monitoring of patients is necessary to ensure that PD treatment can be maintained safely.

Non-Infectious Complications of Peritoneal Dialysis in Senegal

Introduction: Senegal has pioneered the implementation of peritoneal dialysis (PD) in West Africa, practicing it since 2004. Non-infectious complications are a significant cause of failure of this technique and the transfer of patients to haemodialysis. The aim of this study was to determine the prevalence and the different types of non-infectious complications in our context. Patients and Methods: This was a 5-year, descriptive, retrospective study of patients on chronic peritoneal dialysis for more than 3 months. Results: During the study period, 75 patients were included. The prevalence of non-infectious complications was 88%, including 45.3% mechanical complications and 76% metabolic complications. Catheter migration was the most common mechanical complication (55.9%), followed by catheter blockage (23.5%). Metabolic complications were dominated by hypoalbuminemia (76.3%). Dyslipidaemia and hypokalaemia affected more than 50% of patients, occurring in 59.3% and 56.9% of cases, respectively. Conclusion: In our study, non-infectious complications related to PD were frequent and varied. They remain a significant cause of technical failure. Mechanical complications are often the cause of permanent transfer to haemodialysis.

Non-infectious complications of peritoneal dialysis in children

The article discusses non-infectious complications of peritoneal dialysis. Attention is focused on the causes of non-infection complications, diagnostics, treatment and prevention. Both common and rather rare complications are described.

Utility of Scintigraphy in Assessment of Noninfectious Complications of Peritoneal Dialysis.

Dialysis is an artificial process to remove waste products and excess water from the body in patients with kidney failure. Two main types of dialysis are available. Hemodialysis, which uses an artificial filtration apparatus, is usually done at specialized centers but can be done in a patient's home. Peritoneal dialysis functions by placing dialysis fluid, also called dialysate, into the peritoneal cavity, allowing for solute to be removed from the peritoneal capillaries through diffusion across a chemical gradient into the dialysate and removal of water through an osmotic gradient created by hypertonic dextrose. Peritoneal dialysis can be either automated, which is done with the help of a machine called a cycler, or continuous ambulatory, which is a process involving multiple exchanges a day and is performed using only gravity to infuse and drain the solution from the peritoneal cavity. For many reasons, the number of people using home dialysis has recently started to rise, with the largest increase in the United States occurring after the implementation of the prospective bundled payment system for end-stage renal disease. With the increased use of home dialysis, potential complications will increase as well. It is imperative that our health-care system be poised not only to increase the number of home dialysis patients but also to diagnose and manage any complications. Nuclear imaging is a commonly available modality to detect various complications related to peritoneal dialysis. In this review article, we discuss the role of peritoneal scintigraphy in detecting some noninfectious peritoneal dialysis complications, with emphasis on scintigraphy technique; imaging time points; the role of planar, SPECT, and SPECT/CT imaging; and the clinical indications, with illustrative case examples.

A Rare Case of Unilateral Pleural Effusion in a Pediatric Patient on Chronic Peritoneal Dialysis: Is it a Pleuroperitoneal Leakage?

Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year- old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula. Key words: Peritoneal dialysis; Pleuroperitoneal communication; Peritoneography; Pleural effusion; PD catheter

Noninfectious Complications of Peritoneal Dialysis in Korean Children: A 26-Year Single-Center Study.

PurposeThe aim of this study was to investigate noninfectious complications of peritoneal dialysis (PD), including mechanical and metabolic complications, at a single center in Korea.Materials and MethodsWe analyzed data from 60 PD patients aged ≤18 years (40 boys and 20 girls) during the period between 1986 and 2012. The collected data included gender, age, causes of PD, incidence of noninfectious complications, and treatment for the complications.ResultsThe mean duration of PD therapy was 28.7±42.1 months (range 1-240 months). The most common cause of end-stage renal disease was glomerular disease (43.3%). There were no statistically significant differences between patients with and without mechanical complications regarding gender, age at the start of PD, and total duration of PD. Outflow failure was the most common catheter-related complication (14.3%), followed by leakage (10.0%) and hernia (8.6%). Metabolic complications, such as hyperglycemia and hypokalemia, were observed in three of 16 patients. The frequency of noninfectious complications of PD in our study was comparable with those in previous pediatric studies. PD was switched to hemodialysis (HD) in only three patients.ConclusionOur results indicate that noninfectious complications of PD are common, though they hardly lead to catheter removal or HD in pediatric patients on PD.

Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience

The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients.

Diagnostic value of CT peritoneography for non-infectious complications of peritoneal dialysis

To assess the diagnostic value of CT peritoneography for peritoneal complications of continuous ambulatory peritoneal dialysis (CAPD). CT peritoneography in 11 CAPD patients with clinically suspected dialysis-related complications was prospectively studied. The CAPD patients were all treated in Renji Hospital from 2005 to 2007. CT images were reviewed according to the evidence of peritoneal leaks, hernias, loculate pleural fluid collections, and adhesions. Abnormal findings were found in 9 of 11 CAPD cases including inguinal hernias (3 cases), umbilical hernia (1 case), hydrocele (1 case), leaks in catheter tunnel (2 cases), and peritoneal adhesions (2 cases). Parts of them were confirmed by surgical operation. CT peritoneography is useful for the evaluation of complications related to CAPD, and it offers excellent tissue contrast and multiplanar imaging for assessment of the complications.

Noninfectious Complications of Peritoneal Dialysis

Noninfectious complications of peritoneal dialysis (PD) are increasing in relative importance due to success in decreasing the rate of PD peritonitis. Mechanical catheter complications are emerging as an important cause of technique failure at the same time as experience with PD is declining in North America. There is also increasing interest in metabolic complications of PD and in glucose-sparing strategies to reduce the risk for hyperglycemia, hyperinsulinemia, and hyperleptinemia. This clinical commentary focuses on these noninfectious complications of PD.