The risk of hernia with large exchange volumes

Large exchange volumes of 2.5 and 3 L are frequently necessary to improve clearances to the level suggested by the DOQI guidelines. However, abdominal wall hernias are a well known complication of peritoneal dialysis (PD) related to increased abdominal pressure, and might increase with higher exchange volumes. We studied the effect of using higher exchange volumes in PD patients on the incidence of hernia formation. Seventy-nine (12%) of 656 PD patients over a 15-year span developed abdominal wall hernias. Eleven percent of patients using 2 L or smaller volumes, 15% of patients using more than 2 L but less than 3 L, and 13% of patients using 3 L developed hernias (not significantly different). Five percent of patients on cyclers for their entire PD experience (3 of 63 patients) developed one or more hernias, compared to 13% of patients on continuous ambulatory peritoneal dialysis for at least part of their experience (P = 0.06). The use of larger volumes increased dramatically over time; only 11% of patients used more than 2-L exchange volumes during the years 1982 through 1986, compared to 73% in the period from 1992 to 1997. We conclude that increased volumes in PD patients do not lead to an increased risk of hernia formation. Exchange volumes can be increased as needed to improve clearances.