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Risk factors for abdominal wall complications in peritoneal dialysis patients
Gloria Del Peso1, María Auxiliadora Bajo, Olga Costero
1Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain. gpeso@hulp.insalud.es
Insights
Peritoneal dialysis (PD) patients frequently experience hernias and peritoneal leaks. Advanced age, polycystic kidney disease, and high BMI are key risk factors, suggesting automated PD with lower fill volumes for at-risk individuals.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Complications
Background:
- Patients undergoing peritoneal dialysis (PD) face elevated intra-abdominal pressure.
- This pressure increases the likelihood of abdominal wall complications.
Purpose of the Study:
- To determine the incidence of hernias and peritoneal leaks in PD patients.
- To identify potential risk factors associated with these complications.
Main Methods:
- A study of 142 unselected PD patients over five years.
- Analysis included patient demographics, PD modalities (CAPD, APD), and complication rates.
- Follow-up averaged 39 months.
Main Results:
- 37% of patients developed hernias and/or leaks, with rates of 0.08 hernias/patient/year and 0.13 leaks/patient/year.
- Continuous ambulatory PD (CAPD) was associated with higher complication rates compared to automated PD (APD).
- Risk factors identified include advanced age, polycystic kidney disease, and high body mass index.
Conclusions:
- Abdominal hernias and peritoneal leaks are common in PD patients.
- Age, polycystic kidney disease, and high BMI are significant risk factors.
- Consider automated PD with reduced daytime fill volumes for high-risk patients.
Background:
Patients treated with peritoneal dialysis (PD) have increased intra-abdominal pressure and a high prevalence of abdominal wall complications.
Objective:
The purpose of this study was to determine the incidence of hernias and peritoneal leaks in our PD patients and to investigate their potential risk factors.
Patients:
We studied 142 unselected patients treated with PD during the past 5 years, including those that were already on PD and those that started PD during this period. Mean age was 54 years and mean follow-up on PD was 39 months. 72 patients had been treated with only continuous ambulatory PD (CAPD), 8 with automated PD (APD), and 62 with both modalities.
Results:
53 patients (37%) developed hernia and/or leak. A total of 39 hernias and 63 leaks were registered. The overall rates were 0.08 hernias/patient/year and 0.13 leaks/patient/year. 17 patients had both abdominal complications. Hernia was most frequently located in the umbilical region, and the most frequent site of leakage was the pericatheter area. Both complications appeared more frequently during the CAPD period (87% of hernias, 81% of leaks). The rate of hernias was higher in patients treated only with CAPD than in those that used only cyclers [0.08 vs 0.01 hernias/patient/year, not significant (NS)]. No patient treated only with APD had peritoneal leak; 25% (18/72) of patients treated with CAPD developed this complication (p = 0.18, NS). Dialysate exchange volumes ranged from 2000 to 2800 mL. 25 (66%) patients required surgical repair of the hernia, with recurrence in 7 patients (28%). 27 (84%) patients with leaks were initially treated with transitory temporary transfer to hemodialysis, low volume APD, or intermittent PD for 4 weeks. The leak recurred in half of the cases and surgical repair was necessary in 12 cases. The development of hernia and/or leak did not correlate with gender, diabetes, duration of follow-up, type of PD, history of abdominal surgery, or with the largest peritoneal exchange volume used. Polycystic kidney disease was the only factor associated with higher rate of hernias (p = 0.005), whereas increased age (p = 0.04) and higher body mass index (p = 0.03) were significantly associated with the appearance of leaks.
Conclusion:
Abdominal hernias and peritoneal leaks are very frequent in the PD population. Advanced age, polycystic kidney disease, and high body mass index are independent risk factors for their development. Automated PD with low daytime fill volume should be considered in all patients at risk for hernias and/or leaks.