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Complications of Peritoneal Dialysis

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Core Concepts in Dialysis and Continuous Therapies

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Abstract

Peritoneal dialysis (PD) represents the most common form of home-based dialysis treatment for end-stage kidney failure (ESKF) and accounts for approximately 11 % of globally performed dialysis. Compared with haemodialysis (HD), PD confers a number of significant clinical advantages, including possibly superior survival in the first few years improved preservation of residual kidney function, delayed need for HD vascular access (and particularly high-risk CVC catheters); reduced risk of hepatitis virus infection transmission, better subsequent early renal transplant outcomes, reduced blood transfusion requirements and enhanced suitability for implementing incremental dialysis and lower costs Despite these advantages, a major limitation of PD in many (though not all) countries is relatively short median technique survival rates of 2–3 years. Infectious and noninfectious complications account for majority of such instances of technique failure, such that early identification and effective management of these complications is paramount to optimal patient recruitment and retention for this important renal replacement therapy.

This chapter will review the antecedent risk factors, diagnosis, management and prevention of PD infectious complications, including exit-site infection, tunnel infection and peritonitis. It will also review the noninfectious complications of PD, including drainage dysfunction, inflow pain, pericatheter and other forms of PD fluid leakage, haemoperitoneum, abdominal wall herniation and intestinal perforation. Finally, encapsulating peritoneal sclerosis, which can be triggered by infection or bioincompatible dialysis fluids, will also be examined.

The principal objective of this chapter is to provide an overview of best management practice for PD complications with reference to the International Society of Peritoneal Dialysis (ISPD) guidelines and other bodies of evidence. Although the general principles could be applied to paediatric patients, the evidence outlined below focuses primarily on PD-related complications in adult patients.

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Authors and Affiliations

  1. Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Alice Kennard MBBS (Hons), BSc, David W. Johnson MBBS (Hons), PhD, DMed, (Res) & Carmel M. Hawley MBBS (Hons), MMed, Stat

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  1. Alice Kennard MBBS (Hons), BSc
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  2. David W. Johnson MBBS (Hons), PhD, DMed, (Res)
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  3. Carmel M. Hawley MBBS (Hons), MMed, Stat
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Correspondence to David W. Johnson MBBS (Hons), PhD, DMed, (Res) .

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Editors and Affiliations

  1. Department of Nephrology, Beaumont Hospital, Dublin, Dublin, Ireland

    Colm C. Magee

  2. Department of Medicine/Renal Division, Brigham and Women's Hospital, BOSTON, Massachusetts, USA

    J. Kevin Tucker

  3. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

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Kennard, A., Johnson, D., Hawley, C. (2016). Complications of Peritoneal Dialysis. In: Magee, C., Tucker, J., Singh, A. (eds) Core Concepts in Dialysis and Continuous Therapies. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7657-4_10

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