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Peritoneal dialysis and its complications

November 22, 2021

The number of patients suffering from chronic kidney disease or loss of kidney function is increasing worldwide and with it the number of people who need renal replacement therapy. One of the major tasks of the kidneys is the filtering of the metabolite from the blood. If the kidneys are no longer able to perform this task, the blood has to be cleansed and drained artificially by way of dialysis (blood washing). Some patients choose the flexible method of dialysis called peritoneal dialysis (PD), which uses the membrane of the peritoneum as a filter. The advantage of peritoneal dialysis is that it can be performed independently at home, which improves the quality of life. In addition, this vascular-sparing form of removing excess water and dissolved urinary substances can often better preserve any remaining kidney function. The solution used during PD is a mixture of dextrose (sugar), salt, and other minerals dissolved in water, called dialysis solution, which is placed in a person’s abdominal cavity through a catheter. 

Peritoneal Dialysis related infections, including peritonitis, exit‐site infections (ESI), and tunnel infections, are important complications, resulting in significant morbidity and risk of death. 

Early complications related to peritoneal access are divided into mechanical (bleeding, visceral perforation, dialysate leaks, catheter dysfunction, hernia formation, cuff extrusion) and infectious (early peritonitis, surgical wound, tunnel and exit site infections).

The most frequent and important complication of peritoneal dialysis (PD) catheters is an infection called:

  • Peritonitis, an infection of the lining of the abdominal cavity (peritoneum). This infection can also develop at the site where the tube (catheter) is inserted to carry the cleansing fluid into and out of your abdomen.
  • Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the dialysates might cause you to take in hundreds of extra calories daily, leading to weight gain. The extra calories can also cause high blood sugar, especially if you have diabetes.
  • Holding fluid in your abdomen for long periods may strain your muscles.
  • Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.

To prevent complications of peritoneal dialysis there are protocols in place to decrease the infection risk in PD patients. These include proper catheter placement, exit-site care including Staphylococcus aureus prophylaxis, careful training of patients with periodic re-training, prevention of contamination, and prevention of procedure-related and fungal peritonitis.

Author
Suzanne Naeem

Review
Dr. Umair Haider

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