Chronic Peritoneal Dialysis: Mechanical and Infectious Complications

Abstract

The present report summarizes the mechanical and infectious complications attributable to the devices and procedures used for chronic peritoneal dialysis (PD), comparing the type and frequency of such complications in contemporaneous groups of patients undergoing continuous ambulatory PD (CAPD) or intermittent PD (IPD). Mechanical complications related directly to the catheter and its placement proved to be equally frequent during CAPD and IPD. On the other hand, mechanical complications related to increased intraperitoneal pressure were more frequent during CAPD. In most instances mechanical complication can be managed without permanent interruption of chronic PD. Peritonitis occurs more frequently during CAPD (1.6 episodes per patient-year) than during IPD (0.4 episodes per patient-year), with a tendency to more frequent peritonitis among diabetics, children, patients with white blood cell abnormalities, patients with catheter cuff or tunnel inflammation, and during the 1st month of treatment. Medical therapy eradicates peritonitis and allows continuation of chronic PD with retention of the catheter in more than 90% of episodes, although special problems may be encountered with fungal, pseudomonal, and some coagulase-positive staphylococcal infections.

Microbiological aspects of peritonitis associated with continuous ambulatory peritoneal dialysis

“…More than half of all peritonitis episodes are observed in only 25% of all patients on CAPD (109,134). Approximately 60% of patients on CAPD will have developed at least one episode of peritonitis during the first year of dialysis (97,134).…”

“…Approximately 60% of patients on CAPD will have developed at least one episode of peritonitis during the first year of dialysis (97,134). The mean and median intervals are not significantly different between episodes (115), and, with the possible exception of corynebacteria (1,74,94,107), bacteria (but not fungi) do not show any preference for any episode (131,136).…”

“…The mean and median intervals are not significantly different between episodes (115), and, with the possible exception of corynebacteria (1,74,94,107), bacteria (but not fungi) do not show any preference for any episode (131,136). Multiple episodes are observed in more than 50% of all patients who have gone through one episode (47,115,134); in one series, two-thirds of the episodes were relapses, i.e., infections with the same microorganisms (47). Exit site infections have occurred at a mean rate of 0.7 per patient per year (83); this value, of course, would increase with an increased incidence of peritonitis caused by S. aureus and P. aeruginosa, the main agents of exit site infections.…”

A single-center experience on percutaneously performed partial omentectomy in pediatric peritoneal dialysis patients

“…Laparoscopic and open surgical omentectomy techniques are widely used methods. 11,13,15,16 To our knowledge, this is the first report to describe percutaneously performed partial omentectomy in pediatric PD patients. In our opinion, percutaneous omentectomy, when a catheter enveloped by omentum is identified at the time of catheter replacement, is a minimally invasive means of salvaging non-functioning PD catheters.…”

“…Catheter failure has been reported to occur in as many as 21-42% of children undergoing peritoneal catheter placement. 3,6,8,12,13 In these studies, surgical placement was the main technique. 3,[8][9][10][11] On contrary, ours is a study of percutaneously-placed PD catheters.…”