Hernias: A Frequent Complication in Children Treated With Continuous Peritoneal Dialysis

Lilien, Tassilo von; Salusky, Isidro B.; Yap, Hui-Kim; Fonkalsrud, Eric W.; Fine, Richard Ν.

doi:10.1016/s0272-6386(87)80101-4

Cited by 36 publications

(5 citation statements)

References 30 publications

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“…Abdominal wall hernias are common in children on CPD, occurring in 22-40% of paediatric patients [10,11]. However, only one patient (3.3%) developed hernia after initiation of CAPD in our patients.…”

Section: Discussionmentioning

confidence: 63%

Continuous peritoneal dialysis in children: a single-centre experience in a developing country

et al. 2005

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Continuous peritoneal dialysis (CPD) is the most commonly used modality of dialysis in children. Continuous ambulatory peritoneal dialysis (CAPD) has been an established form of therapy in adult patients with end-stage renal failure in India for more than a decade. There is a paucity of published experience of CPD in children from developing countries. We retrospectively studied children with end-stage renal failure (ESRD) that had been on CAPD over the past 10 years. Thirty patients with ESRD, mean age 13+/-8 years (range 5-21 years), male 18, were started on CAPD from 1994 to October 2004. The mean break-in period was 12+/-3 days. Of these 30 patients, 15 had a total of 21 episodes of peritonitis. The peritonitis rate was 0.58 episodes per patient year. E. coli was the commonest organism causing peritonitis. On outcome analysis, 7/30 (23.3%) patients received a renal transplant, while 11/30 (36.6%) continued on CAPD, awaiting a kidney transplant. Of the rest, eight (26.6%) patients died, two (6.7%) suffered technique failure and were changed to haemodialysis, and two (6.7%) were lost to follow-up after 2 months. The mean cumulative survival time of patient on CPD was 42 months. We conclude that CPD is a viable option for dialysis in ESRD children in a developing country and is a successful bridge between ESRD and renal transplantation.

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Section: Discussionmentioning

confidence: 63%

Continuous peritoneal dialysis in children: a single-centre experience in a developing country

et al. 2005

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“…The mean instilled volume for the test of our patients (children and adults) was almost 1,200 ml/m 2 and they did not have any change in their usual instilled volume per exchange in 2 months preceding the measurement of IPP, but it was significantly greater in adults than in children (P=0.001). However; hernias are more frequent in children than adults on CAPD [20][21][22][23][24][25]. The development of hernia is not only related to the IPP, but also depends on other risk factors, such as metabolic changes and anatomical weak sites in the abdominal wall [13,27].…”

Section: Discussionmentioning

confidence: 99%

“…Hernias are more frequent in children than adults on PD. The incidence ranged from 2.0% to 31.4% in adults [20][21][22] and from 11.8% to 40% in pediatric patients [23,24,25], and was lower with intermittent PD (only supine position) than with CAPD (supine plus upright positions) [13]. Patients with hernias may develop pain, peritonitis due to incarcerated bowel, intestinal obstruction, and strangulation [3,22].…”

Section: Introductionmentioning

confidence: 99%

Intraperitoneal pressure and hernias in children on peritoneal dialysis

Aranda¹,

Romão²,

E³

et al. 2000

Pediatric Nephrology

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Abdominal wall hernias have been increasingly recognized in patients on continuous ambulatory peritoneal dialysis (CAPD). They are also more frequent in children than in adults. The aim of this study was to determine the influence of intraperitoneal pressure (IPP) on the development of hernias in children on CAPD, and if there was a difference between IPP in children and adults. We studied 14 children aged 11.2 +/- 3.2 years, body weight 31.1 +/- 9.4 kg, who had undergone CAPD for 16.2 +/- 14.4 months. Also, 10 adults were studied, aged 48 +/- 18 years, body weight 62.4 +/- 13.9 kg, on the CAPD program for 35 +/- 27 months. The IPP was measured via a column of dialysate in the peritoneal dialysis line, immediately before the drainage of the peritoneal cavity. The pressure was measured with the patients in the supine position, at the level of the umbilical cicatrix with the zero point located on the mean axillary line. IPP was measured at inspiration and at expiration, and the mean of these two measurements was calculated. The children were divided in two groups: group 1 (n = 7) without hernias and group 2 (n = 7) with hernias (5 umbilical and 2 inguinal). The IPP of all children was 9.5 +/- 2.9 cm H2O. The IPP was 8.1 +/- 2.6 and 10.9 +/- 2.6 cm H2O in groups 1 and 2, respectively (P = 0.003). The instilled volume for test was similar in both groups. The IPP of the adults was 13.8 +/- 2.8 cm H2O, which was significantly greater than that of the children (P = 0.001). In conclusion, hernia is a common complication in children on CAPD and its prevalence is affected by IPP. Other associated factors may be the presence of anatomically weak sites in the abdominal wall of the children, since IPP is lower in children than in adults.

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“…In order to obtain the necessary peritoneal clearances of small solutes, larger dialysate fill volumes are recommended in underdialyzed patients (3). We could expect that, with increasing peritoneal exchange volumes, the risk of abdominal wall complications, such as hernias and leaks, would be higher; however, most reports (4-7) have found no correlation between hernia development and dialysate fill volume.…”

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confidence: 97%

Risk Factors for Abdominal Wall Complications in Peritoneal Dialysis Patients

et al. 2003

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← 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.

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Hernias: A Frequent Complication in Children Treated With Continuous Peritoneal Dialysis

Cited by 36 publications

References 30 publications

Continuous peritoneal dialysis in children: a single-centre experience in a developing country

Continuous peritoneal dialysis in children: a single-centre experience in a developing country

Intraperitoneal pressure and hernias in children on peritoneal dialysis

Risk Factors for Abdominal Wall Complications in Peritoneal Dialysis Patients

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