Intraperitoneal pressure and hernias in children on peritoneal dialysis

Abstract

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.

The Risk Factors and the Impact of Hernia Development on Technique Survival in Peritoneal Dialysis Patients: A Population-Based Cohort Study

“…Although Dejardin et al demonstrated a positive correlation between higher body mass index, larger dialysate volume and higher IPP (10), an association between the level of IPP and the risk of hernia in PD patients is still controversial. An increased IPP has been shown to correlate with the development of hernias in PD patients (9,17), yet other studies have not reported a correlation between IPP, dialysate volume and the risk of hernia formation (2,3,7,10). In our study, after the logistic regression analysis, a larger maximal dialysate volume was not significantly related to the risk of hernia formation, which further supports the idea that increased IPP alone may not increase the risk of hernia formation.…”

Peritoneal dialysis and infants: further insights into a complicated relationship

“…However, infants with limited abdominal wall, particularly if hypoproteinemic, are at risk of distal cuff extrusion [14], with a subsequent higher risk of leakage, exit site infection, and eventually peritonitis. This risk can be reduced by delaying dialysis onset to 2-3 weeks after implantation and by monitoring intraperitoneal pressure [15,16]. Concerns also exist that a downward exit site may be a risk factor for infections in small children using diapers.…”

Peritoneal dialysis in infants

“…They can be avoided by delaying the onset of dialysis to 2-3 weeks after implantation and by IPP monitoring [56][57][58].…”