The Role of Peritoneal Scintigraphy in the Detection of Continuous Ambulatory Peritoneal Dialysis Complications

Abstract

While continuous ambulatory peritoneal dialysis (CAPD) offers several advantages over hemodialysis in patients with end-stage renal disease, several complications have been recognized. The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes the patient to leaks and herniations through defects in the abdominal wall. The use of an intraperitoneal radiolabeled colloid has been previously described to image entities such as hernias, patent processus vaginalis, abdominal wall, and diaphragmatic leakage. This study shows a simple, non-invasive method of determining the site of dialysate leak and its importance to assist further patient management. There has been a continuing increase in the number of end stage renal disease patients maintained on chronic peritoneal dialysis (CPD). Many patients choose CPD as their preferred chronic dialysis treatment, though approximately 20% of patients who drop out transfer to hemodialysis annually.[1] Although peritonitis remains the major reason for transfer to hemodialysis, other factors such as exit site infections, catheter-related problems, abdominal wall and inguinal hernias, loss of ultrafiltrations, and poor clearance contribute to CPD technique failure.[2] In order to permit the continuation of long-term therapy with CPD, these complications should be resolved. Routine laboratory evaluation or physical examination can detect some CPD-related problems; however, some patients require more complicated investigations to evaluate their problems properly.

Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

“…This had been demonstrated both in scintigraphy [4] and in autopsy specimens with localized absence of diaphragmatic muscle fibres [5]. The raised intraabdominal pressure with dialysate infusion, in a patient with such a communication, promotes the translocation of dialysate into the pleural space.…”

Pericardial Dialysate Leakage in a Peritoneal Dialysis Patient

“…Literatürdeki tanımlanmış olan 2 çocuk olguda da perikardiyal boşluğa sıvı geçişi sırasında plevral efüzyon olmadığı bildirilmiştir (1,5). Perikardiyuma diyalizat kaçağı gösterilen erişkin ve çocuk PD olguların bir kısmında kaçak öncesinde perikarda cerrahi girişim uygulanmıştır (3,6).…”

“…Dren yerleştirildikten sonra perikardiyal basıncın azalmasını takiben yapılan periton diyalizi işleminde sıvı geçişi hızlanmış ve glükoz içeriği yükselmiştir (1). Periton diyalizi yapılan hastalarda perikardiyal diyalizat kaçağı intraperitoneal gadolinium veya radyonüklid madde verilmesini takiben manyetik rezonans görüntüleme, dinamik sintigrafi veya bilgisayarlı tomografi ile yapılan peritoneografi ile gösterilebilir (2,(4)(5)(6)(7)(8). Genel olarak daha az radyasyona maruz bırakması ve küçük hastalarda sedasyon gerekmemesi nedeniyle sintigrafik yöntem tercih edilmektedir (5,8).…”

Mechanical Complications of Peritoneal Dialysis

“…It is a solid diagnostic modality, especially in areas without easy availability to advanced imaging such as CT and MRI. Despite the availability of advanced technology, peritoneal scintigraphy continues to be frequently used to assess patients with suspected PD leaks [13,36,37]. Advantages include high diagnostic accuracy in detecting leaks and hernias, low cost, decreased radiation exposure, and low risk of contrast associated peritonitis and allergic reaction to iodine contrast.…”