Utility of Scintigraphy in Assessment of Noninfectious Complications of Peritoneal Dialysis

Abstract

Dialysis is an artificial process to remove waste products and excess water from the body in patients with kidney failure. Two main types of dialysis are available. Hemodialysis, which uses an artificial filtration apparatus, is usually done at specialized centers but can be done in a patient's home. Peritoneal dialysis functions by placing dialysis fluid, also called dialysate, into the peritoneal cavity, allowing for solute to be removed from the peritoneal capillaries through diffusion across a chemical gradient into the dialysate and removal of water through an osmotic gradient created by hypertonic dextrose. Peritoneal dialysis can be either automated, which is done with the help of a machine called a cycler, or continuous ambulatory, which is a process involving multiple exchanges a day and is performed using only gravity to infuse and drain the solution from the peritoneal cavity. For many reasons, the number of people using home dialysis has recently started to rise, with the largest increase in the United States occurring after the implementation of the prospective bundled payment system for end-stage renal disease. With the increased use of home dialysis, potential complications will increase as well. It is imperative that our health-care system be poised not only to increase the number of home dialysis patients but also to diagnose and manage any complications. Nuclear imaging is a commonly available modality to detect various complications related to peritoneal dialysis. In this review article, we discuss the role of peritoneal scintigraphy in detecting some noninfectious peritoneal dialysis complications, with emphasis on scintigraphy technique; imaging time points; the role of planar, SPECT, and SPECT/CT imaging; and the clinical indications, with illustrative case examples.

Spectrum of Complications of Patients with Chronic Kidney Disease on Maintenance Continuous Ambulatory Peritoneal Dialysis: An Experience of Tertiary Nephrology Center in Najaf City-Iraq

“…The peritoneum and its fenestrated capillary bed are responsible for the exchange of many substances such as electrolytes, glucose, urea, and other small molecules from the blood because it is acting as a semipermeable membrane. The solute is removed from the peritoneal capillaries by a diffusion process and through chemical gradient into the dialysate, while the removal of water done by creation of osmotic gradient by hypertonic dextrose [12], [13].…”

Clinical Impact of SPECT/CT in Evaluation of Abdominothoracic Fistula

“…Chest x-ray showed right pleural effusion, and thoracentesis revealed a high glucose concentration, indicating a high possibility of pleuroperitoneal shunt 2 . To confirm the presence of pleuroperitoneal fistula, SPECT/CT was performed using 99m Tc-phytate 3,4 . 99m Tc-phytate of 5 mCi was injected into the abdominal cavity through a CAPD catheter, and anterior scintigraphy and posterior scintigraphy were performed at 5 minutes, 30 minutes, 60 minutes, and 120 minutes 5 .…”

Peritoneal Scintigraphy confirming pleural-peritoneal fistula

“…He declined thoracentesis due to previous pneumothorax complication. Given concerns for peritoneal leak he underwent radionucleotide scintigraphy with intraperitoneal injection of technetium-99 m sulfur colloid [ 1 ]. Delayed images after injection demonstrated radiotracer uptake in the right pleural cavity, confirming evidence of a right pleural-peritoneal communication (Fig.…”