OJNeph  Vol.4 No.3 , September 2014
Mechanical Complications of Peritoneal Dialysis
Abstract: Introduction: The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. The mechanical complications of peritoneal dialysis (MCPD) are a major cause of the failure of the technique. The aim of the study was to define the prevalence of peritoneal dialysis (PD) mechanical catheter complications, to determine the time and the factors associated with their occurring. Materials and Methods: A retrospective study was conducted between January 2009 and January 2014 at the nephrology, dialysis and renal transplants department of Ibn Sina university hospital in Rabat. We included all patients who were on peritoneal dialysis and presented mechanical complications. These mechanical catheter complications are represented by catheter migration or obstruction, inguinal or umbilical hernias, early and late peritoneal dialysate leakage, subcutaneous cuff extrusion and hemoperitoneum. Results: MCPD were noted in 23 of the 62 patients (37% of cases). Onset time of complications was 24.8 ± 18.9 months [3 - 60 months]. Among these complications, we noted a catheter migration (65.2%), postoperative hematoma (21.7%), cracking or perforation of catheter (17.4%), epiploic aspiration (17.4%), sleeve externalization (17.4%), catheter obstruction (13%), hemoperitoneum (13%), hernia (22%; 13% umbilical and 8.7% inguinal), early dialysate leakage (13%), and pleuroperitoneal leakage (8.7%). The average age of our patients was 54.9 ± 15.5 years [21 - 81 years old], with a male predominance and a sex ratio of 2.28. The average body mass index (BMI) was 25.4 kg/m2. Diabetic patients represent 48.7% of our series. In our study, MCPD represent 13% of causes of transfer to hemodialysis (HD). Conclusion: Prevention of MCPD remains crucial. It is based on good patient education on hygiene and handling errors but also periodic retraining of patients and caregivers.
Cite this paper: Miftah, M. , Asseban, M. , Bezzaz, A. , Kallat, A. , Iken, A. , Nouini, Y. and Benamar, L. (2014) Mechanical Complications of Peritoneal Dialysis. Open Journal of Nephrology, 4, 103-109. doi: 10.4236/ojneph.2014.43015.

[1]   Chanliau, J. and Kessler, M. (2011) Peritoneal Dialysis for ESRD Patients: Financial Aspects. Néphrologie & Thérapeutique, 7, 32-37.

[2]   Haddiya, I., Skalli, Z., Lioussfi, Z., Radoui, A., Ouzeddoun, N., Ezaitouni, F., et al. (2010) Peritoneal Dialysis: A Satisfying Experience of a Misknown Technique in Rabatat the University Hospital. Néphrologie & Thérapeutique, 6, 569-575.

[3]   Flanigan, M. and Gokal, R. (2005) Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: A Review of Current Developments. Peritoneal Dialysis International, 25, 132-139.

[4]   Singh, N., Davidson, I., Minhajuddin, A., Gieser, S., Nurenberg, M., Saxena, R. (2010) Risk Factors Associated with Peritoneal Dialysis Catheter Survival: A 9-Year Single-Center Study in 315 Patients. The Journal of Vascular Access, 11, 316-322.

[5]   Santarelli, S., Zeiler, M., Marinelli, R., Monteburini, T., Federico, A. and Ceraudo, E. (2006) Videolaparoscopy as Rescue Therapy and Placement of Peritoneal Dialysis Catheters: A Thirty-Two Case Single Centre Experience. Nephrology Dialysis Transplantation, 21, 1348-1354.

[6]   Schaubel, D.E., Blake, P.G. and Fenton, S.S. (2001) Trends in CAPD Technique Failure: Canada, 1981-1997. Peritoneal Dialysis International, 21, 365-371.

[7]   Scarpioni, R. (2003) Acute Hydrothorax in a Peritoneal Dialysis Patient: Long-Term Efficacy of Autologous Blood Cell Pleurodesis Associated with Small-Volume Peritoneal Exchanges. Nephrology Dialysis Transplantation, 18, 2200-2201.

[8]   Zakaria, H.M. (2011) Laparoscopic Management of Malfunctioning Peritoneal Dialysis Catheters. Oman Medical Journal, 26, 171-174.

[9]   Fleisher, A.G., Kimmelstiel, F.M., Lattes, C.G. and Miller, R.E. (1985) Surgical Complications of Peritoneal Dialysis Catheters. The American Journal of Surgery, 149, 726-729.

[10]   Farooq, M.M. and Freischlag, J.A. (1997) Peritoneal Dialysis: An Increasingly Popular Option. Seminars in Vascular Surgery, 10, 144-150.

[11]   Peppelenbosch, A., van Kuijk, W.H., Bouvy, N.D., van der Sande, F.M. and Tordoir, J.H. (2008) Peritoneal Dialysis Catheter Placement Technique and Complications. Nephrology Dialysis Transplantation, 1, 23-28.

[12]   Morris-Stiff, G., Coles, G., Moore, R., Jurewicz, A. and Lord, R. (1997) Abdominal Wall Hernia in Autosomal Dominant Polycystic Kidney Disease. British Journal of Surgery, 84, 615-617.

[13]   Del Peso, G., Bajo, M.A., Costero, O., Castro, M.J., Gil, F. and Selgas, R. (2001) Mechanical Complications of Abdominal Wall in Patients Treated with Peritoneal Dialysis. Peritoneal Dialysis International, 21, 24S.

[14]   García-Ureña, M.A., Rodríguez, C.R., Vega Ruiz, V., Carnero Hernández, F.J., Fernández-Ruiz, E., Vazquez Gallego, J.M. and Velasco García, M. (2006) Prevalence and Management of Hernias in Peritoneal Dialysis Patients. Peritoneal Dialysis International, 26, 198-202.

[15]   Szeto, C.C. and Chow, K.M. (2004) Pathogenesis and Management of Hydrothorax Complicating Peritoneal Dialysis. Current Opinion in Pulmonary Medicine, 10, 315-319.

[16]   Tse, K.C., Yip, P.S., Lam, M.F., Li, F.K., Choy, B.Y., Chan, T.M. and Lai, K.N. (2002) Recurrent Hemoperitoneum Complicating Continuous Ambulatory Peritoneal Dialysis. Peritoneal Dialysis International, 22, 488-491.

[17]   Singh, N., Davidson, I., Minhajuddin, A., Gieser, S., Nurenberg, M. and Saxena, R. (2010) Risk Factors Associated with Peritoneal Dialysis Catheter Survival: A 9-Year Single-Center Study in 315 Patients. Journal of Vascular Access, 11, 316-322.

[18]   Kolesnyk, I., Dekker, F.W., Boeschoten, E.W. and Krediet, R.T. (2010) Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality. Peritoneal Dialysis International, 30, 170-177.