Dialysate Leaks in Peritoneal Dialysis

Abstract

Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the lumen of the catheter. The incidence of dialysate leakage is somewhat more than 5% in continuous ambulatory peritoneal dialysis (CAPD) patients, but this percentage probably underestimates the number of early leaks. The incidence of hydrothorax or pleural leak as a complication of PD remains unclear. Factors identified as potentially related to dialysate leakage are those related to the technique of PD catheter insertion, the way PD is initiated, and weakness of the abdominal wall. The pediatric literature tends to favor Tenckhoff catheters over other catheters as being superior with respect to dialysate leakage, but no consensus on catheter choice exists for adults in this regard. An association has been found between early leaks (< or =30 days) and immediate CAPD initiation and perhaps median catheter insertion. Risk factors contributing to abdominal weakness appear to predispose mostly to late leaks; one or more of them can generally be identified in the majority of patients. Early leakage most often manifests as a pericatheter leak. Late leaks may present more subtly with subcutaneous swelling and edema, weight gain, peripheral or genital edema, and apparent ultrafiltration failure. Dyspnea is the first clinical clue to the diagnosis of a pleural leak. Late leaks tend to develop during the first year of CAPD. The most widely used approach to determine the exact site of the leakage is with computed tomography after infusion of 2 L of dialysis fluid containing radiocontrast material. Treatments for dialysate leaks include surgical repair, temporary transfer to hemodialysis, lower dialysate volumes, and PD with a cycler. Recent recommendation propose a standard approach to the treatment of early and late dialysate leaks: 1-2 weeks of rest from CAPD, and surgery if recurrence. Surgical repair has been strongly suggested for leakage causing genital swelling. Delaying CAPD for 14 days after catheter insertion may prevent early leakage. Initiating CAPD with low dialysate volume has also been recommended as a good practice measure. Although peritonitis and exit-site infections are the most frequent causes of technical failure in peritoneal dialysis (PD), dialysate leaks represent one of the major noninfectious complications of PD. In some instances, dialysate leakage may lead to discontinuation of the technique (1). Despite its importance, the incidence, risk factors, management, and outcome of dialysate leakage are poorly characterized in the literature. We will review the limited available information on this topic in the next few sections.

Pericardial Dialysate Leakage in a Peritoneal Dialysis Patient

“…Hastamıza her ne kadar perikardiyal dren uygulaması yapılmış ise de, bu işlemden önce zaten perikardiyal sıvı birikimi olduğu gösterilmiştir. Karın içi yer kaplayan organların büyüklüğü (polikistik böbrek hastalığı gibi), obezite ve konstipasyon intraabdominal basınç artışına katkıda bulunan durumlardır (3,4). Hastamızda bu risk faktörleri yok idi.…”

“…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).…”

“…Literatürdeki çocuk olgular Tablo I'de özetlenmiştir. Tedavi seçeneğinde PD'e ara verilmesi (hemodiyaliz ile devam edilmesi), dolum hacminin azaltılması ve özellikle genital bölgeye geçişi olanlarda cerrahi onarım önerilmektedir (1,3,4,9). Peritonit sonrası hidrotoraks gelişen olgularda PD ile devam edilmemesi önerilmiştir (4).…”

Klinikinis Atvejis: Dviguba Mechaninė Peritoninės Dializės Komplikacija

“…CAPD pacientų. Ankstyvas (apie 30 dienų) pratekėjimas būdingas perikateterinei sričiai, vėlyvas pratekėjimas pasireiškia pilvo poodžio tinimu, svorio priaugimu, lytinių organų tinimu [14]. Dializato pratekėjimas per išvaržos maišą į poodį gali būti viena išvaržos komplikacijų PD pacientams [15].…”

Treatment by Functional Electrical Therapy of an Unresolved Peritoneal Leakage in a Peritoneal Dialysis Patient

“…Several factors may be responsible for malfunction, including catheter malposition or migration, intraluminal obstruction (by fibrin strands or blood clots), and extraluminal obstruction (by omental wrapping or adhesions) (1).…”