Troubleshooting in Patients with Peritoneal Dialysis

The essential elements for peritoneal dialysis are a viable peritoneal cavity, reliable access to the peritoneal dialysis cavity (usually with an indwelling catheter), dialysis fluid, and a delivery system. Peritoneal dialysis is an important home-based therapy that accounts for 11% of all dialysis in the US. Infections and access to the peritoneal cavity hampered expansion of peritoneal dialysis for renal replacement therapy in the early stages of this therapy, but conditions have substantially improved. PD catheter related infection is considered the most important problem by patients and clinicians, and technical improvements and better prophylactic measures have led to significant reductions in PD related infection rates (to 0.26 cases per year per patient in the US). This remains, however, the leading cause of technique failure. Accurate diagnosis and appropriate intervention are important to allow reassumption of dialysis, to decrease the risk of catheter loss, and, in the event of loss, expedite the return to hemodialysis. This chapter will discuss in detail the clinical presentation, diagnosis, and management of the most common complications related to peritoneal dialysis: impaired flow, drain pain, peri catheter leak, Hernia, bleeding, chyloperitoneum, hydrothorax and PD catheter related infections.