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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD  
Year : 2016  |  Volume : 27  |  Issue : 1  |  Page : 107-110
Mechanical complications of continuous ambulatory peritoneal dialysis: Experience at the Ibn Sina University Hospital


Nephrology-Dialysis-Renal Transplantation Department, Ibn Sina University Hospital, Rabat, Morocco

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Date of Web Publication15-Jan-2016
 

   Abstract 

Peritoneal dialysis is a new renal replacement therapy recently introduced in Morocco since 2006. Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study was to evaluate the outcome of complications in patients treated with peritoneal dialysis at our center. The nature of non-infectious complications was noted during follow-up in these patients. Fiftyseven complications were noted among 34 patients between June 2006 and June 2014. Catheter migration was the most common complication (36.8%), followed by obstruction (14%), dialysate leaks (14%), hemorrhagic complications (10.5%) and, finally, hernia (12.2%), catheter perforation (5.2%) and externalization (3.5%).

How to cite this article:
Flayou K, Ouzeddoun N, Bayahia R, Rhou H, Benamar L. Mechanical complications of continuous ambulatory peritoneal dialysis: Experience at the Ibn Sina University Hospital. Saudi J Kidney Dis Transpl 2016;27:107-10

How to cite this URL:
Flayou K, Ouzeddoun N, Bayahia R, Rhou H, Benamar L. Mechanical complications of continuous ambulatory peritoneal dialysis: Experience at the Ibn Sina University Hospital. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Sep 16];27:107-10. Available from: http://www.sjkdt.org/text.asp?2016/27/1/107/174089

   Introduction Top


Continuous ambulatory peritoneal dialysis (CAPD) is a well-recognized alternative to hemodialysis (HD) for treating patients with end-stage renal disease (ESRD). However, it is associated with several complications (infectious or non-infectious). Mechanical complications of CAPD dialysis are frequent and diverse. The complications can be diagnosed easily and their evolution is mild; they can sometimes lead to technique failure and a change to HD in approximately 20% of cases. [1],[2]

The complications may be related to the peritoneal dialysis catheter, increased intra-abdominal pressure due to instillation of dialysis fluid, metabolic changes and changes in the peritoneal membrane characteristics.

The aim of this study was to describe noninfectious complications encountered in our center and their impact on technique survival.


   Materials and Methods Top


This observational study was carried out in 89 patients with ESRD undergoing CAPD.

A double-cuffed straight Tenckhoff catheter was inserted in all patients in our center using the surgical technique. After placement of the catheter, the patients were instructed on how to perform dialysis exchanges.

Recorded data included the demographics profile of the patients, catheter implantation method, duration of CAPD, non-infectious complications, favoring factors, treatment and impact on the technique survival.


   Results Top


Since the opening of the peritoneal dialysis unit in June 2006, a total of 89 double-cuff Tenckhoff catheters were surgically implanted in patients with ESRD. Thirty-four patients who used a detachable double-bag system developed a total of 57 mechanical complications.

Our study group comprised 27 males and seven females with a mean age of 49 ± 13.2 years [Table 1]. Diabetic nephropathy was the most common cause of ESRD in our study patients (48.4%). One patient had undergone abdominal surgery (cesarean section) before starting peritoneal dialysis.
Table 1: Demographic characteristics of the study patients.

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Migration of catheter, especially favored by constipation, was the most common noninfectious complication observed in 21 cases (36.8%). It returned to the normal position with medical treatment with laxatives in 19 cases. The other two cases required laparoscopic replacement with favorable outcome.

Obstruction was observed in eight cases (14%); it was caused by fibrin deposits in four cases who were treated by intra-peritoneal heparin injections and epiploic aspiration in four other cases, which required surgical intervention.

Post-operative bleeding and dialysate leaks were observed in six and eight cases, respectively (10.5% and 14%). Discontinuation of peritoneal exchanges or surgical drainage resulted in a favorable outcome.

The reason and predisposing factors of mechanical complications are given in [Table 2]. The outcome of these complications was favorable in all our patients and none of them were switched to HD. Some of them required surgery.
Table 2: Predisposing factors and evolution of peritoneal dialysis' mechanical complications.

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   Discussion Top


Tenckhoff catheter insertion for CAPD is a procedure associated with significant surgical morbidity. Non-infectious complications are classified into two groups on the basis of onset from the time of insertion of catheter: early onset (1-4 months) and late onset. [3]

Early complications arise soon after the catheter insertion and are usually related to the implantation procedure because of congenital anatomic abnormalities and/or due to increased intra-abdominal pressure generated by infusion of dialysate into the peritoneal cavity. [4]

Patients with diabetes mellitus, glomerulonephritis and ongoing sepsis are at a greater risk of early complications, and must be stabilized before catheter insertion. [5]

In our study, diabetic nephropathy was noted in 48.4% of the cases. These patients were placed under rigorous monitoring of glycemic balance and early detection of factors favoring non-infectious complications.

The prevalence of mechanical complications in our series was higher compared with the different series published in the literature [6],[7] Catheter migration was the most common noninfectious complication in our study followed by epiploic aspiration, while in several recent studies epiploic aspiration has been the major cause. [8]

Hernias are less common in continuous cyclic peritoneal dialysis patients, presumably because of the lower intra-abdominal pressure during recumbency. It was a common complication in our series, but its severity was moderate, with a predominance of umbilical hernia; this is in accordance with the published reports. [9]

Hemo-peritoneum was infrequent and had spontaneous resolution in our study. Recurrent hemo-peritoneum is a benign complication (3- 4%) of CAPD [10],[11] and has no significant longterm effects on patient survival, predisposition to peritonitis or failure of ultrafiltration.

The majority of non-infectious complications in these patients was treatable and did not interfere with catheter survival. Some precautionary measures will help prevent these complications [Figure 1].
Figure 1: Preventive measures of non-infectious complications.

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In conclusion, catheter-related complications often result from errors made during catheter insertion and are exacerbated by the presence of co-morbid conditions and the increased hydrostatic pressure caused by intra-abdominal contents. Careful evaluation of the patient, attention to the implantation technique and rigorous care during the intraand post-operative period can markedly prevent many of these complications.

Conflict of interest: None declared.

 
   References Top

1.
Schaubel DE, Blake PG, Fenton SS. Trends in CAPD technique failure: Canada, 1981-1997. Perit Dial Int 2001;21:365-71.  Back to cited text no. 1
    
2.
Mujais S, Story K. Peritoneal dialysis in the US: Evaluation of outcomes in contemporary cohorts. Kidney Int Suppl 2006;103:S21-6.  Back to cited text no. 2
    
3.
Prakash J, Singh LK, Shreeniwas S, Ghosh B, Singh TB. Non-infectious complications of continuous ambulatory peritoneal dialysis and their impact on technique survival. Indian J Nephrol 2011;21:112-5.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Diaz-Buxo JA. Complications of peritoneal dialysis catheters: early and late. Int J Artif Organs 2006;29:50-8.  Back to cited text no. 4
    
5.
Tiong HY, Poh J, Sunderaraj K, Wu YJ, Consigliere DT. Surgical complications of Tenckhoff catheters used in continuous ambulatory peritoneal dialysis. Singapore Med J 2006;47:707-11.  Back to cited text no. 5
    
6.
Attaluri V, Lebeis C, Brethauer S, Rosenblatt S. Advanced laparoscopic techniques significantly improve function of peritoneal dialysis catheters. J Am Coll Surg 2010;211:699-704.  Back to cited text no. 6
    
7.
Moreiras Plaza M, Cuíña L, Goyanes GR, et al. Mechanical complications in chronic peritoneal dialysis. Clin Nephrol 1999;52(2):124-30.  Back to cited text no. 7
    
8.
Zakaria HM. Laparoscopic management of malfunctioning peritoneal dialysis catheters. Oman Med J 2011;26:171-4.  Back to cited text no. 8
    
9.
Afthentopoulos IE, Panduranga Rao S, Mathews R, Oreopoulos DG. Hernia development in CAPD patients and the effect of 2.5 l dialysate volume in selected patients. Clin Nephrol 1998;49:251-7.  Back to cited text no. 9
    
10.
Scarpioni R. Acute hydrothorax in a peritoneal dialysis patient: Long-term efficacy of autologous blood cell pleurodesis associated with small-volume peritoneal exchanges. Nephrol Dial Transplant 2003;18:2200-1.  Back to cited text no. 10
[PUBMED]    
11.
Tse KC, Yip PS, Lam MF, et al. Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Perit Dial Int 2002; 22:488-91.  Back to cited text no. 11
    

Top
Correspondence Address:
Kaoutar Flayou
Nephrology-Dialysis-Renal Transplantation Department, Ibn Sina University Hospital, Rabat, Morocco
Morocco
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DOI: 10.4103/1319-2442.174089

PMID: 26787575

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    Tables

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