NDT Advance Access published online on May 21, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm258
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Is abdominal surgery still a contraindication for peritoneal dialysis?
Nephrology Department, Valdecilla Universitary Hospital, Santander, Spain
Correspondence and offprint requests to: Rosa Palomar, Nephrology Department, Marqués de Valdecilla Hospital. Avda. Marqués de Valdecilla s/n, 39008 Santander, Spain. Email: nefpfm{at}humv.es
Keywords: peritoneal dialysis; abdominal surgery
Peritoneal Dialysis (PD) is considered an underutilized modality of renal replacement treatment (RRT) in our media if we compare with other countries as Canada [1], with an incidence that has reached a plateau in the last years (Figure 1). In the 2005 Spanish Registry only 14% started RRT with PD, with a reported prevalence in the technique of about 6%.
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Both the incidence and prevalence of PD patients vary between different regions, depending on their experience and availability. We observe that in some areas as Cantabria o La Rioja the incidence is higher than 20% while in others as Aragón it is almost nonexistent (Figure 2). We must consider that there are some well-defined indications and contraindications for PD that determine its use [2,3]. Many patients are not given the chance to choose the RRT as far as PD is concerned, since some renal units apply this indication too restrictively. A history of previous abdominal surgery is responsible for most of the patients’ refusal. If there is careful selection of the potential PD by the patients, the probabilities of failure decrease considerably.
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In our hospital the population on PD represents 35% of all the incident patients in RRT with a prevalence of 20%. Our programme started in 1983 and to date, a total of 456 patients have been treated with PD; none of them has been refused for PD, beforehand, because of previous abdominal surgery, abdominal wall defects or intestinal diverticular/inflammatory disease. We performed a transversal study in January 2006; 69 patients were on PD at that time, 18 (26%) of which had at least one surgical episode before PD catheter placement. Most of the abdominal surgeries were intestinal resections for, either perforation or tumours (five patients), three cases of cholecystectomy, two appendectomies and two splenectomies. We also had four patients with major vascular interventions, three aorto-bifemoral by-passes and one aorto-mesentheric by-pass. Two women had had a hysterectomy years before PD was started. None of the patients had any mechanical problems (fluid infusion or drainage), not even an increase in peritonitis rate.
When analysing the literature, we observed that there is a big gap in the evaluation of PD outcome in patients with some abdominal interventions as bowel resections, appendectomies, splenectomies or hysterectomies.
Patients with intra-abdominal vascular devices for aorta aneurisms or arterial thrombosis frequently suffer from chronic renal failure and the election of RRT is often controverted. PD should be the elective RRT because of cardiovascular instability, but there is some fear that the insertion of the catheter or its complications might lead to prosthesis infections [7].
Many centres consider abdominal surgery a contraindication for PD although there are no reliable (clinical or by image techniques) predictive makers of PD failure. Our own experience has demonstrated that the exclusion of PD as an RRT in patients with previous abdominal surgery should not be the rule. That is the reason why we accept any patient for PD who desires it, provided that no absolute contraindications are present.
Conflict of interest statement. None declared
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[Abstract/Free Full Text]
Accepted in revised form: 3. 4.07
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