Abdominal Hernias in Chronic Peritoneal Dialysis Patients: A Review

Of 1365 patients on continuous ambulatory peritoneal dialysis (CAPD) identified by a literature review, 174 (12.7%) developed one or more abdominal hernias. Twenty-three per cent of these hernias were inguinal, 19.1% developed at the site of catheter insertion, 18.6% were umbilical, 8.3% were ventral, 9.8% were at other incisional sites, 7.4% were at other sites, and 13.7% were unclassified. Twenty-seven (13.2%) of the hernias were strangulated or incarcerated. The incidence of abdominal hernias in 827 CAPD patients was one per 104.2 cathetermonths, with a range among dialysis centers of one hernia per 47.4 to 779.0 catheter-months. Among 436 patients on intermittent peritoneal dialysis, 12 (2.8%) developed an abdominal hernia, four times less frequently than in CAPD patients (P < 0.001).

Noninfectious complications of peritoneal dialysis

Peritoneal dialysis is an established form of renal replacement therapy. With its increasing popularity, we are now encountering a variety of complications. Noninfectious complications are usually less common as compared with infectious complications. In this review, we discuss some of the common noninfectious complications of peritoneal dialysis such as hernias, hydrothorax, hemoperitoneum, pancreatitis, ischemic colitis and necrotizing enterocolitis, pneumoperitoneum, GERD, subcapsular steatosis and hypokalemia. The awareness of these complications will help in early diagnosis and treatment.

Hernias: a frequent complication in children treated with continuous peritoneal dialysis

The course of 93 children, treated with continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) over a total of 1,819 months, was evaluated retrospectively regarding hernia development. Thirty-seven patients (40%) developed 60 hernias (one per 30 patient-months), of which 36 were ventral, 7 umbilical, 14 inguinal, and 3 scrotal. Hernia occurrence was inversely correlated to patient's age and duration of CAPD/CCPD. The rate of hernia development was highest within the first 3 months following initiation of CAPD/CCPD with a subsequent rapid decrease. The dialysate inflow volume was not related to hernia development. The only complication due to the presence of a hernia was one episode of incarceration of the small bowel that required immediate surgical intervention. Surgical repair was the treatment performed in 75% of the cases. The remaining hernias were managed with volume reduction, conversion from CAPD to CCPD, or discontinuation of the daytime dialysate dwell in patients undergoing CCPD. Our observations suggest that hernia development is a frequent complication in children treated with CAPD/CCPD.