Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Noninfectious Complications in Peritoneal Dialysis

Video Transcription

Video Summary

Jenny Shen presents a talk on non-infectious complications of peritoneal dialysis (PD). She begins with catheter-related problems, highlighting “drain pain” on cyclers caused by negative pressure suctioning viscera; key fixes include treating constipation, aligning cycler height with the patient, and using a tidal prescription that leaves residual fluid to prevent suction. She then reviews catheter outflow failure from constipation, omental wrapping, fallopian tube obstruction, or catheter malposition—managed with position changes, “bicycling,” temporary CAPD, laxatives, and KUB imaging; persistent issues may need fluoroscopic or surgical revision. If both inflow and outflow fail and “worms” appear in the effluent, fibrin blockage is likely; vigorous syringe push-pull and intraperitoneal heparin can restore patency.<br /><br />Next, she discusses complications from increased intra-abdominal pressure: hernias, scrotal leaks/hydroceles, early exit-site leaks, and pleuroperitoneal leaks causing right-sided hydrothorax (diagnosed via transudative pleural fluid with glucose higher than serum, sometimes confirmed by scintigraphy). Management generally involves reducing fill volumes, supine low-volume PD, temporarily holding PD, and surgical repair when recurrent.<br /><br />She briefly covers hemoperitoneum, usually benign (often menses/ovulation), but requiring common-sense escalation if alarming symptoms occur. Finally, she summarizes encapsulating peritoneal sclerosis (EPS): rare but high mortality, typically after long PD duration, presenting with nausea/vomiting, weight loss, bowel obstruction, and CT findings of peritoneal thickening/calcification and bowel tethering; treatment includes stopping PD, immunosuppression, nutritional support, and selective surgery.

Asset Subtitle

Jenny Shen

Meta Tag

Module DIAL

Speaker Jenny Shen

Keywords

peritoneal dialysis complications

PD catheter drain pain

catheter outflow failure

fibrin blockage in PD effluent

increased intra-abdominal pressure hernia leak

pleuroperitoneal leak hydrothorax

encapsulating peritoneal sclerosis EPS