Non-infectious complications of peritoneal dialysis and peritoneal scintigraphy

Peritoneal dialysis (PD) is an alternative to hemodialysis that is indicated in patients with chronic end-stage disease. It has many advantages, but also complications such as dialysate leaks around the catheter insertion site, in the abdominal wall or in the pleural cavity, inguinoscrotal hernia and even intra-abdominal fluid collection. Peritoneal scintigraphy is a simple, non-invasive, low-irradiation examination, without the risk of allergy, that allows both diagnosing and locating these complications because it allows acquiring images at the time of infusion, as well as remotely and after drainage of the dialysate. Tomoscintigraphy coupled with scanner SPECT / CT (Single Photon Emission Computed Tomography / Computed Tomography) can also help narrow the diagnosis. The objective of this article is to clarify the value of peritoneal scintigraphy in the diagnosis of non-infectious complications of peritoneal dialysis, the conditions for performing the examination and the potential indications, as illustrated by a few cases.

Utility of Peritoneal Scintigraphy in Peritoneal Dialysis Patients: One Center Experience

BackgroundPeritoneal dialysis (PD) is the RRT of choice in 15% of patients with CKD and has multiple advantages over hemodialysis. PD leaks can prompt technique failure and dropout. Use of peritoneal scintigraphy (PS) for diagnosis of PD leaks has declined in favor of more complex and expensive tests. We analyzed the utility of PS for PD leak diagnosis in our center.MethodsWe retrospectively analyzed all PS done in our center from January 2000 until December 2018, inclusive, in all patients on PD with a suspected dialysate leak.ResultsA total of 39 PS procedures were done in 36 patients on PD in the study period. Of those, 81% were male and 11% had CKD due to polycystic kidney disease. During this period, 23 leaks were diagnosed, showing an incidence of 6% (three episodes per patient per year). In all cases with negative PS, other tests did not confirm a peritoneal dialysate leak.ConclusionsPS is a safe, inexpensive, reproducible, and highly effective diagnostic tool for peritoneal dialysate leaks that allows nephrologists to tailor or stop PD therapy if required. In our opinion, it should be the first-line imaging test to diagnose PD leaks with minimum exposure to radiation, contrast, or other substances that could irritate the peritoneal membrane. We believe PS should be considered as the initial test of choice to diagnose this PD complication as soon as possible, minimizing technique failure and dropout due to leaks.

Acute Genital Edema during Peritoneal Dialysis: A Review for Surgeons

Acute genital edema (AGE) is an infrequent but disruptive complication in patients on continuous ambulatory peritoneal dialysis. It is a common manifestation of dialysate leakage caused by inguinal, umbilical, femoral, or incisional hernias; peritoneal tears; leaks around the dialysis catheter; trauma; fluid overload; and malignancy. The evaluation of AGE begins with a history and physical exam. However, the physical exam in these patients is often indeterminate. Several diagnostic measures exist to evaluate and guide management of AGE occurring during continuous ambulatory peritoneal dialysis but little agreement exists on an optimum method. We have conducted a review of the literature on the evaluation and management of AGE and present a summary of the data. CT peritoneography and peritoneal scintigraphy have been used extensively to evaluate AGE although no comparative studies exist. MRI peritoneography has also been described. CT peritoneography offers more anatomical detail but may not be as sensitive as peritoneal scintigraphy in detecting a peritoneal fluid leak as the cause for AGE. CT is also more costly and subjects the patient to more radiation. MRI is a noncontrast study without radiation risk, but has not been studied to the same degree. If testing is equivocal or bilateral hernias are suspected, diagnostic laparoscopy is helpful and can be combined with hernia repair. Whether the etiology is a leak or tear, low-volume peritoneal dialysis (PD) or cessation of PD for two to four weeks will allow closure. However, hernias almost always require operative repair with mesh usually without disrupting PD.

Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion.Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy.Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

Evaluation of Hepatic Hydrothorax by 99mTc-MAA Peritoneal Scintigraphy

Background: Hepatic hydrothorax occurs 6-10% of advance cirrhotic patient. If we can diagnosed quickly and accurately, it can present the patients from unnecessary investigations and early start correct treatment. Objective: To evaluate the results of using 99mTc-MAA peritoneal scintigraphy for demonstrate peritoneo-pleural communication in the patients with suspected hepatic hydrothorax. Material and Method: Descriptive retrospective study. Collected and analized data of the cirrhotic patients who was investigated by 99mTc-MAA peritoneal scintigraphy in nuclear medicine section , Rajavithi hospital , Thailand from 2005-2012. Results: Eleven patients were identified, 7 male and 4 female average age 52.55 years. Most common cause of cirrhosis was viral hepatitis C (45%) and almost all (10/11) were in child class C. 88% of patient who was evaluated by gastroscope had esophageal varies. 91% of patients had ascites which 90% were massive , 20% moderate and 10% small amount. Peritoneal scintigraphy were positive in 7 patients , excluded a patient who was suspected cause of pleural effusion form pulmonary infection , percent of demonstrated peritoneo-pleural communication was 70. A patient who didn’t have ascites also had positive scintigraphy. Time since radiotracer administration until it appears in pleural cavity was less than 1 hour in 57% of patients, 2 hours 14.3% , 4 hours 14.3% and 24 hours 14.3% Conclusion: 99mTc-MAA peritoneal scintigraphy is a safe , rapid, cheap, minimally invasive and low radiation method for evaluation of the patients who was suspected hepatic hydrothorax with medium positive results (70%) and high specificity