PERITONEAL DIALYSIS IN PATIENTS WITH TRANS-ABDOMINAL LINES: A CASE SERIES
VINCENT WONG1, SOPHIE O’BRIEN1, KEE WHYE CHIN1, DANA FORCEY1, SCOTT WILSON1
1Department of Renal Medicine, Alfred Health, , Australia
Background: Trans-abdominal lines, with or without background immunosuppression, have long been considered a relative contraindication to the use of Peritoneal Dialysis (PD) due to concerns around seeding infection to or from either line.
Case report: A review of the nephrology medical records at a major tertiary health service from 2016 to 2023 identified four cases of PD in patients with pre-existing trans-abdominal lines. All were male, with a median age of 53 years and a median time of 25 months between trans-abdominal line insertion and PD catheter insertion. Two patients with left ventricular assist devices developed end stage kidney disease (ESKD) in the setting of cardiorenal syndrome. Two patients, one post heart-transplant and one post lung-transplant, had gastrostomy feeding tubes and developed ESKD due to calcineurin inhibitor toxicity combined with vesicoureteral reflux, and renovascular disease. PD catheters were inserted laparoscopically (n=1) or percutaneously with fluoroscopic guidance (n=3) and patients received PD for median of 10 months. No episodes of PD peritonitis were recorded; there was one episode of trans-abdominal line infection which did not adversely impact PD. Patients achieved a median Kt/V of 1.71 and median creatinine clearance of 65.18 L/week/1.73 m2. Cessation of dialysis was due to combined heart/renal transplant (n=1) and withdrawal of active treatment (n=3) for reasons unrelated to ESKD.
Conclusion: These cases describe the successful use of PD in four patients with pre-existing trans-abdominal lines with minimal line associated complications, even with pre-existing immunosuppression. It highlights PD as a valuable option for renal replacement therapy in this patient population.