Peritoneal Dialysis Contraindications

Absolute Contraindications

The American Journal of Kidney Diseases recommends that patients with documented loss of peritoneal function or extensive abdominal adhesions should not undergo peritoneal dialysis (PD), as it may limit dialysate flow 1, 2, 3
Patients who are physically or mentally unable to perform PD without a suitable assistant are also contraindicated, as optimal PD performance requires specific physical and intellectual abilities 1, 2, 3
Uncorrectable mechanical defects that prevent effective PD or increase the risk of infection are another absolute contraindication, including irreparable hernias, omphalocele, gastroschisis, diaphragmatic hernia, and bladder exstrophy 1, 2, 3

The American Journal of Kidney Diseases suggests that recently implanted intra-abdominal foreign bodies may be a relative contraindication, requiring a 4-month waiting period after abdominal vascular prostheses or recent ventriculoperitoneal shunt placement 1, 4, 3
Peritoneal leaks, which can cause local problems and increase the risk of contamination, are also a relative contraindication 1, 4, 3
Body size limitations, where the patient is too small to tolerate the prescribed dialysate volume or too large to achieve adequate dialysis, may be a relative contraindication 1, 4, 3
Inflammatory or ischemic bowel disease, which increases the risk of transmural contamination of enteric organisms, is another relative contraindication 1, 4, 3
Frequent episodes of diverticulitis, which can result in peritonitis, are also a relative contraindication 1, 4, 3
Abdominal or chest wall infections, which can lead to contamination of the catheter exit site, tunnel, and peritoneal cavity, are a relative contraindication 1, 4, 3
Morbid obesity, which can create problems with peritoneal catheter placement, healing, and provision of adequate dialysis, is a relative contraindication 1, 4, 3
Severe malnutrition, which can compromise wound healing and increase the risk of peritoneal protein losses, is also a relative contraindication 1, 4, 3

The National Kidney Foundation (NKF) guidelines distinguish between absolute and relative contraindications for peritoneal dialysis (PD) related to hernias, with only surgically irreparable hernias being absolute contraindications 5
Small, repairable hernias are manageable with surgical correction, enabling safe PD, as per the NKF-K/DOQI guidelines 5

Hernias can trap dialysate in the hernia sac, preventing effective contact with the peritoneal membrane and impairing dialysis efficiency, according to the American Journal of Kidney Diseases 5, 6
The increased intra-abdominal pressure from dialysate infusion exacerbates existing structural defects, leading to complications such as peritoneal leaks and infection risk 5, 6

Tension-free mesh repair techniques, such as anterior tension-free mesh or plug repair under local anesthesia, are safe and effective in PD patients, with low recurrence rates 7
Synthetic mesh can be used in clean surgical fields without increased infection risk, as recommended by the World Journal of Emergency Surgery 7

Elective hernia repair before starting PD eliminates the risk of hernia-related PD failure, and patients can safely start PD after adequate healing, typically 4-6 weeks post-repair 5
Simultaneous repair and catheter placement is a safe alternative, with high catheter survival rates and no hernia recurrences, as shown in prospective studies 5
Low-volume exchanges can be used initially if dialysis cannot be delayed, with close monitoring for signs of incarceration and planning for elective hernia repair as soon as medically feasible 5