Peritoneal Dialysis Access

Abstract

Currently approximately 10% of the 650,000 ESRD patients in the U.S. requiring renal replacement therapy are on peritoneal dialysis (PD).  Although equally efficacious as hemodialysis (HD), advantages of PD may include a more flexible schedule allowing greater freedom to work or travel, better tolerability in patients with cardiovascular compromise, and decreased costs.   PD requires an intact peritoneal membrane and abdominal wall and the ability to perform at home, either by the patient  or by a caregiver.  Although PD catheters can be inserted via open or laparoscopic techniques, laparoscopic insertion allows for direct visualization and placement of the tip of the catheter, as well as the ability to secure the tip of the dialysis catheter in the pelvis.  Laparoscopic insertion improves catheter survival, reduces the incidence of mechanical complications, and allows for additional procedures, such as repair of umbilical hernias, lysis of adhesions, or omentopexy. Laparoscopy is also ideal for secondary procedures for catheter salvage.  Infections remain the most frequent complication of peritoneal dialysis catheters and the most common reason for catheter removal or conversion from PD to HD.   This review contains 16 figures, 6 tables, and 40 references. Key Words: Peritoneal dialysis; End-stage renal disease; renal replacement therapy; dialysis; laparoscopy; catheter-associated peritonitis; exit site infections; catheterpexy; omental wrapping; catheter outflow obstruction.