Dialysate leaks in peritoneal dialysis.


:Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the lumen of the catheter. The incidence of dialysate leakage is somewhat more than 5% in continuous ambulatory peritoneal dialysis (CAPD) patients, but this percentage probably underestimates the number of early leaks. The incidence of hydrothorax or pleural leak as a complication of PD remains unclear. Factors identified as potentially related to dialysate leakage are those related to the technique of PD catheter insertion, the way PD is initiated, and weakness of the abdominal wall. The pediatric literature tends to favor Tenckhoff catheters over other catheters as being superior with respect to dialysate leakage, but no consensus on catheter choice exists for adults in this regard. An association has been found between early leaks (< or =30 days) and immediate CAPD initiation and perhaps median catheter insertion. Risk factors contributing to abdominal weakness appear to predispose mostly to late leaks; one or more of them can generally be identified in the majority of patients. Early leakage most often manifests as a pericatheter leak. Late leaks may present more subtly with subcutaneous swelling and edema, weight gain, peripheral or genital edema, and apparent ultrafiltration failure. Dyspnea is the first clinical clue to the diagnosis of a pleural leak. Late leaks tend to develop during the first year of CAPD. The most widely used approach to determine the exact site of the leakage is with computed tomography after infusion of 2 L of dialysis fluid containing radiocontrast material. Treatments for dialysate leaks include surgical repair, temporary transfer to hemodialysis, lower dialysate volumes, and PD with a cycler. Recent recommendation propose a standard approach to the treatment of early and late dialysate leaks: 1-2 weeks of rest from CAPD, and surgery if recurrence. Surgical repair has been strongly suggested for leakage causing genital swelling. Delaying CAPD for 14 days after catheter insertion may prevent early leakage. Initiating CAPD with low dialysate volume has also been recommended as a good practice measure. Although peritonitis and exit-site infections are the most frequent causes of technical failure in peritoneal dialysis (PD), dialysate leaks represent one of the major noninfectious complications of PD. In some instances, dialysate leakage may lead to discontinuation of the technique (1). Despite its importance, the incidence, risk factors, management, and outcome of dialysate leakage are poorly characterized in the literature. We will review the limited available information on this topic in the next few sections.


Semin Dial


Seminars in dialysis


Leblanc M,Ouimet D,Pichette V




Has Abstract


2001-01-01 00:00:00














  • Experimental studies on computed tomographic peritoneography. Peritoneal and residual renal function tolerance to iodinated contrast media injected into the peritoneal cavity.

    abstract::Computed tomographic (CT) peritoneography has been widely used as reference standard to evaluate continuous ambulatory peritoneal dialysis-related complications. However, given the varying CT peritoneography approaches used across different institutions, there is no standard value for non-ionic iodinated contrast medi...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Bai J,Dong J,Shu J,Xu Y,Ding W,Chen J

    更新日期:2020-03-01 00:00:00

  • Anemia management in cancer patients with chronic kidney disease.

    abstract::Cancer and kidney disease are linked by causality and comorbidities. Observational data show an increased risk of malignancy as renal function declines. Erythropoietin stimulating agents (ESAs), which are the cornerstone therapy for anemia patients with chronic kidney disease and cancer, are associated with increased ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Latcha S

    更新日期:2019-11-01 00:00:00

  • We Offer Renal Replacement Therapy to Patients Who Are Not Benefitted by It.

    abstract::Nephrologists offer renal replacement therapy (RRT) to patients who are unlikely to benefit in part because of our discomfort discussing goals of care in the setting of an uncertain prognosis for a given individual. Permanent neurological impairment, terminal illness (life expectancy <6 months), medical conditions pre...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Holley JL

    更新日期:2016-07-01 00:00:00

  • Doppler ultrasound: a powerful tool for vascular access surveillance.

    abstract::National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) guidelines recommend Doppler ultrasound (DU) for surveillance of vascular access (VA), but trials have not been unanimous about its benefit on VA patency. The aim of this study was to evaluate the accuracy of DU for patency, as well as t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Guedes Marques M,Ibeas J,Botelho C,Maia P,Ponce P

    更新日期:2015-03-01 00:00:00

  • Laughter and humor therapy in dialysis.

    abstract::Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis pa...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Bennett PN,Parsons T,Ben-Moshe R,Weinberg M,Neal M,Gilbert K,Rawson H,Ockerby C,Finlay P,Hutchinson A

    更新日期:2014-09-01 00:00:00

  • Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies.

    abstract::Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increa...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Gutiérrez OM,Wolf M

    更新日期:2010-07-01 00:00:00

  • Iatrogenic Baclofen Neurotoxicity in ESRD: Recognition and Management.

    abstract::Baclofen is an oral derivative of gamma-aminobutyric acid (GABA) used to treat muscular spasticity from disorders of the central nervous system. However, it is also being used for a variety of other conditions such as musculoskeletal pain, myoclonus, and alcohol withdrawal. The elimination of baclofen is heavily depen...

    journal_title:Seminars in dialysis

    pub_type: 信件


    authors: Roberts JK,Westphal S,Sparks MA

    更新日期:2015-09-01 00:00:00

  • Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient.

    abstract::Parathyroidectomy (PTX) remains an important intervention for dialysis patients with poorly controlled secondary hyperparathyroidism (SHPT), though there are only retrospective and observational data that show a mortality benefit to this procedure. Potential consequences that we seek to avoid after PTX include persist...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Kakani E,Sloan D,Sawaya BP,El-Husseini A,Malluche HH,Rao M

    更新日期:2019-11-01 00:00:00

  • In-center thrombolysis for clotted AV access: a cohort review.

    abstract::Thrombosis is the leading cause of arteriovenous (AV) access failure for hemodialysis patients requiring frequent interventions. We describe a novel approach to the lyse-and-wait technique in thrombosed AV access using nurse-administered thrombolytics in a hospital-based hemodialysis unit. All patients at a single-cen...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Umanath K,Morrison RS,Christopher Wilbeck J,Schulman G,Bream P,Dwyer JP

    更新日期:2013-01-01 00:00:00

  • Comments on plasma parathyroid hormone levels and their relationship to bone histopathology among patients undergoing dialysis.

    abstract::Measurements of the concentration of parathyroid hormone (PTH) in serum or plasma are used widely for the initial diagnostic assessment of patients with renal bone disease, to monitor disease progression, and to gauge responses to treatment. Several analytical methods are used to measure plasma PTH levels, and a varie...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Goodman WG

    更新日期:2007-01-01 00:00:00

  • We Underdose Antibiotics in Patients on CRRT.

    abstract::Appropriate antibiotic dosing in critically ill, infected, patients receiving continuous renal replacement therapy (CRRT) is crucial to improve patient outcomes. Severe sepsis and septic shock result in changes in pharmacokinetic parameters, including increased volume of distribution, hypoalbuminemia, and changes in r...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Shaw AR,Chaijamorn W,Mueller BA

    更新日期:2016-07-01 00:00:00

  • Past, present, and future of quantified peritoneal dialysis.

    abstract::The role of peritoneal dialysis (PD) as a modality in renal replacement therapy has been well established. In this article we review various aspects in the evolution of PD, with special emphasis on adequacy. Until the late 1950s PD was still considered as a last resort in the treatment of terminal uremia. The introduc...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Haq NU,Nolph KD

    更新日期:2001-07-01 00:00:00

  • Blood pressure control in conventional hemodialysis.

    abstract::Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Georgianos PI,Agarwal R

    更新日期:2018-11-01 00:00:00

  • Mycotic aneurysms and death in a hemodialysis patient.

    abstract::A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, b...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Chang CS,Thajeb P,Chen HH,Wu CJ

    更新日期:2005-07-01 00:00:00

  • Ultrapure dialysate: a desirable and achievable goal for routine hemodialysis.

    abstract::United States standards for the microbiologic quality of dialysate are not very stringent and have remained unchanged for more than 20 years, despite significant changes in the patient population and in the technology of hemodialysis. Numerous studies have demonstrated that bacterial products can cross dialysis membra...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Ward RA

    更新日期:2000-11-01 00:00:00

  • Ethical conflicts for physicians treating ESRD patients.

    abstract::Managing an end-stage renal disease (ESRD) patient is complex and presents many ethical challenges for the physician. Ownership of dialysis facilities has shifted over the past decade from largely nonprofit organizations to large companies whose shareholders are primarily interested in the profitability of their inves...

    journal_title:Seminars in dialysis

    pub_type: 社论


    authors: Bennett WM

    更新日期:2004-01-01 00:00:00

  • Retrospective analysis of catheter recirculation in prevalent dialysis patients.

    abstract::Catheter recirculation (CR) occurs when blood returning from the venous limb of the catheter re-enters the arterial limb of the catheter without passage through the circulation. Adequacy of dialysis is influenced by the degree of access recirculation. In this study we evaluate factors influencing the degree of dialysi...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Moossavi S,Vachharajani TJ,Jordan J,Russell GB,Kaufman T,Moossavi S

    更新日期:2008-05-01 00:00:00

  • Clinical features of patients undergoing hemodialysis with COVID-19.

    abstract::Hemodialysis patients are susceptible to coronavirus disease 2019 (COVID-19). The aim of this study was to describe the epidemiological, clinical characteristics, and mortality-related risk factors for those who undergoing hemodialysis with COVID-19. We conducted a retrospective study. A total of 49 hemodialysis patie...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Tian M,Li H,Yan T,Dai Y,Dong L,Wei H,Song X,Dong J,Cheng F,Li W

    更新日期:2020-10-29 00:00:00

  • Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States.

    abstract::The development of interventional nephrology has undoubtedly led to an improvement in patient care at many facilities across the United States. However, these services have traditionally been offered by interventional nephrologists in the private practice arena. While interventional nephrology was born in the private ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Vachharajani TJ,Moossavi S,Salman L,Wu S,Dwyer AC,Ross J,Dukkipati R,Maya ID,Yevzlin AS,Agarwal A,Abreo KD,Work J,Asif A

    更新日期:2011-09-01 00:00:00

  • Stenosis surveillance of hemodialysis grafts by duplex ultrasound reduces hospitalizations and cost of care.

    abstract::Most recent randomized controlled trials (RCTs) have found that hemodialysis graft surveillance combined with preemptive correction of stenosis does not prolong graft survival. Nevertheless, such programs may be justified if they reduce other adverse outcomes or decrease the cost of care. This study tested this hypoth...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,随机对照试验


    authors: Dossabhoy NR,Ram SJ,Nassar R,Work J,Eason JM,Paulson WD

    更新日期:2005-11-01 00:00:00

  • Iron and infection in hemodialysis patients.

    abstract::Intravenous iron is an important component of the treatment of anemia of end-stage renal disease (ESRD), but it is biologically plausible that iron could increase the risk of infection through impairment of neutrophil and T-cell function and promotion of microbial growth. Any such increase in risk would be particularl...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Ishida JH,Johansen KL

    更新日期:2014-01-01 00:00:00

  • Functional Assessment in End-Stage Renal Disease: Enhancing Quality of Life.

    abstract::Why do functional assessments in patients with end-stage renal disease (ESRD) matter? Multiple studies show that new dialysis patients undergo a substantial decline among activities of daily living. Moreover, poor functional status in ESRD patients is associated with early morality. That is why CMS has developed new c...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Saby A,Miller LS

    更新日期:2016-03-01 00:00:00

  • An Unusual yet "Mg"nificent Indication for Hemodialysis.

    abstract::Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Bansal AD,Negoianu D,Warburton KM

    更新日期:2016-05-01 00:00:00

  • Euvolemia-A critical target in the management of acute kidney injury.

    abstract::It has been clearly established that critically ill patients with sepsis require prompt fluid resuscitation. The optimal amount of fluid and when to taper this resuscitation is less clear. There is a growing evidence that fluid overload leads to acute kidney injury, and increased morbidity and mortality. A clinician's...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Colbert GB,Szerlip HM

    更新日期:2019-01-01 00:00:00

  • Epidemiology and demographic aspects of treated end-stage renal disease in the elderly.

    abstract::Over the last 10 years an increasing number of patients worldwide have started dialysis or had transplantation. Many are elderly with complex comorbid conditions. Registries across the world all show a rapid and dramatic increase in the number of older patients accepted for renal replacement therapy. In addition, the ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Krishnan M,Lok CE,Jassal SV

    更新日期:2002-03-01 00:00:00

  • Wishful Thinking: The Surprisingly Sparse Evidence for a Relationship between Oxidative Stress and Cardiovascular Disease in Hemodialysis Patients.

    abstract::The increased frequency of cardiovascular disease observed in hemodialysis patients is secondary to the combination of many traditional (age, male sex, hypertension, smoking, diabetes mellitus, and dyslipidemia) and novel and uremia-related (inflammation, uremic toxins, adipokine imbalance, coagulation disorders, prot...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Bossola M,Tazza L

    更新日期:2015-05-01 00:00:00

  • Salvage of problematic peritoneal dialysis catheters.

    abstract::Peritoneal dialysis (PD) is a markedly underutilized modality for permanent renal replacement therapy in the United States owing to a low rate of patient referral and high rate of patient dropout or transfer to hemodialysis. One cause for patient loss from PD is problematic PD catheters that often are removed rather t...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Asif A,Gadalean F,Vieira CF,Hogan R,Leon C,Merrill D,Ellis R,Amador A,Broche O,Bush B,Contreras G,Pennell P

    更新日期:2006-03-01 00:00:00

  • The impact of dialysis modality and membrane characteristics on intradialytic hypotension.

    abstract::The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Patel S,Raimann JG,Kotanko P

    更新日期:2017-11-01 00:00:00

  • The ADEMEX study and its implications for peritoneal dialysis adequacy.

    abstract::In an attempt to improve patient outcomes in peritoneal dialysis (PD), national organizations (such as the National Kidney Foundation Dialysis Outcomes Quality Initiative [NKF-DOQI] process) have formulated clinical practice guidelines based on clinical evidence available at the time of development. For "adequacy" of ...

    journal_title:Seminars in dialysis

    pub_type: 评论,社论


    authors: Burkart JM

    更新日期:2003-01-01 00:00:00

  • Highlights and hotspots of protein glycation in end-stage renal disease.

    abstract::Analysis of tissues, plasma, urine, other body fluids, and dialysate for glycation adducts has revealed the presence of two major forms: glycation adduct residues of proteins and related glycated amino acids--called glycation free adducts. The major effect on protein glycation in uremia is loss of clearance of glycati...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Thornalley PJ,Rabbani N

    更新日期:2009-07-01 00:00:00