Peritoneal Dialysis

Key points

• Peritoneal dialysis (PD) is a form of kidney replacement therapy using the peritoneal membrane for solute clearance and ultrafiltration. It is a valid long-term dialysis modality, not merely a temporary 'stop-gap' to haemodialysis; modality choice is based on patient preference, clinical suitability and local expertise.
• PD-associated peritonitis: common organisms include coagulase-negative staphylococci and Staphylococcus aureus , but Gram-negative organisms and Pseudomonas must also be covered when empiric treatment is started according to local/ISPD protocols.
• Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of long-term PD, characterised by progressive peritoneal fibrosis/encapsulation and intestinal obstruction; risk increases with longer PD duration and other risk factors.
• MRCP discriminator: PD patient + abdominal pain/cloudy effluent → think PD peritonitis and obtain effluent cell count/culture promptly; empiric treatment must cover Gram-positive and Gram-negative organisms.
• Long-term complication: EPS/encapsulating peritoneal sclerosis → abdominal pain, bowel obstruction, weight loss and progressive peritoneal fibrosis.