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Kidney Week

Abstract: TH-OR091

Retroperitoneal Leakage as an Important Cause of Acute Ultrafiltration Failure in Peritoneal Dialysis Patients

Session Information

  • Peritoneal Dialysis
    November 02, 2017 | Location: Room 290, Morial Convention Center
    Abstract Time: 05:06 PM - 05:18 PM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Zhang, Min, Huashan Hospital, Fudan University, SHANGHAI, China
  • Xie, Qionghong, Huashan Hospital of Fudan University, Shanghai, China
  • Shang, Da, Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
  • Hao, Chuan-Ming, Huashan Hosp., Shanghai, China
  • Zhu, Tongying, Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
Background

Acute ultrafiltration failure (AUFF), characterized by a sudden reduction in ultrafiltration, is one of the causes of technique failure in peritoneal dialysis (PD). AUFF can lead to fluid overload, which is a high risk factor for mortality in PD patients. Retroperitoneal leakage (RPL) is one of the causes of AUFF. In this study, we aimed to analyze the risk factors of RPL in PD patients and observe the outcomes.

Methods

RPL was determined by magnetic resonance (MR) peritoneography in the patients with AUFF. Non-AUFF patients were chosen as controls. Demographic and PD related characteristics were analyzed between these two groups and treatment outcome was observed in RPL patients.

Results

During a 6-year observational period, 142 out of 421 PD patients developed AUFF, and 49 (34.5% in AUFF) of them were diagnosed as RPL by MR Peritoneography. None of RPL patients had hernia, pleural fistula or PD tube exit fistula, while one patient had scrotal fistula. Twenty-one (42.9%) of the RPL cases occurred in the first 3 months, while 16 (32.7%) occurred after 2 years’ PD therapy. The percentage of male patients was significantly higher in the RPL group than in the controls (75% vs. 51%, P=0.003). RPL patients were younger than non-RPL patients (48.42±14.64 vs. 55.86±16.99, P<0.001). No child-bearing experience was a risk factor for RPL in female PD patients (3/12 vs. 10/119, P=0.002). While multi-variants analysis showed that only younger age was a risk factor (P=0.017). After 8 weeks’ intermittent peritoneal dialysis (IPD) or hemodialysis, four patients turned to hemodialysis permanently because of severe and persistent leakage, while others improved remarkably confirmed by MR peritoneography and resumed CAPD.

Conclusion

RPL is common in PD patients and an important cause of AUFF. MR peritoneography is an ideal diagnostic method to detect RPL. Risk factors for RPL include younger age and probably no child-bearing experience in females. RPL is reversible after transitional therapy of IPD or hemodialysis.

Funding

  • Government Support - Non-U.S.