Value of scintigraphy in chronic peritoneal dialysis patients

Background. A variety of factors can adversely impact chronic peritoneal di alysis (CPD) as an effective renal replacement therapy for patients with en d-stage renal disease. These factors include peritonitis, poor clearances, loss of ultrafiltration, and a variety of anatomic problems, such as hernia s, peritoneal fluid leaks, loculations, and catheter-related problems cause d by omental blockage. This study reviews our experience with peritoneal sc intigraphy for the evaluation of some of these difficulties. Methods. From 1991 to 1996, 50 peritoneal scintigraphy scans were obtained in 48 CPD patients. Indications for scintigraphy were evaluated, and the pa tients were placed into four groups: group I, abdominal wall swelling; grou p II, inguinal or genital swelling; group III, pleural fluid; and group IV, poor drainage and/or poor ultrafiltration. A peritoneal scintigraphy proto col was established and the radiotracer isotope that was used was 2.0 mCi o f (99m)technetium sulfur colloid placed in two liters of 2.5% dextrose peri toneal dialysis solution. Results. Ten scans were obtained to study abdominal wall swelling, with sev en scans demonstrating leaks; six of these episodes improved with low-volum e exchanges. Twenty scans were obtained to evaluate inguinal or genital swe lling, and 10 of these had scintigraphic evidence for an inguinal hernia le ak (9 of these were surgically corrected). One of four scans obtained to ev aluate a pleural fluid collection demonstrated a peritoneal-pleural leak th at corrected with a temporary discontinuation of CPD. Sixteen scans were ob tained to assess poor drainage and/or ultrafiltration. Five of these scans demonstrated peritoneal location, and all of these patients required transf er to hemodialysis. The other 11 scans were normal; four patients underwent omentectomies, allowing three patients to continue with CPD. Conclusion. Peritoneal scintigraphy is useful in the evaluation and assessm ent of CPD patients who develop anatomical problems (such as anterior abdom inal, pleural-peritoneal, inguinal, and genital leaks) and problems with ul trafiltration and/or drainage.