Peritoneal dialysis: Its indications and contraindications

Global utilization of peritoneal dialysis ranges from 6% to 91% in various parts of the world. This paper reviews the indications and contraindication s for chronic peritoneal dialysis (PD), providing evidence when available, and recommendations based on the considerable experience of the authors whe n evidence is lacking. Strong indications for pd include obligate situation s such as vascular access failure and intolerance to hemodialysis (HD); med ical preferences such as congestive heart failure, prosthetic valvular dise ase, and children aged 0-5 years; and social situations such as patient pre ference and living far from an in-center dialysis unit. The situations wher e PD is preferred include bleeding diathesis, multiple myeloma, labile diab etes, chronic infections, possibility of transplantation in the near future , age between 6 and 16 years, needle anxiety, and active lifestyle. Situati ons where PD is not preferred but possible with some special considerations include obesity, multiple hernias, severe backache, multiple abdominal sur geries, impaired manual dexterity, blindness, less-than-ideal home situatio n, and depression. Relative contraindications for PD include patients with severe malnutrition, multiple abdominal adhesions, ostomies, proteinuria >1 0 g/day, advanced COPD, ascites, presence of a Le Veen or ventriculo-perito neal shunt, upper limb amputation with no help at home, poor hygiene, demen tia, and those who are homeless. Pd is contraindicated in patients with doc umented Type II ultrafiltration failure, severe inflammatory bowel disease, active acute diverticulitis, abdominal abscess, active ischemic bowel dise ase, severe active psychotic disorder, marked intellectual disability, and in women starting dialysis in the third trimester of pregnancy. Inmost of t he remaining situations, either HD or PD is equally preferred. To take full advantage of the advances that have occurred over the past decade, success ful PD requires committed and knowledgeable physicians and nurses, and a ce nter with at least 20-25 patients on this modality.