Dialysate leaks in peritoneal dialysis

Dialysate leakage represents a major noninfectious complication of peritone al dialysis (PD). An exit-site leak refers to the appearance of any moistur e 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 leaka ge is somewhat more than 5% in continuous ambulatory peritoneal dialysis (C APD) patients, but this percentage probably underestimates the number of ea rly leaks. The incidence of hydrothorax or pleural leak as a complication o f PD remains unclear. Factors identified as potentially related to dialysat e leakage are those related to the technique of PD catheter insertion, the way PD is initiated, and weakness of the abdominal wall. The pediatric lite rature tends to favor Tenckhoff catheters over other catheters as being sup erior with respect to dialysate leakage, but no consensus on catheter choic e exists for adults in this regard. An association has been found between e arly leaks (less than or equal to 30 days) and immediate CAPD initiation an d perhaps median catheter insertion. Risk factors contributing to abdominal weakness appear to predispose mostly to late leaks; one or more of them ca n generally be identified in the majority of patients. Early leakage most o ften manifests as a pericatheter leak. Late leaks may present more subtly w ith subcutaneous swelling and edema, weight gain, peripheral or genital ede ma, and apparent ultrafiltration failure. Dyspnea is the first clinical clu e 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 s ite of the leakage is with computed tomography after infusion of 2 L of dia lysis fluid containing radiocontrast material. Treatments for dialysate lea ks include surgical repair, temporary transfer to hemodialysis, lower dialy sate volumes, and PD with a cycler. Recent recommendation propose a standar d 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 strong ly suggested for leakage causing genital swelling. Delaying CAPD for 14 day s 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, dia lysate leakage may lead to discontinuation of the technique (1). Despite it s importance, the incidence, risk factors, management, and outcome of dialy sate leakage are poorly characterized in the literature. We will review the limited available information on this topic in the nest few sections.