From the Guidelines
Peritoneal Dialysis (PD) is absolutely contraindicated in patients with documented loss of peritoneal function, extensive abdominal adhesions, uncorrectable mechanical defects, and those who are physically or mentally incapable of performing PD without a suitable assistant.
Absolute Contraindications for PD
- Documented loss of peritoneal function or extensive abdominal adhesions that limit dialysate flow, as this compromises the efficiency of PD, which relies on effective peritoneal blood flow, dialysate flow, sufficient peritoneal surface area, and permeability to allow adequate solute and fluid removal 1.
- Uncorrectable mechanical defects that prevent effective PD or increase the risk of infection, such as surgically irreparable hernia, omphalocele, gastroschisis, diaphragmatic hernia, and bladder extrophy 1.
- Lack of a viable peritoneum, such as when the peritoneum has been damaged through surgery or inflammation, is an absolute contraindication for PD 1.
- Physical or mental incapability to perform PD without a suitable assistant, as the optimal performance of PD requires certain physical and cognitive abilities 1. These absolute contraindications highlight the importance of carefully evaluating patients for PD and considering alternative modalities when necessary.
From the Research
Absolute Contraindications for Peritoneal Dialysis (PD)
The following are considered absolute contraindications for PD:
- Recent abdominal or cardiothoracic surgery 2
- Diaphragmatic peritoneal-pleural connections 2
- Faecal or fungal peritonitis 2
Relative Contraindications for Peritoneal Dialysis (PD)
While not absolute, the following conditions may be seen as relative contraindications to PD:
- High age 3
- Comorbidities such as diabetes mellitus, obesity, polycystic kidney disease, heart failure 3
- Previous history of abdominal surgery and renal allograft failure 3
- Presence of bleeding or haemorrhagic conditions, difficulty in obtaining vascular approach, removal of high molecular weight toxins, heart failure refractory to medical treatment 2
Considerations for Patient Selection
When selecting patients for PD, it is essential to consider the presence of these conditions and take measures to overcome potential problems 3. Additionally, family support can increase PD eligibility and choice in patients with barriers to self-care 4.