What is the absolute contraindication to peritoneal dialysis (PD) among the given options: prune belly syndrome, typhoid peritonitis, abdominal surgery, obesity, and umbilical hernia?

Absolute Contraindications to Peritoneal Dialysis

Typhoid peritonitis is an absolute contraindication to peritoneal dialysis among the given options. 1

Understanding Contraindications to Peritoneal Dialysis

According to the NKF-K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy, the absolute contraindications for peritoneal dialysis include:

1. Documented loss of peritoneal function
2. Extensive abdominal adhesions limiting dialysate flow
3. Physical or mental incapability of performing PD without a suitable assistant
4. Uncorrectable mechanical defects that prevent effective PD or increase infection risk 1

Analysis of the Given Options:

1. Typhoid peritonitis: This is an absolute contraindication as it represents an active intra-abdominal infection. Inflammatory bowel disease is listed as a relative contraindication, but active peritonitis would be an absolute contraindication due to the high risk of systemic infection and the inability of the peritoneal membrane to function properly during active infection.

2. Prune belly syndrome: Not specifically mentioned as an absolute contraindication. While this syndrome involves abdominal wall abnormalities, it doesn't necessarily prevent effective peritoneal dialysis.

3. Abdominal surgery: This is a relative contraindication, not an absolute one. The guidelines specifically mention that "fresh intra-abdominal foreign bodies" require a waiting period (4-month wait after abdominal vascular prostheses), but previous abdominal surgery itself is not an absolute contraindication 1.

4. Obesity: Listed as a relative contraindication, particularly morbid obesity in short individuals. The guidelines state that "morbid obesity can pose special dilemmas in peritoneal catheter placement, the healing process, and in providing adequate dialysis" 1.

5. Umbilical hernia: Hernias are mentioned as mechanical problems that can impair the efficiency of PD, but they are not absolute contraindications unless they are "surgically irreparable" 1. Most umbilical hernias can be surgically repaired.

Important Clinical Considerations

• Active infections like typhoid peritonitis would severely compromise the peritoneal membrane's function and increase the risk of systemic infection.

• For patients with relative contraindications like obesity or hernias, peritoneal dialysis may still be possible with appropriate management and surgical intervention.

• When considering peritoneal dialysis, it's crucial to evaluate:

  • Peritoneal membrane integrity and function
  • Patient's physical and cognitive ability to perform the procedure
  • Presence of uncorrectable mechanical defects
  • Risk of infection

• For patients with a history of abdominal surgery, a trial of PD may still be warranted, with documentation of adequate dose delivery 1.

• Peritoneal dialysis remains an important option for treatment of selected patients with renal failure, particularly those who are hemodynamically compromised or have coagulation abnormalities 2.