From the Guidelines
The recurrence rate of pleuroperitoneal leaks in peritoneal dialysis patients is approximately 47% after temporary discontinuation of PD, with significantly lower recurrence rates achieved through surgical interventions such as VATS-assisted mechanical and chemical pleurodesis. When considering management strategies for pleuroperitoneal leaks, it is essential to weigh the benefits and risks of each approach, prioritizing those that minimize morbidity, mortality, and impact on quality of life. According to a systematic review by C HOW et al. 1, temporary discontinuation of PD for a period of 2–6 weeks was successful in 53% of patients without recurrence, implying a recurrence rate of approximately 47%. However, this approach may not be sufficient for all patients, particularly those with large diaphragmatic defects or underlying conditions that increase the risk of recurrence. In such cases, surgical interventions like VATS-assisted mechanical and chemical pleurodesis have been shown to achieve significantly lower recurrence rates, with one study reporting a recurrence rate of 10% when combination mechanical and talc pleurodesis were performed 1. Key factors influencing the choice of management strategy include the size and location of the diaphragmatic defect, patient suitability for surgical intervention, and the presence of underlying conditions that may affect treatment outcomes. Some of the key considerations for minimizing recurrence include:
- Gradual reintroduction of peritoneal dialysis with lower volumes
- Consideration of automated peritoneal dialysis with lower dwell volumes when resuming treatment
- Avoidance of high dialysate volumes and high intra-abdominal pressure during dialysis
- Management of underlying conditions that weaken diaphragmatic tissue. Ultimately, the most effective management strategy will depend on individual patient factors and the specific characteristics of the pleuroperitoneal leak, with the goal of minimizing recurrence and optimizing quality of life 1.
From the Research
Pleuroperitoneal Leaks in Peritoneal Dialysis
- Pleuroperitoneal leaks are a rare but significant complication in patients undergoing Peritoneal Dialysis (PD) 2, 3, 4, 5, 6.
- The incidence of pleuroperitoneal leaks is estimated to be around 1.6% 3.
- These leaks can lead to pleural effusions, which are often unilateral and right-sided, causing symptoms such as shortness of breath and reduced ultrafiltration volume 2, 3, 4, 6.
Diagnosis and Treatment
- Diagnosis of pleuroperitoneal leaks can be made using a combination of biochemical tests and radiological modalities, including peritoneal scintigraphy, contrast-enhanced ultrasonography, and indocyanine green fluorescence system 2, 3, 5, 6.
- Treatment often involves cessation of peritoneal dialysis and transition to hemodialysis, as well as procedures such as thoracocentesis, talc pleurodesis, and video-assisted thoracoscopic surgery (VATS) pleurodesis 2, 4, 5, 6.
Recurrence Rate
- The recurrence rate of pleuroperitoneal leaks is reported to be very high unless the location of the pleural hole is precisely detected during surgery 5.
- However, the exact percentage of pleuroperitoneal leaks that recur in patients undergoing PD is not specified in the provided studies.