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Perit Dial Int 26(6): 684-687 2006
© 2006 International Society for Peritoneal Dialysis
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Clinical

PERIOPERATIVE MANAGEMENT OF PERITONEAL DIALYSIS PATIENTS UNDERGOING HERNIA SURGERY WITHOUT THE USE OF INTERIM HEMODIALYSIS

Hemal Shah, Maggie Chu and Joanne M. Bargman

University Health Network, University of Toronto, Toronto, Ontario, Canada

Correspondence to: J.M. Bargman, University Health Network, 200 Elizabeth St., 8N-840, Toronto, Ontario M5G 2C4 Canada.
joanne.bargman{at}uhn.on.ca

{diamondsuit} Objective: To review the feasibility of undertaking elective hernia repair in peritoneal dialysis (PD) patients without converting them to hemodialysis.

{diamondsuit} Design: A 10-year retrospective review of prospectively collected data.

{diamondsuit} Setting: PD unit of a university-based hospital.

{diamondsuit} Patients and Methods: All patients received regular exchanges until the morning of the surgery and remained off dialysis for the first 48 hours postoperatively. After that, PD was gradually reintroduced. The patients on continuous ambulatory PD (CAPD) received intermittent PD (IPD) 3 times per week for 10 hours per day for 2 weeks, followed by 5 exchanges of low volume (1-1.5 L) CAPD for 2 weeks, returning to the pre-surgery prescription by 4 weeks. Patients on continuous cycling PD (CCPD) received 1 week of IPD followed by 4 weeks of nocturnal IPD and returned to the original dose in 5 weeks. Between 1 April 1995 and 31 March 2005, 50 consecutive patients were managed by this protocol. Average age was 65 years and 67.7% were males. The original disease was diabetes mellitus (19 patients), hypertension (6), chronic glomerulonephritis (13), polycystic kidney disease (6), and others (6). The types of abdominal hernias included umbilical (25 patients), inguinal (18), incisional (5), and epigastric (2). 42 patients were on CAPD and 8 on CCPD. Average duration of PD prior to development of hernia was 16.4 months.

{diamondsuit} Results: Average pre-surgery creatinine was 673 µmol/L, increasing to 968 µmol/L on IPD. Serum potassium increased from 3.4 to 4.7 mmol/L. No episodes of hyperkalemia were noted. The average total follow-up was 33.4 months. None of the patients had leakage or early hernia recurrence due to early resumption of PD; 13 patients had recurrence of the same hernia after a median 19.9 months; 4 patients had hernias at different sites after an average of 55 months.

{diamondsuit} Conclusions: Based on this experience, we recommend that PD patients undergoing elective abdominal hernia surgery should continue PD according to the prescribed protocol. Interim hemodialytic support does not appear to be necessary in most patients.

KEY WORDS: Hernia; hemodialysis; automated peritoneal dialysis..

Received 5 January 2006; accepted 3 May 2006.




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