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Article: Retroperitoneal leakage as a cause of acute ultrafiltration failure: Its associated risk factors in peritoneal dialysis

TitleRetroperitoneal leakage as a cause of acute ultrafiltration failure: Its associated risk factors in peritoneal dialysis
Authors
KeywordsComputerized tomographic peritoneography
Magnetic resonance peritoneography
Retroperitoneal leakage
Ultrafiltration failure
Issue Date2009
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
Citation
Peritoneal Dialysis International, 2009, v. 29 n. 5, p. 542-547 How to Cite?
AbstractBackground: Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors. Methods: After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed. Results: During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP (n = 16) or MRP (n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 ± 24.5 (range 0.5-87.9) months and 0.70 ± 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35-18.69, p < 0.001] and 6.23 (95% CI 1.83-21.19, p = 0.003) respectively. Conclusion: RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF. © 2009 International Society for Peritoneal Dialysis.
Persistent Identifierhttp://hdl.handle.net/10722/129288
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLam, MFen_HK
dc.contributor.authorLo, WKen_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorYip, TPSen_HK
dc.contributor.authorLui, SLen_HK
dc.contributor.authorChan, TMen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-12-23T08:34:43Z-
dc.date.available2010-12-23T08:34:43Z-
dc.date.issued2009en_HK
dc.identifier.citationPeritoneal Dialysis International, 2009, v. 29 n. 5, p. 542-547en_HK
dc.identifier.issn0896-8608en_HK
dc.identifier.urihttp://hdl.handle.net/10722/129288-
dc.description.abstractBackground: Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors. Methods: After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed. Results: During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP (n = 16) or MRP (n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 ± 24.5 (range 0.5-87.9) months and 0.70 ± 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35-18.69, p < 0.001] and 6.23 (95% CI 1.83-21.19, p = 0.003) respectively. Conclusion: RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF. © 2009 International Society for Peritoneal Dialysis.en_HK
dc.languageengen_US
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_HK
dc.relation.ispartofPeritoneal Dialysis Internationalen_HK
dc.subjectComputerized tomographic peritoneographyen_HK
dc.subjectMagnetic resonance peritoneographyen_HK
dc.subjectRetroperitoneal leakageen_HK
dc.subjectUltrafiltration failureen_HK
dc.subject.meshFemale-
dc.subject.meshHemodialysis Solutions-
dc.subject.meshHumans-
dc.subject.meshMagnetic Resonance Imaging-
dc.subject.meshPeritoneal Dialysis - adverse effects-
dc.titleRetroperitoneal leakage as a cause of acute ultrafiltration failure: Its associated risk factors in peritoneal dialysisen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0896-8608&volume=29&issue=5&spage=542&epage=547&date=2009&atitle=Retroperitoneal+leakage+as+a+cause+of+acute+ultrafiltration+failure:+its+associated+risk+factors+in+peritoneal+dialysis-
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.pmid19776048-
dc.identifier.scopuseid_2-s2.0-73949093280en_HK
dc.identifier.hkuros178478en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-73949093280&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume29en_HK
dc.identifier.issue5en_HK
dc.identifier.spage542en_HK
dc.identifier.epage547en_HK
dc.identifier.isiWOS:000270049400012-
dc.publisher.placeCanadaen_HK
dc.identifier.scopusauthoridLam, MF=7202630163en_HK
dc.identifier.scopusauthoridLo, WK=7201502414en_HK
dc.identifier.scopusauthoridTse, KC=7102609864en_HK
dc.identifier.scopusauthoridYip, TPS=7004283977en_HK
dc.identifier.scopusauthoridLui, SL=7102379130en_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK

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