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Query: UMLS:C0019270 (hernia)
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A retrospective case control study was performed on a cohort of 244 peritoneal dialysis patients followed over 5 years to determine whether dialysate fill-volume was associated with hernia development. The laboratory and clinical parameters of patients who developed hernias during this time period were compared with those of patients who did not develop hernias. Information on 27 patients who developed hernias was compared with that on 217 patients who did not develop hernias. Dialysate fill-volume was similar between groups (2.2 +/- .3 L for patients with hernias vs. 2.2 +/- .3 L for controls). Three patients with fill-volumes of 1.5 L developed hernias, and no patients with fill-volumes of 3 L developed hernias. Age, duration of time on dialysis, and body surface area were also similar between groups. This investigation could not find a relationship between fill-volume and hernia formation. From this study it would appear that physicians should not hesitate to increase fill-volume based on concerns of hernia development.
Adv Perit Dial 1998
PMID:Peritoneal dialysate fill-volumes and hernia development in a cohort of peritoneal dialysis patients. 1064 3

Large exchange volumes of 2.5 and 3 L are frequently necessary to improve clearances to the level suggested by the DOQI guidelines. However, abdominal wall hernias are a well known complication of peritoneal dialysis (PD) related to increased abdominal pressure, and might increase with higher exchange volumes. We studied the effect of using higher exchange volumes in PD patients on the incidence of hernia formation. Seventy-nine (12%) of 656 PD patients over a 15-year span developed abdominal wall hernias. Eleven percent of patients using 2 L or smaller volumes, 15% of patients using more than 2 L but less than 3 L, and 13% of patients using 3 L developed hernias (not significantly different). Five percent of patients on cyclers for their entire PD experience (3 of 63 patients) developed one or more hernias, compared to 13% of patients on continuous ambulatory peritoneal dialysis for at least part of their experience (P = 0.06). The use of larger volumes increased dramatically over time; only 11% of patients used more than 2-L exchange volumes during the years 1982 through 1986, compared to 73% in the period from 1992 to 1997. We conclude that increased volumes in PD patients do not lead to an increased risk of hernia formation. Exchange volumes can be increased as needed to improve clearances.
Adv Perit Dial 1998
PMID:The risk of hernia with large exchange volumes. 1064 4

When long-term peritoneal dialysis (PD) is performed without change in the dialysis prescription, uremic symptoms appear owing to insufficient dialysis dose. In such cases, an increase in dialysate volume is required, but this increase is difficult to obtain in all patients owing to limitations in abdominal volume, lifestyle, or body weight. A combination of PD and hemodialysis (HD) is the simplest method of overcoming these limitations. Combination therapy--HD once per week for 4 hours and PD 6 days per week--was performed in our patients. The total weekly dialysis dose (urea) was calculated as follows: to convert the dialysis dose by HD to that of continuous treatment, the equivalent renal urea clearance (EKR) was calculated and added to the dialysis dose by PD. Combination therapy was performed in 12 patients. The reasons for the combination therapy included ultrafiltration (UF) loss in 2 patients, uremic symptoms in 3 patients, poor fluid management in 5 patients, umbilical hernia in 1 patient, and hydrothorax in 1 patient. Total Kt/V per week was increased from 1.61 +/- 0.19 to 2.05 +/- 0.25 in these patients. In the 2 patients with UF loss, weight control became easier after the combination therapy was started, and this control was possible with hypotonic dialysate alone. In patients with uremic symptoms, the symptoms improved; furthermore, dermal pigmentation improved in these patients. In summary, the dialysis dose was increased and body fluids became controllable after inducing combination therapy, resulting in improvement uremic symptoms and increased quality of life.
Adv Perit Dial 1999
PMID:Hemodialysis together with peritoneal dialysis is one of the simplest ways to maintain adequacy in continuous ambulatory peritoneal dialysis. 1068 87

This study investigated the incidence of subclinical abdominal hernia in patients starting peritoneal dialysis (PD). From April 1995 to August 1999, every new patient without clinical evidence of abdominal leakage underwent peritoneal scintigraphy. A total of 59 patients were enrolled in the study. Imaging of the peritoneal cavity was performed by mixing 74 MBq (2 mCi) of 99 m technetium sulfur colloid with 2 L of 1.36% dextrose peritoneal dialysis solution. Sequential gamma camera static images were obtained at 0 minutes, 60 minutes, and after drainage. Ten abdominal hernias (2 diaphragmatic leaks, 8 inguinal hernias) were observed in ten patients (6 males, 4 females; mean age: 65.1 years). One patient with diaphragmatic leak recovered partial renal function and stopped continuous ambulatory peritoneal dialysis (CAPD); the other was switched to automated peritoneal dialysis (APD). Among the eight patients with inguinal hernia, six had no clinical manifestations within eight months of follow-up. Two patients became symptomatic at 15 months and 25 months respectively. They underwent surgical repair. In CAPD patients without obvious abdominal hernias, peritoneal scintigraphy at onset of dialysis discovered 17% positive cases. The technique of scintigraphy is safe, with a low radiation exposure. Surgical repair for maintenance on CAPD is not always necessary, and a change in the PD strategy may be useful.
Adv Perit Dial 2000
PMID:Detection of subclinical abdominal hernia by peritoneal scintigraphy. 1104 72

Continuous cycling peritoneal dialysis (CCPD) uses a cycler to perform dialysis exchanges and requires the patient to respond to an audible alarm signifying an interruption in the therapy. Consequently, an unassisted hearing-impaired patient could not use the system. By converting the standard alarm to a vibrating signal, the cycler was successfully adapted to accommodate the special needs of our hearing-impaired patient. The items required for the modification were the Sonic Alert Wake Up Alarm (Model SA-WA300: Sonic Alert, Troy, MI, U.S.A.) and the Sonic Alert Super Shaker Bed Vibrator (Model SA-SS120V: Sonic Alert). The patient can place the vibrator under either the pillow or the mattress. When the cycler alarm is activated, vibration wakens the patient. The equipment was purchased from Harris Communications (Eden Prairie, MN, U.S.A.) through a referral by the Easter Seal Society. Three days were needed to complete training compared to an average of one or two days for patients previously trained for continuous ambulatory peritoneal dialysis (CAPD). The patient remained on cycler therapy for approximately four months when the unrelated development of an abdominal hernia required termination of peritoneal dialysis and subsequent transfer to hemodialysis. In conclusion, a modified cycler can provide a safe and efficient renal replacement therapy option for a hearing-impaired patient.
Adv Perit Dial 2000
PMID:Adaptation of the Fresenius PD+ Cycler for a hearing-impaired patient. 1104 84

Laparotomic correction with or without omentectomy is occasionally required for malposition of a peritoneal dialysis (PD) catheter. We reviewed the incidence of incisional hernia following laparotomic PD catheter correction with or with omentectomy. From January 1996 to December 1998, PD catheters were implanted by non open-dissection technique using a trocar in 148 patients. Laparotomy for PD catheter malposition was required in 20 of the 148 patients. Omentectomy was performed simultaneously in 11 patients. After laparotomy, the wound was closed with interrupted or continuous layered polyglycolidelactide polymer sutures. Dialysis was resumed after the third or fourth day. Incisional hernia developed in 30% (6/20) of all patients undergoing laparotomy, but in none of the patients not undergoing laparotomy. The incidence increased when omentectomy was performed [5/11 (45.5%) vs 1/9 (11.1%)]. Multiparity, female sex, and laparotomy at a later time also predisposed to development of incisional hernia. Among the patients with incisional hernia, 2 patients showed multiple recurrences and 1 patient showed later leakage; PD catheters were lost in these patients. Another 3 patients continued continuous ambulatory peritoneal dialysis (CAPD) without a recurrence. The results suggest that incisional hernia is prevalent following laparotomic PD catheter correction, especially when omentectomy is performed simultaneously. Situations that seem to increase the risk of incisional hernia--inevitably encountered during corrective laparotomic omentectomy--are discussed. An evaluation is necessary concerning whether omentectomy acts as an independent risk factor for incisional hernia, and whether incisional hernia occurs more frequently when omentectomy is performed after a period on CAPD as compared with when it is performed at the time of PD catheter implantation. Laparotomic omentectomy should be performed as a last resort for the correction of PD catheter malposition.
Adv Perit Dial 2001
PMID:Incisional hernia after corrective omentectomy for peritoneal dialysis catheter malposition. 1151 Feb 61

Controversy still exists as to whether peritoneal dialysis (PD) treatment can be safely continued after herniotomy. Many nephrologists withhold PD treatment for several weeks after herniotomy for fear of dialysate leakage and hernia recurrence. Here, we report on 9 patients (2 women, 7 men) in whom herniotomy was performed for umbilical (n = 3), inguinal (n = 5), or cicatricial hernia (n = 2), or for open processus vaginalis (n = 2). Surgery was performed according to the Lichtenstein method with insertion of a polypropylene mesh and ligation of the hernia sac. In all patients, PD treatment was paused for the day of surgery and for 1-3 days postoperatively, depending on residual renal function. Over the next several days, low-volume (1.0-1.5 L), high-frequency (6 per day) exchanges were started. The patient's original PD regimen was gradually reinstated over the next 2-4 weeks. All patients recovered rapidly, with no uremia or dialysis-related complications. Particularly, no leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be hemodialyzed intercurrently. In conclusion, continuing a modified regimen of CAPD treatment after herniotomy seems to be safe, with excellent patient comfort.
Adv Perit Dial 2001
PMID:Sustaining continuous ambulatory peritoneal dialysis after herniotomy. 1151 Mar 4

The fundamental objective of dialysis is to maintain the dose of solute clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients cannot maintain the target dose of clearance [weekly Kt/V > 2.0, weekly creatinine clearance (CCr) > 60 L/1.73 m2], the dialysis dose needs to be increased. But the means of increasing the dose only by PD are limited, especially for patients with UF failure (UFF). Combination therapy--PD with hemodialysis (PD + HD)--is the simplest way to solve the problem. The purpose of PD + HD therapy is to support solute clearance and UF when PD alone cannot meet the necessary targets. Acute and transient dialysis cases should be excluded. The general prescription for PD + HD should be 5-6 days of PD weekly and 1 session of HD weekly. For determine the adequacy of PD + HD, we adopted the equivalent renal clearance (EKR), transforming the PD weekly Kt/V and then evaluating total clearance from both modalities. Of our 238 dialysis patients, 31 (13%) use combined therapy. Except for 1 patient that transferred from long-term HD, all of patients had been on PD for more than 60 months, and were experiencing uremic symptoms after decline of residual renal function. In 12 cases, the problem was lack of solute clearance; in 5 cases, it was UFF. High permeability was involved in 5 cases: 4 after long-term PD and 1 from the start of PD. Poor self-management occurred in 9 cases. Contributing factors included hernia, diaphragmatic intercourse, and severe heart failure with strict fluid control. Among the 31 patients, 8 used HD twice weekly. After combination therapy was started, the dialysis dose increased and body fluids became controllable. As a result, uremic symptoms improved and the patients' quality of life increased.
Adv Perit Dial 2002
PMID:Five years' experience of combination therapy: peritoneal dialysis with hemodialysis. 1240 89

We successfully used argon plasma coagulation (APC) to treat two cases of dialysis patients with hemorrhagic gastric angiodysplasia. Gastric angiodysplasia is recognized as an important cause of gastrointestinal bleeding. Angiodysplastic lesion confined to the gastric antrum was first described in 1953 and named gastric antral vascular ectasia (GAVE). The condition is characterized as submucosal capillary dilatation and fibromuscular hyperplasia. The typical finding of GAVE is the so-called watermelon stomach, attributable to vasodilatation. In case 1, a 69-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) in July 1997 because of chronic renal failure due to nephrosclerosis. He was hospitalized for severe anemia in December 1997. Gastrointestinal fiberscopy (GIF) showed oozing in the antrum, and gastritis and esophagitis with sliding hernia. Famotidine was started and recombinant human erythropoietin (rHuEPO) was used for anemia. However, the severe anemia did not improve. The patient was hospitalized again for severe anemia and hematemesis. Another GIF showed typical watermelon stomach, which corresponded with GAVE. An APC was performed without complications. Three months later, the anemia was improved, and the dose of rHuEPO was reduced. In case 2, a 57-year-old woman was introduced to hemodialysis in 1998 for uremia due to nephrosclerosis. In October 2000, she was hospitalized for rHuEPO-resistant anemia. A GIF showed oozing in the antrum with diffuse vasodilation in the antrum; GAVE was diagnosed. An APC was carried out without complications. Three months later, anemia was improved. Recently, gastric angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of rHuEPO-resistant anemia. Argon plasma coagulation is an effective treatment for gastric angiodysplasia in patients on dialysis.
Adv Perit Dial 2003
PMID:Gastric angiodysplasia in patients undergoing maintenance dialysis. 1476 50

In this retrospective study, we evaluated the causative factors, outcomes, and complications of therapy in 35 patients (16 girls, 19 boys) started on chronic peritoneal dialysis (CPD) between 1997 and 2002. Average age at initiation of CPD was 9.3 +/- 4.4 years. All patients started on continuous ambulatory peritoneal dialysis (CAPD). Nine patients switched to ambulatory peritoneal dialysis (APD) during the follow-up period. The most common cause leading to end-stage renal disease (ESRD) in the patients was reflux nephropathy (22.9%). The major complication during therapy was peritonitis, with 41 episodes seen in 17 patients (1 episode per 18 patient-months). Of the children on APD, 7 developed 17 episodes of peritonitis (1 episode per 8.3 patient-months); of the children on CAPD, 10 developed 24 peritonitis attacks (1 episode per 24.9 patient-months). The other complications were inguinal hernia in 3 patients, subcutaneous leak in 4 patients, dialysate leak in 2 patients, pericardial effusion in 1 patient, umbilical hernia in 1 patient, hydrothorax in 1 patient, and cuff protrusion in 3 patients. During the follow-up period, 4 patients died owing to sepsis or cardiopulmonary complications. Only 1 patient was transferred to hemodialysis (owing to persistent Candida peritonitis). We think that CPD therapy is a good choice of treatment modality in the management of children with ESRD.
Adv Perit Dial 2003
PMID:Outcome in children on chronic peritoneal dialysis. 1476 77


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