Complications of Peritoneal Dialysis: Non-infectious

Infections are not the only problem that could afflict PD patients

Getty Images/Jacquie Boyd

Patients with kidney failure who opt for peritoneal dialysis (PD) as their preferred modality of treating their condition need to be aware of the complications that come with the procedure. PD is one way of doing dialysis at home and therefore involves transference of a certain degree of health responsibility, from the nephrologist to the patient. Being able to do PD is a privilege in a way, but as they say, with great power comes great responsibility.

Infections of various kind are one major set of complications that can affect PD patients, and these are covered here. However, it is not just infections like peritonitis that we need to guard against in these patients. Other so-called "mechanical" and other non-infectious complications are possible as well.


Mechanical complications are usually related to structural issues with the peritoneal dialysis catheter. 

  • These include leakage of peritoneal dialysis fluid from around the catheter site.  In this case, patients could notice that the dressing around the exit site or their clothes get soaked after initiation of PD
  • If the catheter has been inserted inappropriately/too superficially, cuff excursion could occur. To understand what is a "cuff" take a look at picture 1 and picture 2.
  • Hernia from weakening of the abdominal wall, both from the PD catheter insertion as well as from the pressure generated due to fluid present in the abdomen 
  • Outflow failure, which implies an inability to drain peritoneal dialysis fluid from the abdomen. This could be seen because of a malpositioned catheter or when a catheter becomes encapsulated in between the bowels and surrounding tissue. Another common reason for outflow failure is constipation. Finally, the draining holes of a catheter could become clogged by something called fibrin.
  • A rarer (but not completely unlikely) mechanical complication of PD catheters is an intestinal perforation.  In this case, patients will typically be much sicker with abdominal pain and possibly high fevers and usual signs of infection, although these are not universal signs


This is typically seen as a reaction to the contents of peritoneal dialysis fluid, including dextrose (sugar) and acid.  Adding bicarbonate (which is alkaline) to the fluid can sometimes help relieve this pain.


This can happen because of increased weight and pressure in the abdomen which puts a stress on the spine, specifically the lumbar vertebrae. This pressure leads to gradual and progressive distortion of the normal spinal curvature and puts pressure on the spinal nerves. This is one of the reasons why patients are asked to perform exercises that strengthen abdominal muscles which helps take pressure off the spine.


Patients experience this when PD fluid is being drained from the belly, especially when the peritoneum becomes completely "dry". This lack of fluid inside the belly after drainage could make the catheter rub against the inside of the peritoneum or against the bowels.  This friction can be sometimes enough to cause discomfort in patients. In this case, leaving some peritoneal dialysis fluid in all the time, (also known as tidal peritoneal dialysis) might help.


Symptoms of acid reflux can happen, especially when patients cannot tolerate the volume of  PD fluid in the peritoneum.  Reducing this volume helps alleviate the symptoms, although that needs to be done carefully so as to not jeopardize the dose of dialysis.


This refers to a collection of fluid around the lungs.  This is due to something called a pleural-peritoneal leak where PD fluid escapes from the abdominal cavity into the space around the lungs (pleural cavity).


Hypokalemia, or low potassium levels, can occur in peritoneal dialysis patients.  This is different from hemodialysis patients who typically tend to run high potassium.  This is because of more efficient potassium removal via peritoneal dialysis.  Therefore, an easy way to fix this is to liberalize the patient's diet or, if that does not work, start them on potassium supplements.

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