Medical complications of peritoneal dialysis

These include

• peritonitis:
  • usually due to poor technique
  • routinely culture the drained dialysate
  • instill suitable antibiotics if suspected - suitable blind treatment would be vancomycin plus gentamicin, or ceftazidime
    
    
• hypovolaemia:
  • usually caused by too rapid ultrafiltration - osmolarity of dialysate is too high
  • avoid by regularly monitoring weight and blood pressure
  • increase intravascular volume with parenteral saline or plasma
    
    
• electrolyte disturbance:
  • set dialysate composition accordingly
    
    
• weight gain, hypertriglyceridaemia and hyperglycaemia:
  • due to glucose loading from dialysate
  • give small doses of subcutaneous insulin for hyperglycaemia
    
    
• protein and amino acid losses:
  • provide patient with a high protein diet
  • limit duration of dialysis to maximum of 72 hrs weekly
  • consider haemodialysis if reduced period of peritoneal dialysis inadequate