Myth 2: Peritoneal Dialysis Is Contraindicated in Patients With an Ostomy
The concerns regarding peritoneal dialysis in patients with an ostomy are those of leakage, cross infection of the peritoneal dialysis catheter or exit site by urine or faeces, catheter malfunction because of adhesions from prior surgery, and the potential disruption of or need to terminate peritoneal dialysis upon subsequent abdominal surgery to address the original pathology or its complications, for example, tumour recurrence.
In 1992, Korzets et al. reported that peritoneal dialysis in the presence of an ostomy was associated with reasonable outcomes. KDOQI guidelines acknowledged the concern about infection but suggested that the decision for peritoneal dialysis in the presence of an ostomy be individualized. Presternal catheters have been used for adult and paediatric patients with ostomies with acceptable infectious and mechanical outcomes.[6–9] From an infectious standpoint, presternal catheters are preferred over abdominal catheters by virtue of greater distance of the catheter exit site from the ostomy, although no randomized controlled trials have been performed.
An important consideration in modality choice for the patient with an ostomy is what the indication was for the ostomy. If there was an isolated event, such as resection of a bowel tumour, peritoneal dialysis may be feasible. However, if the patient has an ostomy as a result of inflammatory bowel disease, especially active inflammatory bowel disease, there is a significant risk of peritonitis due to transmural flux of enteric bacteria across the inflamed bowel wall. In this instance, haemodialysis is a better dialysis modality choice.
Curr Opin Nephrol Hypertens. 2016;25(6):602-608. © 2016 Lippincott Williams & Wilkins