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Questions about PD? Ask!

Question:

Naheed Ansari
from USA asked on January 27, 2011:



How should one determine size of peritoneal cavity in a patient to undergo PD? Are there any guidelines or papers on this topic?



Answers:

A1, from (Australia):
There is not much evidence on the determination of peritoneal cavity size. But one would expect that the size of peritoneal cavity is directly proportional to the body surface area. Hence, 'larger' patients should receive increased fill volume (for example 3L).
In a small but nice study by Sarkar and colleagues (AJKD 1999;33:1136-1141), 20 PD patients received 2L, 2.5L and 3L fill volumes. At 75% occasions, patients were unable to correctly identify the fill volume. Furthermore, on 84% occasions there was no discomfort. Thus majority of PD patients can tolerate 2.5 to 3L fill volumes.
Increasing fill volumes also increase intra-abdominal pressure, which may lead to mechanical complications. Hence, we recommend that the fill volume should be increased in small increments and use lower % dextrose at higher volumes. A word of caution, patients should be assessed for the risk factors of hernia and other mechanical complications; and monitored regularly when using higher fill volumes.

A1, Dr. from Beijing (China):
I have consulted with other experts. As far as we know, there is no guide on adult patients. For pediatric patients, the volume is 30 ml/kg. For adults, most patients, even those as small as 40 kg can tolerate 2 liters. The abdomen is quite compliant. The most important is to get the instillation volume gradually increases from a low volume, e.g. 1 liter and gradually increases. Like pregnancy, even small ladies can accommodate a foetus of 3 kg, excluding the amniotic fluid and the uterus. Some advocate measuring intraperitoneal volume, but there is no guideline of the maximal volume as well.

Expert A, from (United States):
I concur with the two other responses. Not only is there no way to determine the size of the peritoneal cavity, it is also not possible to determine the severity of adhesions or scaring (from peritonitis, or previous surgery) - the only option is to do laparascopy or open surgery. Put differently, I would not preclude the possibility of doing PD in any person based on any non-invasive test.

Expert A, from (United States):
I concur with the two other responses. Not only is there no way to determine the size of the peritoneal cavity, it is also not possible to determine the severity of adhesions or scaring (from peritonitis, or previous surgery) - the only option is to do laparascopy or open surgery. Put differently, I would not preclude the possibility of doing PD in any person based on any non-invasive test.

Disclaimer: The answers represent personal views of the experts. The readers should use their own discretion in interpretation and application of the answers and the ISPD does not hold liability for such usage.


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