Questions About PD
Peritoneal dialysis is certainly feasible in obese patients, but one has to be aware of some special considerations. These patients may be at higher risk of leaks and hernias due to the greater intra-peritoneal pressure. In order to avoid leaks, one should try to allow a longer healing time prior to catheter use (eg. 4 weeks rather than 2 weeks). With regard to placement of the catheter, it is important that the exit site be above the patient’s pannus – preferably in the upper abdomen (or pre-sternal). This will decrease the amount of moisture at the catheter site, will allow for easier exit site care and will make the exit site more visible to the patient. While the data are inconsistent, obesity may be associated with an increased risk of peritonitis, so patient training and early recognition of infection is particularly important. Finally, if patients have a large body mass, it is possible that some patients may have trouble achieving adequate PD (although it should be noted that using the patient’s real V rather than ideal V will lead to underestimation of their adequacy as determined by kt/V). Therefore, one should focus on how patient is doing clinically. Despite these considerations, obese patients can do very well on PD and it should certainly be offered to the patient if otherwise appropriate.