Questions About PD
Conventional wisdom has been that the use of PEG tubes in PD patients should be avoided due to the potential risks of leak and infection, particularly that of fungal peritonitis, however data are sparse.
In children at least, there seems to be a distinction in starting PD in a patient with a preexisting PEG tube, and placing a PEG tube in a prevalent PD patient.
Some data in children suggest that the former scenario, PEG before PD, is safer than the latter. Lederman et al. (Ped Neph 2002) found that while children starting PD with a preexisting PEG tube had peritonitis rates of 0.6 episodes per year, those receiving a PEG after PD started was 1.4 episodes per year. Prestidge et al (Ped Neph 2015) reported that in 15 patients receiving PEG after PD the rate of peritonitis were 1.21 episodes per patient year compared with 0.6 episodes of patient year prior to PEG placement. This result was not statistically significant.
Data in adults are scant and limited to case reports. Lew et al. (2011 Perit Dial Int) describe an adult patient with a preexisting PEG tube who subsequently started PD and survived seven months without peritonitis, exit site infection or leak. Paudel and Fan (AJKD 2014) describe a 68 year old man with a PEG placed while on PD. This patient had one episode of peritonitis in a 12 month period but further details are not provided.
At our insitution have had several patients receive PEG tubes while on PD, and both had early peritonitis complications. As a result, we avoid PEG after PD, and we have not yet had a patient with PEG before PD.