Gastrointestinal complications are common among patients on peritoneal dialysis. Risk factors for the development of gastrointestinal complications in this patient population include: toxic effects of uremic toxins, frequent use of nonsteroidal anti-inflammatory drugs, Helicobacter pylori infection, angiodysplasia, increased intra-abdominal pressure, use of bioincompatible solution for peritoneal dialysis, increased glucose in solutions for peritoneal dialysis, secondary hyperparathyroidism (hypercalcemia), a disorder of lipid metabolism (hypertriglyceridemia), and the duration of peritoneal dialysis treatment. The most important non-infectious gastrointestinal complications in patients on peritoneal dialysis are: gastrointestinal bleeding, herniation and leaking of the dialysate from the abdomen (increased intra-abdominal pressure), impaired lung function (intra-abdominal hypertension), acute pancreatitis, and encapsulating sclerosis of the peritoneum. Intra-abdominal hypertension is defined as IAP ≥ 12 mmHg. Pouring the peritoneal dialysis solution leads to increased intra-abdominal pressure, which results in the development of hernias, pleuro-peritoneal dialysate leakage (hydrothorax), and restrictive pulmonary dysfunction. Risk factors for the development of acute pancreatitis in this patient population include: uraemia, secondary hyperparathyroidism with hypercalcemia, hypertriglyceridemia, features of the peritoneal dialysis solution (osmolarity, acidity, glucose, chemical irritation, and calcium in the solution for peritoneal dialysis lead to “local hypercalcemia”), toxic substances from the dialysate, the bags and tubing, and peritonitis and treatment of peritonitis with antibiotics and anticoagulants. Encapsulating sclerosis of the peritoneum is rare and is the most serious complication of long-term peritoneal dialysis. It is characterized by thickening of the peritoneum, including cancer, and signs and symptoms of obstructive ileus. Diagnosis is based on clinical, laboratory and radiological parameters. Encapsulating sclerosis of the peritoneum can be indicated by an AR-CA-125 concentration of less than 33 U/min and a concentration of AR-IL-6 greater than 350 pg/min in the effluent of patients with ultrafiltration weakness. Treatment consists of stopping peritoneal dialysis, using anti-inflammatory (corticosteroids) and anticicatricial drugs (tamoxifen), while surgical treatment includes enterolysis and adhesiolysis.
4. Park SH, Kim YL, Lindholm B. Experimental encapsulating peritoneal sclerosis models: pathogenesis and treatment. Perit Dial Int 2008; 28(Suppl 5): 21-8.
5. Baker S. Diagnosis and Management of Acute Pancreatitis. Critical Care Resuscitation 2004; 6(1): 17-27.
6. Schoenicke G, Grabensee B, Plum J. Dialysis with icodextrine interferes with measurement of serum α-amylase activity. Nephrol Dial Transplant 2002; 17: 1988-92.
7. Petejova N, Martinek A. Acute kidney injury following acute pancreatitis: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157(2): 105-13.
8. Manga F, Lim CS, Mangena L, Guest M. Acute pancreatitis in peritoneal dialysis: a case report with literature review. Eur J Gastroenterol Hepatol 2012; 24(1): 95-101.
9. Waele JJD, Laet IDL, Kirkpatrick AW, Hoste E. Intraabdominal Hypertension and Abdominal Compartment Syndrome. Am J Kidney Dis 2010; 57(1): 159-69.
10. Kirkpatrick AW, Roberts DJ, Waele JD, Jaeschke R, Malbrain MLNG, Keulenaer BD, Keulenaer BD, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39(7): 1190-1206.
11. Mohmand H, Goldfarb S. Renal Dysfunction Associated with Intra-abdominal Hypertension and the Abdominal Compartment Syndrome. J Am Soc Nephrol 2011; 22(4): 615-21.
12. Sarr MG. 2012 revision of the Atlanta Classification of acute pancreatitis. Pol Arh Med Wewn 2013; 123(3): 118-24.
13. Izakson A, Ezri T, Weiner D, Litmanovich D, Khankin EV. New developments in understanding of pathophysiology, diagnosis and treatment of severe acute pancreatitis. J Rom Anest Terap Int 2012; 19(1): 39-50.
14. Stuart S, Booth TC, Cash CJC, Hameeduddin A, Goode JA, Harvey C, Malhotra A. Complications of Continuous Ambulatory Peritoneal Dialysis. RadioGraphics 2009; 29(2): 441-60.
15. Cho Y, Dintini V, Ranganathan D. Acute Hydrotorax Complicating Peritoneal Dialysis: A Case Report. J Med Case Reports 2010; 4(360).
16. Fernando SK, Salzano R, Reynolds JT. Peritoneal Dialysis- Related Hydrotorax-Case Report. Adv Perit Dial 2006; 22(2): 158-61.
17. Lew SQ. Hydrotorax: Pleural effusion associated with peritoneal dialysis. Perit Dial Int 2008; 30(1): 13-8.
18. Tapawan K, Chen E, Selk N, Hong E, Virmani S, Balk R. A Large Pleural Effusion in a Patient Receiving Peritoneal Dialysis. Semin Dial 2011; 24(5): 560-3.