Gastrointestinal Complications

Delayed gastric emptying is relatively common among both diabetic and non-diabetic patients.  Delayed emptying of both solids and liquids has been detected in symptomatic and asymptomatic peritoneal dialysis (PD) patients(1,2).  A mechanical or neurogenic mechanism triggered by the presence of intra-abdominal fluid is thought to retard gastric emptying(3–5), although this has not been shown in all studies (6,7).  Prokinetic medications are the mainstay of therapy for symptomatic cases.

Pancreatitis is an infrequent but serious event often associated with peritoneal dialysis(8–10).  Although there are several potential risk factors for pancreatitis—including the presence of peritoneal dialysis fluid (PDF) in the lesser sac, irritants in PDF, peritonitis, hypertriglyceridemia and hypercalcemia—there is controversy regarding a causative relationship between PD and pancreatitis(11). The clinical manifestations are abdominal pain with or without cloudy fluid, culture negative peritonitis, markedly elevated serum amylase (> 3x normal levels), increased amylase in the dialysis effluent (> 100 U/L) and dialysate leukocytosis with sterile culture.  Traditional therapy is indicated without significant changes in the PD prescription.

Several other gastrointestinal complications have been described including ischemic colitis(12)and necrotizing enteritis, related to hypoperfusion of the bowel following hypotension; gastrointestinal bleeding from dilated submucosal vessels in the bowel(13); pneumoperitoneum with or without pain resulting from free air infused with the dialysis fluid(14); and hepatic subcapsular steatosis among patients receiving intraperitoneal insulin(15).

References

  1. Guz G, Bali M, Poyraz NY, Bagdatoglu O, Yeğin ZA, Doğan I, Atasever T, Sert S, Sindel S. Gastric emptying in patients on renal replacement therapy. Ren Fail. 2004;26(6):619-624. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15600252.
  2. Strid H, Simrén M, Stotzer P-O, Abrahamsson H, Björnsson ES. Delay in gastric emptying in patients with chronic renal failure. Scand J Gastroenterol. 2004;39(6):516-520. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15223673.
  3. Schoonjans R, Van Vlem B, Vandamme W, Van Vlierberghe H, Van Heddeghem N, Van Biesen W, Mast A, Sas S, Vanholder R, Lameire N, et al. Gastric emptying of solids in cirrhotic and peritoneal dialysis patients: influence of peritoneal volume load. Eur J Gastroenterol Hepatol. 2002;14(4):395-398. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11943952.
  4. Fernström A, Hylander B, Grybäck P, Jacobsson H, Hellström PM. Gastric emptying and electrogastrography in patients on CAPD. Perit Dial Int. 1999;19(5):429-437. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11379855.
  5. Brown-Cartwright D, Smith HJ, Feldman M. Gastric emptying of an indigestible solid in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Gastroenterology. 1988;95(1):49-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3371624.
  6. Stompór T, Hubalewska-Hola A, Staszczak A, Sulowicz W, Huszno B, Szybinski Z. Association between gastric emptying rate and nutritional status in patients treated with continuous ambulatory peritoneal dialysis. Perit Dial Int. 2002;22(4):500-505. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12322822.
  7. Van V, Schoonjans RS, Struijk DG, Verbanck JJ, Vanholder RC, Van B, Lefebvre RA, De V, Lameire NH. Influence of dialysate on gastric emptying time in peritoneal dialysis patients. Perit Dial Int. 2002;22(1):32-38. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11929141.
  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. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22027700.
  9. Villacorta J, Rivera M, Alvaro SJ, Palomares JRR, Ortuno J. Acute pancreatitis in peritoneal dialysis patients: diagnosis in the icodextrin era. Perit Dial Int. 2010;30(3):374-378. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20424203.
  10. Quraishi ER, Goel S, Gupta M, Catanzaro A, Zasuwa G, Divine G. Acute pancreatitis in patients on chronic peritoneal dialysis: an increased risk? Am J Gastroenterol. 2005;100(10):2288-2293. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16181382.
  11. Bruno MJ, van Westerloo DJ, van Dorp WT, Dekker W, Ferwerda J, Tytgat GN, Schut NH. Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology. Gut. 2000;46(3):385-389. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10673301.
  12. Koren G, Aladjem M, Militiano J, Seegal B, Jonash A, Boichis H. Ischemic colitis in chronic intermittent peritoneal dialysis. Nephron. 1984;36(4):272-274. Available from: https://www.ncbi.nlm.nih.gov/pubmed/6709119.
  13. Fantry GT, Hanes DS. Gastrointestinal Complications in End-Stage Renal Disease. In: Henrich WL, ed. Principles and Practice of Dialysis. 4th ed. Philadelphia, PA: Walters Kluwer Health; 2009:421-427.
  14. Ionescu C, Ecobici M, Olaru D, Stănescu C, Lupescu I, Voiculescu M. Pneumoperitoneum–rare complication in end stage renal disease patient on automated peritoneal dialysis. Rom J Intern Med. 2008;46(4):351-355. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19480302.
  15. Torun D, Oguzkurt L, Sezer S, Zumrutdal A, Singan M, Adam FU, Ozdemir FN, Haberal M. Hepatic subcapsular steatosis as a complication associated with intraperitoneal insulin treatment in diabetic peritoneal dialysis patients. Perit Dial Int. 2005;25(6):596-600. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16411528.

P/N 102509-01 Rev. A 06-2016