Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis

Abstract

Objectives: To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). Design: Single-center retrospective case review of patients on CAPD over a 10-year period. Setting: Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. Patients: 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. Main Outcome Measures: Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D 4/D 0) with standard 2-L 2.5% glucose dialysate were assessed. Results: There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24 - 76 years) and mean duration of dialysis was 61.6 months (range 2 - 166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2 - 12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1 - 37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes (p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes (p = 0.91) or survival (p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. Conclusions: Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.