Peritoneal dialysis can be done in most patients. There are a number of conditions that may make hemodialysis the preferred dialysis approach.


Contraindication - inadequate peritoneal cavity resulting in inadequate dialysis:

(1) history of colostomy

(2) history of ileostomy

(3) polycystic kidney disease


Contraindication - peritoneal cavity not intact:

(1) recent abdominal surgery with drains or draining wounds

(2) diaphragmatic hernia (pediatric)

(3) omphalocele (pediatric)

(4) gastroschisis (pediatric)

(5) defect in the diaphragm, such as post-traumatic rupture


Contraindication - risk of complications:

(1) history of abdominal aneurysm surgery

(2) severe obstructive lung disease

(3) severe peripheral vascular disease

(4) diverticulosis of the bowel


Contraindication to perform the procedure at home:

(1) unable to perform the procedure properly (failure to understand or adhere to procedure)



• The following conditions were not listed as contraindications but which strike me as posing problems: active Crohn's disease, diffuse peritonitis with adhesions, diffuse carcinomatosis, hepatorenal syndrome, necrotizing enterocolitis (pediatric).


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