Wcn26-4300 Outcomes of Ambulatory Peritoneal Dialysis Catheter Insertion in the National Kidney and Transplant Institute

Introduction: Pleuroperitoneal communication (PPC) is an uncommon complication in patients undergoing peritoneal dialysis (PD), with an incidence ranging from 1.6% to 10% depending on the series.It typically occurs on the right side but can occasionally be bilateral.We report a case of a patient with diabetic nephropathy receiving combined peritoneal dialysis and hemodialysis (combPDHD) who developed bilateral PPC refractory to conservative management, ultimately requiring video-assisted thoracoscopic surgery (VATS).Methods: A 54-year-old man presented with a one-day history of dyspnea.He had a history of diabetes mellitus diagnosed at age 46 and had been receiving hemodialysis (HD) for diabetic nephropathy since age 52.As he wished to initiate PD, combined PD and HD therapy (combPDHD) was started six months earlier.His medical history also included angina pectoris, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia.Two weeks before admission, a reduction in PD effluent volume was noted.On admission, his blood pressure was 177/95 mmHg, pulse rate 86 beats per minute, body temperature 36.6 C, and oxygen saturation 93% breathing 1 L/min of oxygen via nasal cannula.Chest radiography revealed a right pleural effusion.Thoracentesis demonstrated a transudative effusion with an elevated glucose concentration (166 mg/dL), consistent with a right PPC.PD was discontinued, resulting in resolution of symptoms and effusion.PD was restarted 20 days later; however, 21 days after resumption, a left pleural effusion developed, indicating a left PPC.PD was again discontinued and later resumed after improvement.One month after the second resumption, bilateral pleural effusions recurred.Given the recurrent and bilateral nature of the effusions and the decreased PD effluent, bilateral VATS was performed.Intraoperative findings confirmed bilateral PPC, and both diaphragmatic defects were repaired with sutures and polyglycolic acid sheet reinforcement.PD was successfully resumed three weeks postoperatively, and no recurrence was observed two months later.Results: While conservative management is often effective, recurrent PPC, as in this case, may require surgical repair using VATS to enable continuation of PD.Combined PD and HD therapy offers clinical benefits for patients with inadequate solute or fluid removal on PD alone, commonly involving five to six PD sessions and one HD session per week.Because patients on combPDHD visit healthcare facilities weekly, PPC can be detected at an early stage.Conclusion: When conservative management fails, surgical intervention with VATS can effectively repair diaphragmatic defects and allow continuation of PD.In patients receiving combined PD and HD therapy, early recognition of PPC is feasible due to frequent clinical visits.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.