PD in a Pinch - Low Volume PD
Any treatment for kidney failure can have a few bumps in the road. A hernia repair or a catheter problem may upset your peritoneal dialysis (PD) routine. You might need a hemodialysis (HD) catheter so you can use HD for a few days—or a few weeks. Or, you may have one more choice: low volume PD.
What is low-volume PD?
Low volume, recumbent only (LVRO) PD uses small amounts of PD fluid. All exchanges (most often by cycler) are done while you lie flat (recumbent). During the day, you stay dry or use a low fluid volume. In a few weeks, you slowly use more fluid until you reach your normal level. Your doctor prescribes how much fluid to use and when to use more.
LVRO PD may let your peritoneum rest and heal after:
- A hernia repair
- A new catheter
- Moving a catheter to a new spot
- Other surgery to your belly
LVRO is less PD, so you would not want to use it any longer than you have to.
Research on low-volume PD
One study was done of 12 patients who had hernias fixed:
- For 1-3 days after surgery, they did no PD.
- Then, they did 6 exchanges per day of low-volume PD (1.0 to 1.5 liters)
- Patients were back to their PD routine 2-4 weeks later
All of those in the study did well, with no problems and no need for HD.1 A second study used LVRO PD to help patients after their PD catheters were place. There were two groups:
- Group 1 (203 patients) stayed dry for 3-5 days after the catheter was placed.
- Group 2 (159 patients), had their bellies rinsed with PD fluid until the fluid was clear. Then, they did low volume exchanges with a cycler every 2 hours until it stayed clear.
In group 2, all of the catheters worked (none of them failed).2
A second small study was done in the Netherlands. Of 40 patients, 38 were able to keep doing PD with LVRO after they had a PD catheter taken out and a new one put in at the same time. The new catheter was on the other side of the belly from the old one. Patients stopped PD for a day after surgery, and were dry during the day.3
A third small study in Canada looked back at 10 year’s worth of LVRO data in 50 people who had hernias fixed. They stopped PD for 2 days. Then, they used a cycler for 10 hours a day, three times a week for 2 weeks. After that, they used low volume exchanges for 2 weeks. By 4 weeks, they were back to their normal PD schedule. After 3 years, none of the patients had leaks or an early return of the same hernia.4
Avoiding in-center HD
If you are used to PD, you may not want to give up control for a short term switch to HD. And HD catheters have risks of their own—they can cause sepsis (blood poisoning). Ask your nephrologist if LVRO is an option for you.
- Tast C, Kuhlmann U, Stolzing H, Alscher D, Mettang T. Continuing CAPD after herniotomy. EDTNA ERCA J. 2002 Oct-Dec; 28(4): 173-5M.
- Gadallah MF, Torres-Rivera C, Ramdeen G, Myrick S, Habashi S, Andrews G. Relationship between intraperitoneal bleeding, adhesions, and peritoneal dialysis catheter failure: a method of prevention. Adv Perit Dial. 2001; 17: 127-9.
- Posthuma N, Borgstein PJ, Eijsbouts Q, ter Wee PM. Simultaneous peritoneal dialysis catheter insertion and removal in catheter-related infections without interruption of peritoneal dialysis. Nephrol Dial Transplant. 1998 Mar; 13(3): 700-3.
- Shah H, Chu M, Bargman JM. Perioperative management of peritoneal dialysis patients undergoing hernia surgery without the use of interim hemodialysis. Perit Dial Int. 2006 Nov-Dec;26(6):684-7