Abdominal Wall Hernias in Peritoneal Dialysis Patients: Risk Factors and Technique Survival

Introduction: Peritoneal dialysis patients are at increased risk of developing abdominal wall complications, including hernias. This study aimed to determine the incidence of hernias in peritoneal dialysis patients, identify risk factors, and evaluate their impact on technique survival. Methods: A retrospective cohort study was conducted, including prevalent peritoneal dialysis patients in a single center, from January 2010 to October 2020. Data on baseline characteristics, previous abdominal surgeries, and hernia history were collected. Patients with diagnosed hernias during peritoneal dialysis were compared to a control group. Results: Among 155 peritoneal dialysis patients, hernias occurred in 29% (n=45) of the population, with an incidence rate of 0.09 hernias/ patient/year. Umbilical hernias were the most common subtype. Autosomal dominant polycystic kidney disease [OR (odds ratio) 3.925; 95% confidence interval (CI), 1.208 – 12.750], history of surgical repaired hernias (OR 5.586; 95% CI 1.540 – 20.255) and a higher number of previous abdominal surgeries (OR 1.680; 95% CI 1.025 – 2.752) were independent predictors of hernia development. Surgical treatment was performed in 59.3% of cases, with a 18.8% recurrence rate. Higher daytime infusion volumes were associated with hernia recurrence (p=0.045). Peritoneal dialysis technique survival did not differ significantly between the hernia and control groups (p=0.700). Conclusion: Hernias are frequent in peritoneal dialysis patients, with autosomal dominant polycystic kidney disease, previous abdominal surgeries, and history of surgically repaired hernias as identified risk factors. Hernias do not significantly interfere with peritoneal dialysis technique survival, but comprehensive management strategies, including early surgical repair and peritoneal dialysis prescription adaptations, can optimize outcomes.