Raising volumes to the limit of tolerance may be problematic in patients with advanced lung disease or patients with recurrent hydrothorax. Inflammatory or ischemic bowel disease or frequent episodes of diverticulitis are relative contraindications to peritoneal dialysis. It is reasonable to assume that there may be increased risk for transmural contamination by enteric organisms in these circumstances. Abdominal wall or skin infection can lead to contamination of the catheter exit site, tunnel, and peritoneal cavity through touch and cross contamination. Morbid obesity can pose special dilemmas in peritoneal catheter placement, the healing process, and in providing adequate dialysis.
Wound healing is compromised in severely malnourished patients.
Self-dialysis such as PD may not be suitable for many severely malnourished patients because of inability to comply with the dialysis regime. Diverticulitis during peritoneal dialysis often results in peritonitis. Peritoneal dialysis in patients with frequent episodes of diverticulitis places these patients at higher risk for peritonitis. The decision to transfer a PD patient to HD should be based on clinical assessment, the patient's ability to reach HD dose target levels, and the patient's wishes. Inadequate solute transport or fluid removal.