Bulletin de la Dialyse à Domicile

Current status of bariatric surgery treatment in peritoneal dialysis

Victor Fages — 2025-12-17

Obesity is a major public health issue that affects a significant proportion of patients with end-stage renal disease (ESRD). In patients undergoing peritoneal dialysis (PD), obesity complicates treatment by increasing the risk of mechanical complications and infections and reducing the effectiveness of peritoneal exchanges. Furthermore, obesity limits access to kidney transplantation, making weight loss a crucial goal. Bariatric surgery is emerging as an effective strategy for improving metabolic condition and promoting placement on a transplant waiting list.
Sleeve gastrectomy (SG) is now the preferred technique for helping obese patients on ESRD lose weight, particularly due to its favorable safety profile, reduced operating time, and absence of intestinal bypass, thus limiting the risk of deficiencies. The available data, although limited to case series and isolated reports, suggest that SG can be performed in PD patients either with early resumption of PD or after a temporary transition to hemodialysis depending on clinical status. Optimized protocols include a gradual resumption of PD at low volumes, minimizing the risk of leakage or infection.
Bariatric surgery therefore appears feasible and generally safe in PD patients, provided that a rigorous multidisciplinary assessment and close nutritional monitoring are carried out to prevent malnutrition and sarcopenia. It is a relevant therapeutic option for improving access to kidney transplantation and optimizing the prognosis of obese patients with ESRD. This article was written following a presentation at the Société Francophone de Néphrologie, Dialyse et Transplantation 2025 on the feasibility of bariatric surgery in PD.

Traduction Française de la prise de position de la Société Internationale pour la Dialyse Péritonéale (ISPD) : Enseigner la dialyse péritonéale

Sophie Mougel — 2025-12-17

Information about this translation : As part of a partnership agreement between the ISPD and the RDPLF ( https://doi.org/10.25796/bdd.v4i3.63033 ), the RDPLF is the official French translator of the ISPD recommendations.

The RDPLF is committed to faithfully translating the original text, under the responsibility of two nephrologists and nurses known for their expertise in the field. The translation is available on the ISPD website and in the Bulletin de la Dialyse à Domicile.

Like the original, this translation is freely downloadable under copyright CC By 4.0 https://creativecommons.org/licenses/by-nc/4.0/.

This translation is intended to help professionals in the French-speaking community to familiarize themselves with ISPD recommendations in their mother tongue. Any reference in this article should be to the original open-access text: Peritoneal Dialysis International https://doi.org/10.1177/08968608251375512. In articles written for French journals, keep the reference to the original English version above, but add "traduction française: https://doi.org/10.25796/bdd.v8i4.87095

Recurrence of inguinal hernia and scrotal edema due to dialysate leakage through the processus vaginalis: clinical case.

Victor Calderon — 2025-12-17

Peritoneal dialysis is a therapeutic option for end-stage kidney disease patients that offers a better quality of life Peritoneal dialysis is a treatment option for patients with stage V chronic kidney disease that offers a better quality of life compared to hemodialysis. Abdominal wall hernias and scrotal edema are potential complications of peritoneal dialysis that may require discontinuation of the technique. However, radiological diagnosis and treatment of the hernia allow peritoneal dialysis to be resumed. We report here the case of a 72-year-old patient presenting with unilateral recurrence of an inguinal hernia with scrotal edema after bilateral open repair due to leakage of peritoneal dialysis fluid through a patent processus vaginalis, and we reviewed the existing literature. The literature reports that 4 to 14% of peritoneal dialysis patients develop an abdominal hernia and that dialysate leakage or scrotal edema, which are rarer, are often associated with an indirect inguinal hernia or a persistent patent processus vaginalis. Several risk factors have been identified: age, male gender, obesity, polycystic kidney disease, history of hernia, and high dialysate volumes. The diagnosis is based mainly on peritoneal computed tomography. Management may be conservative, but surgical repair using a tension-free technique, preferably according to Lichtenstein, is recommended in cases of confirmed primary or recurrent hernia. The optimal time to resume peritoneal dialysis remains variable, but is most often between 2 and 6 weeks.