KEY ACTIVITIES
- Inspect and examine suspect sites
- Refer to surgeon to determine intervention
- Umbilical hernias may be asymptomatic and can be managed by avoiding large fill volumes
- Schedule patient follow-up
THERAPEUTICS
- Significant hernia requires surgical repair
- Hernias should be repaired with prosthetic mesh techniques to minimize the high risk of recurrence in patients on PD.1 Until more information is known about resistance to infection of intraperitoneally placed prosthetic materials in the event of PD-related peritonitis, extraperitoneal hernia repair techniques with prosthetic mesh is advised.2
- Appropriate surgical attention to details in producing a watertight peritoneal closure and the use of supine, low-volume intermittent PD permits immediate resumption of therapy after hernia repair and avoids the need for temporary hemodialysis
- Patients have been continued on PD during the postoperative period after hernia repair; use of lower volume exchanges with dry days have allowed for continuation of PD without conversion to temporary HD3
Consider HD backup in patients with no residual renal function in whom small volume frequent exchanges are insufficient to control azotemia
