Hernia development in CAPD patients and the effect of 2.5 l dialysate volume in selected patients.

The aim of this study was to estimate the prevalence of hernia formation in CAPD patients and to study the effect of increased dialysate volume (2.5 l) in selected population of patients who could tolerate it. We reviewed the charts of 454 individuals treated with CAPD in our center during a five-year period (September 1991-September 1996). Out of 404 patients who used 2.0 l dialysate exchange volume forty-nine (11%) developed hernia (umbilical 53%, inguinal 33%, incisional 14%) after having been on CAPD for an average of 10 +/- 11 months, while only one of the 50 patients who would tolerate 2.5 l developed a hernia (inguinal 2%), after having been on CAPD for 12 months. All hernias were repaired surgically and most of the patients returned to CAPD after temporary intermittent peritoneal dialysis. Age, sex, nutritional status, polycystic kidneys, and diabetes do not seem to be predisposing factors for hernia formation, while previous operation for aortic abdominal aneurysm repair, or low body weight (< 60 kg) were risk factors. The use of increased dialysate volume (2.5 l) in patients who could tolerate it, did not result in a higher frequency of hernia development. Surprisingly, patients with hernias seem to have a higher mortality than those without.