Which of the following factors indicate a poor candidate for PD?

• A. Extensive abdominal adhesions
• B. All of the above
• C. Unrepaired hernias
• D. Malnutrition

Answer: (B)

PD candidacy is strongly influenced by conditions that compromise safety and how well dialysate can work in the peritoneal cavity. Extensive abdominal adhesions, often from prior surgeries or infections, can fix or distort the peritoneal surfaces, making catheter placement difficult and limiting dialysate flow. This can lead to poor drainage, catheter dysfunction, or inadequate dialysis clearance.

Unrepaired hernias pose a risk because filling the abdomen with dialysate increases intra-abdominal pressure. If a hernia is not repaired, dialysate can worsen the hernia, cause leakage, or lead to incarceration, complicating treatment or necessitating postponement of PD until repair.

Malnutrition weakens healing and immune defenses, increasing the risk of exit-site infections and peritonitis and slowing recovery from any procedure like catheter placement. It also correlates with poorer overall outcomes on dialysis.

Since each factor individually makes PD less safe or effective, having all of them together indicates a poor candidate for peritoneal dialysis.