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Live Symposia 
General Topics
       What is Dialysis?
       Residual Renal Function
          The Importance of RRF
       Diabetes Management
          PD and the Diabetic Patient
          General Facts: Diabetes
          When to Initiate PD in the Diabetic Patient
       Renal Osteodystrophy
          Renal Osteodystrophy Clinical Studies
       Numbers-Their Use and Interpretation
       Basic Statistics
       Vaccinating CKD and Dialysis Patients
Peritoneal Dialysis
       History of PD
          History of PD
          Evolution of PD
       Basic Principles of PD
          Anatomy of the Peritoneum
          Physiology of Peritoneal Transport
       Peritoneal Transport 
          Understanding Testing Methods
          Transport Status:Classification and Implications
          Peritoneal Function After Exposure to PD
       Modalities of Therapy
          PD Modalities
       PD Adequacy
          Prescribing Dialysis
             Targets of PD Prescription
             Determinants of Dose
             Exchange Volume and Position
             How to Reach the Goals
             Monitoring the PD Patient
             Evaluating the Patient as a Whole
             StdKt/V - Dose Equivalency
          Importance of Volume Control
          How to Achieve Adequate PD UF
          Non-Infectious Complications of PD
          Peritoneal Dialysis-Related Infections
             Management of ESI
             Diagnosis and Treatment of Peritonitis 
       Dialysis Access
          The Evolution of PD Catheters
          Preop Management
          Placement of PD Catheters
          Intraoperative Management
          Post Operative Care and Management
          Complications of PD Catheters
       Clinical Outcomes
          Clinical outcomes of PD and HD
       History of Hemodialysis
       Kinetic Principles
          Impact of t & Kr on Kt/V
          Measuring Hemodialysis dose
       Modalities of Therapy
          Hemodialysis Regimens/Prescriptions
          Extracorporeal Modalities
       Home HD
          HD Regimens/Prescriptions
          The Influence of Dose, Time & Frequency
          Every other day HD (HD3.5)
          Time Versus Dialysis-Free Interval
          Benefits of Increased HD Frequency
          Increased Frequency – Other Modalities
          Potential Lifestyle Benefits of HD3.5
          Home Program Management
             Establishing a Home Program
       Intradialytic Complications
          Difficulties in Prescribing Adequate Dialysis
       Sodium Modeling
       Hemodialysis Access
          Introduction to Vascular Access
          Overview of Arteriovenous Fistula
          Overview of Arteriovenous Grafts
          Overview of Central Venous Catheters
          Vascular Access Monitoring and Surveillance
       Access Complications
          Overview of Hemodialysis Complications
          AVF Stenosis
          Interventions for AVF and AVG Stenosis
          Primary Fistula Failure
          Catheter Related Bacteremia
       Other Links


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Hemoperitoneum is a frequent complication of PD particularly among premenopausal women with an incidence of 6-57%1,2.  It may be due to the peritoneal dialysis procedure or to factors unrelated to the procedure or to renal disease.  The regular performance of dialysis exchanges allows early detection. 


Etiology of Hemoperitoneum.

•        Gynecological

–       Menstruation - ovulation

–       Ovarian cyst - endometriosis

•        Neoplastic

–       Renal cell carcinoma

–       Adenocarcinoma of colon

–       Carcinomatosis of the liver or hepatoma

•        Hematological

–       Thrombocytopenic purpura- anticoagulation

•        Polycystic diseases

•        Gastrointestinal

–       Splenic rupture or infarct, cholecystitis, pancreatitis, colonic perforation

•        Sclerosing peritonitis

•        Peritoneal calcification

•        Retroperitoneal or iliopsoas hematoma


Evaluation and Management.  Obtain white blood cell count in PD effluent and blood, amylase in PD fluid and culture at the first occurrence of hemoperitoneum.  To determine the severity of bleeding obtain an effluent hematocrit and monitor changes in blood hemoglobin levels.  Heavy recurrent bleeding associated with pain and fever demands urgent evaluation.  An effluent hematocrit > 2% suggests severe bleeding.  Further evaluation includes coagulation studies, abdominal imaging (CT scan, ultrasound, magnetic resonance, angiography).  Rapid exchanges and the use of intraperitoneal heparin (500-1,000 U/l) as long as the dialysate has visible blood or fibrin have been recommended to prevent clotting.  Oral contraceptives may prevent ovulation and control bleeding.  Aspirin and anticoagulants should be stopped, if possible.  If bleeding persists, surgical exploration may be required. 


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  1. Greenberg A, Bernardini J, Piraino BM, Johnston JR, Perlmutter JA. Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review. Am J Kidney Dis 19:252-256, 1992
  2. Harnett JD, Gill D, Corbett L, Parfrey PS, Gault H. Recurrent hemoperiotneum in women receiving CAPD.  Ann Int Med 107:341-343, 1987
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