Peritoneal Dialysis in Patients with Crohn Disease: Absolute Contraindication or Grey Area with Pink and Purple Polka Dots?

Introduction: Most end-stage kidney disease (ESKD) patients with inflammatory bowel disease (IBD) undergo hemodialysis (HD) because IBD has traditionally been considered a clinical contraindication to peritoneal dialysis (PD). Literature regarding PD use in IBD patients is scarce. We present two cases where PD was initiated in patients with Crohn’s Disease (CD). Case Description: Case 1: A 46-year-old man with a history of stricturing ileocolonic CD for 20 years developed ESKD from monoclonal gammopathy of renal significance and acute interstitial nephritis possibly related to Vedolizumab. His CD was in clinical remission with Risankizumab at the initiation of PD. He had surgical history of cholecystectomy and bilateral inguinal repair. PD catheter was placed percutaneously with fluoroscopic guidance by Interventional Nephrology. He was started on continuous cycler peritoneal dialysis, which was later transitioned to once-a-day exchange of Icodextrin. He received a kidney transplant 7 month after the initiation of PD. He did not develop any episodes of PD peritonitis during the period. Case 2: A 27-year-old man with a history of CD for 7 years became ESKD from IgA nephropathy. He had non-stricturing non-penetrating ileal CD, previously treated with Azathioprine, Adalimumab, Ustekinumab, and Vedolizumab without persistent response. He was on Risankizumab at the initiation of PD and he was in endoscopic remission based on a normal ileocolonoscopy. He did not have previous abdominal surgeries. A PD catheter was placed under fluoroscopy. However, he immediately experienced outflow failure. A laparoscopic revision of PD catheter was performed with fibrin sheath dissection and partial omentectomy, during which some adhesions from the omentum to the pelvic wall were found. Because he continued to have PD catheter malfunctioning, the catheter was removed, and he was transitioned to HD. He continued HD until he received a kidney transplant 7 months later. Discussion: We present one successful and one unsuccessful case of PD use in CD. Our cases demonstrate that it may be possible in IBD patients under the proper conditions, with clear remission and a clear plan for prompt transplantation if they are considered candidates. Further research is needed to define the detailed indications and contraindications of PD in patients with IBD.