Peritoneal dialysis in Crohn's disease: A gray area worth revisiting

Crohn's disease (CD) has traditionally been considered a relative or absolute contraindication to peritoneal dialysis (PD) because of concerns regarding chronic inflammation, peritoneal membrane injury, adhesions, and increased risk of peritonitis. However, clinical evidence supporting these concerns remains sparse. We report two patients with CD who initiated PD with differing outcomes. A 46-year-old man with longstanding stricturing ileocolonic CD developed end-stage kidney disease (ESKD) from monoclonal gammopathy of renal significance and acute interstitial nephritis. His CD was in clinical and endoscopic remission at PD initiation. He successfully continued PD without episodes of peritonitis or catheter-related complications until kidney transplantation 7 months later. In contrast, a 27-year-old man with ileal CD and ESKD from IgA nephropathy developed immediate PD catheter outflow failure. His prior CD therapies included multiple biologic agents, all without sustained remission, although endoscopic remission was eventually achieved. Despite laparoscopic intervention, catheter malfunction persisted, leading to catheter removal and transition to hemodialysis. These cases illustrate that PD may be feasible in selected patients with CD, particularly those with sustained clinical remission, and that the role of PD in this population may warrant re-evaluation.