Pleuroperitoneal Leaks: Diagnosis, Management, and Outcomes in the North American Peritoneal Dialysis Catheter Registry
Bibliographic record
Abstract
Background: Pleuroperitoneal leaks are an uncommon but well-known complication of peritoneal dialysis (PD) that often lead to discontinuation of therapy. This study aims to describe the incidence, clinical presentation, diagnosis, management, and outcomes of patients who developed pleuroperitoneal leaks in a contemporary cohort of PD patients registered in the International Society for Peritoneal Dialysis (ISPD) North American PD Catheter Registry. Methods: Data from the ISPD PD Catheter Registry were used for the analysis. Adult patients 18 years of age and older who underwent PD catheter insertion at 12 participating sites between November 18, 2015 and December 29, 2022 were captured. Cases that developed a pleuroperitoneal leak at any point during follow-up were identified and descriptive statistics were used to report the incidence, clinical presentation, diagnostic tests used, management strategies, and patient outcomes. Results: Forty-seven cases of pleuroperitoneal leaks were identified among 2,300 patients, corresponding to an incidence rate of 2%. Forty-two patients (89%) presented with a unilateral right-sided pleural effusion. Diagnosis was made based on thoracentesis in 47% of cases, clinical history alone in 26% of cases, and CT peritoneography in 23% of cases. The remaining cases were diagnosed using nuclear medicine scans or at the time of surgery. Once a leak was identified, 32 patients (68%) were transitioned to hemodialysis permanently, 8 patients (17%) underwent chemical or surgical pleurodesis, 5 patients (11%) temporarily transferred to HD, and 2 patients (4%) had their PD prescription modified. A total of 12 patients reattempted PD and 7 (58%) had no recurrence of the leak. All 5 patients who underwent pleurodesis and attempted PD again were successful. Conclusion: Pleuroperitoneal leaks remain a rare complication of PD. The majority were transferred to HD and never returned to PD. However, more than half of patients who re-attempted PD had no recurrence of their leaks and all patients who underwent pleurodesis and re-attempted PD were successful.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".