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Outcome and complications in peritoneal dialysis patients: A five-year single center experience  [cached]
Alwakeel Jamal,Alsuwaida Abdulkareem,Askar Akram,Memon Nawaz
Saudi Journal of Kidney Diseases and Transplantation , 2011,
Abstract: Peritoneal dialysis (PD) is one of the modes of renal replacement therapy being utilized for the management of end-stage renal failure in King Khalid University Hospital, King Saud Uni-versity, Riyadh, for more than two decades. The aim of this study was to evaluate the complications related to PD as well as its outcome in patients on this mode of therapy during the period between January 2004 and December 2008. There were 72 patients included in the study, of whom 43 were females. The average age was 50.7 ± 30.1 years (14-88 years). Diabetes was the leading cause of end-stage renal disease (ESRD) seen in 40.2% of the study patients. Twenty-eight patients (38.9%) were on continuous ambulatory peritoneal dialysis (CAPD) and 44 (61.1%) were on automated PD (nocturnal intermittent peritoneal dialysis, NIPD or continuous cycler peritoneal dialysis, CCPD). The mean du-ration on PD of the study patients was 25.5 ± 16.58 months (1-60 months). The peritonitis rate was one episode per 24.51 patient-months or one episode per 2.04 patient-years. The incidence of peritonitis per person-year was calculated as 0.42. The leading causative agent for peritonitis was Staphylococcus (32%). Exit-site infection (ESI) rate was one episode per 56.21 patient-months. The incidence of ESI was 0.214 per person-years. The most common infective organism for ESI was Pseudomonas aeru-ginosa (58.8%). At the end of 5 years, 35 patients were continuing on PD, 13 patients were shifted to hemodialysis (HD), nine patients underwent renal transplantation, and six patients were transferred to other centers. Among the 13 patients who were shifted to HD, four patients had refractory peritonitis, four others had catheter malfunction, three patients had inadequate clearance on PD and two patients had lack of compliance. A total of 11 patients died during the study period, giving an overall mortality rate of 15.27% for the five-year period. Our study suggests that there has been considerable improvement in overall outcome and mortality in patients on PD. Additionally, a marked reduction in the infectious and non-infectious complications was noted with the peritonitis and ESI rates in our center being comparable to other studies and international guidelines.
Mechanical Complications of Peritoneal Dialysis  [PDF]
Marwa Miftah, Mohammed Asseban, Aicha Bezzaz, Adil Kallat, Ali Iken, Yassine Nouini, Loubna Benamar
Open Journal of Nephrology (OJNeph) , 2014, DOI: 10.4236/ojneph.2014.43015
Abstract: Introduction: The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. The mechanical complications of peritoneal dialysis (MCPD) are a major cause of the failure of the technique. The aim of the study was to define the prevalence of peritoneal dialysis (PD) mechanical catheter complications, to determine the time and the factors associated with their occurring. Materials and Methods: A retrospective study was conducted between January 2009 and January 2014 at the nephrology, dialysis and renal transplants department of Ibn Sina university hospital in Rabat. We included all patients who were on peritoneal dialysis and presented mechanical complications. These mechanical catheter complications are represented by catheter migration or obstruction, inguinal or umbilical hernias, early and late peritoneal dialysate leakage, subcutaneous cuff extrusion and hemoperitoneum. Results: MCPD were noted in 23 of the 62 patients (37% of cases). Onset time of complications was 24.8 ± 18.9 months [3 - 60 months]. Among these complications, we noted a catheter migration (65.2%), postoperative hematoma (21.7%), cracking or perforation of catheter (17.4%), epiploic aspiration (17.4%), sleeve externalization (17.4%), catheter obstruction (13%), hemoperitoneum (13%), hernia (22%; 13% umbilical and 8.7% inguinal), early dialysate leakage (13%), and pleuroperitoneal leakage (8.7%). The average age of our patients was 54.9 ± 15.5 years [21 - 81 years old], with a male predominance and a sex ratio of 2.28. The average body mass index (BMI) was 25.4 kg/m2. Diabetic patients represent 48.7% of our series. In our study, MCPD represent 13% of causes of transfer to hemodialysis (HD). Conclusion: Prevention of MCPD remains crucial. It is based on good patient education on hygiene and handling errors but also periodic retraining of patients and caregivers.
Etiology of renal failure and peritoneal dialysis complications in Isfahan  [PDF]
Soheila Mojdeh, Shirin Karimi, Ali Mehrabi, Soheila Bakhtiari
Health (Health) , 2013, DOI: 10.4236/health.2013.510229
Abstract:

Introduction: Worldwide specific diseases are jeopardizing people’s health in the world as well as in Iran. Chronic renal failure as a developed and irreversible failure is usually progressive. End Stage Renal Disease (ESRD) is a situation when renal function is not sufficient to preserve one’s life leading to acute uremia resulting in dialysis and/or kidney transplantation for the patients. Although dialysis methods bring about complications for the patients, peritoneal dialysis is relatively cost-effective and more convenient to survive. The present study aimed to investigate (the) Etiologic factor of renal failure and imposed complications of peritoneal dialysis in the patients of Isfahan Alzahra hospital. Materials and Methods: It was a cross-sectional descriptive study conducted on 67 patients in Isfahan Peritoneal Dialysis Center. The data from the patients were collected through a two-section questionnaire whose first section was allocated to demographic information and the second part was related to the disease and complications of peritoneal dialysis. The collected data were analyzed by SPSS version 18. Results: The findings showed that there were 39 (58%) males and 28 (42%) females. Mean age of the subjects was 48 (18.8) years old. Regarding marital status, 65% were married and 35% were single. Considering complications, 28 subjects (53.5%) had infectious complications while 24 subjects (46.2%) had non-infectious complications. The highest frequency in etiologic factor of renal failure was diabetes mellitus in 29 subjects (43.9%) and the lowest for polycystic kidney in 2 subjects (3%); in addition, hypertension was observed in 51 subjects (77.3%). Discussion: The most frequent and important complication of peritoneal dialysis catheters is infection, whic

Survival and complications of peritoneal dialysis catheters: introducing a laparoscopic method under local anesthesia
Keshvari A,Jafari- javid M,Najafi I,Chaman R
Tehran University Medical Journal , 2008,
Abstract: "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Chronic peritoneal dialysis is a safe method for the treatment of end-stage renal failure. Worldwide, patients on chronic peritoneal dialysis constititute approximately 15% of the total number of patients on dialysis. In Iran, very few people have access to chronic peritoneal dialysis, which is targeted by the Ministry of Health. This lack of access is primarily due to the high occurrence of mechanical complications. Improving catheterization procedures is an important way to extend the use of peritoneal dialysis in Iran. Thus, a prospective study was implemented to evaluate the outcome of a new laparoscopic technique for the insertion of peritoneal dialysis catheters under local anesthesia."n"n Methods: A total of 115 catheters (two-cuff, swan-necked, coiled) were inserted into the peritoneal cavity of 109 patients with end-stage chronic renal failure during a 16-month period. The method of insertion was a two-port laparoscopic technique with local anesthesia and sedation. All patients were followed for 12 to 28 months. We prospectively evaluated mechanical and infectious complications and survival rates of the catheters."n"n Results: The average age of the patients was 51.5 years (range: 15-84 years); 54.8% of these patients were female. The overall one-year and two-year catheter survival rates using this approach were 88% and 73%, respectively. Event-free catheter survival was 35%. The most common infectious and mechanical complications were peritonitis in 52 cases (45.2%) and temporary dialysate leakage in 10 cases (8.7%) respectively."n"n Conclusion: Laparoscopic insertion of peritoneal dialysis catheter with local anesthesia is a safe and simple procedure, giving reasonable rates of catheter survival and complications. "nKeywords: laparoscopy, peritoneal dialysis, catheter, loca
Diagnostic value of CT peritoneography for non-infectious complications of peritoneal dialysis  [cached]
Qin WANG
Zhong Xi Yi Jie He Xue Bao , 2008,
Abstract: Objective: To assess the diagnostic value of CT peritoneography for peritoneal complications of continuous ambulatory peritoneal dialysis (CAPD).Methods: CT peritoneography in 11 CAPD patients with clinically suspected dialysis-related complications was prospectively studied. The CAPD patients were all treated in Renji Hospital from 2005 to 2007. CT images were reviewed according to the evidence of peritoneal leaks, hernias, loculated pleural fluid collections, and adhesions.Results: Abnormal findings were found in 9 of 11 CAPD cases including inguinal hernias (3 cases), umbilical hernia (1 case), hydrocele (1 case), leaks in catheter tunnel (2 cases), and peritoneal adhesions (2 cases). Parts of them were confirmed by surgical operation.Conclusion: CT peritoneography is useful for the evaluation of complications related to CAPD, and it offers excellent tissue contrast and multiplanar imaging for assessment of the complications.
Laparoscopic Placement of Peritoneal Dialysis Catheters in CAPD Patients: Complications and Survival
H Ashegh,J Rezaii,K Esfandiari,A Roueentan
Tehran University Medical Journal , 2008,
Abstract: Background: Laparoscopic techniques for the placement of peritoneal dialysis catheters are becoming increasingly popular. Recently, with the improvements in laparoscopic surgery, various methods for the insertion of peritoneal dialysis catheters have been reported, indicating that the laparoscopic insertion is preferred over the open and percutaneous techniques. The aim of this study was to introduce and assess a simplified laparoscopic method for the insertion of peritoneal dialysis catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods: We enrolled 79 consecutive end-stage renal patients (46 men and 33 women) with a mean age of 50 years (range: 19-83 years) in this study. During the surgery, a 5-mm trocar was placed in the left upper quadrant for the optics and another 5-mm trocar was placed to the left of the umbilicus. Using the second trocar, a tunnel was formed 2 cm left of the umbilical plane for the insertion of a Tenckhoff catheter. Under direct vision, the catheter was advanced into the abdomen. The catheter was tested for patency. Catheters of all subjects were capped for two weeks before dialysis initiation.Results: The mean duration of the operation was 15 minutes. Ten patients died during the follow-up period, all due to other medical problems, and six patients underwent renal transplantation; however, no deaths or complications were observed during surgery. Early onset complications were seen in 12 patients (15.1%). The most frequent late-onset medical and mechanical complications were peritonitis (6.3%) and hernia (3.7%). During a follow-up period of four years, removal of the catheter was required in two patients as a result of peritonitis.Conclusion: We obtained a low complication rate and a high catheter survival rate with this laparoscopic insertion of the Tenckhoff catheter. We believe future experience will encourage the use of this safe, simple and quick procedure.
Effectiveness of a Separate Training Center for Peritoneal Dialysis Patients  [cached]
Souqiyyeh Muhammad,Al-Wakeel Jamal,Al-Harbi Ali,Al-Shaebi Fuad
Saudi Journal of Kidney Diseases and Transplantation , 2008,
Abstract: The aim of this study is to analyze the patients′ database of the Baxter′s Training Peritoneal Dialysis Program (BTPDP) adopted at the Baxter Renal Education Center (BREC), Riyadh, Saudi Arabia in order to determine its effectiveness in the management, compliance, and outcome of the trained peritoneal dialysis (PD) patients. The study analyzes the database of the BTPDP, which includes the demographic data, duration of follow-up, complications, and outcome of the patients trained on PD between September 2003 and November 2007. Records of 376 patients with a mean age of 46.0 ± 22.6 years were available in the database for analysis. Of them, 187 (49.7%) were males, 312 (82.9%) were trained at the BREC, 315 (83.8%) were new PD patients, and 298 (79.3%) were trained on automated PD (APD). The dropouts during the study period included 172 patients (46%); 42 (24.4%) were transplanted, 45 (26.2%) switched to hemodialysis, 57 (33.1%) died and 28 (16.3%) were lost to follow-up. A comparison was made between the group trained at the BREC and the group trained at the hospital. There was an overwhelming adoption of BTPDP by the different hospitals during the study period (p < 0.00001). There were 264 (84.6%) patients trained on APD at the BREC vs. 34 (53.1%) at the hospital (p < 0.00001), and the patients trained at the BREC had significantly less dropouts than those trained at the hospital during the study period 135 (43.3%) vs. 38 (59.4%) respectively (p < 0.02). The mean period of follow-up was significantly different between the patients trained at the BREC and those trained at the referring hospital (390 ± 461 days vs. 679 ± 779 days respectively (p < 00000.8). Also, there was a trend for better technique survival after the second year, among the patients trained at the BREC. We conclude that the BREC model has increased the recruitment to PD, and helped in spreading this method of renal replacement therapy among patients. This model emphasizes the role of a designated training course by an expert team, and unifies the training standards. Furthermore, application of this model can be expanded nationwide and even to other countries.
Continuous ambulatory peritoneal dialysis—a guide to imaging appearances and complications
Mark Goldstein,Maria Carrillo,Sangeet Ghai
Insights into Imaging , 2013, DOI: 10.1007/s13244-012-0203-y
Abstract: Multimodality imaging plays an important role in the diagnosis of these complications.
Mechanical and infectious complications of peritoneal dialysis catheters in surgical wards of Imam Khomeini Hospital: 7 year experience
A. Keshvari,M. Leasan Pezeshki,M. Younesian
Tehran University Medical Journal , 2006,
Abstract: Background: The aim of this study was to evaluate the mechanical and infectious complications of continuous ambulatory peritoneal dialysis catheter in surgical wards of Imam Khomeini Hospital. Methods: We retrospectively reviewed 80 catheters that were inserted into 69 patients (52 men and 28 women) with end-stage chronic renal failure during a period of 84 months (13 Nov. 1996 to 13 Nov. 2003. Results: The mean age of patients was 48:35 years (16 to 79 years). The most common complications were infectious ones (71.25%), while the most common causes of the catheter removal were mechanical ones (46.5% vs. 39.55%. The predominate cause of the mechanical complications was improper position (17.5%). Migration of catheter to upper abdomen and outflow failure were the other common mechanical complications. The most common infectious complication was peritonitis (62.5%). Conclusions: The occurrence of the mechanical complications is lower than the infectious ones, but the probability of catheter loss is higher if it occurs.
Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience
MO Mekki, HM Fedail, EMA Ali, MB Abdelraheem, H Al-Sanousi, S Elamin, BJ Kaballo, L Tammam, HH Abdelwahab, SA Medani, AH Khamis, H Abu-Aisha
Arab Journal of Nephrology and Transplantation , 2011,
Abstract: Introduction: The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. Methods: We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. Results: The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Conclusion: Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients. Care is, therefore, needed to screen CAPD patients for these complications in order to timely address and manage problems.
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