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Peritoneal Dialysis Penetration and Peritonitis Rate at a Single Centre during Last Decade  [PDF]
Jana Uhlinova,ülle Pechter,Kadri Kermes,Mai Ots-Rosenberg
International Journal of Nephrology , 2011, DOI: 10.4061/2011/470426
Abstract: Peritoneal dialysis (PD) has been intensively offered at our centre to patients (pts) with end-stage renal disease (ESRD) from 2000, and the number of PD pts was noticed to raise. We aimed to analyse the PD population from the aspect of penetration and peritonitis rate during eleven years. Cumulative number of new RRT pts was 378 during the study period. We found high PD penetration rate: 53% (range 32–72%). The rate of peritonitis was as high as 9.8 during first study years, but it has declined progressively last year being 29.1 by September 2010 and 21.7 by December 2010. Most cases of peritonitis were due to gram-positive pathogens. We have demonstrated steady high single-centre PD penetration rate and improvement of management of patients during last decade probably because of the result of better pts education and a continued dedication of the staff. 1. Introduction Penetration of peritoneal dialysis varies widely across the world. It ranges from about 80% in Hong Kong and Mexico to few percentage points in the United States and some developing countries [1–5]. Peritoneal dialysis appears to have some excellent properties as a first-line renal replacement therapy (RRT) [6]. The use of dialysis and transplantation as complementary therapies for RRT is well established in our country. RRT data at December 31, each year have been reported regularly to European Dialysis and Transplantation Association Registry [7] and detailed epidemiologic data available in Annual Report of Kidney Diseases in Estonia 2009 [8]. According to reports, the incidence and prevalence of RRT patients in our country remains lower than that reported from the other European countries. The incidence of RRT has a decreasing tendency during last three years in the country being 62.7?pmp at day 91 in 2008 [7]. Peritoneal dialysis (PD) was introduced to the clinical practice already 17 years ago at our university hospital which is the second largest centre in the country. Since 2000, after structural changes at our centre when nephrology division was connected with dialysis unit, we started to intensively offer PD treatment to every patient with end-stage renal disease (ESRD) without contraindications for PD, and the number of PD patients raised sharply. The number of peritoneal dialysis patients have been the highest in the country compared with other centres [8]. According to the Annual Report PD, patients formed 47% from dialysis prevalence patients at Tartu University Hospital at the end of 2009, whereas the percentage was lower in other centres: 21% at West-Tallinn Hospital and
Peritoneal dialysis - experiences  [PDF]
?ur?evi?-Mirkovi? Tatjana
Medicinski Pregled , 2010, DOI: 10.2298/mpns1012753d
Abstract: Peritoneal dialysis is the method of treatment of terminal-stage chronic kidney failure. Nowadays, this method is complementary to haemodialysis. It is based on the principles of the diffusion of solutes and ultrafiltration of fluids across the peritoneal membrane, which acts as a filter. The dialysate is introduced into the peritoneum via the previously positioned peritoneal catheter. The peritoneal dialysis is carried out on daily basis, at home by the patient, and the ”exchange” is repeated 4-5 times during the 24 hours. The first steps in peritoneal dialysis at the Department for Haemodialysis of the Clinical Centre of Vojvodina date back to 1973. Until 1992, the patients were subjected to this program only sporadically. Since 1998 the peritoneal dialysis method has been performed at the Clinic for Nephrology and Clinical Immunology. In the period 1998-2008 ninety nine peritoneal catheters were placed. Chronic glomerulonephritis, nephroangiosclerosis and diabetes were identified as the most common causes of chronic renal failure. Two methods of catheter placement were applied: the standard open surgery method (majority of patients) and laparoscopy. Most of the patients were subjected to continuous ambulatory peritoneal dialysis, whereas four patients received automatic dialysis. Transplantation was performed in 10 patients, i.e. cadaveric transplantation and living-related donor transplantation, each in 5 patients. Peritoneal dialysis was available as a service outside our institution as well. A ten-year experience in peritoneal dialysis gained at our Centre has proved the advantages and qualities of this method, strongly supporting its wider application in the treatment of terminal-stage chronic kidney failure.
Peritoneal Membrane Injury and Peritoneal Dialysis  [PDF]
Shaan Chugh,Sultan Chaudhry,Timothy Ryan,Peter J. Margetts
Advances in Nephrology , 2014, DOI: 10.1155/2014/573685
Abstract: For patients with chronic renal failure, peritoneal dialysis (PD) is a common, life sustaining form of renal replacement therapy that is used worldwide. Exposure to nonbiocompatible dialysate, inflammation, and uremia induces longitudinal changes in the peritoneal membrane. Application of molecular biology techniques has led to advances in our understanding of the mechanism of injury of the peritoneal membrane. This understanding will allow for the development of strategies to preserve the peritoneal membrane structure and function. This may decrease the occurrence of PD technique failure and improve patient outcomes of morbidity and mortality. 1. Introduction PD involves both diffusive and convective clearance driven mainly by glucose-based hyperosmolar PD fluid. The peritoneal membrane overlies the surface of all intra-abdominal organs, the diaphragm, and the parietal peritoneal wall. The peritoneal membrane is a fairly simple structure, with a superficial epithelial-like cell layer—the mesothelium—which is attached to a basement membrane (Figure 1). Beneath the basement membrane is a submesothelial layer consisting of connective tissue, fibroblasts, and blood vessels. Under optimal conditions, the peritoneum acts as an efficient, semipermeable dialysis membrane, enabling removal of metabolites, uremic toxins, salt, and water from the patient. Figure 1: Changes in the peritoneal membrane with dialysis treatment. (a) Normal peritoneal membrane consists of an intact mesothelium overlying a thin submesothelial compact zone containing extracellular matrix, blood vessels, and a few scattered cells—fibroblasts and peritoneal macrophages. (b) After time on dialysis, activated fibroblasts or myofibroblasts appear along with increased submesothelial extracellular matrix and angiogenesis. Mesothelial cells are injured and sometimes denuded from the peritoneal surface. The rate of removal of these products from the blood correlates with the vascular surface area in contact with PD fluids in the peritoneal cavity [1]. Peritoneal membrane solute transport is commonly quantified as a dialysate to plasma ratio of solute (i.e., d/p creatinine). Increased peritoneal membrane solute transport should confer benefit for the patient as blood clearance would be more efficient. However, many studies have demonstrated the opposite [2]. A meta-analysis of observational studies demonstrated that every 0.1 increase in d/p creatinine carries a 15% increased risk of mortality [3]. This risk may be modified by the use of nocturnal cycling PD and use of alternate fluids such as
The use of peritoneal dialysis in newborns  [PDF]
Stojanovi? Vesna,Bregun-Doronjski Aleksandra,Dobanova?ki Du?anka,Marinkovi? Smiljana
Medicinski Pregled , 2007, DOI: 10.2298/mpns0708377s
Abstract: Introduction. Acute renal failure is a common complication in critically ill newborn infants. The therapy of acute renal failure is conservative and etiological. Patients not responding to this kind of therapy require peritoneal dialysis. Material and methods. This retrospective study included 6 newborn infants undergoing peritoneal dialysis during the period from January 2004 to June 2006, at the Nephrology Department of the Institute of Child and Youth Health Care in Novi Sad. All patients presented with complications of acute renal failure including hypercalemia and uremic encephalopathy. Results. Complete restoration of kidney function was evident in four patients on peritoneal dialysis. Three patients are still alive, but in one patient acute renal failure progressed to chronic renal failure. One patient died in the third month of life due to multiple organ dysfunction, after just two days of dialysis. Several complications were reported: intra-abdominal hemorrhage, dialysate leakage, peritonitis and dialysis catheter obstruction. Discussion. Periotoneal dialysis catheter placement is a great problem due to the size of the newborn. If it is estimated that it will be a long-lasting dialysis, Tenckhoff catheter is recommended. In very low birth weight newborn infants, in poor overall condition, general anesthesia is too risky, and acute peritoneal dialysis catheter should be placed (i.v. cannula, venous catheter). Conclusion. Peritoneal dialysis is the method of choice in newborns with acute renal failure, and it is used in the treatment of neonatal asphyxia till the restoration of kidney function is achieved. .
Anemia in peritoneal dialysis patients
Lau?evi? Mirjana,Ne?i? Vidosava,Jovanovi? Nata?a,Stojimirovi? Biljana
Srpski Arhiv za Celokupno Lekarstvo , 2006, DOI: 10.2298/sarh0604133l
Abstract: A normocytic normochromic anemia is one of the first signs of renal failure. Since anemia increases morbidity and mortality, its elimination is one of the essential objectives of the treatment. Human recombinant erythropoietin (rHuEPO) has changed the therapeutical approach to anemia. The aim of the present study was to compare efficacy of anemia correction in peritoneal dialysis patients depending on treatment and dialysis modality. The study is the retrospective analysis of 64 patients who presented to our Clinic in 2003. Eighteen (28.13%) patients were treated with rHuEPO, 14 (28%) underwent continuous ambulatory peritoneal dialysis (CAPD), 2 (100%) - automated peritoneal dialysis (APD) and 2 (33.3%) - intermittent peritoneal dialysis (IPD). Mean hemoglobin level was 98.6±17.82 g/l in patients treated with rHuEPO versus 98.81±15.14 g/I in patients without rHuEPO treatment. Erythropoietin requirements were 3392.85±1211.77 IU/week. AII patients received iron supplementation during rHuEPO therapy. Mean serum ferritin levels were 463.41 ±360 μg/l. Transferrin saturation (TSAT) was 0.35±0.16%. No difference of serum iron and TSAT levels was found between CAPD and IPD patients. The degree of anemia significantly differed between CAPD and IPD patients. A total of 17.11% of PD patients were given blood transfusions, most frequently during the first three months after the onset of dialysis. Our conclusion is that the number of patients receiving rHuEPO should be increased, as 50% of our patients should be substituted, while only 28% are being treated. As 50% of patients receiving rHuEPO failed to reach target Hgb levels, higher EPO doses should be considered. Iron stores should be continuously monitored, particularly in patients receiving rHuEPO, since iron deficiency is an important problem for patients undergoing peritoneal dialysis, especially during erythropoietin therapy. Oral iron supplementation is satisfactory in the majority of patients, and iron-gluconate is absorbed better than iron-sulphate. If required, intra-venous iron bolus is safe and efficient. Continuous peritoneal dialysis treatment improves blood count more effectively compared to intermittent procedures, as hemoglobin levels are significantly higher in patients with comparable iron stores. Peritoneal dialysis is particularly efficient in improving the blood count in diabetics, since no significant difference of anemia between patients affected by diabetes mellitus and the others could be found in our study.
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.
Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis  [PDF]
Józef Penar,Wac?aw Weyde,Magdalena Krajewska,Katarzyna Madziarska
Post?py Higieny i Medycyny Do?wiadczalnej , 2009,
Abstract: Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells. These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.
Hypertension in peritoneal dialysis patients
Lau?evi? Mirjana,Jovanovi? Nata?a,Bonti? Ana,Stojimirovi? Biljana
Medicinski Pregled , 2006, DOI: 10.2298/mpns0604130l
Abstract: Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is effective in reducing blood pressure. Mean arterial pressure falls within 6 months of starting CAPD in the majority of patients. This improved blood pressure control reflects removal of excess fluid volume and body sodium. However, after several years, there is a decline in the efficacy of CAPD in controlling blood pressure. High incidence of hypertension in long-term CAPD patients may be related to hypervolemia as a consequence of loss of residual renal function (RRF), loss of ultrafiltration (UF) due to functional or structural changes in the peritoneal membrane, to a more liberated intake of sodium and fluid, or to administration of erythropoietin. The aim of the present study was to compare the efficacy in blood pressure control in peritoneal dialysis patients depending on the dialysis modality and duration, RRF and dialysis adequacy. Material and methods. This study was a retrospective analysis of 67 patients who attended our Clinic monthly in 2003. All patients received antihy-pertensive therapy (monotherapy-16 pts, two drugs-27 pts, three drugs-22 pts and four-2 pts.). Results. The prevalence of hypertension (TA > 140/90 mmHg) was 73.13%. Most of them (50.75%) had mild hypertension (mean value TA < 160/100 mmHg). There was no statistically significant difference in hypertension prevalence between diabetic (78.27%) and non-diabetic patients (75%). The prevalence of hypertension in patients with residual diuresis of more than 1000 ml was 36.6%, but there were 80.64% patients with residual diuresis less than 500 ml. A statistically significant negative correlation was found between D/DO, UF volume and systolic blood pressure and RRF, D/DO and Ccr and diastolic blood pressure. A statistially significant positive correlation was found between age, body weight, duration of dialysis and systolic blood pressure and age and diastolic blood pressure. Conclusion. We can conclude that duration of PD treatment has a negative effect on blood pressure control. Residual renal function plays an important role in volume and blood pressure control. High and high average transporters are the two groups of patients at increased risk of developing hypertension, especially if they are anuric. .
Peritoneal dialysis update 1994.  [cached]
Nolph K
Journal of Postgraduate Medicine , 1994,
Abstract: Each year there are over 400 papers published in the field of peritoneal dialysis. In this review I have touched on only a few highlights of some of the more active areas of investigation and development. The advances in controlling peritonitis rates with the Y-set have been dramatic and have resulted in peritonitis rates in many centers less than one episode per 24 patient months. Technique survivals have also improved with lower peritonitis rates. The enormous literature on new approaches to treatment and new understandings of host defenses are beyond the scope of this review. There are also many advances in peritoneal access. We now have many new types of catheters under investigation such as the Swan-Neck Missouri catheter and the Moncrief-Popovich catheter, with complete burial of the catheter until eventual externalization for CAPD training. There have been major advances in understanding the normal healing of exit sites and the early diagnosis and treatment of exit-site infections. All the extensive literature on catheter development in the management of exit sites will be reviewed elsewhere. I have focused primarily on an update of worldwide demographics, some of the new findings in peritoneal transport, the use of low-calcium solutions, experiences with EPO, new thinking about adequacy and nutrition, and finally, on recent comparisons of CAPD and hemodialysis.
Peritoneal Adipocytes and Their Role in Inflammation during Peritoneal Dialysis
Kar Neng Lai,Joseph C. K. Leung
Mediators of Inflammation , 2010, DOI: 10.1155/2010/495416
Abstract: Adipose tissue is a major site of chronic inflammation associated with peritoneal dialysis (PD) frequently complicating peritonitis. Adiposity-associated inflammation plays a significant contributory role in the development of chronic inflammation in patients undergoing maintenance PD. However, the molecular and cellular mechanisms of this link remain uncertain. Adipose tissue synthesizes different adipokines and cytokines that orchestrate and regulate inflammation, insulin action, and glucose metabolism locally and systemically. In return, inflammation retards adipocyte differentiation and further exacerbates adipose dysfunction and inflammation. An understanding of the inflammatory roles played by adipose tissue during PD and the healing mechanism of injured mesothelium will help to devise new therapeutic approach to slow the progression of peritoneal damage during peritoneal dialysis. This article reviews the roles of peritoneal adipose tissue in chronic peritoneal inflammation under PD and in serosal repair during PD.
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