Group B Streptococcus: An Unusual Cause of Severe Peritonitis in Young Children Treated With Continuous Ambulatory Peritoneal Dialysis

In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months. In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid. We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL). Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02). Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL). Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment. We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.

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Histologic Change of Peritoneal Membrane in Relation to Adequacy of Dialysis in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080302302s05 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 26-30 ◽

Cited By ~ 3

Author(s):

Irini Savidaki ◽

Dionisios Karavias ◽

Florentia Sotsiou ◽

Sotiria Alexandri ◽

Pantelitsa Kalliakmani ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Structural Changes ◽

Mesothelial Cells ◽

Peritoneal Membrane ◽

Histologic Change ◽

Significant Difference ◽

Uremic Patients ◽

Group B ◽

Histologic Changes

Background Long-term exposure of peritoneal membrane to bioincompatible dialysis solutions leads to structural changes and loss of ultrafiltration capability. Objective We studied the possible relationship between histologic change and the transport characteristics of peritoneal membrane and adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods The study included 18 CAPD patients (11 men, 7 women) who underwent a peritoneal biopsy either at initiation of treatment (group A, n = 9) or after a mean of 4 years on CAPD (group B, n = 9). The morphologic changes in the mesothelial cells and the vascular compartment and the thickness of the submesothelial collagenous zone were estimated and compared with observations from 6 patients with normal renal function who underwent biopsy of the parietal peritoneum during abdominal surgery. The relationship of the observed changes in CAPD patients to results from a peritoneal equilibration test (PET) and to adequacy of dialysis [total weekly creatinine clearance (CCr) and Kt/V urea] were also investigated. Results The main histologic changes in both groups of patients were loss of mesothelial cells and decrease in the normal mesothelial surface, thickening of the submesothelial collagenous zone, and presence of vascular hyalinosis. The thickness of the submesothelial collagenous zone in both groups of patients was significantly greater than that found in controls (410 μm and 580 μm vs 50 μm, p < 0.05). Although no significant difference was found between morphologic change in the peritoneal membrane of uremic patients starting on CAPD and those who had been on peritoneal dialysis (PD) for a mean period of 4 years, a trend was observed toward more severe lesions in the latter patients. The PET, CCr, and Kt/V urea were not significantly different in the two groups of patients. Those parameters also showed no significant changes when examined at initiation of CAPD and after a mean of 4 years of PD in the same patients (group B). No significant correlations were observed between the histologic changes and the PET, CCr, or Kt/V in both groups of patients. Conclusions Significant structural changes are observed in the peritoneal membrane of uremic patients, and those changes become worse with CAPD treatment. Structural changes are not followed by functional changes during the first 4 years on CAPD.

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Residual Renal Function Affects Lipid Profile in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089701700306 ◽

1997 ◽

Vol 17 (3) ◽

pp. 243-249 ◽

Cited By ~ 8

Author(s):

Alexander Kagan ◽

Eti Elimalech ◽

Zvi Lerner ◽

Aaron Fink ◽

Yaacov Bar-Khayim

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Lipid Profile ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Density Lipoprotein ◽

Serum Levels ◽

Residual Renal Function ◽

Lipoprotein Cholesterol ◽

Group A ◽

Group B

Objective To determine whether lipoprotein abnormalities associated with continuous ambulatory peritoneal dialysis (CAPD) are influenced by residual renal function (RRF). Design Open, non randomized prospective and com -parative study. Setting Single university teaching hospital dialysis unit and outpatient clinic. Patients Twenty adult patients on standard CAPD (1 -38 months) were divided into two groups: group A (RRF ≤ 0.8 mL/min, n = 10) and group B (RRF ≥ 1.1 mL/ min, n = 10). Patients in the two groups were matched for age, time on dialysis, body weight, body mass index, serum urea and albumin levels, peritoneal and urinary albumin losses, and peritoneal transport characteristics such as overnight 8hour peritoneal creatinine and β2-microglobulin clearances and overnight 8-hour effluent glucose concentrations. Results The degree of uremia in patients with preserved RRF (group B) was obviously lower than in patients with negligible RRF (group A), that is, patients in group B had significantly lower serum creatinine and β2-microglobulin levels and significantly higher weekly KTN than group A patients. Despite the prevalence of allele 4 of apolipoprotein E genotype in group A patients, their levels of serum total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], apolipoprotein B (ApoB), and apolipoprotein A1 (ApoA1) were significantly lower than those of patients with preserved RRF (group B). The two groups did not differ significantly in the serum levels of triglyceride or high-density lipoprotein cholesterol. Serum concentrations of Lp(a) and ApoA1, as well as ratios of ApoA1 to ApoB, were correlated significantly with RRF (r = 0.63, r = 0.51, and r = 0.61, respectively). Conclusions The findings suggest that RRF affects the lipid profile of CAPD patients, especially serum levels of cholesterol-rich lipoproteins.

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Surgical Complications during Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686088500500110 ◽

1985 ◽

Vol 5 (1) ◽

pp. 39-42 ◽

Cited By ~ 16

Author(s):

Giovanni Valenti ◽

Donata Cresseri ◽

Maria Luisa ◽

Bianchi Enzo ◽

Corghi Marc Lorenz ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Surgical Complications ◽

Abdominal Cavity ◽

Temporary Change ◽

Elderly Males ◽

Group A ◽

Main Factors ◽

Group B ◽

Diaphragmatic Hernias

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two. From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.

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Longitudinal Study of Peritoneal Membrane Function in Continuous Ambulatory Peritoneal Dialysis: Relationship with Peritonitis and Fibrosing Factors

Peritoneal Dialysis International ◽

10.1177/089686080002000617 ◽

2000 ◽

Vol 20 (6) ◽

pp. 679-685 ◽

Cited By ~ 24

Author(s):

Teresa Y.H. Wong ◽

Cheuk-Chun Szeto ◽

Ka-Bik Lai ◽

Christopher W.K. Lam ◽

Kar-Neng Lai ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Growth Factor ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Mesothelial Cell ◽

Severe Infection ◽

Longitudinal Change ◽

Cancer Antigen 125 ◽

Membrane Function ◽

Peritoneal Transport ◽

Severe Peritonitis

Background The peritoneal equilibration test (PET) is a useful assessment of peritoneal function in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the natural course of longitudinal change in peritoneal transport is not well defined. Patients We studied 105 unselected CAPD patients. Average age at enrollment was 50.7 ± 11.3 years. Methods A PET was performed at enrollment. Peritoneal transport was expressed as dialysate-to-plasma creatinine ratio at 4 hours (D/P). Fibrosing factors and mesothelial cell markers, including TGFJJ, epidermal growth factor (EGF), platelet-derived growth factor (PDGF), hyaluronan, and cancer antigen 125 (CA125), were measured in overnight peritoneal dialysate effluent (PDE). Patients were followed for two years. Peritonitis episodes were recorded. Severe peritonitis was defined as an episode that required catheter removal or antibiotic therapy for more than 3 weeks. After two years, 75 patients were still alive and on CAPD. Results The PET was repeated in 64 patients, of whom 35 were male and 9 had diabetes. The change in D/P over two years was represented as ΔD/P. No significant change in peritoneal transport was seen after two years (D/P: 0.56 ± 0.12 vs 0.55 ± 0.13). A centripetal pattern of change in D/P was observed. The ΔD/P had normal distribution and was inversely correlated with D/P at baseline ( r = -0.427, p < 0.005). Both results suggest a regression-to-mean phenomenon. The ΔD/P had no significant correlation with the total number of peritonitis episodes (Spearman r = 0.052, p = 0.74), but after severe peritonitis, affected patients had higher ΔD/P than patients who experienced no severe infection (0.040 ± 0.136 vs -0.032 ± 0.120, p < 0.05). For patients with no episodes of severe peritonitis (n = 47), ΔD/P was weakly correlated with baseline TGFβ level ( r = -0.506, p < 0.01). No correlation was seen between the levels of other fibrosing factors and change in peritoneal transport. Conclusions Our findings suggest that the centripetal change of peritoneal transport probably reflects a regression-to-mean phenomenon. Peritoneal transport increases after severe peritonitis. The role of TGFβ levels in PDE with regard to longitudinal change in peritoneal transport requires further study.

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PERITONITIS CAUSED BY GROUP B STREPTOCOCCUS IN A CHILD RECEIVING CONTINUOUS CYCLING PERITONEAL DIALYSIS

The Pediatric Infectious Disease Journal ◽

10.1097/00006454-199906000-00026 ◽

1999 ◽

Vol 18 (6) ◽

pp. 570-571

Author(s):

Alex R. Constantinescu ◽

Patricia Whitley-Williams

Keyword(s):

Peritoneal Dialysis ◽

Group B Streptococcus ◽

Continuous Cycling Peritoneal Dialysis ◽

Continuous Cycling ◽

Group B

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Recurrent, Fatal Hemophilus Influenzae Sepsis in a Splenectomized Child on Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088500500114 ◽

1985 ◽

Vol 5 (1) ◽

pp. 51-52

Author(s):

Richard A. Cohn ◽

Thomas E. Nevins ◽

Donald I. Moel

Keyword(s):

Peritoneal Dialysis ◽

Young Children ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Fatal Case ◽

Effective Vaccine ◽

Renal Transplant Recipients ◽

Hemophilus Influenzae ◽

Stage Renal Disease ◽

End Stage

This child, who was on CAPD, had two episodes of Hemophilus influenzae sepsis, the second of which proved fatal. Predisposing factors were prior splenectomy, recent immunosuppression and cytomegalovirus infection. Peritonitis was not present. Nephrologists must consider various risk factors when caring for the increasing number of young children on CAPD, particularly those who are splenectomized. In some renal transplant recipients splenectomy has been advocated in an effort to improve graft survival (I). The procedure entails both perioperative risk and long-term complications, most notably bacterial sepsis. The risk of overwhelming, post splenectomy infection (OPSI) is higher in young children (2) and may be further increased in patients with end-stage renal disease. We report a fatal case of recurrent Hemophilus influenzae (H. flu) septicemia in a splenectomized child receiving continuous ambulatory peritoneal dialysis (CAPD). In the absence of an available, effective vaccine to prevent hemophilus infections in children, our experience with this child suggests that prophylactic antibiotics should be given to reduce the risk of OPSI in susceptible individuals.

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IgG2 Deficiency in Young Children Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088900900406 ◽

1989 ◽

Vol 9 (4) ◽

pp. 261-265 ◽

Cited By ~ 18

Author(s):

Cornelis H. Schröder ◽

Jan A. J. M. Bakkeren ◽

Corry M. R. Weemaes ◽

Leo A. H. Monnens

Keyword(s):

Peritoneal Dialysis ◽

Young Children ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Young Patients ◽

Igg Subclasses ◽

Control Groups ◽

Igg2 Deficiency ◽

Serum Immunoglobulins

In most series of children treated with continuous ambulatory peritoneal dialysis (CAPO), the incidence of peritonitis is higher than in adults. This phenomenon has been insufficiently explained. In the serum of 12 young children treated with CAPO, the serum immunoglobulins IgA, IgM, and IgG, as well as the IgG subclasses, were evaluated. In 11 of them, IgG2 was not detectable. Total IgG was also slightly decreased in these patients. In control groups, consisting of children before CAPO was started, children treated with hemodialysis, and adult CAPO patients, no clear abnormalities were found. It is concluded that in young patients peritoneal dialysis causes IgG loss leading to IgG2 deficiency.

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The Effect of Hemoglobin Concentration on Peritoneal Mass Transfer and Drain Volumes in Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089201200210 ◽

1992 ◽

Vol 12 (2) ◽

pp. 230-233 ◽

Cited By ~ 9

Author(s):

Alastair J. Hutchison ◽

Norma J. Ofsthun ◽

Debbie Howarth ◽

Ram Gokal

Keyword(s):

Mass Transfer ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Hemoglobin Concentration ◽

Hemoglobin Level ◽

University Teaching ◽

Renal Unit ◽

Before And After ◽

Group A ◽

Group B

Objective To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A -hemoglobin less than 8.5 g/dL; Group B hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL. Setting Single renal unit of a university teaching hospital. Patients:Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A -14 patients; Group B -13 patients; Group C (subgroup of A) -8 patients. Main outcome measures Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy. Results No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C. Conclusions Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.

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