Various Clinical Approaches to Minimise Complications in Peritoneal Dialysis

2002 ◽  
Vol 25 (5) ◽  
pp. 365-372 ◽  
Author(s):  
B. Stegmayr
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Cavity ◽  
Rectus Muscle ◽  
Controlled Study ◽  
Technical Problems ◽  
X Ray ◽  
Ultrafiltration Failure ◽  
Sampling Procedures

The main reason for a failure of peritoneal dialysis is due to technical problems or infections. By starting PD immediately after the insertion of a dialysis catheter (instead of starting HD before optimal healing of the PD-catheter) it may be easier to achieve acceptance for PD by the patients. An easy and tight access is achieved when inserting the PD-catheter through the rectus muscle, fixing it with three purse string sutures, two of them fixing the inner cuff between the peritoneal membrane and the inner rectus fascia. Thereby early and late leakage will be rare and good drainage is normally achieved besides a low risk for exit site infections. Using Coloplast® adhesive insulin can be injected into the PD bags in a simple way even by patients with bad vision. Using ultraviolet light, as additional exchange device (UV-box), the risk for peritonitis is reduced compared to classic manual connection. Using the Y-set or duo-bag system the risk for peritonitis is further lowered. Malfunction by dislocation of the intraperitoneal part of the catheters can often be corrected without surgery using a bent stylet. A controlled study showed that antibiotic prophylactics could significantly reduce the risk for peritonitis in the follow up after insertion of PD catheters. Additionally the risk for peritonitis is reduced using a special connector for the PET-sampling procedures. X-ray of catheter location in the abdominal cavity can be performed by injection of 20-ml contrast media into 100 ml of PD fluid residing in the PD-bag. After mixing, small portions of this fluid can be infused into the abdomen for X-ray determination of the location. An increased ultrafiltration failure during PD may be due to use of beta-blocker medication. After ceasing this medication recovery may occur. Avoiding pets in the room used for PD-exchange may lower the risk for peritonitis further. A devoted nurse and physician will keep up the patients' spirit and help to convert patients not suitable for PD to HD or the other way round. By such measures the incidence of peritonitis can be reduced to 1 in 40 treatment months or less.

scholarly journals Can EPS Development be Avoided with Early Interventions? The Potential Role of Tamoxifen—A Single-Center Study

2014 ◽  
Vol 34 (6) ◽  
pp. 582-593 ◽  
Author(s):  
Erika De Sousa–Amorim ◽  
Gloria Del Peso ◽  
M. Auxiliadora Bajo ◽  
Laura Alvarez ◽  
Marta Ossorio ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cumulative Number ◽  
Randomized Controlled Studies ◽  
Single Center Study ◽  
Ultrafiltration Failure ◽  
Life Threatening ◽  
Severe Peritonitis ◽  
Prompt Diagnosis

BackgroundEncapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Identification of patients at high risk for EPS (“EPS-prone”) and delivery of appropriate interventions might prevent its development. Our aim was to evaluate the clinical characteristics and outcomes of all EPS and EPS-prone patients diagnosed at our PD unit.MethodsFor a 30-year period representing our entire PD experience, we retrospectively identified all patients with EPS (diagnosed according to International Society for Peritoneal Dialysis criteria) and all patients defined as EPS-prone because they met at least 2 established criteria (severe peritonitis, PD vintage greater than 3 years, severe hemoperitoneum, overexposure to glucose, and acquired ultrafiltration failure).ResultsOf 679 PD patients, we identified 20 with EPS, for an overall prevalence of 2.9%. Mean age at diagnosis was 50.2 ± 16.4 years, with a median PD time of 77.96 months (range: 44.36 – 102.7 months) and a median follow-up of 30.91 months (range: 4.6 – 68.75 months). Of patients with EPS, 10 (50%) received tamoxifen, 10 (50%) received parenteral nutrition, and 2 (10%) underwent adhesiolysis, with 25% mortality related to EPS. Another 14 patients were identified as EPS-prone. Median follow-up was 54.05 months (range: 11.9 – 87.04 months). All received tamoxifen, and 5 (36%) received corticosteroids; none progressed to full EPS. We observed no differences in baseline data between the groups, but the group with EPS had been on PD longer (84 ± 53 months vs 39 ± 20 months, p = 0.002) and had a higher cumulative number of days of peritoneal inflammation from peritonitis (17.2 ± 11.1 days vs 9.8 ± 7.9 days, p = 0.015). Overall mortality was similar in the groups. The incidence of EPS declined during our three decades of experience (5.6%, 3.9%, and 0.3%).ConclusionsBeing a serious, life-threatening complication of PD, EPS requires high suspicion to allow for prompt diagnosis and treatment. Early detection of EPS-prone states and delivery of appropriate intervention might prevent EPS development. Tamoxifen seems to be a key strategy in prevention, but caution should be used in interpreting our results. Additional randomized controlled studies are needed.

scholarly journals Elevation of whole-blood glutathione in peritoneal dialysis patients by L-2-oxothiazolidine-4-carboxylate, a cysteine prodrug (Procysteine).

1998 ◽  
Vol 9 (6) ◽  
pp. 1093-1099 ◽  
Author(s):  
J B Moberly ◽  
J Logan ◽  
P R Borum ◽  
K O Story ◽  
L E Webb ◽  
...  
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Whole Blood ◽  
Oxidant Stress ◽  
Cellular Damage ◽  
Controlled Study ◽  
Dialysis Patients ◽  
Protein Thiols ◽  
Cysteine Prodrug

Glutathione is a major cellular antioxidant that protects protein thiols and inhibits cellular damage due to oxygen free radicals. It has been reported previously that patients undergoing dialysis have low levels of blood glutathione, which may lead to increased susceptibility to oxidant stress. L-2-oxothiazolidine-4-carboxylic acid (OTZ) is a cysteine prodrug that raises cellular glutathione levels by increasing delivery of cysteine, the rate-limiting substrate for glutathione synthesis. This study investigates the effect of OTZ on blood glutathione in a blinded, placebo-controlled study of patients with chronic renal failure treated by peritoneal dialysis. Twenty patients were randomly selected to receive OTZ (0.5 g three times a day orally with meals) or placebo for 14 d. Patients visited the clinic for predose blood collection and safety evaluation at baseline (days 3, 7, and 14 and again at 14 d from the last dose [follow-up]). Glutathione concentrations were determined in whole blood by HPLC. OTZ resulted in a significant rise in whole-blood glutathione at days 7 (594 +/- 129 mumol/L) and 14 (620 +/- 108 mumol/L) compared with baseline (544 +/- 139 mumol/L) (P < 0.01 and P < 0.05, respectively). Glutathione was also significantly increased at days 7 and 14 when normalized by hematocrit (Hct) or hemoglobin to correct for anemic status (e.g., 20.7 +/- 5.7 mumol/L per % Hct [day 7] and 20.9 +/- 4.0 mumol/L per % Hct [day 14] versus 18.0 +/- 4.2 mumol/L per % Hct [baseline]; P < 0.05). Glutathione levels did not change in the placebo group at any patient visit, and levels in the OTZ-treated group returned to baseline at follow-up. There were no serious adverse events attributable to OTZ, and the drug appeared to be well tolerated by patients with renal failure treated by continuous ambulatory peritoneal dialysis. Our results show that OTZ increases blood glutathione levels, which may improve antioxidant status in dialysis patients.

Encapsulating Peritoneal Sclerosis in Japan: Prospective Multicenter Controlled Study

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 67-71 ◽  
Author(s):  
Hideki Kawanishi ◽  
Hiroyoshi Fukui ◽  
Hara Shigeko ◽  
Akio Imada ◽  
Yoshindo Kawaguchi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Features ◽  
Multicenter Study ◽  
Mortality Rates ◽  
Controlled Study ◽  
Dialysis Patients ◽  
Survey Period ◽  
Prospective Multicenter Study ◽  
Current Incidence

♦ Objective Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis. The aim of this study was to determine the incidence, clinical features, and variation in mortality rates for EPS. ♦ Design A prospective multicenter design was used, in which peritoneal dialysis patients were pre-registered by facilities across Japan and the incidence of EPS was observed in the registrants. The registrants were followed for a total of 4 years to accurately observe the onset of EPS. ♦ Results As of April 1999, 2216 peritoneal dialysis patients from 64 facilities were registered. By the end of March 2001, 332 patients had dropped out, and 17 of the dropouts had developed SEP. The incidence was 0.77%. After excluding 110 patients who died, the incidence in 2106 patients was 0.81%. The incidence of EPS increased with the duration of peritoneal dialysis. Of the 17 patients with EPS, 12 developed the condition after discontinuing peritoneal dialysis and changing to hemodialysis. During the 2-year survey period, 6 of the 17 EPS patients died. The interval from onset to death was 10.8 ± 5.8 months (range: 3 – 19.5 months). ♦ Conclusions From this prospective multicenter study, the current incidence of EPS is 0.77% (0.81% when dropout owing to death is censored). After a follow-up of 2 years, we conjecture that the incidence of EPS will increase. The incidence, etiology, and prognosis of EPS will be further clarified by periodic observation of dropouts until the end of March 2003.

scholarly journals Analysis of Ultrafiltration Failure Diagnosed at the Initiation of Peritoneal Dialysis with the Help of Peritoneal Equilibration Tests with Complete Drainage at Sixty Minutes. A Longitudinal Study

2016 ◽  
Vol 36 (4) ◽  
pp. 442-447 ◽  
Author(s):  
Daniela Machado Lopes ◽  
Ana Rodríguez-Carmona ◽  
Teresa García Falcón ◽  
Andrés López Muñiz ◽  
Tamara Ferreiro Hermida ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Time Course ◽  
Free Water ◽  
Control Group ◽  
First Year ◽  
Study Group ◽  
Ultrafiltration Failure ◽  
Small Pore

BackgroundUltrafiltration failure (UFF) diagnosed at the initiation of peritoneal dialysis (PD) has been insufficiently characterized. In particular, few longitudinal studies have analyzed the time course of water transport in patients with this complication.ObjectiveTo investigate the time course of peritoneal water transport during the first year on PD in patients presenting UFF since the initiation of this therapy (study group).MethodProspective, observational, single-center design. We analyzed, at baseline and after 1 year of follow-up, peritoneal water transport in 19 patients incident on PD with UFF. We used incident patients without UFF as a control group. Water transport was characterized with the help of 3.86/4.25% dextrose-based peritoneal equilibration tests (PETs) with complete drainage at 60 minutes.ResultsThe study group revealed a disorder of water transport affecting both small-pore ultrafiltration (SPUF) ( p = 0.054 vs incident without UFF) and free water transport (FW T) ( p = 0.001). After 1 year of follow-up, FWT displayed a general increasing trend in the study group (mean variation 48.9 mL, 95% confidence interval [CI] 15.5, 82.2, p = 0.012), while the behavior of SPUF was less predictable (-4.8 mL, 95% CI -61.4, 71.1, p = 0.85). These changes were not observed in incident patients without UFF. Neither initial clinical characteristics, baseline PET-derived parameters, or suffering peritoneal infections during the first year predicted the time course of the capacity of UF in the study group. Recovery from incident UFF was apparently linked to improvement of SPUF.ConclusionsPatients with UFF at the start of PD suffer a disorder of peritoneal water transport affecting both FWT and SPUF. Free water transport increases systematically in these patients after 1 year of follow-up. The evolution of SPUF is less predictable, and improvement of this parameter marks reversibility of this complication.

Impact of ACE Inhibitors and AII Receptor Blockers on Peritoneal Membrane Transport Characteristics in Long-Term Peritoneal Dialysis Patients

2007 ◽  
Vol 27 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Inna Kolesnyk ◽  
Friedo W. Dekker ◽  
Marlies Noordzij ◽  
Saskia le Cessie ◽  
Dirk G. Struijk ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Animal Studies ◽  
Control Group ◽  
Peritoneal Transport ◽  
Ultrafiltration Failure ◽  
Significant Difference

Background Long-term peritoneal dialysis (PD) may lead to peritoneal fibrosis and ultrafiltration failure. The latter occurs due to high solute transport rates and diabetiform peritoneal sclerosis. Angiotensin-II (AII) is known to be a growth factor in the development of fibrosis and a number of animal studies have shown it likely that inhibiting the effects of AII by angiotensin-converting enzyme (ACE) or angiotensin receptor blocker (ARB) will attenuate these complications. Objective To investigate the effects of ACE/AII inhibitors in long-term PD patients. Patients and Setting We analyzed data from 66 patients treated with PD therapy at our center for at least 2 years, during which time at least 2 standard peritoneal permeability analyses (SPAs) were performed. 36 patients were treated with ACE/AII inhibitors (ACE/ARB group); the other 30 received none of the above drugs during the entire follow-up (control group). The two groups were compared with respect to changes in peritoneal transport over the follow-up time. Results A significant difference in time course of peritoneal transport was found between the 2 groups: in the ACE/ARB group, small solute transport had decreased, while it had increased in the control group. This finding was confirmed by analysis using mixed model for repeated measures. The value of mass transfer area coefficient of creatinine was influenced by the duration of PD therapy ( p = 0.017) and this interaction was different with respect to use of ACE/AII inhibitors ( p = 0.037). The trend was not found in protein clearances or fluid kinetics. Conclusion Our findings suggest that ACE/AII inhibition is likely to prevent the increase in mass transfer area coefficients that occurs in long-term PD, which is in line with results of experimental animal studies.

scholarly journals Peritoneal Dialysis with Marked Pneumoperitoneum

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Norio Nakamura ◽  
Masamichi Nakata ◽  
Daiki Nagawa ◽  
Ikuyo Narita ◽  
Takeshi Fujita ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Abdominal Cavity ◽  
X Ray ◽  
Free Air ◽  
Old Japanese ◽  
Dialysis Bag ◽  
Stage Renal Disease ◽  
End Stage

Pneumoperitoneum, the presence of free air within the peritoneal cavity, is often caused by the perforation of gas-containing viscus and commonly requires surgical treatment. However, in patients with peritoneal dialysis, free air is commonly seen on X-ray. We present the case of a patient with peritoneal dialysis with marked pneumoperitoneum. A 75-year-old Japanese male with end-stage renal disease due to antineutrophil cytoplasmic antigen-associated vasculitis had been receiving continuous ambulatory peritoneal dialysis for 9 years. He had a poor appetite and general malaise without abdominal pain or fever. These symptoms gradually worsened, and he was hospitalized. At the time of admission, chest X-ray revealed bilateral free air in the abdomen. Subsequent computed tomography of the abdomen revealed marked pneumoperitoneum. Peritonitis due to perforation of the digestive tract was considered; however, the absence of abdominal pain, fever, and turbidity of dialysis drainage indicated that peritonitis was unlikely. Insufficient air venting during continuous ambulatory peritoneal dialysis bag replacement was suspected. The bag was carefully changed, resulting in a gradual decrease in the free air. We encountered a patient with continuous ambulatory peritoneal dialysis who had significant free air in the abdominal cavity in the absence of peritonitis. The source of the air was determined to be the dialysis bag due to insufficient venting during replacement. This case underscores the importance of instructing patients with continuous ambulatory peritoneal dialysis on the thorough removal of air from the bag during replacement.

Aortic Arch Calcification and Bone-Associated Molecules in Peritoneal Dialysis Patients

2019 ◽  
Vol 47 (Suppl. 2) ◽  
pp. 81-87
Author(s):  
Misao Tsukada ◽  
Naoko Miwa ◽  
Norio Hanafusa ◽  
Nobue Tanaka ◽  
Ken Tsuchiya ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Aortic Arch ◽  
Pulse Wave ◽  
Fibroblast Growth Factor 23 ◽  
Fatal Complication ◽  
X Ray ◽  
Plain Chest ◽  
Chest X Ray ◽  
Aortic Arch Calcification

Background/Aims: Aortic arch calcification (AoAC) is a fatal complication in dialysis. AoAC progression-related molecules in continuous ambulatory peritoneal dialysis (CAPD) remain unclear. Methods: AoAC was estimated using plain chest radiography scoring (AoACS) in 30 CAPD patients (age 49.3 ± 13.4 years). AoAC progression was defined as increased AoACS on follow-up chest X-ray at the end of the study (progressors). Fibroblast growth factor-23 and osteoprotegerin (OPG) were measured. Results: Median follow-up was 38.5 months. Progressors were older, had shorter PD vintage, higher body mass index, and higher serum OPG levels (255.6 ± 109.2 pg/mL) than nonprogressors (183.4 ± 68.2 pg/mL; p = 0.0400). Progressors also showed higher pulse pressure (62.4 ± 20.0 mm Hg) and pulse wave velocity (1,909.9 ± 310.6 cm/s) than nonprogressors (48.5 ± 13.6 mm Hg; p = 0.0030 and 1,390.1 ± 252.8 cm/s; p = 0.0005, respectively). Conclusion: AoAC progression was associated with increased aortic stiffness. OPG may be associated with AoAC progression in CAPD.

The Adjustable proGAV Shunt

Neurosurgery ◽  
2010 ◽  
Vol 66 (3) ◽  
pp. 465-474 ◽  
Author(s):  
Christian Sprung ◽  
Hans-Georg Schlosser ◽  
Johannes Lemcke ◽  
Ullrich Meier ◽  
Martina Messing-Jünger ◽  
...  
Keyword(s):  
Observational Study ◽  
Multicenter Study ◽  
Pressure Level ◽  
Prospective Multicenter Study ◽  
Shunt System ◽  
X Ray ◽  
Pediatric Hydrocephalus ◽  
Different Types

Abstract OBJECTIVE To evaluate the reliability of the gravitation-assisted adjustable proGAV shunt system with a prospective multicenter study conducted in 10 German hospitals. METHODS Enrollment for this observational study began in April 2005 and concluded in February 2006. The protocol required re-examinations 3 and 6 months postoperatively and fixed the endpoint of follow-up at 12 months after implantation. Patients with different types of adult, juvenile, and pediatric hydrocephalus were included and 165 patients were enrolled; 9 died and 12 had incomplete follow-up. RESULTS Of the assessable 144 patients, 130 completed the protocol after 12 months, whereas 14 failed because of the need to explant the device, mainly because of infection. In 12 patients, components of the shunt, not the valve, were revised. In 65 of the 144 patients, there were 102 readjustments of the valve in 67 incidences because of underdrainage and in 35 because of overdrainage. In 1 case, readjustment was not possible. Determination of pressure level with the verification instrument was safe and corresponded to the required x-ray controls after adjustments. No unintended readjustments were noted. CONCLUSION The proGAV is a safe and reliable device.

Electron Microscopy of Human Gallstones

1971 ◽  
Vol 29 ◽  
pp. 296-297
Author(s):  
C. Wolpers ◽  
R. Blaschke
Keyword(s):  
Electron Microscopy ◽  
Room Temperature ◽  
Bile Pigment ◽  
X Ray Diffraction ◽  
Triclinic Crystal System ◽  
X Ray ◽  
Follow Up Study ◽  
Infra Red ◽  
Main Components

Scanning microscopy was used to study the surface of human gallstones and the surface of fractures. The specimens were obtained by operation, washed with water, dried at room temperature and shadowcasted with carbon and aluminum. Most of the specimens belong to patients from a series of X-ray follow-up study, examined during the last twenty years. So it was possible to evaluate approximately the age of these gallstones and to get information on the intensity of growing and solving.Cholesterol, a group of bile pigment substances and different salts of calcium, are the main components of human gallstones. By X-ray diffraction technique, infra-red spectroscopy and by chemical analysis it was demonstrated that all three components can be found in any gallstone. In the presence of water cholesterol crystallizes in pane-like plates of the triclinic crystal system.

X-Ray Analysis of Frozen Hydrated Sections:The Unconventional Approach

1982 ◽  
Vol 40 ◽  
pp. 754-757
Author(s):  
R. Beeuwkes ◽  
A. Saubermann ◽  
P. Echlin ◽  
S. Churchill
Keyword(s):  
Ratio Method ◽  
Frozen Sections ◽  
Technical Problems ◽  
Sample Handling ◽  
X Ray ◽  
Common Group ◽  
Ideal Method ◽  
Classic Paper ◽  
Physical Principles ◽  
The Ideal

Fifteen years ago, Hall described clearly the advantages of the thin section approach to biological x-ray microanalysis, and described clearly the ratio method for quantitive analysis in such preparations. In this now classic paper, he also made it clear that the ideal method of sample preparation would involve only freezing and sectioning at low temperature. Subsequently, Hall and his coworkers, as well as others, have applied themselves to the task of direct x-ray microanalysis of frozen sections. To achieve this goal, different methodological approachs have been developed as different groups sought solutions to a common group of technical problems. This report describes some of these problems and indicates the specific approaches and procedures developed by our group in order to overcome them. We acknowledge that the techniques evolved by our group are quite different from earlier approaches to cryomicrotomy and sample handling, hence the title of our paper. However, such departures from tradition have been based upon our attempt to apply basic physical principles to the processes involved. We feel we have demonstrated that such a break with tradition has valuable consequences.

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