Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

2003 ◽  
Vol 23 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Walther H. Boer ◽  
Pieter F. Vos ◽  
Marien W.J.A. Fieren
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
University Hospital ◽  
Differential Count ◽  
Antibiotic Resistant ◽  
Dialysis Unit ◽  
Leukocyte Counts ◽  
Chemical Peritonitis ◽  
Culture Negative ◽  
Hospital Center

← Background In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. ← Design Case studies in 12 patients. ← Setting Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). ← Patients 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. ← Results At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100 – 1500 cells/mm3). Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. ← Conclusion Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.

scholarly journals Chemical peritonitis associated with intraperitoneal vancomycin: A case series

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
José Silvano ◽  
◽  
Luciano Pereira ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Drug Withdrawal ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Case Series ◽  
Aseptic Technique ◽  
Drug Challenge ◽  
Chemical Peritonitis ◽  
Culture Negative

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

2002 ◽  
Vol 22 (3) ◽  
pp. 357-364 ◽  
Author(s):  
Alicja E. Grzegorzewska ◽  
Danuta Antczak-Jȩdrzejczak ◽  
Magdalena Leander
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Control Period ◽  
University Hospital ◽  
Control Group ◽  
Peritoneal Equilibration Test ◽  
Dialysis Unit ◽  
Dialysis Solution ◽  
Glucose Ratio ◽  
Peritoneal Permeability

Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

Abdominal Wall Hernias in End-Stage Renal Disease Patients on Peritoneal Dialysis

2008 ◽  
Vol 28 (4) ◽  
pp. 391-396 ◽  
Author(s):  
Gustavo Martínez-Mier ◽  
Eduardo Garcia-Almazan ◽  
Hugo E. Reyes-Devesa ◽  
Victor Garcia-Garcia ◽  
Sergio Cano-Gutierrez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Peritoneal Dialysis ◽  
Body Mass ◽  
Small Body ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Dialysis Patients ◽  
Dialysis Unit ◽  
Mesh Hernioplasty

Objective To describe our experience with hernioplasty in peritoneal dialysis patients and to identify possible risk factors for surgical complications. Design A 4-year retrospective chart review of data. Setting Peritoneal dialysis unit of a university hospital. Patients and Methods 58 hernias in 50 patients were included. Detailed surgical technique and complications were recorded. Possible risk factors included age, gender, weight, height, body mass index, previous surgery, diabetes, time on dialysis, emergency surgery, hospital stay, type of hernia, mesh use, blood hemoglobin, and serum urea, creatinine, and potassium. Results Complications occurred in 12 hernioplasties (4 wound infections, 2 peritonitis, 4 catheter dysfunction, and 5 re-operations). Recurrence rate was 12% without mesh use and 0% with mesh hernioplasty. Dialysis was re-instituted in 96% of cases within 3 days postoperatively. Identified risk factors for complications were diabetes, low weight, low height, small body mass index, and low serum creatinine. Conclusions Mesh hernioplasty in peritoneal dialysis patients is advisable. Postoperative dialysis with low volume is feasible after surgery. Prospective studies will corroborate our risk factors for morbidity.

Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Bradley A. Warady ◽  
Vicki Bahl ◽  
Uri Alan ◽  
Stanley Hellerstein
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Symptomatic Relief ◽  
Duration Of Treatment ◽  
Child Treatment ◽  
Dialysis Unit ◽  
Case Evaluation ◽  
Fill Volume ◽  
Unique Approach ◽  
Tidal Peritoneal Dialysis

Objective To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification. Design Prospective case evaluation. Setting The Home Peritoneal Dialysis Unit, Children's Mercy Hospital. Patient Seven-year-old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum. Intervention Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months. Results The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months. Conclusion Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.

scholarly journals Campylobacter Peritonitis Complicating Peritoneal Dialysis: A Review of 12 Consecutive Cases

2013 ◽  
Vol 33 (2) ◽  
pp. 189-194
Author(s):  
Terry King-wing Ma ◽  
Kin Ping Lee ◽  
Kai Ming Chow ◽  
Wing Fai Pang ◽  
Bonnie Ching Ha Kwan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Response Rate ◽  
Primary Response ◽  
Resistance Rate ◽  
Cure Rate ◽  
First Line ◽  
Dialysis Unit ◽  
Complete Cure ◽  
Conventional Antibiotics ◽  
Culture Negative

BackgroundPeritoneal dialysis–associated peritonitis secondary to Campylobacter organisms is uncommon. Few studies have assessed either treatment or clinical outcomes.MethodsWe reviewed all Campylobacter peritonitis episodes occurring in a single dialysis unit from 1994 to 2011.ResultsDuring the study period, 12 episodes of Campylobacter peritonitis (0.45% of all peritonitis episodes) were recorded. Diarrhea was uncommon (8.3%). The overall primary response rate was 91.7%; the complete cure rate was 75.0%. Among 6 patients who failed to respond to standard antibiotics by day 5, all improved after administration of an oral macrolide (erythromycin or clarithromycin). Of those 6 patients, 5 experienced a complete cure, and 1 patient experienced relapse of culture-negative peritonitis. No patient required Tenckhoff catheter removal or temporary hemodialysis support. The 30-day mortality was 0%.ConclusionsCampylobacter peritonitis might not respond to first-line conventional antibiotics, and an oral macrolide is recommended if Campylobacter is confirmed. The findings from our analysis do not support the use of fluoroquinolone, which is associated with a high resistance rate.

Treatment and outcome of Peritonitis in Automated Peritoneal Dialysis, using a Once-Daily Cefazolin-Based Regimen

2002 ◽  
Vol 22 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Richard E. Fielding ◽  
Michelle Clemenger ◽  
Lawrence Goldberg ◽  
Edwina A. Brown
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Automated Peritoneal Dialysis ◽  
Patient Death ◽  
Dialysis Unit ◽  
Once Daily ◽  
Yeast Infection ◽  
Primary Peritonitis ◽  
Culture Negative

Objective We determined the effectiveness of a once-daily cefazolin-based regimen in treating automated peritoneal dialysis (APD) peritonitis. Design We carried out a retrospective analysis of all APD peritonitis episodes treated with a once-daily cefazolin protocol. Setting The study was performed in a peritoneal dialysis unit in a tertiary care hospital. Patients and Methods We studied 60 episodes of primary peritonitis in 40 patients on APD. Each patient was treated with a vancomycin-free regimen consisting of intraperitoneal cefazolin (1.5 g IP) with gentamicin IP administered in the daytime exchange. The main outcome measures were successful treatment of peritonitis, removal of peritoneal catheter, relapse of peritonitis, and patient death. Results Gram-positive infections occurred in 35 episodes (58.3%), gram-negative infections in 10 episodes (16.7%), culture-negative infections in 14 episodes (23.3%), and a yeast infection in 1 episode (1.7%). Of the 60 episodes, 47 (78.3%) were successfully treated. In 10 episodes (16.7%), catheters were removed (9 for treatment failure, 1 for yeast infection). Four patients (8%) had a relapse of infection within 4 weeks of completing antibiotic therapy. One patient (1.7%) died. Conclusions Our results demonstrate that once-daily cefazolin with gentamicin IP is an effective treatment for APD peritonitis, with the advantage of being easy to administer and enabling patients to remain on APD during treatment.

Mycobacterium Chelonei Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dial ysis (CAPD)

1983 ◽  
Vol 3 (2) ◽  
pp. 86-88 ◽  
Author(s):  
Michel Poisson ◽  
Vincent Beroniade ◽  
Pierre Falardeau ◽  
Carlos Vega ◽  
Richard Morisset
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Antimicrobial Therapy ◽  
Tap Water ◽  
Mycobacterial Infection ◽  
Gram Stain ◽  
Bacterial Peritonitis ◽  
Aerobic And Anaerobic ◽  
Culture Negative

This paper describes a case of Mycobacterium chelonei peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). The patient probably acquired the infection from tap water. He presented with cloudy effluent, abdominal pain and systemic toxicity. Originally, gram stain, Ziehl-Neelsen stain, aerobic and anaerobic cultures were negative. One week later, culture grew an aerobic, fast growing, acid fast bacterium, which later was identified as Mycobacterium chelonei. The peritonitis was treated successfully with erythromycin and catheter removal. The diagnosis of tuberculous and non-tuberculous mycobacterial peritonitis during CAPD can be difficult. Compared to usual bacterial peritonitis associated with CAPD, everything in these cases proves to be nonspecific. Mycobacterial infection should be suspected in all episodes of culture-negative peritonitis especially those which do not respond to usual antimicrobial therapy.

Dyslipidemia in Peritoneal Dialysis — Relation to Dialytic Variables

2000 ◽  
Vol 20 (3) ◽  
pp. 306-314 ◽  
Author(s):  
Ann-Cathrine Johansson ◽  
Ola Samuelsson ◽  
Per-Ola Attman ◽  
Börje Haraldsson ◽  
James Moberly ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Glucose Uptake ◽  
Surface Area ◽  
Plasma Lipids ◽  
Plasma Concentrations ◽  
University Hospital ◽  
Protein Loss ◽  
Dialysis Unit ◽  
Peritoneal Surface

Objective To investigate whether the specific lipoprotein (LP) abnormalities of peritoneal dialysis (PD) are associated with functional variables of this mode of dialysis. Design A survey of the LP profile in relation to peritoneal dialysis capacity (PDC) variables. The LP profile was compared to that of a group of age- and sex-matched controls. Setting The Peritoneal Dialysis Unit at Sahlgrenska University Hospital in Gothenburg, Sweden. Patients Twenty-two nondiabetic PD patients (5 women, 17 men) who had been on PD for at least 6 months. Main Outcome Measures The LP profile included plasma lipids, apolipoproteins (Apo), and individual ApoA- and ApoB-containing LP. The PDC measurement determined peritoneal glucose uptake, protein losses, effective peritoneal surface area, and total weekly creatinine clearance. Results The patients had been on PD for 6 to 48 months (mean 15.3 months) and had a total weekly creatinine clearance of 69.7 ± 13.3 L/1.73m2 body surface area, an average peritoneal glucose uptake corresponding to 446 ± 162 kcal/24 hour, and a protein loss of 8.1 ± 2.5 g/24 hr. The patients had significantly higher total cholesterol (7.1 mmol/L), VLDL-cholesterol (1.0 mmol/L), LDL-cholesterol (4.7 mmol/L), and triglyceride levels (2.5 mmol/L); whereas the HDL-cholesterol level (1.2 mmol/L) was significantly lower than in controls. The PD patients had increased levels of ApoB-containing LPs, both of the cholesterol-rich LP-B and of the triglyceride-rich LP-B complex, reflected in higher plasma concentrations of ApoB, ApoC-III, and ApoE. Furthermore, they had significantly lower levels of LP-A-I:A-II, as well as of ApoA-I and ApoA-II. The LP-A-I:A-II and ApoA-II levels correlated inversely with the duration of PD treatment ( r = 0.54, p < 0.01 and r = 0.52, p < 0.05, respectively). The ApoA-II level was inversely correlated with the peritoneal surface area ( r = 0.53, p < 0.05). There were no other correlations between LP variables and PDC variables, nor did any of the LP variables correlate with peritoneal glucose uptake or protein losses. Conclusion The proatherogenic lipoprotein profile of patients on PD is characterized by increased concentrations of cholesterol-rich and triglyceride-rich ApoB-containing LPs. While the duration of treatment appears to have some influence on the development of this type of dyslipidemia, the pathophysiological links to the dialysis mode must be further explored.

scholarly journals Clinical Characteristics and Outcomes of “Silent” and “Non-Silent” Peritonitis in Patients on Peritoneal Dialysis

2013 ◽  
Vol 33 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Jie Dong ◽  
Suping Luo ◽  
Rong Xu ◽  
Yuan Chen ◽  
Ying Xu
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Treatment Failure ◽  
Clinical Characteristics ◽  
Cell Counts ◽  
Daily Energy ◽  
Baseline Values ◽  
Gram Negative Organisms ◽  
Pain Patients ◽  
Culture Negative

♦ObjectivesWe compared the clinical characteristics and outcomes of “silent” peritonitis (meaning episodes without fever and abdominal pain) and “non-silent” peritonitis in patients on peritoneal dialysis (PD).♦MethodsOur cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis.♦ResultsOf 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older ( p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes ( p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33).♦ConclusionsSilent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.

Adiponectin Levels and Atherosclerotic Risk Factors in Pediatric Chronic Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Sevcan A. Bakkaloglu ◽  
Necla Buyan ◽  
Tohru Funahashi ◽  
Hatice Pasaoglu ◽  
Atilla H. Elhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Apolipoprotein B ◽  
University Hospital ◽  
Chronic Peritoneal Dialysis ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Lipoprotein A ◽  
Control Subjects ◽  
Significant Difference

Background Atherosclerotic vascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) treated with chronic peritoneal dialysis (CPD), even in children. Adiponectin (ADPN) is a recently discovered adipocyte-derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. Objective To clarify the atherosclerotic risk and especially the significance of ADPN levels in pediatric patients on CPD. Design Cross-sectional study in the pediatric peritoneal dialysis unit of a university hospital. Patients 18 children, aged 12.6 ± 5.6 years, being treated with CPD and 20 healthy age- and sex-matched control subjects were enrolled in this study. Methods Serum ADPN levels and other risk factors, including blood pressure, blood glucose, serum lipid/lipoprotein fractions, apolipoprotein B, C-reactive protein (CRP), lipoprotein(a), and homocysteine levels, were studied in CPD patients and compared to the controls. Results Serum ADPN levels were three times higher in the CPD group compared to the control subjects, as was previously reported. Apolipoprotein B and CRP levels were also high in the CPD group. No significant difference was found in other atherosclerotic parameters, including lipoprotein(a) and homocysteine levels. Interestingly, we found a negative correlation between log ADPN and creatinine levels among the CPD patients ( r = –0.54, p < 0.05). There was no correlation between log ADPN and duration of CPD. Creatinine and low-density lipoprotein levels could account for 54% of the total variation in ADPN levels. Conclusion Among pediatric CPD patients, serum levels of the anti-atherogenic protein, ADPN, were inversely associated with creatinine. ADPN level might be a novel marker to predict prognosis in pediatric CPD patients.

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