Prevalence and Management of Hernias in Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Miguel Ángel García-Ureña ◽  
César Remón Rodríguez ◽  
Vicente Vega Ruiz ◽  
Francisco Javier Carnero Hernández ◽  
Evaristo Fernández-Ruiz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Local Anesthesia ◽  
Surgical Techniques ◽  
Catheter Insertion ◽  
University Hospital ◽  
Dialysis Patients ◽  
Tension Free ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Objectives The aim of this study was to assess the prevalence of hernias before and after the start of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal disease, and to evaluate the result of a proposed surgical treatment. Design Prospective observational study. Setting University hospital. Patients 122 patients who started CAPD from 1994 to 2000; 26 hernias were diagnosed in 21 (17.2%) patients. Main Outcome Measures Finding of hernias; morbidity associated with catheter insertion and hernia repair; recurrence of hernias. Results 19 hernias were detected in 15 patients (12.3%) before they began CAPD; only 7 hernias were observed while on CAPD. Umbilical (61.5%) and inguinal (26.9%) hernias were the most common. Multiple hernias were detected in 4 patients. Simultaneous repair of hernia and catheter insertion was performed in patients with preexisting hernias. Under local anesthesia, most patients were operated on with surgical techniques of tension-free hernioplasty using a polypropylene mesh. Only mild postoperative complications were recorded: 3 seromas and 1 hematoma. No fluid leakage was found in our series. There were no long-term complications (infection or recurrence) related to the mesh. Conclusions 73% of hernias in peritoneal dialysis patients occur before starting dialysis. Hernia problems in these high-risk patients can be safely solved using a careful technique with application of tension-free hernioplasty. Most may be repaired under local anesthesia with simultaneous catheter insertion.

scholarly journals Urgent vs. early-start peritoneal dialysis: patients' profile and outcomes

2020 ◽  
Author(s):  
Viviane Calice-Silva ◽  
Bruna C. Tonial ◽  
Helen C. Ferreira ◽  
Fabiana B. Nerbass
Keyword(s):  
Peritoneal Dialysis ◽  
Demographic Data ◽  
Dropout Rate ◽  
Catheter Insertion ◽  
Dialysis Patients ◽  
Short Term ◽  
Early Start ◽  
Fill Volume ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT Introduction: Peritoneal dialysis (PD) has been considered a safe option of therapy in end-stage renal disease patients with urgent need of dialysis. Recently, it was proposed that Urgent-Start-PD (US-PD) be defined when PD starts within 72 hours after catheter placement and “early start” PD (ES-PD) when PD starts between 3 and 14 days after. We aimed to compare demographic and clinical characteristics between patients in US-PD and ES-PD as well as 30-day complications, 6-month hospitalization, and dropout rate. Methods: Adult patients starting PD within 14 days after catheter insertion (October/2016 - February/2019) were included and divided into US-PD group and ES-PD group based on the their PD initiation time. Clinical and demographic data, fill volume for the first PD session, 30-day complications, 6-month hospitalization, and dropout rate were assessed. Results: In our study, 72 patients were analyzed (US-PD=40, ES-PD=32) with mean age of 53.2±15.2 years old. No differences between US-PD and ES-PD regarding demographic characteristics, 30-day complications, 6-month hospitalization, and dropout events were found. The most frequent short-term complication in patients who started PD urgently was leakage. The most common cause of dropout was transfer to HD. Conclusion: Fifty five percent of our sample started PD less than 72 hours after catheter insertion. The lack of difference in the measured outcomes compared to patients that had therapy initiated after this period encourages the use of urgent PD when needed.

scholarly journals Biological basis of hypoalbuminemia in ESRD.

1998 ◽  
Vol 9 (12) ◽  
pp. 2368-2376 ◽  
Author(s):  
G A Kaysen
Keyword(s):  
Peritoneal Dialysis ◽  
Acute Phase ◽  
Synthesis Rate ◽  
Albumin Concentration ◽  
Albumin Synthesis ◽  
Dialysis Patients ◽  
Extravascular Space ◽  
Amyloid A ◽  
Stage Renal Disease ◽  
End Stage

Hypoalbuminemia is associated with mortality in patients with end-stage renal disease (ESRD) maintained either on peritoneal dialysis (PD) or hemodialysis (HD). Serum albumin concentration is determined by its rate of synthesis, by the catabolic rate constant (the fraction of the vascular pool catabolized per unit time), by external losses, and by redistribution from the vascular to the extravascular space. Hypoalbuminemia in dialysis patients is primarily a consequence of reduced albumin synthesis rate in both HD and PD patients, and in the case of PD patents, of transperitoneal albumin losses as well. Continuous ambulatory peritoneal dialysis patients are able to increase albumin synthesis to replace losses. Thus, ESRD does not directly suppress albumin synthesis. The rate of albumin synthesis is inversely proportional to the serum concentration of one potential acute phase protein (alpha2 macroglobulin), and albumin concentration is inversely proportional to that of either C-reactive protein or serum amyloid A in both HD and PD patients. The cause of decreased albumin synthesis is primarily a response to inflammation (the acute phase response), although it is possible that inadequate nutrition may also contribute. The cause of the inflammatory response is not immediately evident. There is no evidence that shifts of albumin to the extravascular space or that dilution of the plasma by volume expansion plays any role in causing hypoalbuminemia in ESRD patients.

scholarly journals Counteracting the Metabolic Effects of Glucose Load in Peritoneal Dialysis Patients; an Exercise-Based Approach

2019 ◽  
Vol 48 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Sana F. Khan ◽  
Claudio Ronco ◽  
Mitchell H. Rosner
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Glucose Absorption ◽  
Metabolic Effects ◽  
Glucose Load ◽  
Dialysis Patients ◽  
Metabolic Complications ◽  
Positive Effects ◽  
Stage Renal Disease ◽  
End Stage

Glucose-based peritoneal dialysis (PD) solutions are the predominantly used dialysate in PD patients. Glucose absorption has been shown to be associated with several unfavorable metabolic complications. Several studies have shown positive effects of exercise in end-stage renal disease patients. This paper provides an overview of glucose-associated metabolic complications, and proposed exercise regimens to counteract the caloric load associated with glucose absorption.

scholarly journals P1229PREVALENCE OF LIPID DISORDERS IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Safa Fattoum ◽  
Barbouch Samia ◽  
Hajji Mariem ◽  
Tasnim Mesbahi ◽  
Braiek Nessrine ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ldl Cholesterol ◽  
Average Duration ◽  
Hdl Cholesterol ◽  
Dialysis Patients ◽  
Lipid Disorders ◽  
Renal Replacement Therapies ◽  
Average Serum ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Lipid disorders are common in end stage renal disease patients. Renal replacement therapies and especially peritoneal dialysis (PD) results in further alteration rather than correction of lipidemia. The aim of this study is to precise the prevalence of the different lipid disorders of PD patients. Method It’s a retrospective study conducted in our PD unit in December 2019. We collected all data concerning clinical characteristics of all patients currently in PD, as well as incidence of different lipid disorders. Results There were 90 patients with an average age of 45 years (extremes: 20.5 years and 80.6 years). The sex ratio is 1.25. Fourteen were diabetic (15.5%). All patients were on Automated PD (APD) except one on Continuous Ambulatory PD (CAPD). The average duration of PD was 40.5 months. The causal nephropathy was glomerular in 26,6 % (diabetic in 14 patients (15,5%)), hypertensive 13,3%,, interstitial in 16,66%., and undetermined in 27,7%. The average Charlson score was 3,2. The average serum level of total cholesterol (TC) was 4,96 mmol/L, of triglycerides (TG) was 1,7mmol/L, of HDL-cholesterol(HDLc) was 0,93 mmol/L, and of LDL-cholesterol(LDLc) was 3,05 mmol/L. Fifty one patients had dyslipidaemia: 13 had isolated hypercholesterolemia, 19 had isolated hypertriglyceridemia, and 19 had hypercholesterolemia and hypertriglyceridemia. All dyslipidemic patients were on hypolipemic diet. Twelve (13,3%) were taking statin, no one was taking fibrate. Conclusion Chronic dialysis patients have several cardiovascular risk factors due to renal failure and comorbidities often associated. Dyslipidemia is a modifiable risk factor. It must be screened and treated to reduce morbidity and mortality.

Peripheral Vascular Disease in Diabetic Peritoneal Dialysis Patients

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 210-214 ◽  
Author(s):  
Heikki H.T. Saha ◽  
Yrjö K.J. Leskinen ◽  
Juha P. Salenius ◽  
Jorma T. Lahtela
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Current Knowledge ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Review Current

In the present article, we review current knowledge of the epidemiology, diagnosis, and treatment of peripheral vascular disease in patients with end-stage renal disease. The main focus is placed on diabetic patients receiving peritoneal dialysis, but studies on patients receiving hemodialysis are also reviewed, because most reports involve this patient group, and the number of reports on peripheral vascular disease in PD patients alone is limited.

Peritoneal dialysis in children: Review of surgical techniques

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 272-274
Author(s):  
N. Capozza ◽  
G. Mosiello ◽  
M. De Gennaro ◽  
E. Matarazzo ◽  
S. Rinaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Surgical Techniques ◽  
Average Weight ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage ◽  
Surgical Guidelines ◽  
Pediatric Icu

Peritoneal dialysis has become an effective and widely used technique for the treatment of patients with end-stage renal disease. Peritoneal dialysis has become more practical for use in pediatric patients since equipment and techniques have been adapted for smaller patients. In the present work we describe the surgical technique that we currently use at our institution for surgical placement of peritoneal dialysis catheter. From January 1985 to January 1992, 19 peritoneal catheters were placed in 17 children, at the Bambino Gesù Children's Hospital. At the time of catheter insertion the average weight of the children was 14.2 kg., and the average age was 4 y. 10m. Peritoneal dialysis catheters were always placed under sterile conditions, in an operating room or in a pediatric ICU, with surgical technique. Regarding our surgical technique we recommend: 1) to use Tenckhoff catheter, 2 cuffs pigtail (curled) type; 2) to perform a minilaparatomy with lateral surgical approach and a routine omentectomy; 3) to create a submuscular tunnel (rectus abdominis) to reduce the leakaqe of peritoneal dialysis fluid. Furthermore the various clinical problems encountered in our experience and some surgical guidelines for the prevention of complications are reviewed.

Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 42-46 ◽  
Author(s):  
Jean Francis ◽  
David B. Simon ◽  
Peter Jeurgensen ◽  
Fredric O. Finkelstein
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Secondary Hyperparathyroidism ◽  
Hormone Secretion ◽  
Phosphate Binders ◽  
Serum Phosphate Level ◽  
Dialysis Patients ◽  
Intravenous Vitamin ◽  
Stage Renal Disease ◽  
End Stage

Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease. It has been associated with increased cardiovascular events and mortality. Traditional therapy has been based on vitamin D analogs and phosphate binders; but these therapies often do not control secondary hyperparathyroidism, particularly in peritoneal dialysis patients for whom phosphate clearances are limited and intravenous vitamin D is impractical. Cinacalcet, a calcimimetic, suppresses parathormone secretion by interacting with the calcium-sensing receptor on the surface of parathyroid gland cells. The resulting suppression of parathyroid hormone secretion produces a reduction in serum phosphate level and CaxPO4 product. The present paper reviews the efficacy of cinacalcet in the management of secondary hyperparathyroidism in peritoneal dialysis patients.

Assisted Automated Peritoneal Dialysis (Aapd) for the Functionally Dependent and Elderly Patient

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 60-63 ◽  
Author(s):  
Johan V. Povlsen ◽  
Per Ivarsen
Keyword(s):  
Nursing Home ◽  
Peritoneal Dialysis ◽  
International Standards ◽  
University Hospital ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Acute Peritonitis ◽  
Data Files ◽  
Stage Renal Disease ◽  
End Stage

♦ Objective To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program. ♦ Design Retrospective single-center study based on patient records and data files. ♦ Setting University Hospital. ♦ Patients 64 physically dependent AAPD patients followed for 1.012 treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff. ♦ Result Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months. ♦ Conclusions AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do not justify withholding dialysis from this group of patients.

Risk of and Fatality from Acute Pancreatitis in Long-Term Hemodialysis and Peritoneal Dialysis Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 30-36 ◽  
Author(s):  
I-Kuan Wang ◽  
Shih-Wei Lai ◽  
Hsueh-Chou Lai ◽  
Cheng-Li Lin ◽  
Tzung-Hai Yen ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Peritoneal Dialysis ◽  
Propensity Score ◽  
Dialysis Patients ◽  
Hazard Ratios ◽  
Significant Difference ◽  
Taiwan National Health Insurance ◽  
Stage Renal Disease ◽  
End Stage

Background This study was conducted to evaluate the risk of developing acute pancreatitis (AP) and the fatality from AP in hemodialysis (HD) and peritoneal dialysis (PD) patients, using the claims data of Taiwan National Health Insurance. Methods From patients with newly diagnosed end-stage renal disease (ESRD) in 2000–2010, we identified a PD cohort ( N = 9,766), a HD cohort ( N = 18,841), and a control cohort ( N = 114,386) matched by sex, age, and the diagnosis year of the PD cohort. We also established another 2 cohorts with 9,744 PD patients and 9,744 propensity score-matched HD patients. The incident AP and fatality from AP were evaluated for all cohorts by the end of 2011. Results The adjusted hazard ratios (HRs) of acute pancreatitis were 5.68 (95% confidence interval [CI] = 5.05 – 6.39), 4.91 (95% CI = 4.32 – 5.59), and 7.47 (95% CI = 6.48 – 8.62) in the all dialysis, HD, and PD patients, compared with the controls, respectively. Peritoneal dialysis patients had an adjusted HR of 1.41 (95% CI = 1.21 – 1.65) for AP, compared with propensity score-matched HD patients. Peritoneal dialysis patients under icodextrin treatment had a lower incidence of AP than those without the treatment, with an adjusted HR of 0.59 (95% CI = 0.47 – 0.73). There was no significant difference in the 30-day mortality from AP between HD and PD patients. Conclusions Peritoneal dialysis patients were at a higher risk of developing AP than HD patients. Icodextrin solution could reduce the risk of developing AP in PD patients.

scholarly journals Risk of Dementia in Peritoneal Dialysis Patients Compared with Hemodialysis Patients

2015 ◽  
Vol 35 (2) ◽  
pp. 189-198 ◽  
Author(s):  
Dawn F. Wolfgram ◽  
Aniko Szabo ◽  
Anne M. Murray ◽  
Jeff Whittle
Keyword(s):  
Cognitive Impairment ◽  
Peritoneal Dialysis ◽  
The United States ◽  
Dialysis Modality ◽  
Dialysis Patients ◽  
Incident Dementia ◽  
National Cohort ◽  
Stage Renal Disease ◽  
End Stage ◽  
Incidence Of Dementia

Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.

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