Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy

Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarizes the available pharmacokinetic data used to inform optimal dosing in patients on CAPD or APD. The determinants of vancomycin disposition and pharmacodynamic effects are critically summarized, knowledge gaps explored, and a vancomycin dosing algorithm in PD patients is proposed.

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Continuous Ambulatory Peritoneal Dialysis is Better than Automated Peritoneal Dialysis as First-Line Treatment in Renal Replacement Therapy

Peritoneal Dialysis International ◽

10.1177/089686080702702s26 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 153-157

Author(s):

Philip Kam-Tao Li ◽

Kwok Yi Chung ◽

Kai Ming Chow

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Large Scale ◽

Residual Renal Function ◽

Health Care Economics ◽

Automated Peritoneal Dialysis ◽

First Line ◽

Randomized Controlled Studies

This article examines the roles of continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD) as first-line renal replacement therapy. To date, no high-quality large-scale randomized controlled studies have compared CAPD with APD as first-line therapy. However, a discussion on this issue is important so that nephrologists can decide and patients can have a choice of modality on which to start dialysis, especially in the context of health care economics. We review the literature and present Hong Kong as the model of a “CAPD first” policy, an appealing, cost-effective approach for any country. An ideal renal replacement therapy should provide optimal survival, lowest possible risk for comorbidity, highest level of quality of life, and equally important, acceptable cost to society. When we consider this subject in the context that all patients should be started on one first-line modality, the data suggest that a “CAPD first” policy has all these advantages, with APD probably having the edge only with regard to patient preference. The present review highlights preservation of residual renal function, removal and balancing of sodium, incidence of peritonitis, peritoneal membrane transport status, patient rehabilitation, and financial issues in demonstrating that a “CAPD first” policy is the model that should be adopted.

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Phase II study of individualized sunitinib (SUN) as first-line therapy for metastatic renal cell cancer: Pharmacokinetic data

Annals of Oncology ◽

10.1093/annonc/mdx371.054 ◽

2017 ◽

Vol 28 ◽

pp. v319

Author(s):

G.A. Bjarnason ◽

J. Knox ◽

C.K. Kollmannsberger ◽

D. Soulieres ◽

D.S. Ernst ◽

...

Keyword(s):

Phase Ii ◽

Renal Cell Cancer ◽

Renal Cell ◽

Phase Ii Study ◽

Cell Cancer ◽

Pharmacokinetic Data ◽

First Line ◽

Metastatic Renal Cell Cancer ◽

First Line Therapy ◽

Line Therapy

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Peritonitis as the First Presentation of Disseminated Listeriosis in a Patient on Peritoneal Dialysis—a Case Report

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00205 ◽

2017 ◽

Vol 37 (2) ◽

pp. 239-240 ◽

Cited By ~ 1

Author(s):

Weiwei Beckerleg ◽

Vaibhav Keskar ◽

Jolanta Karpinski

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Listeria Monocytogenes ◽

Empiric Therapy ◽

Second Line ◽

First Line ◽

Systemic Involvement ◽

First Line Therapy ◽

Line Therapy ◽

High Index Of Suspicion

Infections with Listeria monocytogenes are uncommon but serious, with mortality rate approaching 30% in cases of systemic involvement despite first-line therapy. They are usually caused by ingestion of contaminated foods, but spontaneous infections have also been described. Listeria monocytogenes is a rare cause of peritonitis, and most of the published cases are in patients with cirrhosis and ascites. There are a few reported cases of Listeria peritonitis associated with peritoneal dialysis (PD), primarily isolated peritonitis. If detected early, Listeria peritonitis can be successfully treated with ampicillin, alone or in combination with gentamicin. Vancomycin has been listed as a second-line agent. However, it has been associated with treatment failure. In this case report, we present a patient who developed disseminated listeriosis, with peritonitis as the first manifestation of disseminated infection. This case illustrates the importance of having a high index of suspicion for L. monocytogenes if patients deteriorate despite empiric therapy for PD-associated peritonitis and serves as a further example demonstrating the inadequate coverage of vancomycin for L. monocytogenes.

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Peritoneal dialysis in polycystic kidney disease patients

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v3i4.58183 ◽

2020 ◽

Vol 3 (4) ◽

pp. 241-249

Author(s):

Hajar Benzouina ◽

Aziza Guennoun ◽

Naima Ouzeddoun ◽

Rabia Bayahia ◽

Loubnna Benamar

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Polycystic Kidney ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

First Line Treatment ◽

Survival Predictors

Introduction: Peritoneal dialysis (PD) in patients with polycystosis. Currently, it can be offered as a first-line treatment in these patients. The aim of our work is to analyse and compare the clinical and biological parameters, the evolution of residual renal function, technical survival and specific complications of PD in PKR subjects treated with PD compared to those without PKR and treated with the same supplementation technique.Patients and methods: Retrospective, observational study between July 2006 and October 2019 including 191 PD patients, 15 of whom had PKR.Results: The prevalence of PKR in PD is 8.9%. PKR is associated with a better quality of dialysis compared to the non-PKR group thanks to the persistence of RFR, it is also associated with a better technical (59 months versus 47 months) and patient (82 years versus 76 years) survival. Predictors of adequate dialysis are BMI <22 kg/m2 and persistence of residual renal function (RRF) after 3 years of PD. Hernias are more common in PKR patients (20%) but no predictive factors have been identified.Conclusion: PD can be offered as first-line therapy in PKR patients. A comparative study between PD and hemodialysis in PKR patients is necessary to demonstrate the value of PD in this population

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