Mycobacterium septicum associated peritonitis: A case report

Although peritoneal dialysis (PD)-associated peritonitis secondary to mycobacterium is rare, the treatment is challenging and outcomes remain poor. We report the first case of PD-associated peritonitis secondary to Mycobacterium septicum. The patient is a 53-year-old Caucasian man who developed end-stage kidney disease due to systemic sclerosis. He was initially started on intermittent hemodialysis and was then switched to PD 10 months later. He presented with generalized abdominal pain and an increase in the number of nucleated cells and neutrophils in the dialysate effluent sample (854 total nucleated cells/µL and 512 neutrophils/µL). Ten days later, the fluid grew M. septicum, a rapidly growing nontuberculous mycobacterium (NTM). Once the organism was identified, he was treated with moxifloxacin and doxycycline, and the PD catheter was removed. Antibiotics were adjusted due to sensitivities profile and side effects, and he completed 4 months of antibiotic treatment with decreasing cell counts and negative PD fluid cultures. This case highlights the growing list of organisms responsible for NTM peritonitis and complexity of care in the patient with NTM peritonitis.

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Mild sodium reduction in peritoneal dialysis solution improves hypertension in end stage kidney disease: a case-report study

BMC Nephrology ◽

10.1186/s12882-021-02380-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Luigi Vecchi ◽

Mario Bonomini ◽

Roberto Palumbo ◽

Arduino Arduini ◽

Silvio Borrelli

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Case Report ◽

Kidney Disease ◽

Substantial Reduction ◽

End Stage Kidney Disease ◽

Low Sodium ◽

First Case ◽

End Stage ◽

Residual Diuresis

Abstract Introduction Blood Pressure (BP) control is largely unsatisfied in End Stage Kidney Disease (ESKD) principally due to sodium retention. Peritoneal Dialysis (PD) is the most common type of home dialysis, using a peritoneal membrane to remove sodium, though sodium removal remains challenging. Methods This is a case-study reporting two consecutive ESKD patients treated by a novel peritoneal PD solution with a mildly reduced sodium content (130 mmol/L) to treat hypertension. Results In the first case, a 78-year-old woman treated by Continuous Ambulatory PD (CAPD) with standard solution (three 4 h-dwells per day 1.36% glucose 132 mmol/L) showed resistant hypertension confirmed by ambulatory blood pressure monitoring (ABPM), reporting 24 h-BP: 152/81 mmHg, day-BP:151/83 mmHg and night-ABP: 153/75 mmHg, with inversion of the circadian systolic BP rhythm (1.01), despite use of three anti-hypertensives and a diuretic at adequate doses. No sign of hypervolemia was evident. We then switched from standard PD to low-sodium solution in all daily dwells. A six-months low-sodium CAPD enabled us to reduce diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), restoring the circadian BP rhythm, with no change in ultrafiltration or residual diuresis. Diet and drug prescription were unmodified too. The second case was a 61-year-old woman in standard CAPD (three 5 h-dwells per day) suffering from hypertension confirmed by ABPM (mean 24 h-ABP: 139/84 mmHg; mean day-ABP:144/88 mmHg and mean night-ABP:124/70 mmHg). She was switched from 132-Na CAPD to 130-Na CAPD, not changing dialysis schedule. No fluid expansion was evident. During low-sodium CAPD, antihypertensive therapy (amlodipine 10 mg and Olmesartan 20 mg) has been reduced until complete suspension. After 6 months, we repeated ABPM showing a substantial reduction in mean 24 h-ABP (117/69 mmHg), mean diurnal ABP (119/75 mmHg) and mean nocturnal ABP (111/70 mmHg). Ultrafiltration and residual diuresis remained unmodified. No side effects were reported in either cases. Conclusions This case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.

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A Case Report: Calciphylaxis Presenting as Digital Ischemia in Patient with End Stage Kidney Disease on Peritoneal Dialysis

Open Journal of Nephrology ◽

10.4236/ojneph.2019.92006 ◽

2019 ◽

Vol 09 (02) ◽

pp. 49-53

Author(s):

Hatoon Abbas ◽

Manal Alotaibi ◽

Ralph J. Lebron

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Kidney Disease ◽

End Stage Kidney Disease ◽

Digital Ischemia ◽

End Stage

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Successful peritoneal dialysis for the end-stage kidney disease associated with Prader–Willi syndrome: a case report

CEN Case Reports ◽

10.1007/s13730-019-00395-3 ◽

2019 ◽

Vol 8 (3) ◽

pp. 216-220 ◽

Cited By ~ 1

Author(s):

Emi Anno ◽

Keiichiro Hori ◽

Ainori Hoshimoto ◽

Makiko Harano ◽

Sou Hagiwara ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Kidney Disease ◽

Prader Willi Syndrome ◽

End Stage Kidney Disease ◽

End Stage

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Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06342-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Edyta Gołembiewska ◽

Kazimierz Ciechanowski

Keyword(s):

Pseudomonas Aeruginosa ◽

Peritoneal Dialysis ◽

Case Report ◽

Polycythemia Vera ◽

Significant Risk ◽

Renal Amyloidosis ◽

Site Infection ◽

Exit Site ◽

Exit Site Infection ◽

First Case

Abstract Background Infectious complications of peritoneal dialysis (PD) remain a common cause of catheter loss and discontinuation of PD. Exit site infection (ESI) constitutes a significant risk factor for PD-related peritonitis and determination of predisposing states is relevant. We here present a case of repeat ESI due to Pseudomonas aeruginosa in a PD patient with skin changes in the course of polycythemia vera (PV). Case presentation A 73-year-old PD patient with chronic kidney disease secondary to renal amyloidosis and ankylosing spondylitis, presented to the nephrology unit with signs of ESI. In 2006 he was diagnosed with PV and since then has was successfully treated with hydroxyurea; however, he reported recurrent episodes of developing skin nodules in the course of the disease. Exit site swab yielded Pseudomonas aeruginosa and the infection developed in the ulcerated PV nodule that appeared in exit site 2 weeks earlier. Patient was treated with intraperitoneal amikacin and oral ciprofloxacin, however, due to neurological complications, the treatment had to be interrupted and finally catheter was removed. Similar episode of ESI with Pseudomonas aeruginosa developed in the patient two years earlier and also required catheter removal. Conclusion This is the first case report demonstrating the development of ESI on the polycythemia vera skin lesion in this area. Skin manifestations of PV might be a predisposing factor to ESI in PD patients.

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Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

Peritoneal Dialysis International ◽

10.1177/0896860821996927 ◽

2021 ◽

pp. 089686082199692

Author(s):

Vasilios Vaios ◽

Panagiotis I Georgianos ◽

Georgia Vareta ◽

Dimitrios Divanis ◽

Evangelia Dounousi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Pulse Wave ◽

Age Dependence ◽

End Stage Kidney Disease ◽

End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

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Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes – a case report

BMC Nephrology ◽

10.1186/s12882-020-02068-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Kristina Boss ◽

Ina Wiegard-Szramek ◽

Jan Dziobaka ◽

Andreas Kribben ◽

Sebastian Dolff

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Listeria Monocytogenes ◽

Case Reports ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Serum Concentrations ◽

Duration Of Treatment ◽

First Case ◽

Listeria Infection

Abstract Background Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination. Case presentation A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal. Conclusion This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.

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