Surgical Complications during Continuous Ambulatory Peritoneal Dialysis

1985 ◽  
Vol 5 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Giovanni Valenti ◽  
Donata Cresseri ◽  
Maria Luisa ◽  
Bianchi Enzo ◽  
Corghi Marc Lorenz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Surgical Complications ◽  
Abdominal Cavity ◽  
Temporary Change ◽  
Elderly Males ◽  
Group A ◽  
Main Factors ◽  
Group B ◽  
Diaphragmatic Hernias

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two. From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.

Variability of Peritoneal Protein Loss in Diabetic and Nondiabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 242-244 ◽  
Author(s):  
Sophia Spaia ◽  
Fotini Christidou ◽  
Panayotis Pangidis ◽  
Thomas Tsoulkas ◽  
Michalis Pazarloglou ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Protein ◽  
Peritoneal Fluid ◽  
Protein Loss ◽  
Glucose Levels ◽  
Short Period ◽  
Group A ◽  
Group B

In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months. In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid. We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL). Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02). Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL). Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment. We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.

Residual Renal Function Affects Lipid Profile in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1997 ◽  
Vol 17 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Alexander Kagan ◽  
Eti Elimalech ◽  
Zvi Lerner ◽  
Aaron Fink ◽  
Yaacov Bar-Khayim
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Lipid Profile ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Density Lipoprotein ◽  
Serum Levels ◽  
Residual Renal Function ◽  
Lipoprotein Cholesterol ◽  
Group A ◽  
Group B

Objective To determine whether lipoprotein abnormalities associated with continuous ambulatory peritoneal dialysis (CAPD) are influenced by residual renal function (RRF). Design Open, non randomized prospective and com -parative study. Setting Single university teaching hospital dialysis unit and outpatient clinic. Patients Twenty adult patients on standard CAPD (1 -38 months) were divided into two groups: group A (RRF ≤ 0.8 mL/min, n = 10) and group B (RRF ≥ 1.1 mL/ min, n = 10). Patients in the two groups were matched for age, time on dialysis, body weight, body mass index, serum urea and albumin levels, peritoneal and urinary albumin losses, and peritoneal transport characteristics such as overnight 8hour peritoneal creatinine and β2-microglobulin clearances and overnight 8-hour effluent glucose concentrations. Results The degree of uremia in patients with preserved RRF (group B) was obviously lower than in patients with negligible RRF (group A), that is, patients in group B had significantly lower serum creatinine and β2-microglobulin levels and significantly higher weekly KTN than group A patients. Despite the prevalence of allele 4 of apolipoprotein E genotype in group A patients, their levels of serum total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], apolipoprotein B (ApoB), and apolipoprotein A1 (ApoA1) were significantly lower than those of patients with preserved RRF (group B). The two groups did not differ significantly in the serum levels of triglyceride or high-density lipoprotein cholesterol. Serum concentrations of Lp(a) and ApoA1, as well as ratios of ApoA1 to ApoB, were correlated significantly with RRF (r = 0.63, r = 0.51, and r = 0.61, respectively). Conclusions The findings suggest that RRF affects the lipid profile of CAPD patients, especially serum levels of cholesterol-rich lipoproteins.

The Effect of Hemoglobin Concentration on Peritoneal Mass Transfer and Drain Volumes in Continuous Ambulatory Peritoneal Dialysis

1992 ◽  
Vol 12 (2) ◽  
pp. 230-233 ◽  
Author(s):  
Alastair J. Hutchison ◽  
Norma J. Ofsthun ◽  
Debbie Howarth ◽  
Ram Gokal
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemoglobin Concentration ◽  
Hemoglobin Level ◽  
University Teaching ◽  
Renal Unit ◽  
Before And After ◽  
Group A ◽  
Group B

Objective To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A -hemoglobin less than 8.5 g/dL; Group B hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL. Setting Single renal unit of a university teaching hospital. Patients:Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A -14 patients; Group B -13 patients; Group C (subgroup of A) -8 patients. Main outcome measures Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy. Results No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C. Conclusions Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.

scholarly journals Long-term clinical effects of treatment by daytime ambulatory peritoneal dialysis with an individualized dialysis dose mode are comparable to traditional dialysis methods (hemodialysis or continuous ambulatory peritoneal dialysis) for end-stage renal failure

2014 ◽  
Vol 8 (1) ◽  
pp. 67-73
Author(s):  
Zhang Zhi-yong ◽  
Li Ming-xu ◽  
Yu Yong-wu ◽  
Zhou Chun-hua
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Clinical Effects ◽  
Dialysis Dose ◽  
End Stage Renal Failure ◽  
Group A ◽  
Group B ◽  
End Stage

Abstract Background: At present, patients with end-stage renal failure (ESRD) face the question of how to achieve adequate dialysis to maintain their survival with the best quality of life as long as possible. Therefore, the choice of suitable dialysis methods and dialysis dose is important. Objective: To find suitable dialysis methods and an appropriate dialysis dose for patients with ESRD. Methods: Our research compares the long-term clinical effects between the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), daytime ambulatory peritoneal dialysis (DAPD), and hemodialysis (HD). Thirty-two patients subjected to peritoneal dialysis were selected and divided into group A (n = 16) and group B (n = 16), group A was treated by using the traditional CAPD pattern; group B was treated by using DAPD. Forty-six patients of renal failure at final stage were divided into group A (n = 23) and group B (n = 23), group A was treated by using a HD method, group B was treated by using a DAPD method. Results: When the same dialysis dose was applied, the patients with long-term DAPD treatment can obtain satisfactory clinical therapeutic efficacy for the period of maintenance dialysis, thoroughness of dialysis, maintenance of nutritional status, blood pressure regulation, reduction in incidence rate of peritoneal infection, maintenance of relatively high activity in daily life and alleviation in depression, comparable to patients treated with traditional CAPD or HD methods. Conclusion: The long-term clinical effects of DAPD are comparable to CAPD or HD.

Management of Fungal Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD)

1986 ◽  
Vol 6 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Vargemezis Zoe L. Vassilis ◽  
Homer Papadopoulou ◽  
Anna-Maria Liamos ◽  
Taisir Natscheh Belechri ◽  
George Vergoulas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Lavage ◽  
Pathogenic Fungi ◽  
Significant Loss ◽  
The Other ◽  
Peritoneal Adhesions ◽  
Fungal Peritonitis ◽  
Group A ◽  
Group B

A group of 138 patients (pts) on CAPD for a total of 1889 patientmonths had 176 episodes of peritonitis. Eighteen (13%) had fungal peritonitis at one to 20 months after beginning CAPD. The responsible organisms were Candida albicans (nine pts), Candida parapsilosis (five), Candida torulopsis (three), and Trichosporum capitatum (one). These infections were treated by various combinations of antifungal agents using two different strategies: Removal of the Tenckhoff catheter and interruption of CAPD for 10 to 14 days in nine pts (Group A), and continuous peritoneal lavage for four to six days in the remainder -nine pts (Group B). Fourteen of the 18 were cured (seven of nine in each group). In group A, two patients died, one continues on CAPD while the other six (67%) were transferred to hemodialysis because they developed peritoneal adhesions with significant loss in peritoneal space. In group B, only two patients have been transferred to hemodialysis; the other seven continue on CAPD. In our experience, the preferred initial form of treatment is continuous peritoneal lavage in conjunction with antifungal therapy. Catheter removal should be reserved for those who fail to respond to this treatment. Continuous ambulatory peritoneal dialysis (CAPD) is now accepted as a alternative treatment for end-stage renal disease. However, despite continuous progress in this field, peritonitis still remains a major complication and results in increased morbidity and cost. Although pathogenic fungi account for only 2 7% of peritonitis in patients on CAPD (1–3), the illness is severe and represents a major clinical challenge to these patients. In addition, the therapy of fungal peritonitis is still controversial, especially with regard to the need for removal of the catheter. This paper presents a retrospective study and describes our experience during the past four years with the management of fungal peritonitis in 18 patients undergoing CAPD at our center.

Do Patients on Continuous Ambulatory Peritoneal Dialysis Need Arterio-Venous Fistula?

1986 ◽  
Vol 6 (4) ◽  
pp. 193-194 ◽  
Author(s):  
Preben Joffe ◽  
Robert Skov ◽  
Finn Olsen
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Jugular Vein ◽  
Repeated Treatment ◽  
Patient Needs ◽  
Vein Access ◽  
Group A ◽  
Group B ◽  
Subclavian Catheter ◽  
Venous Fistula

The authors studied 43 patients on continuous ambulatory peritoneal dialysis (CAPD) for 5.8 years. The patients were divided into two groups. Group A consisted of 19 patients with an arteriovenous fistula. In only four of these was it necessary to use the fistula during 269 treatment months. Group B consisted of 24 patients without fistulas. Four of these needed dialysis via a subclavianvein catheter during interruption of CAPD, and one via a jugular-vein access side. The patients in group B were observed for 455 treatment months. Permanent vascular access should be constructed only in CAPD patients with repeated treatment failure. A subclavian catheter should be used whenever the patient needs temporary hemodialysis.

Six-Month Prospective Cross-Over Study to Determine the Effects of 1.1% Amino Acid Dialysate on Lipid Metabolism in Patients on Continuous Ambulatory Peritoneal Dialysis

1997 ◽  
Vol 17 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Madhukar Misra ◽  
David A. Reaveley ◽  
Jacqueline Ashworth ◽  
Bruce Muller ◽  
Mary Seed ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lipid Metabolism ◽  
Amino Acid ◽  
Total Cholesterol ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Density Lipoprotein ◽  
Protein Excretion ◽  
Group A ◽  
Group B ◽  
To Receive

Objective To evaluate the effect of 1.1% amino acid dialysate (A AD) (Nutrineal, Baxter, Castlebar, Ireland) on lipid metabolism in hyperlipidemic patients on continuous ambulatory peritoneal dialysis (CAPD). Design Patients were alternately assigned to receive AAD in the first (group A), or the second (group B), 6 months of a prospective cross-over study. Setting University teaching hospital. Patients Eighteen stable CAPD patients with a serum cholesterol 5.5 mmol/L or greater. Interventions One post prandial exchange of AAD during a 24-hour period for 6 months. Main Outcome Measures A significant change in serum lipid levels. Results Patients in group A (n = 10) received a single daily exchange of AAD in place of their post prandial dextrose exchange for the first 6 months, and then crossed over to the dextrose phase. Patients in group B (n = 8) continued their usual dextrose dialysis for the first 6 months and then crossed over to receive AAD in the latter 6 months. Measurements of serum lipids and lipoproteins along with other biochemical parameters were made at regular intervals. Although a downward trend in mean serum total cholesterol was seen on AAD in group A, no significant change in total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol was observed in any group. Mean serum triglycerides fell on AAD in both groups, but were not statistically significant. Serum lipoprotein(a) [Lp(a)] and apolipoprotein B were elevated in both groups but did not change on AAD or with time. No change was observed in serum apoprotein A1 levels. Serum Lp(a) was not correlated to dialysate protein excretion. No change in mean serum albumin was observed, in either group, on AAD. KT/V urea, total weekly creatinine clearance, net ultrafiltration, and dialysate protein excretion remained unchanged on AAD. Conclusions The use of A AD, although clinically safe and without side effects, had no effect on the dyslipidem ia in our group of CAPD patients.

Histologic Change of Peritoneal Membrane in Relation to Adequacy of Dialysis in Continuous Ambulatory Peritoneal Dialysis Patients

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 26-30 ◽  
Author(s):  
Irini Savidaki ◽  
Dionisios Karavias ◽  
Florentia Sotsiou ◽  
Sotiria Alexandri ◽  
Pantelitsa Kalliakmani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Structural Changes ◽  
Mesothelial Cells ◽  
Peritoneal Membrane ◽  
Histologic Change ◽  
Significant Difference ◽  
Uremic Patients ◽  
Group B ◽  
Histologic Changes

Background Long-term exposure of peritoneal membrane to bioincompatible dialysis solutions leads to structural changes and loss of ultrafiltration capability. Objective We studied the possible relationship between histologic change and the transport characteristics of peritoneal membrane and adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods The study included 18 CAPD patients (11 men, 7 women) who underwent a peritoneal biopsy either at initiation of treatment (group A, n = 9) or after a mean of 4 years on CAPD (group B, n = 9). The morphologic changes in the mesothelial cells and the vascular compartment and the thickness of the submesothelial collagenous zone were estimated and compared with observations from 6 patients with normal renal function who underwent biopsy of the parietal peritoneum during abdominal surgery. The relationship of the observed changes in CAPD patients to results from a peritoneal equilibration test (PET) and to adequacy of dialysis [total weekly creatinine clearance (CCr) and Kt/V urea] were also investigated. Results The main histologic changes in both groups of patients were loss of mesothelial cells and decrease in the normal mesothelial surface, thickening of the submesothelial collagenous zone, and presence of vascular hyalinosis. The thickness of the submesothelial collagenous zone in both groups of patients was significantly greater than that found in controls (410 μm and 580 μm vs 50 μm, p < 0.05). Although no significant difference was found between morphologic change in the peritoneal membrane of uremic patients starting on CAPD and those who had been on peritoneal dialysis (PD) for a mean period of 4 years, a trend was observed toward more severe lesions in the latter patients. The PET, CCr, and Kt/V urea were not significantly different in the two groups of patients. Those parameters also showed no significant changes when examined at initiation of CAPD and after a mean of 4 years of PD in the same patients (group B). No significant correlations were observed between the histologic changes and the PET, CCr, or Kt/V in both groups of patients. Conclusions Significant structural changes are observed in the peritoneal membrane of uremic patients, and those changes become worse with CAPD treatment. Structural changes are not followed by functional changes during the first 4 years on CAPD.

scholarly journals Effectiveness and Safety of Peritoneal Dialysis Treatment in Patients with Refractory Congestive Heart Failure due to Chronic Cardiorenal Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Qiuyuan Shao ◽  
Yangyang Xia ◽  
Min Zhao ◽  
Jing Liu ◽  
Qingyan Zhang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Survival Time ◽  
Heart Function ◽  
Cardiorenal Syndrome ◽  
Term Survival ◽  
Group A ◽  
Group B

Aims. To evaluate the effectiveness and safety of peritoneal dialysis (PD) in treating refractory congestive heart failure (RCHF) with cardiorenal syndrome (CRS).Methods. A total of 36 patients with RCHF were divided into type 2 CRS group (group A) and non-type 2 CRS group (group B) according to the patients’ clinical presentations and the ratio of serum urea to creatinine and urinary analyses in this prospective study. All patients were followed up till death or discontinuation of PD. Data were collected for analysis, including patient survival time on PD, technique failure, changes of heart function, and complications associated with PD treatment and hospitalization.Results. There were 27 deaths and 9 patients quitting PD program after a follow-up for 73 months with an average PD time of22.8±18.2months. A significant longer PD time was found in group B as compared with that in group A (29.0±19.4versus13.1±10.6months,p=0.003). Kaplan–Meier curves showed a higher survival probability in group B than that in group A (p<0.001). Multivariate regression demonstrated that type 2 CRS was an independent risk factor for short survival time on PD. The benefit of PD on the improvement of survival and LVEF was limited to group B patients, but absent from group A patients. The impairment of exercise tolerance indicated by NYHA classification was markedly improved by PD for both groups. The technique survival was high, and the hospital readmission was evidently decreased for both group A and group B patients.Conclusions. Our data suggest that PD is a safe and feasible palliative treatment for RCHF with type 2 CRS, though the long-term survival could not be expected for patients with the type 2 CRS. Registration ID Number isChiCTR1800015910.

Increase of the Bioavailabllity of Intraperitoneal Erythropoietin in Children on Peritoneal Dialysis by Administration in Small Dialysis Bags

1997 ◽  
Vol 17 (5) ◽  
pp. 467-470 ◽  
Author(s):  
Roel E. Reddingius ◽  
Alberdina W. De Boer ◽  
Cornelis H. Schröder ◽  
Johannes L. Willems ◽  
Leo A.H. Monnens
Keyword(s):  
Peritoneal Dialysis ◽  
Transferrin Saturation ◽  
Intraperitoneal Administration ◽  
Hemoglobin Level ◽  
Wilcoxon Test ◽  
University Hospital ◽  
Renal Anemia ◽  
Dialysis Fluid ◽  
Group A ◽  
Group B

Objective To establish the effectivity of administration of erythropoietin intraperitoneally in a small amount of fluid in children with renal anemia on continuous ambulatory peritoneal dialysis (CAPD). Design Prospective study in which children with renal anemia on CAPD were treated with erythropoietin intraperitoneally, administered in a specially designed bag containing 50 mL NaCl 0.9%. Setting University hospital. Patients The patient population consisted of 9 children treated with CAPD and 1 treated with nightly intermittent peritoneal dialysis. The median age was 7.8 years (range 4.1 -15.2). Four of these children had not been treated with erythropoietin before (group A), and 6 had been treated with erythropoietin administered intraperitoneally in 250 mL of dialysis fluid (group B). Interventions Patients in group A started on a dose of approximately 300 units/kg per week (group A). Patients in group B received their previous dose. Do sage was adjusted to achieve a target hemoglobin level of 6.5 7.0 mmol/L (104 -112 g/L). Serum ferritin levels and transferrin saturation were monitored and iron supplementation was prescribed in the case of iron deficiency. Main outcome measures Weekly erythropoietin dose in relation to hemoglobin level. Results In group A, median hemoglobin level rose from 5.3 mmol/L (85 g/L) to 6.6 mmol/L (106 g/L) after 6 months of therapy, whereas the median erythropoietin dose decreased from 266 to 234 U/kg/week. In group B, hemoglobin levels remained stable and median erythropoietin dose decreased from 262 to 194 U/kg/week. One patient in this group, for unknown reasons, never responded to erythropoietin treatment. He was excluded from further analysis. In the remaining 5 patients the median cumulative erythropoietin dose was 3250 U/kg in the 3-month period prior to the start of the study and 2713 in the 3-month period starting 6 months after the beginning of the study. This difference of 17% was statistically significant using a Wilcoxon test (p < 0.05). Conclusion Intraperitoneal administration of erythropoietin in a small amount of dialysis fluid leads to a decrease in the required dose.

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