Peritonitis-Related Deaths in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

1990 ◽  
Vol 10 (1) ◽  
pp. 45-47 ◽  
Author(s):  
George E. Digenis ◽  
Georgi Abraham ◽  
Eugene Savin ◽  
Peter Blake ◽  
Nicholas Dombros ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Serum Proteins ◽  
Total Serum ◽  
Contributing Factors ◽  
Peritoneal Catheter ◽  
Staph Aureus ◽  
Artery Disease ◽  
Present On Admission

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients. We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.

Major and Minor Risk Factors for Cardiovascular Disease in Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 133-137 ◽  
Author(s):  
Sarah Prichard
Keyword(s):  
Oxidative Stress ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Chronic Inflammation ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Treatment Strategies ◽  
Dialysis Patients ◽  
Lipid Abnormalities ◽  
Conventional Risk Factors

Uremia in general and peritoneal dialysis in particular bring with them risk factors for the development of cardiovascular disease. These factors include multiple lipid abnormalities, hyperhomocysteinemia, abdominal obesity, chronic inflammation, hypoalbuminemia, oxidative stress, and AGE formation. When these are combined with conventional risk factors, one can appreciate why the incidence of cardiovascular disease is so high in peritoneal dialysis patients. Treatment strategies should address each of these risks appropriately.

Single-Dose Pharmacokinetics of Intraperitoneal Ofloxacin in Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 383-385 ◽  
Author(s):  
Ignatius Kum-Po Gheng ◽  
Pak-Yin Ghau ◽  
Gyrus R. Kumana ◽  
Ghing-Ying Ghan ◽  
Maybelle Kou ◽  
...  
Keyword(s):  
High Pressure ◽  
Renal Function ◽  
Liquid Chromatography ◽  
Single Dose ◽  
Peritoneal Dialysis ◽  
Serum Concentration ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Serum ◽  
Serum Clearance ◽  
Time Required

The present study examines the pharmacokinetics of ofloxacin given In a single dose of 200 mg intraperitoneally (Ip) In the first bag of three 2-L 8-hour exchanges. Ofloxacin was measured using high-pressure liquid chromatography (HPLC) in the serum and peritoneal effiuent over 24 hours. Six patients without and 3 patients with peritonitis were studied. Ofloxacin given Ip was almost completely absorbed after an 8-hour dwell, and this was not affected by peritonitis. The time required to reach peak serum concentration was longer than that reported previously following oral administration. Elimination halflife (11/2) of ofloxacln was markedly prolonged compared to patients with normal renal function. Peritoneal clearance accounted for only one-tenth of total serum clearance. Peritonitis appeared to shorten the T112 of ofloxacln, but this was mainly due to an Increase In total serum clearance rather than a change In peritoneal clearance. Peritoneal drug concentration >0.5 mg/L was reached In the second and third exchange by the second hour. No Bide effects from Ip ofloxacin were observed. We concluded that ofloxacin given in a single dose of 200 mg is safe and provides adequate therapeutic serum and peritoneal concentration for more than 24 hours in patients on continuous ambulatory peritoneal dialysis (CAPD) with 8-hour exchanges.

Continuous Ambulatory Peritoneal Dialysis in High-Risk Patients: Patients with Cardiovascular Diseases -Role of the Nurse

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 499-503
Author(s):  
Marie-Christine Z. Lambert ◽  
Holger Schilling
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Ventricular Hypertrophy ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Therapeutic Success ◽  
Risk Patients ◽  
Continuous Peritoneal Dialysis ◽  
Artery Disease

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis -induced effects on the heart. With continuous peritoneal dialysis (CAPO) some of the cardiovascular complications are ameliorated owing to slow ultrafiltration and absence of an arteriovenous fistula. CAPO might be concluded to be the preferable option in patients with cardiovascular disease, but a few disadvantages, such as hyperlipidemia and hyperinsulinemia, also exist. Nurses also play an important role in the therapeutic success and outcomes of these patients.

scholarly journals Co-existence of Hypertension and Pre-existing Cardiovascular Disease and Mortality in Patients on Continuous Ambulatory Peritoneal Dialysis

2020 ◽  
Author(s):  
Xiaoyang Wang ◽  
Xiaojiang Zhan ◽  
Qing Zhou ◽  
Xiaoran Feng ◽  
FenFen Peng ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Harmful Effect ◽  
Competing Risk ◽  
Control Group ◽  
Risk Models ◽  
All Cause Mortality ◽  
Competing Risk Models ◽  
Cvd Mortality

Abstract Background Little is known about whether co-existence of hypertension (HTN) and pre-existing cardiovascular disease (CVD) has a more harmful effect on mortality compared with either comorbidity alone in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods We conducted a retrospective study of 3073 incident Chinese patients on CAPD from five dialysis centers between January 1, 2005 and December 31, 2018 in a real-world setting. The primary and secondary outcomes were all-cause and CVD mortality. The association between interesting comorbidities and mortality was analyzed using Cox regression models and the Fine and Gray competing risk models. Results Over a median of 33.7 months of follow-up, 581 (18.6%) patients died, with 286 (9.3%) CVD mortality. The incidence of all-cause mortality was 32.2, 56.1, 74.4, and 131.0/1000 patient-years, and the incidence of CVD mortality was 15.0, 28.2, 34.7, and 69.6/1000 patient-years in the control group (those without either hypertension or CVD), HTN group, CVD group, and HTN plus CVD group respectively. After adjusting for the confounding factors, HTN plus CVD, CVD, and HTN groups had a higher risk of all-cause mortality (HR 3.98, 95% CI 3.07 to 5.17; HR 2.18, 95% CI 1.27 to 3.74; and HR 1.83, 95% CI 1.47 to 2.28) and CVD mortality (HR 4.68, 95% CI 3.27 to 6.69; HR 2.11, 95% CI 0.96 to 4.63; and HR 1.87, 95% CI 1.37 to 2.54), respectively, compared to the control group. Similar findings were observed using the Fine and Gray competing risk models. There was no significant interaction between HTN and CVD on all-cause and CVD mortality (β = 0.010, P = 0.973; β = 0.058, P = 0.892) in the study population. Conclusions Among CAPD patients, co-existence of HTN and pre-existing CVD at the start of CAPD had a more harmful effect on mortality compared to either HTN or pre-existing CVD alone, and pre-existing CVD may have also a more harmful effect on mortality than HTN.

Continuous Ambulatory Peritoneal Dialysis and the Heart

1995 ◽  
Vol 15 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Martin A. Alpert ◽  
Jürgen Hüting ◽  
Zbylut J. Twardowski ◽  
Ramesh Khanna ◽  
Karl D. Nolph
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Left Ventricular ◽  
Computer Search ◽  
Pericardial Disease ◽  
Artery Disease

Objective To review clinical research pertaining to continuous ambulatory peritoneal dialysis (CAPD) and the heart. Data Sources A Medline computer search was employed to identify appropriate references from 1970 1994. Indexing terms were: continuous ambulatory peritoneal dialysis, hemodialysis, heart or cardiac, left ventricle, coronary artery disease, and survival. English and non-English language abstracts were scrutinized. Study Selection Forty-six studies were reviewed and utilized. Numerical data extracted are reported in this review as they were reported in the original article. Results This review provides a broad-based survey of studies pertaining to CAPD and the heart. Most of the studies relate to CAPD and left ventricular structure or function. Little information exists concerning CAPD and coronary artery disease, valvular disease, pericardial disease, and cardiac arrhythmias. Studies pertaining to patient survival on CAPD identify coronary artery disease and congestive heart failure as major risk factors, but in-depth quantification of these cardiovascular disorders is lacking in the literature. Conclusions CAPD is capable of decreasing left ventricular (LV) volume and improving LV systolic function in patients with L V enlargement and those with L V systolic dysfunction. The effect of CAPD on left ventricular hypertrophy (LVH) and LV diastolic function is variable. CAPD produces symptomatic improvement in patients with refractory congestive heart failure, but its effect on survival in such patients is uncertain. Atherogenic lipid abnormalities occur in CAPD patients. The clinical significance of these abnormalities is uncertain. Coronary artery bypass surgery can be performed safely and effectively on CAPD patients. CAPD is not arrhythmogenic. Survival of CAPD patients is similar to that of hemodialysis patients except in elderly diabetics for whom it is slightly lower.

An Unusual Cause of Massive Intraperitoneal Bleeding in CAPD

1984 ◽  
Vol 4 (4) ◽  
pp. 257-258 ◽  
Author(s):  
Joseph Shohat Zaki ◽  
Shapira Alexander Yussim ◽  
Geoffrey Boner
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Vessels ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rare Complication ◽  
Fibrous Tissue ◽  
Massive Bleeding ◽  
Peritoneal Catheter ◽  
Intraperitoneal Hemorrhage ◽  
Intraperitoneal Bleeding ◽  
Capd Patient

A 73-year-old man, who had been on CAPD for two years, presented with massive intraperitoneal hemorrhage. On laparotomy the peritoneal catheter was situated in a large pouch that was lined by fibrous tissue. The hemorrhage arose from erosion of the pouch wall -an unusual cause of intraperitoneal bleeding in the CAPD patient. Massive intraperitoneal bleeding is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Mild to moderate bleeding, which is more common in CAPD, usually is related to disintegration of small blood vessels. In most patients the bleeding is self-limited. This paper describes an unusual cause of massive bleeding in a CAPD patient.

The Disappearance of Macromolecules from the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis (CAPD) is Not Dependent on Molecular Size

1990 ◽  
Vol 10 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Raymond T. Krediet ◽  
Dirk G. Struijk ◽  
Gerardus C. M. Koomen ◽  
Fransiscus J. Hoek ◽  
Lambertus Arisz
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Serum Proteins ◽  
Molecular Size ◽  
Gel Permeation Chromatography ◽  
Lymphatic Absorption ◽  
Clearance Ratio ◽  
Dextran 70 ◽  
Dextran Clearance

The transport of macromolecules from the circulation to the peritoneal cavity is a size-selective restricted process, while the transport of these solutes from the peritoneal cavity is probably mainly by lymphatic absorption. If so, it should be independent of molecular size. Therefore, we studied with a clearance technique the disappearance of intra peritoneally administered inulin and polydisperse dextran 70 in nine continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results with the simultaneously measured appearance clearance of serum proteins. Using gel permeation chromatography 18 dextran fractions with different molecular radii could be analyzed. Inulin clearance (2.94 mL/min) was higher than total dextran clearance (1.30 mL/min). The maximal dextran concentration in all dialysate samples was found in the 50.4 Å fraction. The clearances of the dextran fractions were the same for different molecular sizes. All disappearance clearances were higher than the appearance clearances: the protein/dextran clearance ratio ranged from 0.15 for albumin/36 Å to 0.04 for alpha2-macroglobulin/91 Å. This confirms that the appearance of a macromolecule, but not its disappearance is dependent on molecular size. It is concluded that the disappearance of macromolecules from the peritoneal cavity is mainly a size independent convective process, possibly by lymphatic uptake. This implies that total dextran 70 clearance can be used for measurement of lymphatic absorption in CAPD patients.

Serum C-Reactive Protein: A Predictor of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

1998 ◽  
Vol 18 (4) ◽  
pp. 387-394 ◽  
Author(s):  
Hyunjin Noh ◽  
Seoung Woo Lee ◽  
Shin Wook Kang ◽  
Sug Kyun Shin ◽  
Kyu Hun Choi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Outcome Measures ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Patient Survival ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Patient Survival Rate

Objective To evaluate the predictive value of a single baseline serum C-reactive protein (sCRP) as a marker of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Design A review of prospectively collected data in a 2-year follow-up study. Setting Tertiary medical center. Patients The study included 106 patients who were stable and had been on CAPD for a minimum of 3 months. Main Outcome Measures Patient survival rate was the main outcome measure of this study. Other outcome measures were technique survival rate, peritonitis rate, and hospitalized days. Covariables used in the survival analysis were age, sex, the presence of cardiovascular disease or diabetes mellitus, sCRP, serum albumin, hematocrit, cholesterol, HDL-cholesterol, malnutrition by subjective global assessment (SGA), weekly Kt/V urea, and weekly standardized creatinine clearance (SCCr). Results The 2-year patient survival rate was significantly lower in the increased sCRP group than in the normal sCRP group (66.7% vs 94.1%, p = 0.001), although there was no significant difference in technique failure, peritonitis rate, and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were: cardiovascular disease (relative risk, RR = 8.96, p < 0.005); increased sCRP level (RR = 1.19, p < 0.05); and high hematocrit (RR = 1.18, p < 0.05). ← Conclusion Serum CRP at enrollment is an independent predictor of 2-year patient survival in CAPD patients.

Does Continuous Ambulatory Peritoneal Dialysis Induce Hypercholesterolemia?

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 421-423 ◽  
Author(s):  
Giacomo Panarello ◽  
Giuseppina Calianno ◽  
Hamurabi De Baz ◽  
Daniela Signori ◽  
Piero Cappelletti ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Body Mass Index ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Coronary Artery ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Metabolic Effects ◽  
Muscle Area ◽  
Artery Disease

Hypercholesterolemia has been recognized as a significant risk factor for atherosclerosis and coronary artery disease. The aim of this study was to evaluate the prevalence of hypercholesterolemia and the role, if any, of type of dialysis. In 19 hemodialysis (HD) and 20 continuous ambulatory peritoneal dialysis (CAPD) subjects, body weight, body mass index (BMI), arm muscle area (AMA), total choles terol (C), HDL and LDL fractions, triglycerldes, C/HDL ratio, glycosilated hemoglobin, and apolipoproteins AI, All, B, CII, CllI, and E were evaluated. Hypercholesterolemia was defined as cholesterol greater than 220 mg/dL and LDL greater than 150 mg/dL. Body weight, body mass index, and arm muscle area were higher (p<0.05) in CAPD as compared with HD; so were total cholesterol, LDL, C/HDL ratio, and glycosllated hemoglobin (Hbalc). Hypercholesterolemia prevalence was 3/19 in HD and 11/20 in CAPD (p<0.05). A relationship between Hbalc and C/HDL ratio was found in the CAPD group (r=0.48; p<0.05). We are greatly concerned about these metabolic effects of CAPD; therefore, we should carefully select patients to be treated by CAPD. Aggressive nutritional and pharmacological treatment for glucose Intolerance and hypercholesterolemia In CAPD patients must be performed in order to reduce the incidence of coronary artery disease (CAD).

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