Sclerosing Peritonitis Complicating Prolonged Use of Chlorhexidine in Alcohol in the Connection Procedure for Continuous Ambulatory Peritoneal Dialysis

1991 ◽  
Vol 11 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Wai-Kei Lo ◽  
Kwok Tat Chan ◽  
Anthony C.T. Leung ◽  
Siu-Wah Pang ◽  
Chun-Yan Tse
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Intestinal Obstruction ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Sclerosing Peritonitis ◽  
Asymptomatic Patients ◽  
Ultrafiltration Failure ◽  
Bloody Ascites

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiologies. We have documented 14 cases of SP in 18 patients who had used chlorhexidine in alcohol (ChA) in the connection procedure for CAPD. Thirteen died. Nine of the 14 patients had been transferred to hemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer -even the 5 who were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They presented at around 5 years (30–80 months) after commencement of CAPD. Most deaths were related to intestinal obstruction. Four other patients with a comparable duration of ChA exposure were continued on CAPD with the Travenol Spike System (TSS), without further exposure to ChA. They were all asymptomatic of SP after 9–12 months. Comparing the 2 groups of asymptomatic patients, those transferred to TSS had a much better outcome after 9 months than those transferred to HD or renal transplantation (P=0.0476). We suggest that ChA is the main cause of SP in our patients and that continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD to prevent the progression of SP.

Recurrent Hemoperitoneum Complicating Continuous Ambulatory Peritoneal Dialysis

2002 ◽  
Vol 22 (4) ◽  
pp. 488-491 ◽  
Author(s):  
Kai-Chung Tse ◽  
Pok-Siu Yip ◽  
Man-Fei Lam ◽  
Fu-Keung Li ◽  
Bo-Ying Choy ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Clinical Outcomes ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Causes Of Death ◽  
Tertiary Care ◽  
Time Interval ◽  
Renal Unit ◽  
Ultrafiltration Failure

♦ Objectives To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). ♦ Design Single-center retrospective case review of patients on CAPD over a 10-year period. ♦ Setting Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. ♦ Patients 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. ♦ Main Outcome Measures Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D4/D0) with standard 2-L 2.5% glucose dialysate were assessed. ♦ Results There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24 – 76 years) and mean duration of dialysis was 61.6 months (range 2 – 166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2 – 12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1 – 37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes ( p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes ( p = 0.91) or survival ( p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. ♦ Conclusions Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.

Tuberculous Peritonitis in a Cohort of Continuous Ambulatory Peritoneal Dialysis Patients

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 202-204 ◽  
Author(s):  
Georgi Abraham ◽  
Milly Mathews ◽  
Lena Sekar ◽  
Aparajitha Srikanth ◽  
Uma Sekar ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Membrane Integrity ◽  
Tuberculous Peritonitis ◽  
Mantoux Test ◽  
Men 2 ◽  
Caseating Granuloma ◽  
Ultrafiltration Failure

Among 155 patients who were initiated on continuous ambulatory peritoneal dialysis (CAPD), 4 patients (2 men, 2 women) developed tuberculous peritonitis. They had been on PD for between 2 months and 84 months when they developed the peritonitis. The Mantoux test was negative in all of them. The diagnosis was made by a variety of means in the various cases: demonstration of Mycobacterium tuberculosis in the peritoneal cavity; presence of caseating granuloma in a peritoneal biopsy; Mycobacterium tuberculosis in a cold abscess adjacent to the peritoneal cavity; and demonstration of IS6110 and MPB64 genes of Mycobacterium tuberculosis by polymerase chain reaction (PCR) technique. Two of the patients developed ultrafiltration failure. Among 3 patients who were switched to hemodialysis, 2 died and 1 continues on maintenance dialysis. The last patient, whose catheter was removed, was reimplanted with a new catheter and continues on PD without ultrafiltration failure. Any patient with peritonitis unresponsive to conventional therapy should be investigated for tuberculous peritonitis. Institution of chemotherapy without delay will preserve peritoneal membrane integrity.

Continuous Ambulatory Peritoneal Dialysis in South Africa -A Four-Year Experience

1984 ◽  
Vol 4 (2) ◽  
pp. 78-81 ◽  
Author(s):  
I. Parsoo ◽  
Y.K. Seedat ◽  
S. Naicker ◽  
J.C. Kallmeyer
Keyword(s):  
South Africa ◽  
Developing Countries ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Minority Groups ◽  
Alternative Therapy ◽  
Major Complication

This study describes our experience with continuous ambulatory peritoneal dialysis (CAPD) over a four year period, during which 88 patients were offered CAPD. It compares and contrasts the response to CAPD among four racial groups in Natal viz asiatics, blacks, coloureds and whites. Peritonitis -the major complication, occurred with an overall incidence of one episode every 4.41 patient months. CAPD remains a useful alternative therapy in developing countries where a high percentage of patients with chronic renal failure would be denied a chronic renal failure program because of lack of expertise in hemodialysis and/or renal transplantation, or limited financial resources. Continuous ambulatory peritoneal dialysis (CAPD) was first described by Moncrief and Popovich (1) and, since its modification by Oreopoulos and his group (2), this technique has gained world wide usage. South Africa, like many developing countries has a high incidence of end-stage renal disease (ESRD) but because of lack of resources and economical problems, few patients with ESRD can be treated by dialysis or renal transplantation. CAPD affords a relatively simple and inexpensive form of therapy for these patients. At the present time about 200 patients are on CAPD in South Africa. Natal, the smallest of four provinces in South Africa, has a population of about five million, the majority being blacks. The minority groups include whites, asiatics and coloureds. There is only one chronic dialysis centre in Natal; situated in Durban, it serves the entire province including parts of the Transkei. This paper describes a four-year experience with CAPD in this mixed population and discusses problems unique to this situation.

National Comparisons: Optimal Peritoneal Dialysis Outcomes among Japanese Patients

1999 ◽  
Vol 19 (3_suppl) ◽  
pp. 9-16 ◽  
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Positive Selection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Japanese Patients ◽  
Current Status ◽  
Technique Survival ◽  
Ultrafiltration Failure ◽  
Dialysis Outcomes

This paper describes the current status of chronic dialysis in Japan and the guidelines used to initiate dialysis (scoring system), and reports the outcome of continuous ambulatory peritoneal dialysis (CAPD), focusing upon our center's experience. Fifty percent of CAPD technique survival was 6.9 ± 1.3 years among those patients classified as “positive selection.” The major causes of withdrawal from CAPD were ultrafiltration failure, the patients’ inability to continue on CAPD by themselves, and peritonitis. The clinical issues that most concern nephrologists in CAPD management are prevention and management of ultrafiltration failure, prevention/therapeutic intervention in encapsulating peritoneal sclerosis, catheter-related infections, and prevention of underdialysis.

The Futility of Pretransplant Coronary Bypass Grafting in Asymptomatic Patients on Peritoneal Dialysis

1998 ◽  
Vol 18 (5) ◽  
pp. 485-488 ◽  
Author(s):  
S. Panduranga Rao ◽  
Susan Lenkei ◽  
Maggie Chu ◽  
Joanne M. Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Comparison Group ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Study Group ◽  
Bypass Grafting ◽  
Comorbid Disease ◽  
Dialysis Patients ◽  
Asymptomatic Patients

Objective To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia. Design Retrospective review in a single PD unit. Participants Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and diseasematched PD patients who did not receive CABG were used as a comparison group. Measurements Clinical outcome from 1990 to the present. Results Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list. Conclusion As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.

Is peritoneal rest a treatment for ultrafiltration failure during continuous ambulatory peritoneal dialysis?

1992 ◽  
Vol 52 (1) ◽  
pp. 202-212 ◽  
Author(s):  
Tosiharu Ikutaka ◽  
Motoyuki Ishiguro ◽  
Seiichi Shimabukuro ◽  
Takahiro Hirano ◽  
Michio Arakawa
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Ultrafiltration Failure

Overnight Mesothelial Cell Exfoliation: A Magic Tool for Predicting Future Ultrafiltration Failure in Patients on Continuous Ambulatory Peritoneal Dialysis

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 107-113
Author(s):  
Talerngsak Kanjanabuch ◽  
Monchai Siribamrungwong ◽  
Rungrote Khunprakant ◽  
Sirigul Kanjanabuch ◽  
Piyathida Jeungsmarn ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Mesothelial Cell ◽  
Mesothelial Cells ◽  
Nutrition Status ◽  
Continuous Exposure ◽  
Peritoneal Membrane ◽  
Dialysis Solution ◽  
Ultrafiltration Failure

⋄ Background Continuous exposure of the peritoneal membrane to dialysis solutions during long-term dialysis results in mesothelial cell loss, peritoneal membrane damage, and thereby, ultrafiltration (UF) failure, a major determinant of mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). Unfortunately, none of tests available today can predict long-term UF decline. Here, we propose a new tool to predict such a change. ⋄ Mesothelial cells from 8-hour overnight effluents (1.36% glucose dialysis solution) were harvested, co-stained with cytokeratin (a mesothelial marker) and TUNEL (an apoptotic marker), and were counted using flow cytometry in 48 patients recently started on CAPD. Adequacy of dialysis, UF, nutrition status, dialysate cancer antigen 125 (CA125), and a peritoneal equilibration test (3.86% glucose peritoneal dialysis solution) were simultaneously assessed and were reevaluated 1 year later. ⋄ Results The numbers of total and apoptotic mesothelial cells were 0.19 ± 0.19 million and 0.08 ± 0.12 million cells per bag, respectively. Both numbers correlated well with the levels of end dialysate–to–initial dialysate (D/D0) glucose, dialysate-to-plasma (D/P) creatinine, and sodium dipping. Notably, the counts of cells of both types in patients with diabetes or with high or high-average transport were significantly greater than the equivalent counts in nondiabetic patients or those with low or low-average transport. A cutoff of 0.06 million total mesothelial cells per bag had sensitivity of 1 and a specificity of 0.75 in predicting a further decline in D/D0 glucose and a sensitivity of 0.86 and a specificity of 0.63 to predict a further decline in UF over a 1-year period. In contrast, dialysate CA125 and other measured parameters had low predictive values. ⋄ Conclusions The greater the loss of exfoliated cells, the worse the expected decline in UF. The ability of a count of mesothelial cells to predict a future decline in UF warrants further investigation in clinical practice.

Glycated Albumin in Serum and Dialysate of Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 84 (6) ◽  
pp. 619-626 ◽  
Author(s):  
E. Lamb ◽  
W. R. Cattell ◽  
A. Dawnay
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Glycated Albumin ◽  
Protein Glycation ◽  
Structural Proteins ◽  
Diabetic Patients ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Ultrafiltration Failure

1. Chronic use of hyperosmolar glucose solutions in continuous ambulatory peritoneal dialysis may cause glycation of peritoneal structural proteins which could contribute to membrane dysfunction and ultrafiltration failure. To determine whether glycation can occur in the environment of the dialysate, we have carried out studies using albumin as a model protein. 2. Glycated albumin was measured in the serum and dialysate of 46 patients on continuous ambulatory peritoneal dialysis (31 non-diabetic patients, 15 diabetic patients). Dialysate and serum glycated albumin (ranges 1.0-12.7% and 0.9-10.2%, respectively) were related to each other (r = 0.988, P <0.001), but dialysate glycated albumin was significantly higher than serum glycated albumin (P <0.0001), with the dialysate to serum glycated albumin ratio being greater than unity in 76% of patients (mean ratio 1.14). This implies either preferential transfer of glycated albumin across the peritoneal membrane or intraperitoneal glycation during the dwell period. 3. In vitro, significant glycation occurred in dialysate during a 6 h incubation period (P <0.01) at a rate related to the glucose concentration in the dialysate (rs = 0.63, P <0.05). The glycation rate was not significantly affected (P = 0.05) by factors other than the glucose concentration. 4. Our results demonstrate that protein glycation occurs within the peritoneum during continuous ambulatory peritoneal dialysis. Further studies are required to establish the relationship of glycation of structural proteins in the peritoneal membrane to membrane function.

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