Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Bradley A. Warady ◽  
Vicki Bahl ◽  
Uri Alan ◽  
Stanley Hellerstein
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Symptomatic Relief ◽  
Duration Of Treatment ◽  
Child Treatment ◽  
Dialysis Unit ◽  
Case Evaluation ◽  
Fill Volume ◽  
Unique Approach ◽  
Tidal Peritoneal Dialysis

Objective To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification. Design Prospective case evaluation. Setting The Home Peritoneal Dialysis Unit, Children's Mercy Hospital. Patient Seven-year-old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum. Intervention Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months. Results The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months. Conclusion Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.

Tidal Peritoneal Dialysis: Preliminary Experience

1992 ◽  
Vol 12 (3) ◽  
pp. 304-308 ◽  
Author(s):  
Michael J. Flanigan ◽  
Cynthia Doyle ◽  
Victoria S. Lim ◽  
Gary Ullrich
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Tidal Flow ◽  
Clinic Visit ◽  
Residual Volume ◽  
University Of Iowa ◽  
Home Dialysis ◽  
Dialysate Flow ◽  
Fill Volume ◽  
Tidal Peritoneal Dialysis

Objectives To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). Design An open enrollment pilot study. Setting The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Patients Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Interventions Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Measurements Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Results Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 + 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/ kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. Conclusion TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

A Comparison of Clearances on Tidal Peritoneal Dialysis and Intermittent Peritoneal Dialysisa

1994 ◽  
Vol 14 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Beth Piraino ◽  
Filitsa Bender ◽  
Judith Bernardini
Keyword(s):  
Peritoneal Dialysis ◽  
Small Molecule ◽  
Flow Rate ◽  
Peritoneal Equilibration Test ◽  
Urea Nitrogen ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Fill Volume ◽  
The Mean ◽  
Tidal Peritoneal Dialysis

Objectives To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate. Design Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 Llexchange for a total of 30 Lltreatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 Lltreatment. Patients Six patients, with a mean dialysatelplasma (DIP) creatinine as determined by the peritoneal equilibration test (PET) of 0.64±0.1 0, were studied. Four had a low -average DIP creatinine, while 2 had a high-average DIP creatinine. Measurements Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test. Results The dialysate flow rates were 3.7±0.1 Llhour for IPD and 3.8±0.2 Llhour for TPD. The mean dialysate dextrose was 1.9±0.5 gldL for both. The creatinine clearances were 9±2 versus 10±3 mLlminute, the urea nitrogen clearances 19±3 versus 20±3 mLlminute, and phosphate clearances 10±3 versus 11±3 mLlminute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9±0.9 mLlminute on IPD and 3.3±1.6 mLI minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average DIP creatinine were higher than for the 4 patients with low -average DIP creatinine. Conclusions When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.

scholarly journals Relationship between body size, fill volume, and mass transfer area coefficient in peritoneal dialysis.

1994 ◽  
Vol 4 (10) ◽  
pp. 1820-1826 ◽  
Author(s):  
P Keshaviah ◽  
P F Emerson ◽  
E F Vonesh ◽  
J C Brandes
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Body Size ◽  
Body Surface ◽  
Time Profiles ◽  
Surface Areas ◽  
Concentration Time ◽  
Fill Volume ◽  
Dialysate Volume ◽  
Tidal Peritoneal Dialysis

A peritoneal dialysate fill volume of 2 L has become the standard of clinical practice, but the relationships between body size, fill volume, and mass transfer area coefficient (KoA) have not been well established. These relationships were studied in 10 stable peritoneal dialysis patients who underwent six peritoneal equilibration studies (2 h each) at fill volumes of 0.5, 1, 1.5, 2, 2.5, and 3 L. The concentration-time profiles for urea, creatinine, and glucose were measured at each fill volume, and residual volumes were calculated from the preceding dwell period. A modified Henderson equation was used to calculate the KoA for the three solutes as a function of fill volume. By normalizing the KoA for each solute to the value at 2 L, the data for all three solutes collapsed onto the same trend line when plotting the normalized KoA versus dialysate volume. Between 0.5- and 2-L fill volumes, the average normalized KoA increases in an almost linear fashion, its value almost doubling over this range. Between 2- and 3-L fill volumes, there is less than a 10% change in the normalized KoA. However, fill volumes for peak urea KoA were found to increase with increasing body surface area (R = 0.76), being around 2.5 L for an average-sized patient and increasing to between 3 and 3.5 L for body surface areas > 2 m2. To maximize solute transport, these relationships between body size, volume, and KoA should be considered when choosing fill volumes for continuous ambulatory peritoneal dialysis and automated peritoneal dialysis and when deciding reserve and tidal volumes for tidal peritoneal dialysis.

Prescription and Assessment of Tidal Peritoneal Dialysis Delivery with a Specific Equilibration Test

1996 ◽  
Vol 16 (3) ◽  
pp. 295-301 ◽  
Author(s):  
Alberto Edefonti ◽  
Marina Picca ◽  
Geltrude Consalvo ◽  
Luciana Ghio ◽  
Beatrice Damiani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Pediatric Nephrology ◽  
Correlation Coefficients ◽  
Dialysis Unit ◽  
Time Points ◽  
Stage Renal Disease ◽  
End Stage ◽  
A Prospective Study ◽  
Clinical Conditions ◽  
Tidal Peritoneal Dialysis

Objective To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery. Design In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (DIP) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables. Setting Dialysis unit of a pediatric nephrology department and patients’ homes. Patients Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD. Interventions Dialysate and blood sample collections. Main Outcome Measures DIP ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15–,30–,60, and 120-minute PETtimes, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances. Results Correlation coefficients between PET -derived and total TPD dialysate-derived DIP ratios, and those between PET -derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. DIP ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the DIP ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances) -that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea. Conclusion The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the DIP ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.

Culture-Negative Peritonitis Associated with the use of Icodextrin-Containing Dialysate in Twelve Patients Treated with Peritoneal Dialysis

2003 ◽  
Vol 23 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Walther H. Boer ◽  
Pieter F. Vos ◽  
Marien W.J.A. Fieren
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
University Hospital ◽  
Differential Count ◽  
Antibiotic Resistant ◽  
Dialysis Unit ◽  
Leukocyte Counts ◽  
Chemical Peritonitis ◽  
Culture Negative ◽  
Hospital Center

← Background In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. ← Design Case studies in 12 patients. ← Setting Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). ← Patients 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. ← Results At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100 – 1500 cells/mm3). Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. ← Conclusion Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.

Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

2002 ◽  
Vol 22 (3) ◽  
pp. 357-364 ◽  
Author(s):  
Alicja E. Grzegorzewska ◽  
Danuta Antczak-Jȩdrzejczak ◽  
Magdalena Leander
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Control Period ◽  
University Hospital ◽  
Control Group ◽  
Peritoneal Equilibration Test ◽  
Dialysis Unit ◽  
Dialysis Solution ◽  
Glucose Ratio ◽  
Peritoneal Permeability

Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

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

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.

scholarly journals Management of fungal peritonitis : a Moroccan single peritoneal dialysis unit experience

2019 ◽  
Vol 2 (2) ◽  
pp. 65-69
Author(s):  
Moussokoro Hadja Kone ◽  
Tarik Bouattar ◽  
Ibtissam Fares ◽  
Meryem Benbella ◽  
Naima Ouzeddoun ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Death Rate ◽  
Clinical Signs ◽  
Dropping Out ◽  
Average Delay ◽  
Dialysis Unit ◽  
Fungal Peritonitis ◽  
Individual Care ◽  
Serious Infection ◽  
Encapsulating Peritonitis

Introduction: Fungal peritonitis (PF) in peritoneal dialysis (PD) is a serious infection that involves the functional prognosis of the peritoneum and the patient's vital prognosis. It must benefit from a fast handling but nevertheless not very codified. Each center therefore ensures an individual care of its patients. Materiel and method: The purpose of our study is to describe our 10-year experience through our patients who presented FP. We performed a descriptive retrospective study of FP cases documented in the PD unit. Results: the prevalence of FP was 5,1%, which represent 9 cases. Predominant clinical signs were dialysat turbidity and abdominal pain. FP was primitive for 3 patients. The antifungal therapy used was Fluconazole, which was combined with an increased number of peritoneal exchanges. DP catheter ablation was done for 8 patients with an average delay of 5.5 days. The overall outcome was favorable and 3 patients continued PD. No death or encapsulating peritonitis was a consequence of FP. Discussion and conclusion: FP is an infectious complication in PD. Its’ death rate is elevated; dropping-out of PD rate too is elevated. The favorable evolution of our patients that stayed in PD let us think that it may be possible to maintain more patients in PD after FP.

Peritoneal dialysis-associated peritonitis caused by Enterococcus avium

2021 ◽  
Vol 14 (3) ◽  
pp. e240272
Author(s):  
Rita Calça ◽  
Francisca Gomes da Silva ◽  
Ana Rita Martins ◽  
Patrícia Quadros Branco
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Rare Case ◽  
Clinical Course ◽  
Catheter Removal ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Laboratory Findings ◽  
Microbial Agents

Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.

Feasibility of Reinstitution of CAPD after Partial Hepatectomy in Patients with Malignant Hepatic Tumors

2003 ◽  
Vol 23 (5) ◽  
pp. 504-506 ◽  
Author(s):  
Sing Leung Lui ◽  
Pok Siu Yip ◽  
Man Fei Lam ◽  
Wai Kei Lo
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Analysis ◽  
Partial Hepatectomy ◽  
Serum Biochemistry ◽  
The Other ◽  
University Teaching ◽  
Hepatic Tumors ◽  
Peritoneal Equilibration Test ◽  
Dialysis Unit ◽  
Before And After

Objective To determine the feasibility of reinstitution of continuous ambulatory peritoneal dialysis (CAPD) in patients with malignant hepatic tumors after partial hepatectomy. Design Retrospective analysis of 2 CAPD patients. Setting Dialysis unit of a university teaching hospital. Patients Two CAPD patients with malignant hepatic tumors who had undergone partial hepatectomy. Main Outcome Measures Serum biochemistry, Kt/V, peritoneal equilibration test (PET) results before and after hepatectomy. Results One patient was able to resume CAPD 4 weeks after partial hepatectomy. The other patient was successfully resumed on CAPD after resting the peritoneum for 3 months following partial hepatectomy. The serum biochemistry, Kt/V, and PET results of the 2 patients did not change significantly before and after partial hepatectomy. Conclusions Reinstitution of CAPD after partial hepatectomy in patients with malignant hepatic tumors is feasible.

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