Effect of Duration of Chronic Peritoneal Dialysis Therapy on the Development of Peritonitis

1999 ◽  
Vol 19 (4) ◽  
pp. 376-379 ◽  
Author(s):  
Laura Troidle ◽  
Nancy Gorban–Brennan ◽  
Alan S. Kliger ◽  
Fredric O. Finkelstein
Keyword(s):  
Peritoneal Dialysis ◽  
Morphological Changes ◽  
Chronic Peritoneal Dialysis ◽  
Gram Positive ◽  
Gram Negative ◽  
Group 3 ◽  
Time Periods ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Objective Long-term chronic peritoneal dialysis (CPD) therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function. We thus reviewed our experience with the development of peritonitis among patients maintained on CPD therapy for various time periods to determine if the spectrum of organisms, rates of peritonitis, and outcome changed with the duration of CPD therapy. Setting and Patients Patients maintained on CPD therapy in our out-patient unit in New Haven, Connecticut. Design Retrospective review of the charts of patients maintained on CPD therapy (HomeChoice Cycler or Ultrabag, Baxter, McGaw Park, IL, U.S.A.) between 1 January 1997 and 31 March 1998. These patients were divided into three groups: group 1, patients maintained on CPD therapy < 12 months; group 2, patients maintained on CPD therapy for 13 - 36 months; and group 3, patients maintained on CPD therapy for ≥ 37 months. Results The study included 256 patients: 101 patients in group 1, 110 patients in group 2, and 45 patients in group 3. All groups of patients were similar in age. There were significantly fewer Caucasians and fewer males in group 3 in comparison to groups 1 and 2. The incidence of diabetes mellitus, coronary artery disease, and peripheral vascular disease was significantly lower among patients in group 3 in comparison to groups 1 and 2. There were 155 episodes of peritonitis during the study period for an overall rate of 1 episode in 18.7 patient-months. The overall, gram-positive, and gram-negative rates of peritonitis were not significantly different among the patients in groups 1, 2, and 3. There were more episodes of Staphylococcus aureus peritonitis among patients in group 3 in comparison to group 2 (1 episode in 59.6 vs 1 episode in 280.2 patient-months, respectively). Two weeks after the development of peritonitis, 94.6% of the patients in group 3 continued CPD therapy, while 79.4% of the patients in group 1 continued CPD therapy ( p < 0.05). No patient in group 3 transferred to hemodialysis, while 10.3% and 8.2% of the patients in groups 1 and 2 transferred to hemodialysis ( p < 0.05). The death rate 2 weeks after the onset of peritonitis was 10.3%, 9.8%, and 5.4% in groups 1, 2, and 3, respectively ( p = NS). Conclusions Despite the immunological and morphological changes that occur in the peritoneal cavity with increased time on CPD therapy, there was no difference in the overall, gram-positive, or gram-negative rates of peritonitis for patients maintained on CPD therapy for various time periods. Patients in group 3 continued CPD therapy more often than did patients in group 1. Patients in group 3 transferred to hemodialysis less often than did the remaining patients in the study period. The incidence of death was not significantly different for the three groups of patients.

Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity

Angiology ◽  
2021 ◽  
pp. 000331972199141
Author(s):  
Arafat Yildirim ◽  
Mehmet Kucukosmanoglu ◽  
Fethi Yavuz ◽  
Nermin Yildiz Koyunsever ◽  
Yusuf Cekici ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Vascular Disease ◽  
Operating Characteristics ◽  
Coronary Artery Disease Severity ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA2DS2-VASc ( r = 0.428), and CHA2DS2-VASc-HS ( r = 0.500) scores ( Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

Is Subjective Global Assessment a Good Index of Nutrition in Peritoneal Dialysis Patients with Gastrointestinal Symptoms?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 78-82 ◽  
Author(s):  
Yanjun Li ◽  
Jie Dong ◽  
Li Zuo
Keyword(s):  
Peritoneal Dialysis ◽  
Lean Body Mass ◽  
Body Mass ◽  
Global Assessment ◽  
Handgrip Strength ◽  
Subjective Global Assessment ◽  
Gi Symptoms ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective We investigated whether patients with gastrointestinal (GI) symptoms were prone to be diagnosed as malnourished by subjective global assessment (SGA) by simultaneously evaluating SGA and other indices of nutrition in a cross-sectional survey of peritoneal dialysis (PD) patients. Patients and Method From June 2006 to June 2007, 214 PD patients were involved in the study. We recorded results of a GI symptoms questionnaire (GSQ) and SGA. Other indices of nutrition included dietary intake, chemistry examination, anthropometry, handgrip strength, and lean body mass measured by creatinine kinetics. Results Mean age of the 214 PD patients enrolled in the study was 60.22 ± 14.02 years, and mean dialysis duration was 60.22 ± 14.02 months. Of the 214 patients, 56 (27.16%) were diagnosed as malnourished by SGA. The mean GSQ scores were 9.37 ± 1.71 (range: 8 – 17). There were 90 patients with GSQ scores of 8 (group 1), 80 patients with scores of 9 or 10 (group 2), 44 patients with scores of 11 or more (group 3). The prevalence of malnutrition diagnosed by SGA was significantly different in the three groups: 15.56% in group 1, 27.5% in group 2, and 45.45% in group 3 ( p = 0.02). However, we observed no difference between the three groups in mid-arm circumference, skinfold thickness (biceps, triceps, subscapular, and suprailiac), daily protein and energy intake, handgrip strength, lean body mass, and serum albumin and prealbumin levels ( p > 0.05). Conclusions Our results showed that the reliability of SGA in PD patients with GI symptoms remains worth exploring. These patients are possibly diagnosed as malnourished by SGA, although many other indices of nutrition are not necessarily bad.

scholarly journals Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C K L Leung ◽  
L Y Lam ◽  
K Y Li ◽  
A S Y Yu ◽  
M Z Wu ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Fractional Flow Reserve ◽  
Coronary Vessels ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Adherence Group ◽  
Group 1

Abstract Background Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain. Methods A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization. Results The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P&lt;0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026). Conclusion In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Possibilities of cardioselective beta - blocker bisoprolol therapy in patients having coronary artery disease and bronchial asthma

2019 ◽  
Vol 91 (9) ◽  
pp. 26-31
Author(s):  
N Y Grigorieva ◽  
T P Ilyushina ◽  
E M Yashina
Keyword(s):  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Calcium Antagonist ◽  
Beta Blocker ◽  
Ventricular Extrasystoles ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Aim: to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). Materials and methods. The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. Results. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. Conclusion. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

scholarly journals Relationship of Body Fat and Left ventricular hypertrophy with the Risk of All-cause Death in Patients with Coronary Artery Disease

2021 ◽  
Author(s):  
Baotao Huang ◽  
Lu Yang ◽  
Bosen Yang ◽  
Fangyang Huang ◽  
Qianfeng Xiao ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Body Fat ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Lower Body ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Abstract Background and aimsLeft ventricular hypertrophy (LVH) is prevalent in obese individuals. Besides, both of LVH and obesity is associated with subclinical LV dysfunction. However, little is known about the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease (CAD).MethodsIn this retrospective cohort study, a total of 2243 patients with angiographically proven CAD were included. Body fat and LV mass were calculated using formulas. Higher body fat was defined as the percentage of body fat was greater than 75th percentile. LVH was defined according to guidelines’ definition. Patients were divided into four groups: group 1, lower body fat and no LVH; group 2, lower body fat and LVH; group 3, higher body fat and no LVH; group 4, higher body fat and LVH. Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.ResultsOver 2.2 years, there were 120 deaths. Patients with higher body fat and no LVH (group 3) had similar risk of death (adjusted HR 1.83, 95%CI 1.00-3.38, P = 0.054) compared to the reference group (group 1), while patients with lower body fat and LVH (group 2) had the highest risk (adjusted HR 2.15, 95%CI 1.26–3.64, P = 0.005) of death. The results were robust after different degree of adjustment.ConclusionCertain amount of BF was not associated with increased risk of all-cause death in patients with CAD, even seems protective in those concomitant with LVH.

scholarly journals Pathomorphology of adaptive changes in the remaining kidney in the early postoperative period after nephrectomy

2020 ◽  
Vol 10 (1) ◽  
pp. 19-24
Author(s):  
Igor Sergeevich Shormanov ◽  
Marina S. Los ◽  
Maxim V. Kosenko ◽  
Natalia S. Shormanova
Keyword(s):  
Postoperative Period ◽  
Morphological Changes ◽  
Renal Tissue ◽  
Early Postoperative Period ◽  
Left Group ◽  
White Rats ◽  
Group 3 ◽  
Group 2 ◽  
Single Kidney ◽  
Group 1

Objective. To study the adaptive capacity of a single remaining kidney in the early postoperative period of nephrectomy in an experiment. Materials and methods. The experiment involved 35 laboratory white rats, which were divided into three experimental groups. Group 1 (n = 5) intact animals, group 2 (n = 15) animals underwent nephrectomy on the left; group 3 (n = 15) animals underwent nephrectomy and additionally were created 90 minute hypoxic hypoxia. Histological material was collected on the 5th, 21st and 60th days after surgery. Results. Characteristic morphological changes in the only remaining kidney were an increase in the size of the glomeruli and a decrease in their number. Nephron fibrosis was detected, accompanied by increased production of antigens by the tubular epithelium, which is likely a response to a cascade increase in oxidative stress and increased release of cytokines that stimulate the production of intrarenal collagen. Conclusion. Nephrectomy and hypoxia are provocateurs for the development of systemic distress syndrome, the result of which is the formation of a vicious pathogenetic circle, which reduces the functionality of the renal tissue. This can be considered as one of the early preclinical mechanisms for the initiation of single kidney disease in the future.

scholarly journals Screening for abdominal aortic aneurysms

2003 ◽  
Vol 58 (2) ◽  
pp. 63-68 ◽  
Author(s):  
Telmo Pedro Bonamigo ◽  
Iara Siqueira
Keyword(s):  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Peripheral Artery ◽  
Abdominal Aortic ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Abdominal Aorta Diameter ◽  
Aorta Diameter ◽  
Group 1

OBJECTIVE AND METHODS: Screening for abdominal aortic aneurysms may be useful to decrease mortality related to rupture. We conducted a study to assess the prevalence of abdominal aortic aneurysms in southern Brazil and to define risk factors associated with high prevalence of this disorder. The screening was conducted using abdominal ultrasound. Three groups were studied: Group 1 - cardiology clinic patients; Group 2 - individuals with severe ischemic disease and previous coronary surgery, or important lesions on cardiac catheterism; Group 3 - individuals without cardiac disease selected from the general population. All individuals were male and older than 54 years of age. The ultrasonographic diagnosis of aneurysm was based on an anteroposterior abdominal aorta diameter of 3 cm, or on an abdominal aorta diameter 0.5 cm greater than that of the supra-renal aorta. RESULTS: A total of 2.281 people were screened for abdominal aortic aneurysms in all groups: Group 1 - 768 individuals, Group 2 - 501 individuals, and Group 3 - 1012 individuals. The prevalence of aneurysms was 4.3%, 6.8% and 1.7%, respectively. Age and cigarette smoking were significantly associated with increased prevalence of aneurysms, as was the diagnosis of peripheral artery disease. DISCUSSION: We concluded that screening may be an important tool to prevent the mortality associated with abdominal aortic aneurysms surgery. Additionally, the cost of screening can be decreased if only individuals presenting significant risk factors, such as coronary and peripheral artery disease, smokers and relatives of aneurysm patients, are examined.

scholarly journals PATHOMORPHOLOGICAL CHANGES IN RENAL PARENCHYMA, AFTER MODELING OF ACUTE PYELONEPHRITIS IN MICE, DEPENDING ON THE ABILITY OF BACTERIA TO FORM BIOFILMS.

2017 ◽  
pp. 39-42
Author(s):  
I. O. Mitiuriaeva-Kornijko ◽  
A. A. Vodianyk ◽  
V. V. Lihodievskyy ◽  
V. A. Ponyatovskiy ◽  
A. V. Gniloskurenko ◽  
...  
Keyword(s):  
Acute Pyelonephritis ◽  
Biofilm Formation ◽  
Morphological Changes ◽  
Control Group ◽  
Infection Model ◽  
Ability Group ◽  
Secondary Alteration ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Urinary tract infection is one of the most common infectious diseases that affects people of any age and sex. The purpose of our study was to determine morphological changes in acute pyelonephritis, depending on the ability of bacteria strains to form biofilms. Materials and methods. The model of acute pyelonephritis was reproduced by ascending urinary infection model of laboratory mice with clinical isolates of E.coli with low biofilm formation ability (group # 1) and high biofilm formation ability (group # 2), the material was taken on day 7 of the experiment, histological sections were analyzed in comparison with control (group # 3). Results. In group # 1, leukocyte infiltration of the medulla of the kidney with the presence of edema of the stroma was observed. In group # 2, hyperinfiltration of all parts of the kidney was observed, together with the presence of extravasates and severe edema of the stroma. Discussion. Changes revealed by histological examination may indicate that biofilm formation leads to an ineffective immuneresponse, which in turn leads to increased secondary alteration. Conclusions. Biofilm formation is an important factor in the pathogenicity of microorganisms, which affects the course of acute pyelonephritis.

Robustness of Percutaneously Completed Coronary Revascularization in Stable Coronary Artery Disease: Obstructive Versus Occlusive Lesions

Angiology ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Igor Kranjec ◽  
Dinko Zavrl Džananovič ◽  
Miha Mrak ◽  
Matjaz Bunc
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Chronic Total Occlusions ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Group 1

Our study sought to assess long-term outcomes of percutaneously completed coronary revascularization (CCR) in patients with obstructive coronary artery disease (CAD) comprising chronic total occlusions (CTOs). Between 2010 and 2014, percutaneous coronary interventions (PCIs) of the CTOs were attempted in 213 patients: the CCR was achieved in 125 patients (group 1), while the PCI failed in 88 patients (group 2). They were matched against 252 patients (group 3) with the CCR obtained by the non-CTO PCIs. In the 5-year follow-up, more adverse cardiovascular (CV) events occurred in group 2 (29.5% vs 4.8% in group 1 vs 3.5% in group 3, P = .0001), mainly due to recurrent severe symptoms and additional revascularization of the CTOs; CV mortality did not seem to be significantly affected. Survival curves for the successful CTO and non-CTO PCIs appeared indistinguishable. Stent thromboses were infrequent in the CCR groups. In conclusion, long-term outcomes of the patients with the obstructive CAD containing the CTOs showed a favorable outcome if the CCR had been achieved percutaneously.

scholarly journals Exit site infection in peritoneal dialysis : predictive factors for adverse outcome

2019 ◽  
Vol 2 (3) ◽  
pp. 127-134
Author(s):  
Filipa Sofia Silva ◽  
Joana Tavares ◽  
Sofia O Correia ◽  
Cristina Freitas ◽  
Olivia Santos ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Outcomes ◽  
Drop Out ◽  
Exit Site Infection ◽  
Group 3 ◽  
Male Sex ◽  
Group 2 ◽  
And Staphylococcus Aureus ◽  
Group 1

Infection-related complications in patients on peritoneal dialysis (PD) is a leading complication. Our aim was to evaluate the type and natural course of ESI events in a cohort of PD treated in last decade of our PD program. Registry data of ESI events (n=126, in 74 patients) were retrieved. ESI protocols followed standard international guidelines. A systematic quality control is performed.                The median follow-up was 29.1 (14.0-47.4) months. In this population the adverse outcomes of TI rate and peritonitis rate was 0.12 and 0.13 patient/year, respectively.                Male sex (0.048), older age (0.007) and Staphylococcus aureus (SA) agent (0.006) were predictive of TI while non-optional PD and lower levels of albumin were predictive of peritonitis.                 After grouping the ESI events according to the date of the occurrence of infection (group 1: 2008 to 2012, group 2: 2013 to 2017 and group 3: 2018) a substantial increase of TI in 2018 was evident (P <0.001 when comparing group 3 vs 1 and 0.005 when comparing group 2 and 3).               When ESI occurs simultaneous with TI, the probability of not reaching cure is 65%. Drop-out occurred in 50% of ESI without peritonitis vs 86% with peritonitis (P <0.001). SA is the microorganism most implicated in the failure to heal (P 0.002) and drop-out (P 0.010). In spite of a number of efforts to reduce ESI, a regular audit still point to the need for protocols review in order to avoid adverse outcomes. Focused training of patients is mandatory but also prophylaxis and antibiotic protocols deserve improvement.

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