scholarly journals Success of small-dose fractionated sodium thiosulfate in the treatment of calciphylaxis in a peritoneal dialysis patient

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Yuan Lu ◽  
Lei Shen ◽  
Ling Zhou ◽  
Deyu Xu
Keyword(s):  
Peritoneal Dialysis ◽  
Small Dose ◽  
Sodium Thiosulfate ◽  
Peritoneal Dialysis Patient ◽  
Comprehensive Treatment ◽  
Dialysis Patients ◽  
Intervention Treatment ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a rare, fatal disorder of microvascular calcification and thrombosis that typically affects patients with end-stage renal disease (ESRD) receiving long-term dialysis. Fewer reports describe calciphylaxis in peritoneal dialysis patients than hemodialysis patients as per a literature review. To date, there are no clear guidelines for CUA diagnosis and treatment. While sodium thiosulfate (STS) has been increasingly used for treatment in recent years, there have also been reports of severe side effects. There is no uniform standard for its usage and dosage, especially for peritoneal dialysis patients. Case presentation We present a case of a 40-year-old Chinese male patient with ESRD on peritoneal dialysis who developed calciphylaxis with severe painful cutaneous ulcers on the fingers and toes that were managed successfully for 6 months with comprehensive treatment composed mainly of small-dose fractionated sodium thiosulfate. Conclusions Our experience suggests that the treatment of calciphylaxis requires timely and multi-angle intervention. Treatment with small-dose fractionated sodium thiosulfate has proven effective and tolerated in this patient.

The Use of Community Nurses for Home Peritoneal Dialysis: Is it Cost -Effective?

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 479-482 ◽  
Author(s):  
Gillian Brunier ◽  
Barbara Gray ◽  
Nancy Coulis ◽  
Judy Savage ◽  
Arif Manuel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Members ◽  
Cost Effective ◽  
Peritoneal Dialysis Patient ◽  
Severe Disabilities ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Complex Needs ◽  
Stage Renal Disease ◽  
End Stage

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population}. Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working. Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

scholarly journals A Treatable Encephalopathy in a Peritoneal Dialysis Patient - Cefepime- Induced Encephalopathy

2019 ◽  
Vol 10 (02) ◽  
pp. 324-326 ◽  
Author(s):  
Ching Soong Khoo ◽  
Tze Yuan Tee ◽  
Hui Jan Tan ◽  
Raymond Azman Ali
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Hospital Stay ◽  
End Stage Renal Disease ◽  
Dialysis Patient ◽  
Length Of Hospital Stay ◽  
Peritoneal Dialysis Patient ◽  
Stage Renal Disease ◽  
End Stage ◽  
Reversible Encephalopathy

ABSTRACTWe report a patient with end-stage renal disease on peritoneal dialysis, who developed encephalopathy after receiving a few doses of cefepime. He recovered clinically and electroencephalographically after having discontinued the culprit agent and undergone hemodialysis. This case highlights the importance of promptly recognizing this reversible encephalopathy, which can lead to the avoidance of unnecessary workup, reduce the length of hospital stay, and thereby improve the patients’ outcome.

scholarly journals Removing the problem: parathyroidectomy for calciphylaxis

2018 ◽  
Vol 11 (1) ◽  
pp. e226696 ◽  
Author(s):  
Mohamed Hassanein ◽  
Heather Laird-Fick ◽  
Richa Tikaria ◽  
Saleh Aldasouqi
Keyword(s):  
Treatment Options ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Phosphate Binders ◽  
Treatment Resistant ◽  
Hungry Bone Syndrome ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hungry Bone

Calcific uremic arteriolopathy (CUA), widely known as calciphylaxis, is a rare and lethal disease that usually affects patients with end-stage renal disease. It is characterised by widespread vascular calcification leading to tissue ischaemia and necrosis and formation of characteristic skin lesions with black eschar. Treatment options include sodium thiosulfate, cinacalcet, phosphate binders and in resistant cases, parathyroidectomy. We report a case of recurrent, treatment-resistant CUA successfully treated with parathyroidectomy. Her postoperative course was complicated by hungry bone syndrome and worsening of her wounds before they completely healed. We then discuss the morbidity of CUA, including the controversy around the use of parathyroidectomy and risk of aggressive management of hungry bone syndrome.

scholarly journals Atypical Presentation of Novel Coronavirus Disease 2019 in a Peritoneal Dialysis Patient

2020 ◽  
Vol 8 ◽  
pp. 232470962093123 ◽  
Author(s):  
Subhasish Bose ◽  
Sreedhar Adapa ◽  
Venu Madhav Konala ◽  
Hemapriya Gopalreddy ◽  
Salim Sohail ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Health Care Systems ◽  
Public Awareness ◽  
Peritoneal Dialysis Patient ◽  
Atypical Presentation ◽  
Novel Coronavirus ◽  
Stage Renal Disease ◽  
End Stage

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a rapidly spreading disease causing increased morbidity and mortality across the globe. There is limited available knowledge regarding the natural history of the SARS-CoV-2 infection. Other factors that are also making this infection spread like a pandemic include global travelers, lack of proven treatment, asymptomatic carriers, potential reinfection, underprepared global health care systems, and lack of public awareness and efforts to prevent further spread. It is understood that certain preexisting medical conditions increase the risk of mortality with COVID-19; however, the outcome of this disease in traditionally vulnerable chronic illnesses such as end-stage renal disease is not well documented. We present a case of a 56-year-old African American lady with end-stage renal disease on the peritoneal dialysis who presented predominantly with nausea, vomiting, and subsequently found to have COVID-19. We use this case to illustrate an atypical presentation of the COVID-19 in a vulnerable patient and discuss the literature.

scholarly journals Biological basis of hypoalbuminemia in ESRD.

1998 ◽  
Vol 9 (12) ◽  
pp. 2368-2376 ◽  
Author(s):  
G A Kaysen
Keyword(s):  
Peritoneal Dialysis ◽  
Acute Phase ◽  
Synthesis Rate ◽  
Albumin Concentration ◽  
Albumin Synthesis ◽  
Dialysis Patients ◽  
Extravascular Space ◽  
Amyloid A ◽  
Stage Renal Disease ◽  
End Stage

Hypoalbuminemia is associated with mortality in patients with end-stage renal disease (ESRD) maintained either on peritoneal dialysis (PD) or hemodialysis (HD). Serum albumin concentration is determined by its rate of synthesis, by the catabolic rate constant (the fraction of the vascular pool catabolized per unit time), by external losses, and by redistribution from the vascular to the extravascular space. Hypoalbuminemia in dialysis patients is primarily a consequence of reduced albumin synthesis rate in both HD and PD patients, and in the case of PD patents, of transperitoneal albumin losses as well. Continuous ambulatory peritoneal dialysis patients are able to increase albumin synthesis to replace losses. Thus, ESRD does not directly suppress albumin synthesis. The rate of albumin synthesis is inversely proportional to the serum concentration of one potential acute phase protein (alpha2 macroglobulin), and albumin concentration is inversely proportional to that of either C-reactive protein or serum amyloid A in both HD and PD patients. The cause of decreased albumin synthesis is primarily a response to inflammation (the acute phase response), although it is possible that inadequate nutrition may also contribute. The cause of the inflammatory response is not immediately evident. There is no evidence that shifts of albumin to the extravascular space or that dilution of the plasma by volume expansion plays any role in causing hypoalbuminemia in ESRD patients.

scholarly journals Counteracting the Metabolic Effects of Glucose Load in Peritoneal Dialysis Patients; an Exercise-Based Approach

2019 ◽  
Vol 48 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Sana F. Khan ◽  
Claudio Ronco ◽  
Mitchell H. Rosner
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Glucose Absorption ◽  
Metabolic Effects ◽  
Glucose Load ◽  
Dialysis Patients ◽  
Metabolic Complications ◽  
Positive Effects ◽  
Stage Renal Disease ◽  
End Stage

Glucose-based peritoneal dialysis (PD) solutions are the predominantly used dialysate in PD patients. Glucose absorption has been shown to be associated with several unfavorable metabolic complications. Several studies have shown positive effects of exercise in end-stage renal disease patients. This paper provides an overview of glucose-associated metabolic complications, and proposed exercise regimens to counteract the caloric load associated with glucose absorption.

scholarly journals P1229PREVALENCE OF LIPID DISORDERS IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Safa Fattoum ◽  
Barbouch Samia ◽  
Hajji Mariem ◽  
Tasnim Mesbahi ◽  
Braiek Nessrine ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ldl Cholesterol ◽  
Average Duration ◽  
Hdl Cholesterol ◽  
Dialysis Patients ◽  
Lipid Disorders ◽  
Renal Replacement Therapies ◽  
Average Serum ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Lipid disorders are common in end stage renal disease patients. Renal replacement therapies and especially peritoneal dialysis (PD) results in further alteration rather than correction of lipidemia. The aim of this study is to precise the prevalence of the different lipid disorders of PD patients. Method It’s a retrospective study conducted in our PD unit in December 2019. We collected all data concerning clinical characteristics of all patients currently in PD, as well as incidence of different lipid disorders. Results There were 90 patients with an average age of 45 years (extremes: 20.5 years and 80.6 years). The sex ratio is 1.25. Fourteen were diabetic (15.5%). All patients were on Automated PD (APD) except one on Continuous Ambulatory PD (CAPD). The average duration of PD was 40.5 months. The causal nephropathy was glomerular in 26,6 % (diabetic in 14 patients (15,5%)), hypertensive 13,3%,, interstitial in 16,66%., and undetermined in 27,7%. The average Charlson score was 3,2. The average serum level of total cholesterol (TC) was 4,96 mmol/L, of triglycerides (TG) was 1,7mmol/L, of HDL-cholesterol(HDLc) was 0,93 mmol/L, and of LDL-cholesterol(LDLc) was 3,05 mmol/L. Fifty one patients had dyslipidaemia: 13 had isolated hypercholesterolemia, 19 had isolated hypertriglyceridemia, and 19 had hypercholesterolemia and hypertriglyceridemia. All dyslipidemic patients were on hypolipemic diet. Twelve (13,3%) were taking statin, no one was taking fibrate. Conclusion Chronic dialysis patients have several cardiovascular risk factors due to renal failure and comorbidities often associated. Dyslipidemia is a modifiable risk factor. It must be screened and treated to reduce morbidity and mortality.

Peripheral Vascular Disease in Diabetic Peritoneal Dialysis Patients

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 210-214 ◽  
Author(s):  
Heikki H.T. Saha ◽  
Yrjö K.J. Leskinen ◽  
Juha P. Salenius ◽  
Jorma T. Lahtela
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Current Knowledge ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Review Current

In the present article, we review current knowledge of the epidemiology, diagnosis, and treatment of peripheral vascular disease in patients with end-stage renal disease. The main focus is placed on diabetic patients receiving peritoneal dialysis, but studies on patients receiving hemodialysis are also reviewed, because most reports involve this patient group, and the number of reports on peripheral vascular disease in PD patients alone is limited.

scholarly journals Calciphylaxis in a Patient on Home Hemodialysis

2020 ◽  
Vol 8 ◽  
pp. 232470962092271 ◽  
Author(s):  
Sreedhar Adapa ◽  
Srikanth Naramala ◽  
Vijay Gayam ◽  
Narayana Murty Koduri ◽  
Subba Rao Daggubati ◽  
...  
Keyword(s):  
Wound Care ◽  
Sodium Thiosulfate ◽  
Skin Lesions ◽  
Current Treatment ◽  
Home Hemodialysis ◽  
Calcium Phosphorus ◽  
Calcific Uremic Arteriolopathy ◽  
Stage Renal Disease ◽  
End Stage ◽  
Subcutaneous Adipose

Calciphylaxis is a rare and severe complication characterized by calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue that leads to ischemia, necrosis, and painful skin lesions in patients with end-stage renal disease (ESRD). It is also known as calcific uremic arteriolopathy. Calciphylaxis occurs most commonly with the ESRD with skin ulceration as a predominant presenting feature. Calcium-phosphorus dysregulation in dialysis patients are traditionally considered as a risk factor for the development of calciphylaxis. The involvement of an integrated interdisciplinary and multifaceted approach is key to the success of the calciphylaxis treatment. We present a case of a 51-year-old female with ESRD on home hemodialysis who developed calciphylaxis, which was successfully managed with increasing dialysis prescription, diligent wound care, and sodium thiosulfate infusion. Management of calciphylaxis in a patient receiving home hemodialysis has never been reported as per the review of the literature. Calciphylaxis is a sporadic disease, frequently encountered in the patients undergoing hemodialysis and carries a very grave prognosis. Current treatment is rarely effective, so preventive strategies play an important role by modifying the risk factors that promote the development of calciphylaxis.

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