scholarly journals Chronic Peritoneal Dialysis in Children with Special Needs or Social Disadvantage or Both: Contraindications are not Always Contraindications

2012 ◽  
Vol 32 (4) ◽  
pp. 424-430 ◽  
Author(s):  
Nejat Aksu ◽  
Onder Yavascan ◽  
Murat Anil ◽  
Orhan Deniz Kara ◽  
Alkan Bal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Special Needs ◽  
Vesicoureteral Reflux ◽  
Psychosocial Problems ◽  
Infectious Complications ◽  
Social Disadvantage ◽  
Children With Special Needs ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Unit ◽  
Children With Disability

ObjectiveOur aim in the present study was to identify outcomes in children with special needs or social disadvantage, or both, receiving chronic peritoneal dialysis (CPD) treatment in a pediatric dialysis unit.MethodsAmong 110 children started on CPD in our unit during the period between November 1995 and November 2008, we identified 13 patients (8 girls, 5 boys) with major physical, mental, or psychosocial problems. Age at CPD initiation in the group with disability ranged from 4.0 years to 16.5 years (median: 7.5 years). Under lying diseases were vesicoureteral reflux (4 patients), neuropathic bladder and vesicoureteral reflux (3 patients), chronic pyelonephritis (3 patients), amyloidosis (2 patients), and Alport syndrome (1 patient). Challenges encountered were adverse family or social circumstances (4 patients), cerebral palsy (3 patients), Down syndrome (1 patient), rectovesical fistula in conjunction with ectopic anus and previous multiple abdominal surgery (1 patient), blindness and deafness (1 patient), ventriculoperitoneal shunt (1 patient), colostomy and malnutrition (1 patient), and mental retardation and blindness (1 patient). All catheters were implanted percutaneously.ResultsMedian duration of dialysis was 18 months (range: 6 – 124 months). The frequency of peritonitis was not different between children with and without disability ( p > 0.05). In children with disability compared with children without disability, the frequencies of catheter- related infections (1 episode/79.3 patient–months vs 1 episode/32.4 patient–months) and of catheter-related non-infectious complications (1 episode/238 patient–months vs 1 episode/115.7 patient–months) were lower ( p < 0.05). Chronic peritoneal dialysis was terminated in 5 children (for renal transplantation in 3, switch to hemodialysis in 1, death in 1).ConclusionsOur results suggest that, with appropriate family support and an experienced multidisciplinary team, CPD can be effectively performed in children with special needs or social disadvantage, or both.

IS THE GENDER OF A TEACHER A DETERMINANT OF ATTITUDE TOWARDS INCLUSION? : A CASE STUDY IN SELECTED SCHOOLS OF BHOPAL

2021 ◽  
Vol 10 (1) ◽  
pp. 50-56
Author(s):  
Yachana Saxena ◽  
Keyword(s):  
Special Needs ◽  
Inclusive Education ◽  
Children With Special Needs ◽  
Children With Disability ◽  
Significant Difference ◽  
Teachers Attitudes ◽  
Relationship Of ◽  
The Relationship ◽  
Attitudinal Measurement

Inclusive-education (IE) remains to be an unexplored but essential area in education with a lot of unanswered questions, especially pertaining to the views of teachers’ attitude towards Children with Special Needs (CWSN). This study examined the relationship of gender, a relevant teachers’ personal variable with teachers’ attitudes towards CWSN. This quantitative study was designed to investigate teachers’ attitudes towards Children with Special Needs with an exclusive comparison between female and male Educators. Data was collected from 260 teachers of Bhopal using a self-developed survey instrument entitled Multidimensional Attitudinal Measurement of Teachers towards Children with Disability Scale (MAMTCD-Scale). The findings revealed a non-significant difference in attitude between male and female educators.

Emergence of Mupirocin-Resistant Staphylococcus Aureus in Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection

2001 ◽  
Vol 21 (6) ◽  
pp. 554-559 ◽  
Author(s):  
Rajeev Annigeri ◽  
John Conly ◽  
Stephen I. Vas ◽  
Helen Dedier ◽  
Kannam P. Prakashan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Peritoneal Dialysis ◽  
Chronic Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Total Study Population ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Mannitol Salt Agar ◽  
High Level

Objective To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit. Methods Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more. Results Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study. Conclusion We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.

The Organization and Implementation of a Peritoneal Dialysis Program

1980 ◽  
Vol 1 (7) ◽  
pp. 134-136 ◽  
Author(s):  
Sheila Clayton
Keyword(s):  
Peritoneal Dialysis ◽  
Home Visits ◽  
Hospitalized Patients ◽  
Chronic Peritoneal Dialysis ◽  
Close Collaboration ◽  
Careful Planning ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Auxiliary Personnel ◽  
At Home

The organization of a chronic peritoneal dialysis program requires careful planning and close collaboration between nurses and doctors. In-center peritoneal dialysis should be used primarily for back-up dialysis of home PD patients with complications, and for those who cannot be dialyzed at home. If a unit has a large number of patients at home, it needs a larger number of in-center nurses to care for the increased numbers of hospitalized patients. The home peritoneal dialysis unit should be located near the center unit. The home nurses should be responsible for training, home visits, for clinics and for monthly tubing changes. The unit also needs a number of auxiliary personnel to complement the work of the training nurses.

scholarly journals Urgent-Start Peritoneal Dialysis: The First Year of Brazilian Experience

2017 ◽  
Vol 44 (4) ◽  
pp. 283-287 ◽  
Author(s):  
Dayana Bitencourt Dias ◽  
Marcela Lara Mendes ◽  
Vanessa Burgugi Banin ◽  
Pasqual Barretti ◽  
Daniela Ponce
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rates ◽  
High Volume ◽  
Infectious Complications ◽  
Chronic Patients ◽  
Safe Alternative ◽  
Dialysis Unit ◽  
Technique Survival ◽  
Stage Renal Disease ◽  
End Stage

Background: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. Methods: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (<72 h) PD catheter placement. After hospital discharge, patients were treated with intermittent PD on alternate days in a dialysis unit until family training was provided. Results: Fifty-one patients fulfilling the following criteria were included: age was 62.1 ± 15 years, with diabetes as the main etiology of end-stage renal disease (39%), and uremia as the main dialysis indication (76%). Metabolic and fluid controls were achieved after 3 sessions of HVPD, and patients remained in intermittent PD for 23.2 ± 7.2 days. Mechanical complications occurred in 25.7% and peritonitis rate was 0.5 episode/patient-year. In the first 6 months, technique and patients survival rates were 86 and 82.4% respectively. Conclusion: The PD modality was a feasible and safe alternative to hemodialysis in the urgent-start dialysis.

Complications Linked to Chronic Peritoneal Dialysis in Children after Kidney Transplantation: Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 570-573 ◽  
Author(s):  
Barbara Andreetta ◽  
Enrico Verrina ◽  
Palma Sorino ◽  
Alberto Edefonti ◽  
Francesco Perfumo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Transplantation ◽  
Infectious Complications ◽  
Chronic Peritoneal Dialysis ◽  
Exit Site ◽  
Post Transplantation ◽  
Liver And Kidney ◽  
The Mean ◽  
Living Related

Our objective was to evaluate the infectious complications of the post-transplant period attributable to the persistence of catheter and other complications when chronic peritoneal dialysis (CPD) was performed posttransplantation. The design was a retrospective study, and the setting was an Italian registry of pediatric chronic peritoneal dialysis. There were 86 pediatric renal transplants (9/86 from living related donors, 2/86 simultaneous liver and kidney transplantation for oxalosis). Six of 86 transplants were lost at follow-up. Mean age of the children (n = 80) at transplantation was 9.3 years (range:1.7–21 years). They had been on CPD for a mean period of 1.7 years (range: 0.2 -4.6 years). During CPD, 67 peritonitis episodes (80% related to exit-site and/or tunnel infections) were observed, with an incidence of peritonitis of one episode per 16 months CPD. The mean safe interval of peritonitis and/ or exit-site or tunnel infection was 208 days (range: 36 1897 days). The mean time of catheter removal was 80.3 days (range: 0 216 days) post-transplantation. During the first month post-transplantation, one episode of peritonitis secondary to a sepsis occurred in one child. No other episodes of peritonitis or exit-site and/or tunnel infections were observed. Two of 80 children returned to CPD (at four and at 12 months, respectively) because of persistent allograft failure. Furthermore, 12 patients were on CPD because of temporary graft failure. In all these patients the pretransplant peritoneal dialysis (PD) catheter was utilized, with no complications. These data show that the persistence of the PD catheter after kidney transplantation has produced no infections or other complications. What is more, the catheter was safely utilized during acute rejection or primary allograft nonfunction.

Adiponectin Levels and Atherosclerotic Risk Factors in Pediatric Chronic Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (4) ◽  
pp. 357-361 ◽  
Author(s):  
Sevcan A. Bakkaloglu ◽  
Necla Buyan ◽  
Tohru Funahashi ◽  
Hatice Pasaoglu ◽  
Atilla H. Elhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Apolipoprotein B ◽  
University Hospital ◽  
Chronic Peritoneal Dialysis ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Lipoprotein A ◽  
Control Subjects ◽  
Significant Difference

Background Atherosclerotic vascular diseases are the major cause of mortality in patients with end-stage renal disease (ESRD) treated with chronic peritoneal dialysis (CPD), even in children. Adiponectin (ADPN) is a recently discovered adipocyte-derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. Objective To clarify the atherosclerotic risk and especially the significance of ADPN levels in pediatric patients on CPD. Design Cross-sectional study in the pediatric peritoneal dialysis unit of a university hospital. Patients 18 children, aged 12.6 ± 5.6 years, being treated with CPD and 20 healthy age- and sex-matched control subjects were enrolled in this study. Methods Serum ADPN levels and other risk factors, including blood pressure, blood glucose, serum lipid/lipoprotein fractions, apolipoprotein B, C-reactive protein (CRP), lipoprotein(a), and homocysteine levels, were studied in CPD patients and compared to the controls. Results Serum ADPN levels were three times higher in the CPD group compared to the control subjects, as was previously reported. Apolipoprotein B and CRP levels were also high in the CPD group. No significant difference was found in other atherosclerotic parameters, including lipoprotein(a) and homocysteine levels. Interestingly, we found a negative correlation between log ADPN and creatinine levels among the CPD patients ( r = –0.54, p < 0.05). There was no correlation between log ADPN and duration of CPD. Creatinine and low-density lipoprotein levels could account for 54% of the total variation in ADPN levels. Conclusion Among pediatric CPD patients, serum levels of the anti-atherogenic protein, ADPN, were inversely associated with creatinine. ADPN level might be a novel marker to predict prognosis in pediatric CPD patients.

Chronic Tunnel Infections in Children: Removal and Replacement of the Continuous Ambulatory Peritoneal Dialysis Catheter in a Single Operation

1993 ◽  
Vol 13 (3) ◽  
pp. 198-200 ◽  
Author(s):  
Cornelis H. Schröder ◽  
René S.V.M. Severijnen ◽  
Maria C.J.W. De Jong ◽  
Leo A.H. Monnens
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Contralateral Side ◽  
Infectious Complications ◽  
Peritoneal Dialysis Catheter ◽  
Toronto Western Hospital ◽  
Dialysis Unit ◽  
Single Operation ◽  
Causative Microorganism ◽  
Catheter Design

Objective Chronic tunnel infections often necessitate the removal of the continuous ambulatory peritoneal dialysis (CAPD) catheter. Most published studies advocate postponing the insertion of a new catheter for several weeks. For young children it will be particularly difficult to wait this length of time, since vascular access may be cumbersome, and hemodialysis may not be well tolerated. The present study describes the results of the simultaneous removal and replacement of the CAPD catheter. .Design: Twenty-three Toronto Western Hospital II catheters were inserted in 17 children because of infectious complications (21 chronic tunnel infections; 2 recurrent peritonitis) in a single operation under appropriate antibiotic prophylaxis. The new catheter was inserted at the contralateral side of the abdomen with the deep cuff in the midline, using the same entrance to the peritoneal cavity. Dialysis was resumed immediately after the operation. Setting A university pediatric dialysis unit. Patients Seventeen children (mean age 3.7 years; range 1.0–8.5 years) were studied. In this group 23 catheters were replaced. Results In four cases a relapse of the tunnel infection was observed within 3 months. All other cases remained free of infection for a period of at least 6 months. The main causative microorganism was Staphylococcus aureus (15 occurrences). Conclusion It is not necessary to interrupt peritoneal dialysis for the replacement of a CAPD catheter because of infectious complications.

Peritoneal Transport Kinetics of Proteins in Children on Chronic Peritoneal Dialysis

2003 ◽  
Vol 23 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Klaus Arbeiter ◽  
Regina Stemberger ◽  
Laurence Greenbaum ◽  
Thomas Mueller ◽  
Andrea Konstantin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Close Correlation ◽  
Cross Sectional Study ◽  
Transport Kinetics ◽  
Chronic Peritoneal Dialysis ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Pediatric Dialysis ◽  
Molecular Weights ◽  
Peritoneal Transport

Objective This study describes a modified 4-hour peritoneal equilibration test (PET) for analyzing peritoneal transport characteristics of proteins with different molecular weights and predicting daily peritoneal protein losses in children on chronic peritoneal dialysis (PD). Design Cross-sectional study. Setting A single regional pediatric dialysis unit in a teaching hospital. Patients 9 stable pediatric dialysis patients; 4 were on continuous ambulatory PD, 5 were on continuous cycling PD. Main Outcome Measures Serum and dialysate concentrations of IgG, albumin, β2-microglobulin, and transferrin were determined during a PET. Changes in dialysate-to-plasma (D/P) ratios were determined hourly. Agreement between PET-derived and measured daily peritoneal protein losses was examined. Results The D/P ratio decreased with increased molecular radius ( p < 0.0001). Many children had low plasma levels of IgG, albumin, and transferrin, but elevated levels of β2-microglobulin. The D/P ratio increased linearly during the PET for all measured proteins, regardless of molecular weight. There was close correlation between 4-hour PET protein losses and 24-hour losses during routine PD. Conclusions Proteins are lost through the peritoneum according to their size, demonstrating linear transport kinetics during a 4-hour PET. The PET-derived data predicted daily protein losses in children on chronic PD. This approach might help to eliminate inaccuracies due to incomplete dialysate collection.

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