(1→3)-β–d-Glucan and Galactomannan for Differentiating Chemical “Black Particles” and Fungal Particles Inside Peritoneal Dialysis Tubing

BackgroundAseptic, sheet-like foreign bodies observed inside Tenckhoff (TK) catheter lumens (referred to as “black particles”) are, on gross morphology, hardly distinguishable from fungal colonization because these contaminants adhere tightly to the catheter. Detection of fungal cell wall components using (1→3)-β–d-glucan (BG) and galactomannan index (GMI) might be an alternative method for differentiating the particles.MethodsForeign particles retrieved from TK catheters in 19 peritoneal dialysis patients were examined microscopically and cultured for fungi and bacteria. Simultaneously, a Fungitell test (Associates of Cape Cod, Falmouth, MA, USA) and a Platelia Aspergillus ELISA assay (Bio-Rad Laboratories, Marnes-La-Coquette, France) were used to test the spent dialysate for BG and GMI respectively.ResultsOf the 19 patients, 9 had aseptic black particles and 10 had fungal particles in their tubing. The fungal particles looked grainy, were tightly bound to the catheter, and appeared more “colorful” than the black particles, which looked sheet-like and could easily be removed by milking the tubing. Compared with effluent from patients having aseptic particles, effluent from patients with fungal particles had significantly higher levels of BG (501 ± 70 pg/mL vs. 46 ± 10 pg/mL) and GMI (10.98 ± 2.17 vs. 0.25 ± 0.05). Most of the fungi that formed colonies inside the catheter lumen were molds not usually found in clinical practice, but likely from water or soil, suggesting environmental contamination. Interestingly, in all 10 patients with fungal colonization, visualization of black particles preceded a peritonitis episode and TK catheter removal by approximately 1–3 weeks; in patients with aseptic particles, a 17-week onset to peritonitis was observed.ConclusionsIn all patients with particle-coated peritoneal dialysis tubing, spent dialysate should be screened for BG and GMI. Manipulation of the TK catheter by squeezing, hard flushing, or even brushing to dislodge black particles should be avoided. Replacement of the TK catheter should be suspended until a cause for the particles is determined.

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Systemic Endotoxin in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00036 ◽

2018 ◽

Vol 38 (5) ◽

pp. 381-384 ◽

Cited By ~ 1

Author(s):

Ali M. Shendi ◽

Nathan Davies ◽

Andrew Davenport

Keyword(s):

Peritoneal Dialysis ◽

Extracellular Volume ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Fungal Cell ◽

Membrane Function ◽

Patient Demographics ◽

Markers Of Inflammation ◽

Systemic Endotoxemia

Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 – 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 – 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β–glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.

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Foreign body ingestion-related peritonitis in an elderly peritoneal dialysis patient

SAGE Open Medical Case Reports ◽

10.1177/2050313x211056414 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110564

Author(s):

Taghavi Maxime ◽

Bellavia Salvatore ◽

Thibaut Véronique³ ◽

De Pelsemaeker Marie-Caroline ◽

Mesquita Maria do Carmo Filomena ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Foreign Body ◽

Dialysis Patient ◽

Foreign Bodies ◽

Peritoneal Dialysis Patient ◽

Medication Administration ◽

Abdominal Sepsis ◽

Dialysis Patients ◽

Accidental Ingestion ◽

Ileal Perforation

Among peritoneal dialysis patients, peritoneal dialysis-related peritonitis is a well-known complication, but it can also be non-peritoneal dialysis-related (e.g. ruptured appendix). Ileal perforation by foreign bodies such as blister pill packs can be seen in the emergency room. Differentiating this from peritoneal dialysis-related peritonitis can be difficult, since they can have both identical presentations. Computed tomography can be of value in detecting abscess, thickening of the digestive wall or adhesions, and exclude other causes of intra-abdominal sepsis. Because of the aging population, ingestion of foreign body can be expected to rise. We therefore recommend that blister pill packs should not be divided into single-dose pieces, and we invite elderly patient’s entourage to check medication administration. Furthermore, manufacturing efforts are highly recommended to improve blister pill pack’s design, to avoid accidental ingestion. We report the case of an elderly peritoneal dialysis patient who presented with peritonitis due to ileal perforation because of blister pill pack ingestion.

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Chromium: Rise and Shine in Peritoneal Dialysis Patients?

Peritoneal Dialysis International ◽

10.3747/pdi.2019.00013 ◽

2019 ◽

Vol 39 (4) ◽

pp. 320-322

Author(s):

Guido Filler ◽

Christopher McIntyre

Keyword(s):

Trace Elements ◽

Peritoneal Dialysis ◽

Selenium Deficiency ◽

Cross Sectional Study ◽

Chromium Concentration ◽

Feed Water ◽

Dialysis Patients ◽

Cross Sectional ◽

Spent Dialysate ◽

Beneficial Outcome

Some trace elements are altered with chronic kidney disease. Selenium, zinc, and manganese tend to be wasted, and there is growing evidence that selenium deficiency is associated with mortality on dialysis. Other trace elements accumulate, such as chromium, cobalt, lead, molybdenum, and vanadium. The highest chromium levels are found in dialysis patients. The dialysis modality may further affect these levels, especially in hemodialysis patients, where even small contaminations in the dialysis feed water may lead to a concentration gradient that increases the concentration of certain trace elements. Chromium levels in peritoneal dialysis (PD) patients have been understudied. A single cross-sectional study found substantially higher chromium levels in PD patients. In that study, the chromium concentration in the spent dialysate decreased substantially, suggesting that PD fluid could be a source of chromium. Chromium-lactate complexes may have been formed, which are easily absorbed. In our center, we observed a decrease in chromium level when using physiological PD fluids. This review discusses the potential mechanisms and raises the question of whether this accumulation of chromium is unlikely to be associated with a beneficial outcome.

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Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall

Journal of Renal Nutrition ◽

10.1053/j.jrn.2020.08.003 ◽

2020 ◽

Author(s):

Maryanne Zilli Canedo Silva ◽

Barbara Perez Vogt ◽

Nayrana Soares Carmo Reis ◽

Rogerio Carvalho Oliveira ◽

Jacqueline Costa Teixeira Caramori

Keyword(s):

Peritoneal Dialysis ◽

Total Nitrogen ◽

Protein Intake ◽

Dialysis Patients ◽

Dietary Recall

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Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

Brazilian Journal of Nephrology ◽

10.1590/10.1590/2175-8239-jbn-2020-0018 ◽

2020 ◽

Author(s):

Firas Ajam ◽

Arda Akoluk ◽

Anas Alrefaee ◽

Natasha Campbell ◽

Avais Masud ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiac Conduction ◽

Future Research ◽

Dialysis Patients ◽

Bundle Branch Block ◽

Conduction Abnormality ◽

Ckd Stage ◽

Stage 1 ◽

Electrocardiogram Ecg ◽

Ecg Abnormalities

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

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