Chronic Ambulatory Peritoneal Dialysis Research Articles

Pharmacokinetics of intravenous piperacillin/tazobactam among patients with peritoneal dialysis-associated peritonitis.

Currently, pharmacokinetic information on intravenous (IV) piperacillin/tazobactam in patients with peritoneal dialysis-associated peritonitis (PD peritonitis) is limited. This study employed a prospective single-dose pharmacokinetic design to assess the pharmacokinetics of IV piperacillin/tazobactam in these patients. Four patients with PD peritonitis who received an IV loading dose of 4000 mg/500 mg piperacillin/tazobactam were enrolled in this study. The concentrations of piperacillin and tazobactam in plasma, peritoneal dialysis fluid (PDF) and urine were determined by high-performance liquid chromatography. Non-compartmental methods were used for pharmacokinetic analysis. During a 6-h dwell time for chronic ambulatory peritoneal dialysis (CAPD), 9.23 ± 4.01% of the piperacillin was recovered in the PDF. This result is greater than that observed in patients without peritonitis in prior research. Piperacillin's PD clearance (CLPD), steady-state volume of distribution (Vss) and terminal half-life (t 1/2) were 5.79 ± 2.55 mL/min, 24.35 ± 11.26 L and 5.74 ± 1.53 h, respectively. These values are also higher than those of patients without peritonitis in a prior study. Eight hours following the loading dosage, the plasma and PDF piperacillin concentrations of all patients (98.25 ± 26.03 and 52.70 ± 22.99 mg/L, respectively) surpassed the Pseudomonas aeruginosa and Enterobacterales Clinical and Laboratory Standards Institute susceptible breakpoints. In summary, the CLPD, Vss and t 1/2 for piperacillin were found to be greater in patients with PD peritonitis than in CAPD patients without peritonitis when compared with the results of a previous study. The IV loading dose of 4000 mg/500 mg piperacillin/tazobactam is sufficient to treat peritonitis caused by susceptible P. aeruginosa and Enterobacterales. The multiple-dose pharmacokinetics of IV piperacillin and tazobactam in this specific patient group should be further investigated.

PS-BPC11-9: ADMA/SDMA RATIO AND ITS RELATIONS TO URIC ACID AND ALBUMIN IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS IN INDONESIA

Background and Aims: Asymmetric Dimethylarginine (ADMA) and Symmetric Dimethylarginine (SDMA), rarely reported together, are markers of endothel dysfunction and kidney function. ADMA was inversely related to albumin, while SDMA was positively correlated to albumin. Meanwhile, uric acid was positively correlated to both SDMA and ADMA. By using ADMA and SDMA as ratio, we postulated that their ratio can more precisely predict activity dimethylarginine dimethylaminohydrolase (DDAH), a key enzyme that metabolized ADMA, and not SDMA, and can be used as marker of NO activity. Low NO activity is related to high vascular tonus and peripheral resistance, hypertension and low Sodium excretion and cardiac output. Method: This was a cross-sectional study conducted in adults underwent chronic Continuous Ambulatory Peritoneal Dialysis (CAPD) in tertiary hospital in Jakarta, Indonesia. Uric acid, albumin, ADMA and SDMA levels were measured at the same time patients controlled to outpatient clinic after washout from hyperuricemia drug for 2 to 4 weeks. Analysis performed using Pearson for normal distribution data, Spearman for nonparametric analysis and linier regression test and ROC curve with SPSS v20. Results and Discussion: Total of 55 subjects (83%) were included, male 63.6%, mean age of 40.71 ± 14,4 year old. Median of CAPD use was 27 months. Causes of CKD were glomerulonephritis (47.3%), diabetes mellitus (25.5%), hypertension (25.5%) and polycystic kidney disease (1.8%). At the time of research, 90.9%, were uncontrolled hypertension patients. Median level of UA was 7.30 ± 1.59 mg/dl and 60% had UA levels of 7 mg/dl or higher. Albumin level lower than 3.5 g/dl (mean 3.55 ± 0.49 g/dl) were 24 patients (43.6%). Median ADMA level was 87.5 ± 16.64 ng/ml and SDMA level was 633.73 ± 231.54 ng/mL. Median ADMA/SDMA ratio was 0.13 + 0,08 ng/ml. ADMA, SDMA, ADMA/SDMA ratio were correlated with uric acid with p = 0.027 (95%CI 0.175–0.471), p < 0.001 (95%CI 0.688–0.928) and p < 0.001 (95%CI -14,96 to -5,03) with sensitivity and specificity 91% and 95%, 97% and 68% and 79% and 96%, respectively. ADMA, SDMA, ADMA/SDMA ratio were not statistically significantly correlated with albumin with p = 0.26, p = 0.14 and p = 0.23, respectively. Albumin level was caused by many factors that are not in the scope of this research, this might explain this result. Conclusion: ADMA/SDMA ratio had comparable sensitivity and specificity to ADMA or SDMA alone when correlated with uric acid in CAPD patients. Albumin might not correlated with ADMA, SDMA, or ADMA/SDMA ratio in CAPD patients.

Sexual dysfunction in female and male patients undergoing chronic ambulatory peritoneal dialysis

To prolong survival and to provide a better quality of life (QoL) are two aims at the forefront in the care of peritoneal dialysis (PD) patients. In this study we aimed to determine frequency of sexual dysfunction (SD) and influencing factors in PD patients. Of the 201 patients, 114 under 65 years and on chronic ambulatory PD for at least 3 months were enrolled. Forty-nine females and 65 males completed the study. Survey forms were applied using face-to-face interview method. Female Sexual Function Index (FSFI) was used to assess SD in women; International Index for Erectile Function (IIEF) was used to assess erectile dysfunction (ED) in men. All patients completed SF-36 and Beck Depression Inventory (BDI) forms. While SD was evident in 89.8% of female patients (FSFI score:10.4 ± 9.7), ED was present in 87.7% of males (IIEF score:13.8 ± 7.9). Depression rates were 65.3% and 49.2% in female and male patients, respectively. BDI scores were 21.6 ± 10.4 and 17.1 ± 9.5; physical component scores, 52.6 ± 20.4 and 55.2 ± 20.2; mental component scores, 45.2 ± 19.8 and 49.9 ± 22, in female and male patients, respectively. FSFI was correlated with age (β = -0.53 p < 0.001) and BDI score (β = -0.23 p = 0.04), (R2 = 0.64). ED showed correlation with age (β = -0.36 p < 0.001), BDI score (β = -0.57 p < 0.001), and hemoglobin level (β = 0.26 p = 0.003), (R2 = 0.74). SD, often overlooked and not discussed by both patients and physicians, is encountered relatively frequently among PD patients. Left not discussed and untreated SD may adversely affect QoL.

In the Literature

Sal E, Stemler J, Salmanton-García J, et al. Invasive Trichoderma spp. infections: clinical presentation and outcome of cases from the literature and the FungiScope® registry [manuscript published online ahead of print 5 August 2022]. J Antimicrob Chemother. https://doi.org/10.1093/jac/dkac235. PMID: 35929089. Sal and colleagues examined 50 cases (46 proven and 4 probable) of invasive infections due to Trichoderma spp. reported in the literature and from Fungiscope, a global registry of invasive fungal infections. The median age of the patients was 45 years (range: 3–82 years) and 64% were male. Nineteen (38%) had a hematologic malignancy and 10 (20%) were undergoing chronic ambulatory peritoneal dialysis. Additional predisposing factors included corticosteroid therapy in 19 (38%), neutropenia in 14 (28%), chemotherapy in 13 (26%), other immunosuppressive therapy in 12 (24%), and broad-spectrum antibiotic therapy in 11 (22%). Ten patients (20%) were receiving antifungal prophylaxis (fluconazole in 6) at the time of diagnosis.

USE OF INDIGENOUSLY MANUFACTURED APD CYCLER IN PAKISTAN: THE BAHRIA TOWN INTERNATIONAL HOSPITAL EXPERIENCE.

Patients with end stage renal disease have the option of utilizing peritoneal dialysis (PD) as their mode of renal replacement therapy. There are basically 2 types of PD which include chronic ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis. APD is the most preferred type of PD utilized globally because of convenience of nighttime therapy but requires a cycler machine. Unfortunately the APD cycler is not available in Pakistan, hence APD utilization in Pakistan is zero. Byonyks Private Limited have recently manufactured an indigenous device for APD in Pakistan. This abstract is the first experience with that device in Pakistan at Bahria Town International Pakistan Lahore after approval from the local institutional research board and ethical committee (IRBEC).

The management of acute pancreatitis among children on chronic ambulatory peritoneal dialysis during COVID-19 pandemic crisis in Indonesia: report of two cases

Background: Children on dialysis seem to be at greater risk for COVID-19. Acute pancreatitis (AP) is an infrequent but severe complication of chronic peritoneal dialysis (PD). It contributes to morbidity and mortality rates of up to 25%. Patients with PD are exposed to a series of factors associated with AP risk. This report aimed to describe rare and interesting cases of acute pancreatitis in children with CAPD following PD-related peritonitis with a favorable response to conservative treatment. Case report: We present two cases admitted to our emergency room (ER) with severe abdominal pain preceded by PD-related peritonitis. Poor adherence, lack of monitoring, and healthcare service restriction during the COVID-19 pandemic predisposed these patients to PD-related complications. Patients were diagnosed as AP based on the revised Atlanta criteria. Both met the criteria as they had abdominal pain, a threefold increase of pancreatic enzymes, and evidence of pancreatitis through ultrasonography (USG) investigation. Both patients presented a rapid resolution of AP after receiving conservative treatment, including fasting, total parenteral nutrition (TPN), prophylactic antibiotics, and analgesics. None of them experienced invasive intervention due to AP. Conclusion: Diagnosing AP in children with CAPD may be challenging since the symptoms mimic other abdominal problems. Our cases are likely to be associated with PD-related peritonitis. This report may prove conservative treatment as a recommendation for managing AP in children with CAPD. The rapid development of innovative clinical management strategies in response to the COVID-19 pandemic is crucial to improving children's health care quality with CAPD.

POS-946 PERITONITIS RATES IN CHILDREN ON CHRONIC PERITONEAL DIALYSIS DURING THE COVID 19 PANDEMIC- OBSERVATIONS FROM AN UNDER-RESOURCED REGION

The COVID-19 pandemic imposed significant restrictions in access to health care facilities. Being a large referral center for pediatric chronic ambulatory peritoneal dialysis(CAPD) in the region, children residing in rural and distant areas form major beneficiaries of our program. This study was undertaken to estimate and compare peritonitis rates and associated risk factors in children on CAPD during the covid pandemic to the pre-covid period.

POS-909 COVID-19 EVOLUTION THROUGH THREE WAVES IN THE DIAYSIS UNIT AT STEVE BIKO ACADEMIC HOSPITAL, PRETORIA, SOUTH AFRICA

Patients with chronic kidney disease (CKD) are at increased risk of COVID-19 infection and complications. Chronic haemodialysis (HD) patients are particularly vulnerable due to frequent need for shared transport to the unit and potentially contaminated spaces in hospital. Home based therapies, including chronic ambulatory peritoneal dialysis (CAPD), have been actively promoted. Mortality is higher in patients with chronic kidney disease (1,2,3). Our chronic HD slots are capped at 50 due to rationing of services.

A Prospective, Self-Controlled Pilot Study of the Efficacy of Roxadustat for Erythropoietin Hyporesponsiveness in Patients Requiring Chronic Ambulatory Peritoneal Dialysis

The present study aimed to explore the efficacy and safety of roxadustat in patients with renal anemia and erythropoietin (EPO) hyporesponsive who are receiving continuous ambulatory peritoneal dialysis (CAPD). This is a single center, before and after treatment, self-controlled study; 55 CAPD patients with renal anemia andEPO hyporesponsiveness were enrolled. The main follow-up parameters included routine blood, liver and kidney function, electrolyte, blood lipid, high-sensitivity C-reactive protein, and iron tests. Serum samples were used to determine interleukin-6 andtumor necrosis factor-α levels via enzyme linked immunosorbent assay. The Modified Quantitative Subjective Global Assessment Score and Malnutrition-Inflammation Scorebefore and after treatment, and adverse events during treatment were recorded. The follow-up observation time was12weeks. Preliminary data 12-24weeks before the enrollment as well as post-follow-up data at 36weeks were also collected. Fifty patients completed the 12-week follow-up. The hemoglobin levels were 8.0±1.2g/dL at baseline and 11.2±2.0g/dL after 12weeks of roxadustat treatment. The hemoglobin increases at all measured time points and was statistically significant compared with the baseline value (P<.05). The overall hemoglobin response rate (hemoglobin increase ≥1.0g/dL) was 80%, and 50% of the patients reached the hemoglobin target (hemoglobin ≥ 11.0g/dL) at 12weeks. Transferrin was higher at 12weeks (2.2±0.5g/L) than at baseline (1.7±0.5g/L) (P<.05), while serum ferritin levels slightly decreased compared with the baseline value (P>.05). The median high-sensitivity C-reactive protein level and other inflammation-related indicators, such as white blood cell counts, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, interleukin-6, and tumor necrosis factor-α,werenot significantly different from their baseline values. Nutrition-related biochemical indices such as albumin, creatinine, and blood lipids were also not significantly changed. The Modified Quantitative Subjective Global Assessment ScoreandMalnutrition-Inflammation Score were slightly lower at 12weeks than at baseline. No serious adverse events were observed during the follow-up period. Post-follow-up data revealed a maintained hemoglobin level in patients who remained on roxadustat treatment while those switched back to EPO treatment after 12weeks resulted in a decreased hemoglobin at 36weeks. In patients with EPO hyporesponsiveness on CAPD, roxadustat can efficiently and safely improve anemia and nutritional status without promoting inflammation.

Opinion: Peritoneal Dialysis In Pakistan: An Insider’s View. State of Affairs and Planning?

Pakistan has an estimated population of 212 million while the incidence of end stage renal disease in Pakistan is 100 patients per million; hence approximately 22,000 patients require maintenance dialysis to sustain life in our country. Remarkably peritoneal dialysis (PD) as a form of maintenance renal replacement is utilized in less than one per cent of these patients. In the absence of a formal dialysis registry, we place the total number of chronic ambulatory peritoneal dialysis patients (CAPD) in Pakistan at approximately 76 excluding holiday patients who are visiting from abroad (*This figure was estimated by enquiring the total number of patients each PD units care in Pakistan. This figure was corroborated with the sole distributor of CAPD fluids in Pakistan.).

Mortality of dialysis patients in Qatar: A retrospective epidemiologic study

Background: End-stage kidney disease (ESKD) patients on maintenance renal replacement therapy (RRT) have far lower life spans than those of the general population. No previous studies have been performed to assess the mortality of dialysis patients in the State of Qatar. We designed this study to assess the mortality of dialysis patients in Qatar and the impact of dialysis modality. Methods: All chronic ambulatory dialysis patients (both on hemodialysis (HD) and peritoneal dialysis (PD) between 2014 and 2016) were included in the study, whereas patients undergoing dialysis for less than 3 months were excluded. We reviewed patients’ demographics, comorbidities, and general laboratory investigations through our electronic record system and collected and analyzed them. We identified patients who died during that period and compared them to those who survived. We performed a subanalysis for HD versus PD patients who died. Results: The total number of deceased dialysis patients was 164, with an overall crude mortality rate of 6.4%. They were significantly older than those who survived (p = 0.0001). The mortality rate was significantly higher in female than in male patients (51.2% and 38.9%, respectively) (p = 0.004) but significantly lower in PD than HD patients (1.36%, PD; 5.0%, HD; p = 0.007). It was also significantly higher in natives than in the expats (60.3% and 39.6%, respectively) (p = 0.0008); however, no significant differences were noted between deceased natives and expats in most demographic and laboratory characteristics. The most common cause of patient death was CVD (62 patients, 37.8%), followed by sepsis (44 patients, 26.8%). Diabetes, cerebrovascular accident, and dyslipidemia were more common in HD deceased patients than in PD patients (80.6%, 47%, and 59%, respectively, in HD patients vs 68.5%, 42%, and 31%, respectively, in PD patients). Albumin and potassium levels in deceased PD patients were significantly lower than in HD patients (p = 0.001). Conclusion: Our study found that the high-risk population had a significant mortality, which was higher in HD than PD patients. This is the first study to look at these outcomes in Qatar. We identified multiple mortality associated factors, such as comorbid conditions and old age. We believe that improving treatment and close monitoring for comorbid conditions in the dialysis population might improve survival.

POS-654 ASSESSMENT OF OVERHYDRATION IN CHILDREN ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS BY BIOIMPEDANCE VECTOR ANALYSIS – A LONGITUDINAL OBSERVATIONAL STUDY

Detecting overhydration in children on chronic ambulatory peritoneal dialysis (CAPD) is critical as it contributes to cardiovascular morbidity and mortality. However, precise clinical assessment of overhydration is challenging. Bio-impedance vector analysis (BIVA) is a bedside body composition tool that can estimate overhydration with a potential role of guiding the clinician on fluid management. This study aimed to longitudinally assess and compare the overhydration status detected using clinical assessment and BIVA in children on CAPD. A longitudinal observational study was undertaken in clinically stable children (age 4-18years) on CAPD (minimum duration of 6 months) from May 2017 to January 2020 at the pediatric chronic kidney disease clinic of a tertiary hospital. Presence of overhydration was assessed by clinical signs, bioimpedance measures and BIVA at enrollment, 3 and 6 months of follow up. Modifications to CAPD prescriptions and antihypertensive medications were based only on clinical assessment. Children were categorized as having clinical overhydration if they fulfilled 2 of 3 criteria of weight gain (>7% of body weight), uncontrolled hypertension (office BP ≥95thcentiles despite being on anti-hypertensive medications) and presence of signs of fluid overload. Based on a normative reference R-Xc graph, derived from z-scores of 20 healthy controls, bioimpedance vectors were plotted. The position of the vector in the left lower quadrant beyond the 95% tolerance ellipse was regarded as overhydration. Differences in the longitudinal vector displacement were analyzed using Hotelling’s T2 test. Twenty six children [18 boys, median age 9.5(4,16)years] on CAPD for 21(12,72) months were enrolled. Non-glomerular etiology was noted in 69% and 58% had residual kidney function. At enrollment, the proportion of children with overhydration assessed clinically and by BIVA was 34.6% and 30.7% respectively. There was poor agreement between measures of overhydration by clinical assessment and BIVA at all three time points. Among those detected to be overhydrated at enrollment, 9/11 (82%) and 4/9 (44%) remained overhydrated at 6 months by BIVA and clinical assessment respectively. The BIVA plots on the reference RXc graph (Figure) revealed a significant difference in the vector displacement towards the quadrant of overhydration at all time points, with the maximum difference seen between enrollment and 6 months (T2 = 32.58, p <0.001). In children on CAPD, there is poor agreement between measures of overhydration detected clinically and by BIVA. Longitudinal vector plots over 6 months reflect persistence of overhydration in a majority, as compared to clinical assessment. Further studies to explore the utility of BIVA in guiding the clinician with fluid management in these children are warranted.

POS-641 THE ASSOCIATION BETWEEN OFFICE BLOOD PRESSURE AND FLUID STATUS USING BIOIMPEDANCE ANALYSIS IN STABLE CHRONIC AMBULATORY PERITONEAL DIALYSIS PATIENTS

Hypertension is common in chronic peritoneal dialysis patients. It remains to be determined the extent to which fluid overload contributes to hypertension in this population. The aim was to determine the association between fluid status as measured using bioimpedance analysis (BIA) and blood pressure (BP) in chronic ambulatory peritoneal dialysis (CAPD) patients.

Mortality of dialysis patients in Qatar: A retrospective epidemiologic study.

End-stage kidney disease (ESKD) patients on maintenance renal replacement therapy (RRT) have far lower life spans than those of the general population. No previous studies have been performed to assess the mortality of dialysis patients in the State of Qatar. We designed this study to assessthe mortality of dialysis patientsin Qatarandthe impact of dialysis modality. All chronic ambulatory dialysis patients (both on hemodialysis(HD)and peritonealdialysis (PD)between 2014 and 2016) were included in the study, whereas patients undergoing dialysis for less than 3 months were excluded. We reviewedpatients' demographics, comorbidities, and general laboratory investigations through our electronic record system and collected and analyzed them. We identified patients who died during that period andcompared them to those who survived. We performeda subanalysisforHD versus PDpatients who died. The total number of deceased dialysis patients was 164, with an overall crude mortality rate of 6.4%. They were significantly older than those who survived (p=0.0001). The mortality rate was significantly higher in female than in male patients (51.2% and 38.9%, respectively) (p=0.004) but significantly lower in PD than HD patients (1.36%, PD; 5.0%, HD;p=0.007). It was also significantly higher in natives than in the expats (60.3% and 39.6%, respectively)(p=0.0008); however, no significant differences were noted between deceased natives and expats in most demographic and laboratory characteristics. The most common cause of patient death was CVD (62 patients, 37.8%), followed by sepsis (44 patients, 26.8%). Diabetes, cerebrovascular accident, and dyslipidemia were more common in HD deceased patients than in PD patients (80.6%, 47%, and 59%, respectively, in HD patients vs 68.5%, 42%, and 31%, respectively, in PD patients). Albumin and potassium levels in deceased PD patients were significantly lower than in HD patients(p=0.001). Our study found that the high-risk population had a significant mortality, which was higher in HD than PD patients. This is the first study to look at these outcomes in Qatar. We identified multiple mortality associated factors, such as comorbid conditions and old age. We believe that improving treatment and close monitoring for comorbid conditions in the dialysis population might improve survival.

Moyamoya Syndrome in Post-Transplant Children with Type 1 Neurofibromatosis and Congenital Nephrotic Syndrome

Background: Neurofibromatosis (NF) is a genetic disorder of the nervous system that affects the development and growth of neuronal tissues. It is characterized by the development of malignant and benign tumors of the peripheral nerves and meningiomas, and the clinical manifestations can vary, including cerebral vascular compromise that precipitates symptoms characteristic of Moyamoya syndrome. The behavior of a posttransplant child with type 1 NF who presents with characteristics of Moyamoya syndrome and is a carrier of a WT1 genetic mutation is unknown, which is why the report was made. Case Report: A child with type I NF with a history of cryptorchidism, hypospadias, bilateral sensorineural hearing loss, and chronic renal failure was arising from a congenital nephrotic syndrome due to a WT1 gene mutation at 3 years of age began renal replacement therapy initially with chronic ambulatory peritoneal dialysis and hemodialysis for refractory peritonitis. He underwent two episodes of transient ischemic attack (TIA) characterized by right hemiparesis during hemodialysis therapy and during six months post-kidney transplantation present a similar episode. Studies for other causes were negative, and imaging studies show characteristics of NF-related vasculitis, cortical lesions, and focal lesions in the left frontal subcortical white matter with annular enhancement and subcortical edema in the parasagittal region of the left parietal lobe, as well as a decrease in flow in the cortical branches of the middle cerebral artery were described. After four weeks, the clinical manifestations of hemiparesis completely disappeared without leaving any sequels continuing with the regular immunosuppression of the everolimus, mycophenolate and low dose steroids. Conclusion: These findings are suggestive of small and mediumsized vessel vasculitis compatible with Moyamoya syndrome in child post-transplantation associated with arteriopathy by NF.

Evaluation of Troponin I Serum Level in Patients With Peritoneal Dialysis and Relationship Between Troponin I and Cardiovascular Risk Factors

End-stage renal disease is a situation that predisposes the patients to cardiovascular disease, especially myocardial infarction (MI). A valuable biomarker for the diagnosis of this event is cardiac troponin. Although some asymptomatic patients show high plasma levels of cardiac troponin I, it is still the most sensitive variable in MI. All patients more than 18-year-old, on chronic ambulatory peritoneal dialysis (CAPD) for at least three months, and did not have a history of acute myocardial infarction or hospitalization for CVD during last month are included in a cross-sectional descriptive study. Troponin I serum level was measured by VIDAS Troponin I Ultra (TNIU) Assay. Correlation between serum troponin level and cardiovascular risk factors are evaluated. In this study, 52% of patients were male. The mean cTnI level was 0.025±0.044 ng/mL, less than 0.11 ng/mL, and only five patients had cTnI level more than the laboratory threshold. The cut-off level of cTnI for diagnosing cardiovascular disease must be re-evaluated and maybe increase to 0.3 ng/mL. Indeed, the asymptomatic patient may need more close observation for cardiovascular disease. © 2019 Tehran University of Medical Sciences. All rights reserved.

Quality of Life and Caregiver Burden Scale in Iranian Children on Continuous Ambulatory Peritoneal Dialysis

Introduction: Chronic kidney diseases are associated with a poor quality of life in patients and their families. Previous studies have shown a three-fold higher rate of exhaustion in peritoneal dialysis compared to hemodialysis patients and their families. Here we studied the quality of life and caregiver’s burden of children receiving chronic ambulatory peritoneal dialysis (CAPD) in comparison with other chronic diseases among pediatric patients.Materials and Methods: This prospective case-control survey was conducted between 2013 and 2014 in Ali- Asghar Children’s Hospital. The inclusion criteria were age below 18 years and having a chronic disease diagnosed at least six months earlier. The parents of 13 children on peritoneal dialysis (cases) and 160 children with other chronic diseases(controls) were requested to complete the Pediatric Quality of Life Inventory (PedsQL™ 4.0™) appropriate to the patient’s age and the Caregiver Burden Scale (CBS). Independent t-test was applied to compare the variables between the two groups. P-values < 0.05 were considered significant.Results: Overall, 353 questionnaires were completed. The CAPD group had a higher mean (SD) score of quality of life in all domains, including somatic symptoms [67 (25.6) vs. 18.5(15.6)], emotional symptoms [71(17) vs. 20.5(15.1)], and social functioning [58(32) vs. 21.3(20)] (p-value<0.001). In addition, the case group had a lower mean (SD) score of caregiver’s burden [50(16.7) vs. 80 (13.5)] compared to the control group (P value<0.001).Conclusions: CAPD children and their parents had better a PedsQL™ 4.0™ score and a lower CBS compared to children with other chronic diseases. The most affected area of the quality of life was school functioning in the CAPD group and somatic symptoms in the control group.Keywords: Quality of life; Renal Dialysis; Adaptation; Psychological; Chronic Disease; Child.

Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study from a developing country.

Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18years of age who commenced and continued PD for more than 3months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12months, declining to 30% at 36months and then remaining stable until the end of follow-up (106months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12months, declining to 44% at 36months and then remaining stable until the end of follow-up (106months). CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.

Monomicrobial non-neutrocytic bacterascites caused by aeromonas hydrophila in a patient with liver cirrhosis.

Aeromonas peritonitis is a rare, but serious infection, as associated with spontaneous bacterial peritonitis, peritonitis in chronic ambulatory peritoneal dialysis, and intestinal perforation. Here, we reported a case of monomicrobial non-neutrocytic bacterascites caused by Aeromonas hydrophila (A. hydrophila). The patient, a 57-year-old man who had a history of alcoholic liver disease and chronic hepatitis C-related Child- Pugh class C liver cirrhosis, was admitted to our hospital with fever, dyspnea and a localized wound pain over left ankle. Ascitic fluid analysis demonstrated that ascitic polymorphonuclear cell count was 30 cells/ mm3. Empirical antimicrobial treatment with a combination of ceftriaxone and clindamycin were administered. However, the patient died due to fatal septic shock on Day 3. His blood and ascites cultures were positive for A. hydrophila. The case report presents the diagnosis, management, and literature review of Aeromonas monomicrobial non-neutrocytic bacterascites.

Home-based training using neuromuscular electrical stimulation in patients on continuous ambulatory peritoneal dialysis: A pilot study.

There is ample evidence that maintenance of basic physical fitness through exercise training is crucial for patients with chronic renal insufficiency. Rehabilitation based on neuromuscular electrical stimulation (NMES) of thigh muscles has been shown to have many beneficial effects in patients with chronic diseases. It is likely that NMES could have beneficial effects also in patients on chronic ambulatory peritoneal dialysis (CAPD). NMES was applied for 20weeks to 14 patients on CAPD, mean age 61.9 (8.7) years, using battery-powered stimulators (CEFAR-REHAB X2; Sweden) and self-adhesive electrodes 80×130 mm (PALS Platinum; Denmark). Stimulation characteristics: biphasic current, pulse width 400μs, 8seconds contraction-12seconds relaxation, frequency modulation 40-60Hz, and maximal intensity 60mA. NMES was home-based and applied simultaneously to quadriceps muscles of both legs (2 × 30min/day). Functional performance, muscle power (Fmax ), arterial stiffness (assessed by cardio-ankle vascular index-CAVI), and quality of life by KDQOL-SF evaluation was done at baseline and at the end of program. Home NMES improved significantly the main functional parameters: VO2peak /kg increased by +2.2 (1.6) mL O2 /kg/min (P<0.002), peak workload by +0.1 (0.1) W/kg (P<0.005), and distance walked in 6MWT by +44.7 (58.4) m (P<0.008). Only insignificant changes were observed in CAVI and Fmax . KDQOL-SF analysis showed significant improvement in seven parameters of QoL (P<0.012-0.049). This pilot study is the first clinical report dealing with the use of NMES in patients on CAPD. The results demonstrate that an improvement of exercise capacity and QoL can be achieved by home-based NMES in CAPD patients.