Complication Of Continuous Ambulatory Peritoneal Dialysis Research Articles

Pseudomonas peritonitis in continuous ambulatory peritoneal dialysis: laboratory predictors of treatment failure

Five episodes of pseudomonas peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) which were not cured by intraperitoneal antibiotics were studied to assess causes for treatment failure. The activity of gentamicin and ceftazidime against these strains was decreased in the presence of sterile used dialysate compared with nutrient broth. Likewise, kinetic studies showed that in dialysate therapeutically used concentrations of antibiotics failed to kill the isolates over 24 h. All five pseudomonas strains were adherent to silicone rubber Tenckoff catheter segments. An in vitro model of CAPD perítonítís demonstrated that persistence of viable adherent bacteria, after exposure to therapeutic concentrations of gentamicin and ceftazidime, contributes to the failure of antibiotics to cure pseudomonas CAPD peritonitis.

Management of Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis: An Australian Perspective

In the decade following the introduction of CAPD by Popovich et al (I) substantial improvements have been made in the management of CAPD peritonitis. This review summarizes the significant advances in the prevention, diagnosis and treatment of CAPD peritonitis in the first 10 years of CAPD therapy (1976–1986) and highlights additional areas where management protocols can be improved further.

Peritonitis During Continuous Ambulatory Peritoneal Dialysis in Children

The use of continuous ambulatory peritoneal dialysis (CAPD) in children has proved beneficial. However, peritonitis remains the major complication. A review of the incidence of peritonitis in 55 children (mean age 9.6 years) who underwent CAPD between 1978 and 1984 showed that there were 67 episodes of peritonitis (1 per 9.4 patient-months) in 33 of the 55. Three patients accounted for 22 of the episodes. In all cases, treatment with antibiotics, given intraperitoneally, was successful. Cephalothin was routinely given for infections due to gram-positive organisms, tobramycin for infections due to gram-negative organisms. Peritonitis recurred in seven patients, of whom five had to have their catheters replaced because of associated chronic infections of the deep peritoneal cuff, the exit site or the catheter tunnel. Although peritonitis was a common complication of CAPD in this population, it did not affect the success of the technique.

Hemoperitoneum: A Red Flag in CAPD

This paper describes two episodes of hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). One patient developed bloody dialysate during an attack of acute cholecystitis, while a second developed this sign immediately after colonoscopy. We found no previous reports which have associated these conditions with bloody dialysate. This paper reviews other causes of spontaneous hemoperitoneum and discusses the significance of bloody dialysate during CAPD.

Genital Edema in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

Two patients who developed massive genital edema while on CAPD were investigated by peritoneal scintigraphy with Tc99m-glucoheptonate. In one the genital swelling was due to an umbilical hernia and in the other it was due to an abdominal-wall hernia. After the hernia was repaired CAPD could be continued. We recommend peritoneal scintigraphy as a technique for the investigaiton of leakage of peritoneal fluid in patients undergoing CAPD. Recently genital swelling has been described as a complication of CAPD (I, 2). In one patient an isotope technique demonstrated an open processus vaginalis (1), and in four patients (2) scrotal or labial edema was due to an inguinal hernia. This communication describes two patients with genital edema which was due to an umbilical hernia in one, and to an abdominal wall hernia in the other.

Uremia and Host Resistance to Peritonitis in C.A.P.D-an Experimental Evaluation

Peritonitis is an important complication of CAPD. Because uremia is believed to impair immunity, we sought to determine whether uremia per se predisposes patients on CAPD to peritoneal infection. Using an animal model of CAPD, we have evaluated the effect of severe uremia on host resistance to peritonitis. Intraperitoneal catheters were implanted in severely uremic and sham-operated non-uremic rats, which were then dialysed four times a day for two days. Alternatively, they were infused with dialysis fluid twice daily for eight days without drainage of the dialysate. Peritonitis was induced by direct inoculation of Escherichia coli; the bacteria in the peritoneal cavity and spleen were counted 24 hours after this challenge. Uremia did not impair resistance to experimentally induced peritonitis in either the dialysed or infused host. Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly popular as a method for longteffil treatment of chronic renal failure. The major disadvantage is the risk of infection and peritonitis remains the single most important complication and reason for transfer of patients to another mode of therapy. Uremia is believed to impair immunity and predispose patients to infection (1, 2). Hence the question arises: Are patients on CAPD predisposed to peritoneal infection by the uremia itself? We developed a model of chronic uremia in rats, which made possible studies uncomplicated by many variabies associated with the clinical management of uremic patients. This paper examines the contribution of uremia to the susceptibility of the dialysed host to peritonitis. In the rats, we found it difficult to maintain dialysis for longer than two days because of rapid blockage of catheters by fibrin and connective tissue. As a consequence, we employed two models: one carried out peritoneal dialysis for two days, and the other involved infusions of dialysate without drainage for a longer period. Uremic and sham-operated animals, either dialysed or infused without drainage, were compared with noffilal controls with respect to their ability to withstand an intraperitoneal challenge with viable Escherichia cali.