Continuous Ambulatory Peritoneal Dialysis Exchanges Research Articles

Relationship between number of daily exchanges at CAPD start with clinical outcomes.

Peritoneal dialysis (PD) continues to be demanding for patients affected by kidney failure. In kidney failure patients with residual kidney function, the employment of incremental PD, a less onerous dialytic prescription, could translate into a decrease burden on both health systems and patients. Between 1st January 2009 and 31st December 2021, 182 patients who started continuous ambulatory peritoneal dialysis (CAPD) at our institution were included in the study. The CAPD population was divided into three groups according to the initial number of daily CAPD exchanges prescribed: one or two (50 patients, CAPD-1/2 group), three (97 patients, CAPD-3 group) and four (35 patients, CAPD-4 group), respectively. Multivariate analysis showed a difference in term of peritonitis free survival in CAPD-1/2 in comparison to CAPD-3 (hazard ratio (HR): 2.20, p = 0.014) and CAPD-4 (HR: 2.98, p < 0.01). A tendency towards a lower hospitalisation rate (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.11 and 0.13, respectively) and decreased mortality (CAPD-3 and CAPD-4 vs. CAPD-1/2, p = 0.13 and 0.22, respectively) in patients who started PD with less than three daily exchanges was detected. No discrepancy of the difference of the mean values between baseline and 24 months residual kidney function was observed among the three groups (p = 0.33). One- or two-exchange CAPD start was associated with a lower risk of peritonitis in comparison to three- or four-exchange start. Furthermore, an initial PD prescription with less than three exchanges may be associated with an advantage in term of hospitalisation rate and patient survival.

Assisted PD throughout Europe: advantages, inequities, and solution proposals

BackgroundPeritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mastered this, while others are still bound by the availability of a volunteer to become responsible for treatment.MethodsA group of leading nephrologists from 13 European countries integrated real-life application of such therapy, highlighting barriers, lessons learned and practical solutions. The objective of this work is to share and summarize several different approaches, with their intrinsic difficulties and solutions, which might helpperitoneal dialysis units to develop and offer assisted peritoneal dialysis.ResultsAssisted peritoneal dialysis does not mean 4 continuous ambulatory peritoneal dialysis exchanges, 7 days/week, nor does it exclude cycler. Many different prescriptions might work for our patients. Tailoring PD prescription to residual kidney function, thereby maintaining small solute clearance, reduces dialysis burden and is associated with higher technique survival. Assisted peritoneal dialysis does not mean assistance will be needed permanently, it can be a transitional stage towards individual or caregiver autonomy. Private care agencies can be used to provide assistance; other options may involve implementing PD training programs for the staff of nursing homes or convalescence units. Social partners may be interested in participating in smaller initiatives or for limited time periods.ConclusionAssisted peritoneal dialysis is a valid technique, which should be expanded. In countries without structural models of assisted peritoneal dialysis, active involvement by the nephrologist is needed in order for it to become a reality.Graphical abstract

Prevention of peritoneal dialysis-related infections.

The use of peritoneal dialysis (PD) varies widely from country to country, with the main limitation being infectious complications, particularly peritonitis, which leads to technique failure, hospitalization and increased mortality. A large number of prophylactic strategies have been employed to reduce the occurrence of peritonitis, including the use of oral, nasal and topical antibiotics, disinfection of the exit site, modification of the transfer set used in continuous ambulatory PD exchanges, changes to the design of the PD catheter implanted, the surgical method by which the PD catheter is inserted, the type and length of training given to patients, the occurrence of home visits by trained PD nurses, the use of antibiotic prophylaxis in patients undergoing certain invasive procedures and the administration of antifungal prophylaxis to PD patients whenever they are given an antibiotic treatment course. This review summarizes the existing evidence evaluating these interventions to prevent exit-site/tunnel infections and peritonitis.

Double bag or Y-set versus standard transfer systems for continuous ambulatory peritoneal dialysis in end-stage kidney disease.

Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis.This is an update of a review first published in 2000. This systematic review sought to determine if modifications of the transfer set (Y-set or double bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes. We searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. Date of last search: 22 October 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing double bag, Y-set and standard peritoneal dialysis (PD) exchange systems in patients with end-stage kidney disease. Data were abstracted by a single investigator onto a standard form and analysed by Review Manager. Analysis was by a random effects model and results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Twelve eligible trials with a total of 991 randomised patients were identified. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial and the methodological quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) in preventing peritonitis in PD. Disconnect systems should be the preferred exchange systems in CAPD.

Non-compliance to the continuous ambulatory peritoneal dialysis procedure increases the risk of peritonitis

Peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is the leading cause of technique failure. Information on the impact of non-compliance in performing CAPD exchange on peritonitis is limited. We aimed to find the prevalence of non-compliance to the CAPD procedure and its influence on the incidence of peritonitis. This observational study included 30 adult patients undergoing CAPD. The CAPD exchange procedure was observed at home and assessed as per the structured checklist and categorized into poor, average and good compliance. The compliance was correlated with the episodes of peritonitis in previous 1 year. The patients' mean age was 52 ± 13 years and the mean duration of CAPD was 2.1 ± 0.9 years. Only 16.5% of patients were good performers, while 67% were average performers, and 16.5% were poor performers. The technique skill was similar across all the steps of the procedure. The most common improperly performed steps were: not putting on a face mask in 68%, not flushing the tubing system in 60%, and not washing hands in 24%. Poor adherence to procedure was independent of age, gender, education and duration of dialysis. Ten episodes of peritonitis occurred in 5 patients over 1-year period. Peritonitis occurred in 60% of poor performers, whereas fully compliant patients had no peritonitis. Also 40% of the poorly compliant patients had multiple episodes of peritonitis. Poor compliance in performing the CAPD procedure is a modifiable risk factor for peritonitis. Adherence to recommended aseptic technique is the cornerstone of peritonitis prevention.

Coiled catheter for recurrent migration.

Sir, Double-cuffed Tenckhoff’s catheters has been widely used for continuous ambulatory peritoneal dialysis (CAPD). Various techniques of insertion have been described with placement of catheter tip downwards into the pelvis for maximal drainage. One of the well-known complications of CAPD is migration of the catheter tip out of the pelvis which leads to inadequate drainage and dialysis. The incidence of this problem varies considerably from center to center (5–35%), depending on the surgical technique, the patient’s body habitus, the presence of adhesions from previous surgeries, excessive omentum and the type of the peritoneal dialysis catheter [1]. Swan-neck coiled catheters were found to have advantages of coiled intraperitoneal segments in reducing the probability of infusion or tip pressure pain [2]. But only one study demonstrated that the double-cuff, swan-neck coiled-end configuration was associated with a considerably lower incidence of migration [3]. In that study, there was catheter tip migration in three patients with the straight catheters compared to one patient with the swan-neck coiled catheter [3]. We present a 28-year-old non-diabetic gentleman with hypertensive end-stage renal disease, who was initiated on CAPD in January 2010. He had no history of previous abdominal surgery. He underwent double-cuff swan-neck curved CAPD catheter insertion by surgical technique. He was initiated on regular CAPD exchanges after a 2-week break-in period. After 1 month, he presented with catheter malfunction. Radiograph of the abdomen showed catheter migration to the right hypochondrium. He underwent catheter removal with repositioning of a new double-cuff swan-neck curved CAPD catheter into the pelvis by laparotomy. Within a month he had again recurrence of catheter migration with malfunction. This time the existing catheter was replaced with a double-cuff swan-neck catheter with coiled tip. After 1 month of follow-up, the catheter position was re-examined, and the coiled-tip catheter had also migrated to the right hypochondrium but there was no complaint of malfunction. The catheter position was checked once the following month. It remained in the same position in right hypochondrium but without malfunction. The plausible explanation for the proper functioning, despite its migration to right hypochondrium, would be that the opening of the catheter remained directed down. Data on the use of coiled-tip catheters are scarce and it is known that migrated catheters might still function. The utility of a coiled-tip catheter for prevention of migration should be further investigated, but it should be remembered that such a coiled catheter might still function even after migration.

Incremental peritoneal dialysis: Effects on the choice of dialysis modality, residual renal function and adequacy

There is still disagreement on whether peritoneal dialysis (PD) should begin with a full dose (Full_Dial) or with incremental doses (Incr_Dial) to compensate for the amount of Kt/V no longer supplied by the residual renal function (RRF). The aim of this study is to assess the effects of an Incr_Dial protocol on the choice of dialysis modality, RRF, and adequacy. The Incr_Dial protocol in our center is as follows: for patients with a glomerular filtration rate (GFR)>5 ml min(-1), PD is initiated with two exchanges per day (continuous ambulatory PD (CAPD)) or four sessions per week (ambulatory PD (APD)); and hemodialysis (HD) is initiated with two sessions per week. The PD dose is then increased in proportion to the reduction in the GFR as follows: GFR< or =5 and >3 ml min(-1)=3 CAPD exchanges or five APD sessions; GFR <3 ml min(-1)=full dialysis dose (Full_Dial). The effects of the Incr_Dial protocol on the choice of dialysis modality were assessed on 87 patients (pts) (age: 69.3+/-13.1 years) who initiated dialysis between 1 January 2004 and 31 May 2007. The effects of Incr_Dial on RRF and dialytic adequacy were assessed in 11 pts treated with two CAPD exchanges per day for a total of 106 months (mean+/-s.d. 9.7+/-6.5), and then treated with three CAPD exchanges per day for an additional 105 months (9.4+/-8.3). The use of Incr_Dial determined the choice of PD in 27 of 44 pts (61.4%) without indications or contraindications to HD or PD. CAPD was chosen by 20 of these pts (74.1%), whereas APD was preferred by 6 of the 8 pts switched from Incr_Dial to Full_Dial. During Incr_Dial, a significant reduction in the loss of GFR of 2.4+/-3.1 ml min(-1) year(-1) was observed when compared to the pre-dialysis period. Incr_Dial allowed for adequate clearance, as confirmed by the Kt/V (2.07+/-0.2), protein nitrogen appearance (1.17+/-0.13), and biochemical parameters. Ultrafiltration (UF) with icodextrin (772+/-166 ml per exchange) provided a daily UF of 517+/-296 ml day(-1) and remained unchanged when the duration of the dwell time increased significantly from 12.3+/-1.4 to 17.5+/-2.6 h.

Good Patient and Technique Survival in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis

The aging population has significant implications for the community. The increasing number of elderly end-stage renal disease (ESRD) patients presses the renal team to find an appropriate management plan. We used a retrospective analysis to study the effectiveness of continuous ambulatory peritoneal dialysis (CAPD) in elderly ESRD patients. Of the 328 CAPD patients recruited for the study, 121 were in the elderly group (>or=65 years of age), and 207 were in the control group (under 65 years of age). Median age in the elderly group was 71 years, and in the control group, 51 years. The elderly group had a higher prevalence (54.5%) of diabetes mellitus. The 2-year and 5-year rates of patient survival were 89.3% and 54.8% respectively in the elderly group and 92.2% and 62.9% in the control group (p=0.19). The 2-year and 5-year rates of technique survival were 84.0% and 45.7% respectively in the elderly group and 80.9% and 49.1% in the control group (p=0.75). The probability of a 12-month peritonitis-free period was 76.6% in the elderly group and 76.5% in the control group (p=0.75). One hundred elderly patients (82.6% of the group) performed their CAPD exchanges by themselves. We observed no significant difference in clinical outcome-including patient survival, technique survival, and peritonitis-free period-between the elderly self-care CAPD and the elderly assisted CAPD groups. In elderly ESRD patients, CAPD is an effective dialysis modality. A slightly longer training time is to be expected for elderly patients. Self-care CAPD for elderly patients who are capable of performing their own exchanges provides them with an independent home life.

Exit site infection due to Zygomycosis resulting in abdominal wall necrosis in a continuous ambulatory peritoneal dialysis patient

Keywords: continuous ambulatory peritoneal dialysis;exit site infection; zygomycosisA 52-year-old gentleman, type 2 diabetic andhypertensive was initiated on continuous ambulatoryperitoneal dialysis (CAPD) in August 2004. He waspartially blind in both eyes owing to diabeticretinopathy. He had also been confined to bed forthe past 2 months, due to severe sensorimotorperipheral neuropathy. His wife and son were perform-ing the exchanges, three per day with 2.5% dextrosesolution of Dianeal (Baxter India Pvt Ltd, New Delhi).He had Kt/V of 1.8 per week and a urine output of350–500ml/day. He had suffered an episode ofperitonitis in September 2005. Methicillin-sensitivecoagulase negative staphylococci was identified atthat time. He was injected with vancomycin 1g IPonce in every 5 days (three doses were given) and withceftriaxone 1g IP in the longest CAPD exchange for 14days. In December, the dermatologist of our Institutediagnosed him with infected scabies, when hepresented with complaints of overall body itching.He had burrows and infected scratch marks all over hisbody. He was prescribed permethrin, liquid paraffinand gamma benzene hexachloride soap. In the lastweek of the same month, he presented to us witherythema and blackening of the skin, starting initiallyaround the exit site and the tunnel and spreading to theentire anterior abdominal wall in a week, resulting infull thickness necrosis and sloughing, exposing therectus and other anterior abdominal muscles (Figure 1and 2). He also complained of abdominal pain, cloudyeffluent of 1-day duration, vomiting of 3-day duration.The results of investigations done were: haemoglobin,7.1g/dl; blood urea, 91mg/dl; creatinine, 5.1mg/dl;serum proteins, 5.6g/dl; serum albumin, 1.7g/dl. TheCAPD catheter was removed. The catheter tip cultureshowed the growth of zygomycetes. The histopathol-ogy of the specimen from wound tissue also revealedthe growth of zygomycetes. Detailed mycologicalidentification was not possible at our institute. Thepatient was initiated on haemodialysis and twice a daycleaning and dressing of the wound with EdinburghUniversity solution of lime (EUSOL), as is the practiceat our institute, and amphotericin. EUSOL isa solution of calcium hypochlorite containing notless than 0.25% w/v of available chlorine bufferedwith boric acid to a pH of 7.5–8.5. After 3 weeks oftreatment, the signs of peritonitis subsided. When theplastic surgeon contemplated thorough debridementunder general anaesthesia, the patient’s general condi-tion was so deteriorated owing to malnourishmentthat his son refused further treatment and he left theInstitute against medical advice.There are very few reports [1–4] of peritonitis andexit site infection due to zygomycosis. In all instances,the catheter had been removed. Mortality related tozygomycosis has been reported as 57% [5].The human infection is rare, despite ampleexposure to zygomycosis, due to efficacy of theimmune system. Underlying factors include diabetic

Diagnosis of Primary Hyperoxaluria Type 1 by Determination of Peritoneal Dialysate Glycolic Acid Using Standard Organic-Acids Analysis Method

Hyperglycolic hyperoxaluria is an important biochemical diagnostic hallmark for primary hyperoxaluria type 1 (PH1). Biochemical work-up on urinary specimens becomes impossible after the development end-stage renal failure and anuria. We studied the diagnostic value of determining glycolic acid content in peritoneal dialysate effluent in PH1. We performed a comparative study on an anuric continuous ambulatory peritoneal dialysis (CAPD) patient whose PH1 was confirmed by genetic study and on 5 anuric CAPD controls. Specimens were taken from each bag of peritoneal dialysate effluent over a 24-hour period, and the corresponding drainage volume was noted. The specimens were then processed using standard procedures for organic-acid analysis. They underwent ethyl acetate extraction, followed by semiquantitative analysis of organic acids by gas chromatography mass spectrometry (GCMS). The daily output of glycolic acid in peritoneal dialysate for each individual was then estimated. All 6 patients were receiving four 2-L CAPD exchanges daily. The estimated daily glycolic acid output for the PH1 patient was 48.3 micromol daily. The mean glycolic acid output for the 5 controls was estimated to be much lower at 19.6 micromol daily (range: 15.1 - 27.5 micromol daily). Standard organic-acid analysis for glycolic acid in peritoneal dialysate could be a useful initial screening tool before invasive or sophisticated testing is done in CAPD patients with suspected PH1.

Review: double bag or Y-set systems reduce peritonitis in patients on continuous ambulatory peritoneal dialysis

. Daly C, Campbell M, Cody J, et al. Double bag or Y-set versus standard transfer systems for continuous ambulatory peritoneal dialysis in end-stage renal disease . Cochrane Database Syst...

Peritonitis in Automated Peritoneal Dialysis: Antibiotic Therapy and Pharmacokinetics

The use of automated peritoneal dialysis (APD) has increased markedly during the past decade, in response to the need to obtain higher clearances and to accommodate individual lifestyles. Peritonitis rates have been observed to be generally lower in APD as compared with continuous ambulatory peritoneal dialysis (CAPD). Still, peritonitis remains a significant complication of APD. Many questions have been raised regarding the appropriateness of applying, to APD, the therapeutic antibiotic regimens used for treatment of peritonitis in CAPD. The original recommendations for treatment of peritonitis in PD mostly used peritoneal dialysate trough levels based on 2-L CAPD exchanges lasting 4 ‐ 8 hours. Because APD uses shorter, more frequent exchanges, with variable fill volumes, at night, the clearance of many antibiotics is expected to be higher than in CAPD. The use of single daily doses injected intraperitoneally (IP) during the long exchange of CAPD or APD has simplified the administration of antibiotics, and arguably, allows a uniform dose to be used for both modalities. However, the higher clearance of some antibiotics during rapid cycling may reduce tissue concentrations below the therapeutic range. Recent pharmacokinetic studies have shed light on this important subject. Those studies should be used as a base from which to design more effective therapeutic guidelines. INCIDENCE OF PERITONITIS IN APD AND CAPD

Importance of dialysis adequacy in mortality and morbidity of Chinese CAPD patients

In continuous ambulatory peritoneal dialysis (CAPD), the impact of dialysis adequacy on patient outcome is well established in Caucasian patients but is less clear in Asian patients. Recent evidence suggests that Asian dialysis patients enjoy better overall survival. We hypothesize that dialysis adequacy may be less important in determining outcome for this ethnic group. We performed a single-center prospective observational study. From September 1995, we enrolled 150 existing and 120 new CAPD patients. They were followed for up to three years. We monitored dialysis adequacy and nutritional indices, including Kt/V, weekly creatinine clearance (CCr), residual glomerular filtration rate (GFR), normalized protein catabolic rate (NPCR), percentage of lean body mass (%LBM), and plasma albumin level. Clinical outcomes included mortality, technique failure, and duration of hospitalization. The duration of study follow-up was 22.1 +/- 12.3 months. In our study population, 136 were male. Seventy were diabetic (25.9%), and 212 were treated with 6 L exchanges per day (78.5%). The body weight was 59.3 +/- 9.4 kg. Baseline total Kt/V was 1.78 +/- 0.41, peritoneal Kt/V 1.48 +/- 0.36, and median residual GFR 0.98 mL/min (range 0 to 7.45). Two-year patient survival was 83.0%, and technique survival was 72.8%. Multivariate analysis showed that the duration of dialysis, diabetes, %LBM, index of dialysis adequacy (Kt/V or CCr), residual GFR, and requirement of a helper for CAPD exchanges were independent factors of patient survival; serum albumin, adequacy index (Kt/V or CCr), and requirement of a helper were independent factors of technique survival. Duration of dialysis, body weight, requirement of helper, cardiovascular disease, HBsAg carrier, serum albumin, and CCr had independent effects on hospitalization. The peritoneal component of Kt/V or CCr had no independent effect on any outcome parameter. When the prevalent and new CAPD cases were analyzed separately, Kt/V predicted survival only for new CAPD cases. Our results show that dialysis adequacy has significant impact on outcome of Asian CAPD patients. Although we have excellent medium-term patient and technique survival, this favorable outcome should not prevent health care workers from providing adequate dialysis to Asian patients. The reason of discrepancy in outcome between Asian and Caucasian dialysis patients requires further study.

A multicenter study of noncompliance with continuous ambulatory peritoneal dialysis exchanges in US and Canadian patients

Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 ± 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.

Teaching Continuous Ambulatory Peritoneal Dialysis Exchange Procedures: Impact on Nurses

Teaching Continuous Ambulatory Peritoneal Dialysis Exchange Procedures: Impact on Nurses

Effectiveness of Single Daily Intraperitoneal Administration of Aztreonam and Cefuroxime in the Treatment of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)

To discover if the management of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) may be effectively simplified by single daily i.p. administration of aztreonam (A) and cefuroxime (C), 10 adult CAPD patients (pts) with peritonitis were trained to start the following treatment procedure: a) sterile collection of dialysate effluent for cultures; b) 4 rapid in-and-out exchanges with antibiotic free dialysate; c) addition of 2 g C and 2 g A to a 2-L exchange for 6-h dwell time (the same dosage was repeated once a day in the overnight exchange); d) routine CAPD exchanges. Concentrations of C and A were measured in dialysate and serum of the patients 2, 12, 18, and 21-23 h after the i.p. administration: C remained within therapeutic range in all samples, while serum and dialysate A levels fell below such range 16 h after the i.p. administration. Seventeen peritonitis episodes occurred during the observation period (12 months): initial dialysate cultures grew Staph. aureus in 6 episodes, Staph epidermidis in 6, Pseudomonas aer. in 2, Streptococcus faecalis in 1, Citrobacter in 1, and Candida in 1. All patients but 1 (with Candida-positive culture) responded to this treatment with no relapse in 2 months. We conclude that once a day i.p. administration of 2 g aztreonam plus 2 g of cefuroxime is an effective and simple way of treating CAPD pts with gram-positive and gram-negative peritonitis.

Further Experience with Two Intraperitoneal Vancomycin Loading Doses for Treatment of Gram-positive or Sterile Peritonitis in CAPD Patients

We present a new protocol for treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. In this protocol, episodes of gram-positive or “sterile” peritonitis are treated with two intraperitoneal (i.p.) doses of vancomycin (30 mg{kg with 6 h of i.p. dwell) which are given one week apart. Patients whose initial peritoneal fluid Gram stain does not reveal any organisms receive an intramuscular (i.m.) loading dose of tobramycin or gentamycin in addition, until the culture result becomes available at 48 h. Those with a negative peritoneal fluid culture (“sterile” peritonitis) receive maintenance i.p. gentamycine or tobramycin. We report our experience with 24 episodes of gram-positive or “sterile” peritonitis. Except for 1 of the 24 episodes that was followed with two successive relapses, all the other episodes responded well (cure rate of 96%). In only 15% of the instances patients were hospitalized to be assisted with their CAPD exchanges. We conclude this new approach remarkably simplifies treatment of peritonitis in CAPD patients, and based on our preliminary results it seems to be as effective, if not superior to, the currently employed treatment protocols. Further studies with this therapeutic regime with careful audiometric evaluation of those who receive both vancomycin and aminoglycoside are necessary in future.

Localized Genital Edema in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Localized genital edema occurred in 8 of 81 patients (10 per cent) undergoing continuous ambulatory peritoneal dialysis. Underlying causes included defects in the inguinal canal and noninguinal peritoneal leaks that were localized with clinical, radiographic and scintigraphic techniques. Management included temporary cessation of continuous ambulatory peritoneal dialysis exchanges in half of the patients, particularly those with recently inserted catheters. Surgical repair was recommended in all cases when inguinal defects were identified. Edema resolved permanently in 6 patients and all patients were able to remain on continuous ambulatory peritoneal dialysis.