Continuous Ambulatory Peritoneal Dialysis Treatment Research Articles

Short-term peritoneal rest reduces peritoneal solute transport rate and increases ultrafiltration in high/high average transport peritoneal dialysis patients: a crossover randomized controlled trial

ABSTRACT Background The peritoneal solute transport rate (PSTR) tends to increase over time in some patients undergoing peritoneal dialysis (PD), potentially leading to ultrafiltration (UF) failure. Previous case reports have shown a significant decrease in PSTR and subsequent recovery of UF after discontinuing PD for a while. Therefore, we conducted a randomized controlled crossover study to evaluate the impact of short-term peritoneal rest on PSTR. Methods The study involved 14 continuous ambulatory peritoneal dialysis (CAPD) patients with high/high-average transport rate. Two groups were randomly assigned different treatment sequences: one group underwent daily intermittent peritoneal dialysis (IPD) for 4 weeks followed by CAPD, while the other group initially received CAPD treatment for 4 weeks and then switched to IPD. Peritoneal equilibration tests were performed before and after each treatment to evaluate PSTR and paired t-tests were used to compare the changes. Volume load, serum potassium and other clinical indicators were monitored at the same time. Results Short-term peritoneal rest (daily IPD) significantly reduced PSTR, with a decrease in the dialysate:plasma creatinine ratio from 0.71 ± 0.05 to 0.65 ± 0.07 (P < .001). Additionally, ultrafiltration significantly increased from 210 ± 165 ml to 407 ± 209 ml (P = .001). But there were no significant changes in interleukin-6 and vascular endothelial growth factor of PD effluent. No serious adverse events such as hypotension or hyperkalaemia occurred. Conclusions In PD patients with high and high-average transport, a 4-week period of short-term peritoneal rest by switching from CAPD to IPD (without long dwell) can lead to reductions in PSTR and increases in UF volumes, while maintaining clinical safety.

Patient adherence to Continuous Ambulatory Peritoneal Dialysis treatment in a low-resource setting: An interventional study

Patient adherence to Continuous Ambulatory Peritoneal Dialysis treatment in a low-resource setting: An interventional study

Economic issues of treating patients with stage 5D chronic kidney disease by dialysis methods of renal replacement therapy in Ukraine: a single-center study

Background. The aim of the work was to determine the cost of treating patients with stage 5D chronic kidney disease (CKD) by dialysis methods of renal replacement therapy (RRT) in 2023 based on the analysis of the costs of using hemodialysis (HD) and peritoneal dialysis (PD) in one medical institution. Materials and methods. An open single-center study was conducted at the Кyiv City Center of Nephrology and Dialysis. During 2023, 779 patients with stage 5D chronic kidney disease received renal replacement therapy by dialysis methods in this institution. Among them, 718 participants were treated by hemodialysis and 61 patients by peritoneal dialysis (36 by continuous ambulatory peritoneal dialysis (CAPD) and 25 by automated peritoneal dialysis (APD)). Direct medical and non-medical costs were included in the calculation of the cost of treating chronic kidney disease patients using both dialysis methods. The estimate of the cost of treatment for one patient during the year was calculated according to the formula: when using hemodialysis/hemodiafiltration (HDF) method — the cost of 1 session × 156 sessions, in case of CAPD/APD — the cost of 1 treatment day × 365 days. Results. The analysis of the costs for the treatment of patients with stage 5D CKD allowed us to state that the average cost of one HD/HDF session in 2023 was 3,626.20 UAH, one day of CAPD and APD treatment was 1,539.78 and 1,829.12 UAH, respectively. The average cost of treatment of one patient by HD/HDF method during 2023 was 565,687.20 UAH, CAPD — 562,019.70 UAH, APD — 667,628.80 UAH. In the structure of the cost of treatment, regardless of the modality of RRT, the most expensive component is the cost of consumables. State reimbursement under the Program of Medical Guarantees in 2023 for the treatment of one patient with stage 5D CKD during the year was 385,788 UAH when using GD/GDF, 412,085 UAH for CAPD, 662,110 UAH for APD. That is, based on the data we received, the Program of Medical Guarantees covers only 68.2 % of the costs of medical institution for the treatment with HD/HDF, 73.3 % for the treatment with CAPD and almost 100 % for the treatment with APD. Conclusions. The real cost of treating patients with stage 5D CKD using dialysis methods of RRT is higher than the rate of state reimbursement. The Program of Medical Guarantees doesn’t fully cover the costs of medical institutions for the treatment of patients with stage 5D CKD using RRT methods. CAPD has indisputable advantages in terms of both medical and economic benefit. In addition, the advantage of using CAPD over other dialysis modalities during the war is the absence of dependence on water and electricity supply, the number and workload of medical personnel, the need for patients to constantly visit the dialysis center.

Left Ventricular Mass Index in End-Stage Renal Disease Patients during Hemodialysis and Continuous Ambulatory Peritoneal Dialysis.

One of the primary reasons for high mortality in end-stage renal disease (ESRD) is cardiovascular disease in patients with renal replacement therapy (RRT). Left ventricular hypertrophy (LVH) significantly predicts mortality and cardiovascular events. We assess the left ventricular mass index change in two dialysis methods: hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). The factors associated with increased left ventricular mass index (LVMI). We recruit more than 50 HD patients and 45 CAPD patients with LVH of similar age, gender, dialysis duration, and LVMI for one-year follow-up. The LVMI in the group of HD patients after one year increased from 180.28 ± 45.32 g/m2 to 212.58 ± 66.22 g/m2 (p = 0.001), while the LVMI in the group of patients with CAPD increased from 190.16 ± 66.01 g/m2 to 197.42 ± 78 g/m2 (p = 0.32). Multivariable logistic regression analysis, we demonstrated that dialysis by HD (β = -1,167, 95% CI: 0.104-0.938, p = 0.036) and anemia treatment lower the goals (β = 1.9566, 95% CI: 1.466-34.094, p = 0.015) were two factors associated with the progression of the LVMI. The LVH of end-stage renal disease patients with HD treatment is worse than CAPD treatment after a follow-up in one year. Dialysis by periodic hemodialysis and anemia treatment that fails to achieve the goal are risk factors associated with increased progression of LVMI in patients with ESRD.

Does the Prolonged Duration of Continuous Ambulatory Peritoneal Dialysis Affect the Serum Levels of Endothelin-1 and Nitric Oxide?

End-stage renal disease and its treatment with continuous ambulatory peritoneal dialysis (CAPD) can affect almost all organs and organ systems including vascular endothelium. Consequently, disturbance in the production of vasoactive substances endothelin-1 (ET-1) and nitric oxide (NO) occurs in these patients. There are only a small number of studies that investigated the impact of long-term CAPD on imbalance in production of vasoactive substances ET-1 and NO among these patients. Therefore, our study aimed to investigate the impact of duration of CAPD on potential overproduction of ET-1 and NO in uremic patients. This study included 23 uremic patients [10 males, mean age: 56.3 (±16.2) years] treated with CAPD. All studied patients were further divided into subgroups, groups A and B. Group A included patients on treatment with CAPD <5 years, and group B included those on treatment longer than five years. Our results showed that serum levels of these vasoactive substances are significantly higher among patients treated with CAPD longer than five years (ET-1: 51.24 ± 32.11 vs. 139.53 ± 42.42; NO: 15.50 ± 2.57 vs. 26.57 ± 5.96, respectively). We concluded that imbalance in production of vasoactive substances is present in long-term CAPD treatment and this imbalance can lead to disturbance in the local blood flow control.

Risk Factors and Pathogen Spectrum in Continuous Ambulatory Peritoneal Dialysis-Associated Peritonitis: A Single Center Retrospective Study.

BackgroundTo investigate the incidence, risk factors, pathogen distribution, and drug resistance patterns in continuous ambulatory peritoneal dialysis-associated peritonitis (CAPDP).Material/MethodsClinical data for 248 patients who underwent continuous ambulatory peritoneal dialysis (CAPD) treatment in a single center in China from March 2018 to January 2021 were retrospectively collected. The patients were divided into the CAPDP group (n=40) and the non-CAPDP group (n=208) according to whether peritonitis occurred. The incidence rate, risk factors, bacterial distribution, and drug sensitivity of CAPDP were analyzed.ResultsThe incidence of CAPDP was 16.13%, and 87.5% of patients with CAPDP continued CAPDP treatment after anti-infection treatment. Patients with and without CAPDP were clearly distinguished, on the basis of their clinical characteristics, by using principal component analysis (PCA) methods. Logistic regression analysis found that body mass index (BMI; P=0.0095), albumin (P=0.016), albumin/globulin ratio (P=0.018), C-reactive protein (P=0.0001), and rapid transport (P=0.034) were independent risk factors for CAPDP. The main pathogens causing the CAPDP were Staphylococcus epidermidis (50.00%), Staphylococcus capitis (13.33%), and Escherichia coli (10.00%).Among the pathogenic bacteria, the main drugs to which gram-negative cocci were sensitive were imipenem, meropenem, piperacillin/tazobactam, cefoperazone/sulbactam, ceftazidime, and tigecycline. The main drugs to which gram-positive cocci were sensitive were vancomycin, teicoplanin, and linezolid. The drug resistance rate of pathogenic bacteria to penicillin G, ampicillin, compound trimethoprim, cefepime, ceftriaxone, and amoxicillin-clavulanic acid drugs was 36.26–100%.ConclusionsBMI, albumin, albumin/globulin ratio, C-reactive protein, and rapid transport are independent risk factors for CAPDP. Gram-positive bacteria are the main pathogens of CAPDP and are sensitive to vancomycin, teicoplanin, and linezolid.

Peritoneal dialysis in Dalmatian County, Croatia: 21 years of a single-center experience.

With end-stage renal disease becoming more prevalent, the importance of continuous ambulatory peritoneal dialysis (CAPD) is expected to rise even more. However, CAPD is associated with several infections with peritonitis being of the biggest importance. We collected data regarding acute peritonitis episodes (APEs), date of birth and CAPD start, BMI, diabetes mellitus (DM) prevalence, year of renal disease discovery, and details about renal replacement therapies. Primary outcomes included death, transplantation, and a switch to hemodialysis (HD). Hundred and twenty-nine men and 123 women were analyzed. 63 patients had DM. The median age at the start of CAPD was 56. The median length of CAPD treatment was 24 months. In the end, 147 patients were still alive of which 97 were transplanted, 33 were on CAPD, and 26 were switched to HD. A total of 327 APE were observed. Although the incidence is decreasing, efforts are required to enhance the prevention and treatment of APE.

Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China.

BackgroundTo analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China.MethodsPatients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student‘s t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale.ResultsThe health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26–15.82]); the change of Mental Component Summary with higher education (β = − 5.96, 95% CI [−10.18–−1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05–9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19–21.7]) and age (>60 years) (β = − 7.36, 95% CI [−14.11–−0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49–14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57–26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46–31.34]), age (>60 years) (β = − 12.12, 95% CI [−22.59–−1.65]), and higher education (β = − 10.38, 95% CI [−19.79–−0.98]).ConclusionsThe conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.

Evaluation of the causes affecting the development of pruritus in patients with peritoneal dialysis.

Several factors play a role in the pathogenesis of pruritus in uremic patients. The pathophysiology is complex and many factors have been identified in these patients. The aim of this study was to investigate the presence, severity, and possible causes of pruritus in patients with peritoneal dialysis (PD) . Eighty patients, who received continuous ambulatory peritoneal dialysis (CAPD) treatment, were included in this study. Biochemical measurements, parathormone, C-reactive protein (CRP), and vitamin B12 levels of all the patients were recorded. Furthermore, substance P (SP) levels were measured by ELISA methods. Patients were examined by a dermatologist and pruritus degrees were queried using the visual analog score (VAS) with skin dryness. In generalized linear model analysis, total urea clearance and SP independently predicted VAS scores. SP was significantly predictive in ROC analysis in identifying the VAS score in patients with peritoneal dialysis. The sensitivity and specificity of SP were 80% and 67% (cut-off > 364), respectively, with an area under the ROC curve of 0.757 (95% CI 0.650-0.865, p < 0.001). SP also was significantly predictive in ROC analysis in identifying xerosis in PD patients. Pruritus was proportional to the amount of substance P and total urea clearance was another reason affecting pruritus in peritoneal dialysis patients.

The occurrence and potential predictive factors of major adverse cardiac and cerebral events in end-stage renal disease patients on continuous ambulatory peritoneal dialysis: A prospective cohort study.

Major adverse cardiac and cerebral events (MACCE) are common complications, which prolong hospitalization and increase mortality rate in end-stage renal disease (ESRD) patients who underwent continuous ambulatory peritoneal dialysis (CAPD). Therefore, this study aimed to investigate MACCE occurrence and its potential predictive factors in those patients.In this prospective cohort study, 196 diagnosis of ESRD patients who underwent CAPD treatment in our hospital were eligible, and their clinical data (including demographic data and biochemical indexes) were documented. Besides, their MACCE occurrence was assessed within 3-year follow-up period.In patients, 1-, 2-, and 3-year MACCE occurrence rates were 5.1%, 11.7%, and 14.8%, respectively. Meanwhile, the mean duration of accumulating MACCE occurrence was 33.1 (95% confidence interval: 32.0–34.2) months. Furthermore, age, peritoneal dialysis duration (PDD), C-reactive protein (CRP), fasting blood glucose (FBG) and total cholesterol high correlated with increased accumulating MACCE occurrence, while high-density lipoprotein cholesterol (HDL-C) high correlated with decreased accumulating MACCE occurrence. Notably, by further multivariate Cox's proportional hazard regression analysis, age, PDD, CRP, serum uric acid, and FBG high were independent predictive factors for raised accumulating MACCE occurrence, while HDL-C high was an independent predictive factor for attenuated accumulating MACCE occurrence.MACCE are common; besides, age, peritoneal dialysis duration, C-reactive protein, serum uric acid, fasting blood glucose, and high-density lipoprotein cholesterol serve as potential markers for indicating MACCE in ESRD patients who underwent CAPD.

Biomechanics Perspective for the Design and Manufacture of Continuous Ambulatory Peritoneal Dialysis Connectors

Chronic kidney disease (CKD) progressively and irreversibly affects the kidneys and is considered a catastrophic disease on a global scale. Continuous ambulatory peritoneal dialysis (CAPD) is one of the most used methods of treatment, involving infusion and draining bags and a transfer line. Patients receiving this treatment have a catheter that is placed during surgery; this depends on having the same catheter supplies, as they are not compatible with other market brands. This research shows the comparison between connector brands used at the outlet of the Tenckhoff® catheter. The methodology shows the design of two connectors using the 3D printing technique. Numerical simulations were carried out to establish the flow patterns through each of the designs; the maximum values of velocity reached 74 mm/s inside the PISA to Baxter (PB) connector, while the pressure and vorticity were controlled and did not represent failures inside the connectors and threads connections. An experimental testbed was designed to verify the connections between the manufactured devices and the market brand elements. The results show numerical and experimental comparisons of the developed titanium-ELI connectors with no leaks at the connection points due to the lack of commercial supplies. These connectors can be used in the treatment of CAPD.

Serum Lipoprotein(a) Level and Apolipoprotein B/A1 Ratio in Patients of Hemodialysis and Peritoneal Dialysis: A New Approach to Predict Cardiovascular Risks in Chronic Kidney Disease

Background: Serum lipoprotein(a) and Apolipoprotein B/A1 ratio are new, independent cardiovascular risk factors in patients on dialysis. Conversely, the choice of dialysis procedure influences the uremic dyslipidemia in chronic kidney disease (CKD) patients.&#x0D; Objective: To compare lipoprotein(a) levels and apolipoprotein B/A1 ratio in patients of chronic kidney disease (CKD) stage 5 undergoing hemodialysis or peritoneal dialysis.&#x0D; Methods: This cross-sectional study was conducted in Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 2016 to March 2018. A total of 55 CKD stage 5 patients were included in the study – 31 in hemodialysis (HD) (group A) and 24 in continuous ambulatory peritoneal dialysis (CAPD) (group B). Group A patients were on low flux dialysis with bicarbonate dialysate 4 hours twice weekly dialysis with unfractionated heparin as anti-coagulant with a dialysis adequacy (Kt/V) &gt;1.2. Group B patients were on 3 exchanges over 24 hours with 2 litres of 1.5% glucose fluid with a weekly measured Kt/V &gt;1.7. Serum levels of Lipoprotein(a), Apolipoprotein B/A1 ratio were measured in both groups by using the standard laboratory technique.&#x0D; Results: In group A, most of the patients were in 31-50 years age group (45.1%), while in group B, majority belonged to &gt;50 years age group (54.16%). Patients’ gender showed a male predominance in both groups, i.e. 54.83% and 70.83% respectively. Most of the patients were from urban areas, i.e. 87.1% and 70.8% group A and B respectively. Dialysis adequacy (Kt/V) was found 1.46 for HD patients (group A) and 1.81 for CAPD patients (group B). Dyslipidemia was evident more in CAPD patients than HD patients, as per raised serum Lipoprotein(a) level (83.3% vs 74.1%) and raised Apolipoprotein B/A1 ratio (100% vs. 77.4%). Moreover, comparing with HD patients, CAPD patients showed increased level of serum Lipoprotein(a) (41.4±23.5 mg/dl vs 37.4±25.3 mg/dl; p&gt;0.05) and Apolipoprotein B/A1 ratio (1.59±0.24 vs 1.04±0.22; p&lt;0.001).&#x0D; Conclusion: The maintenance CAPD treatment is associated with more pronounced alterations of the lipoproteins and lipid metabolism than those observed during HD treatment. Besides, serum lipoprotein(a) level and apolipoprotein B/A1 ratio were found simple, accessible and effective markers of dyslipidemia in both groups.&#x0D; Bangladesh Crit Care J September 2020; 8(2): 91-95

Nutritional status and survival of End-Stage Renal Disease patients treated with continuous ambulatory peritoneal dialysis

The objective of the work was to study the survival peculiarities ofend-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) depending on the nutritional status and informative markers associated with it. Methods. 105 ESRD patients who received CAPD treatment during 2012 - 2017 years at the Kyiv Scientific and Practical Center of Nephrology and Dialysis, which is the clinical base of the State Institution "Institute of Nephrology National Academy of Medical Sciences of Ukraine" were included in the cohort prospective open study. The survival analysis was carried out both in the studied population as a whole and in groups depending on the nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA) points: the first group (n = 51) consisted of patients without malnutrition, the second group (n = 30) - patients with a mild degree of malnutrition, the third group (n = 13) - patients with a moderate degree of malnutrition, and the fourth group (n = 11) - patients with a severe degree of malnutrition. The survival analysis was conducted both in the groups in compliance with NS, and depending on the informational markers associated with NS, in particular, albumin, body mass index (BMI), residual renal function (RRF). Survival were calculated using the Kaplan-Meier method, and the difference between survival rates was analyzed using the log-rank test and χ². The starting date of peritoneal dialysis treatment was considered as the starting point of the monitoring. The difference was considered to be accurate at p &lt;0.05. Analyzed cases were included till January 7, 2019. The event risk assessment was carried out with the probability of relative risk (RR) values calculating their confidence intervals (95% CI). Results.Forty-three (40.95%) patients died during the current analysis, 17 patients were switched to the hemodialysis (HD), 4 patients had undergone kidney transplantations. Cardiovascular disease was the leading cause of death (41.9%), the second cause of death by frequency was bacterial infections (20.9%). Longer monitoring periods death rate was significantly higher in patients of group with an average (11/84.6% vs 14/27.45%, p &lt;0.0001; RR - 3.08; 95% CI: 1.8 -5.09)and a mild degree of nutritional disorders (ND) (11/84.6% vs 11/36.7%, p = 0.0018, RR - 2.3, 95% CI: 1.36-3.89) compared with normal NS.Similarly, the percentage of died patients with a severe ND degree was significantly higher than those with a normal nutritional status (7/63.6% vs. 14/27.45%, p = 0.0091, RR - 2.31, 95% CI: 1.23 - 4.35). The cumulative survival during the 1- year amounted to 90% of patients for 3 and 5 years - 64% and 41%, respectively. It was found that the survival rate of PD patients is credibly higher in groups with normal NS ormild ND degree than patients of group with a moderate or severe degree of nutritional disorders (χ2 = 22,9; df = 3; p = 0,00004). The cumulative survival for 1 and 3 years was 97%, 98%, 70%, 81% and 76%, 70%, 24%, 36% in groups of patients without nutritional disorder, with mild nutritional disorders, moderate and severe disorders, respectively. The cumulative survival with serum albumin level &lt;35 g/l and ≥ 35 g/l in 1 and 3 years was 73% vs 96% and 37% vs 74%, respectively (p = 0.00005, log-rank test). Similarly, the proportion of survivors with BMI &gt; 24 kg/m2 was apparently higher than those with an indicatorBMI ≤ 24 kg/m2, and it was in 1 and 3 years 94% vs 86% and 79% vs 47%, respectively (p = 0.00321, log-rank test). Veritable differences have been registered in the cumulative frequencies of survivors depending on RRF value: the survival rate was significantly higher among patients with RRF ≥ 5 ml/min/1.73 m² and significantly lower among patients with RRF &lt;2 ml/min/1.73 m2 (χ² = 17.4; df = 2; p = 0.00016). Conclusions.Thus, our studyfound that serum albumin level, BMI and RRF magnitude are the markers for the survival of ESRD patientstreated with PD. Veritable difference between the survival of patients depending on the nutritional status was stated. Three-year cumulative survival with mild degree of malnutrition group was twice as high as in severe nutritional disorders and it was 70% vs 36% (p &lt;0.001). The relative risk of death from all causes increases by 3.1 and 2.32 times for moderate and severe nutritional disorders patients compared to the patients group with normal NS.

Factors associated with nutritional status in peritoneal dialysis patients

The aim of our study was to examine the relationship between nutritional status (NS) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and dialysis-related factors.Methods. 105 patients who were treated by CAPD were included in this observational study. To assess the NS we determined the level of serum albumin, body mass index (BMI) and subjective global assessment (SGA). The study was carried out in two stages. At the first stage of the work PD patients’ nutrition status was examined. For further analysis, the patients were divided into four groups according to the condition of the NS: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild nutrition disorders, the third (n = 13) - with an average degree and the fourth (n = 11) with a severe degree of malnutrition. At the second stage of the work specialty of the nutritional status and residual renal function, frequency of PD-peritonitis, transport characteristics of the peritoneum were studied.Results. Nutritional disorders were observed in 54 (51.4 %) patients. A mild malnutrition was diagnosed in 28.7 % of patients, medium and severe in 12,38 % and 10,48% of patients, respectively. Parameters of NS, except BMI, were higher in patients without nutrition disorders (ND) comparing with the patients who had it. RRF was higher in patients without ND; but anuria was observed practically in all patients with severe ND. We receive direct relationship between the level of serum albumin and RRF (r = 0.53; p &lt;0,001), and SGA and RRF (r = 0.52; p &lt;0,001). Number of PD – peritonitis was lower in patients with normal NS and the highest in patients with severe ND. Strong correlation between the level of serum albumin, SGA, and the frequency and duration of peritonitis was established (r = - 0.59; p&lt;0,001 and r = - 0.59; p &lt;0,001 respectively). High transport characteristic of peritoneum was associated with lower degree of serum albumin and SGA (p &lt;0,001). There was no relationship established between SGA, serum albumin, BMI, age, duration of CAPD treatment, gender, and main nosology.Conclusions: Thus, ND were diagnosed in more than 50% of the examined patients. ND were associated with reduce of RRF, frequency and duration of PD-peritonitis, high transport characteristics of the peritoneum. There was no correlation between level of serum albumin, SGA and gender, duration of CAPD, main nosology and age. BMI did not have correlation with any parameters. The received data testify the necessity of constant monitoring of laboratory and functional parameters of the nutrition status.

A case of damage to a peritoneal dialysis tubing by a pet cockatoo and review of the literature

BackgroundPeritoneal dialysis (PD) access is important for patients undergoing PD. However, one of the potential complications of peritoneal dialysis access is damage to the dialysis tubing. Although most dialysis tubing damage is due to human error, there have been reports of damages attributed to pets owned by the patients. Much of the damage caused by pets has been attributable to cat biting or scratching, whereas the present case is an extremely rare case of dialysis tubing damage caused by a pet cockatoo.Case presentationA 65-year-old male with end-stage renal disease due to diabetic nephropathy who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years was admitted to our hospital with the chief complaint of dialysis tubing damage. While the patient was playing with his pet cockatoo on his belly after taking it out of its cage, the bird bit into his dialysis tubing of his transfer set without him realizing it, thus damaging the tube. The patient noticed that his dialysis tubing was leaking and realized that it had been damaged. He folded the end of the damaged tube, secured it with a rubber band to prevent further leakage, and made an emergency visit to our hospital. Upon inspection, we found that the dialysis tubing was completely disconnected, 28 cm from the metal connector of the connection tube. After consultation, the damaged tube was replaced. As a preventive measure for peritonitis, antibiotics were administered orally for 1 week (oral levofloxacin, 250 mg every 48 h). The patient was instructed to be careful when handling his cockatoo, and his CAPD treatment has been continued without incident to date.ConclusionThis is a rare case report of PD tubing damage caused by a cockatoo kept at home. It may be necessary to pay sufficient attention to PD equipment damage by birds in PD patients keeping large birds, such as cockatoos.

The impact of residual renal function on quality of life in patients with peritoneal dialysis .

Residual renal function (RRF) is a crucial factor that plays an important role in peritoneal dialysis (PD) patients, but whether RRF influences the quality of life (QOL) of PD patients is still controversial. The aims of this study were to explore the effects of RRF on QOL in patients with continuous ambulatory peritoneal dialysis (CAPD) and analyze the related factors that might affect patients' QOL. All 120 adult patients in this study received regular CAPD treatment for at least 3 months. Patients were divided into two groups: an RRF group (residual glomerular filtration (rGFR) ≥ 1 mL×min-1×(1.73m2)-1) and a non-RRF group (rGFR ≥ 1 mL×min-1×(1.73m2)-1). The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used as a reference to calculate the scores of CAPD patients for assessing their QOL. Multiple- and single-linear regression analysis was performed to analyze correlation degree of several SF-36-related indexes. The indexes of age, gender, cause of disease, complication, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), hemoglobin (HB), cholesterol, triglycerides, high- and low-density lipoprotein, normalized protein catabolic rate (nPCR), and cardiothoracic ratio (CTR) showed no difference between the two groups (RRF and non-RRF). Comparing with RRF group, the patients without RRF showed a significant difference on indexes of PD duration, urine volume, ultrafiltration volume, dialysis dose, serum albumin, potassium, Kt/V (urea reduction ratio), creatinine, calcium, phosphate, C-reactive protein (CRP), and parathyroid hormone (PTH). Single-linear regression analysis that achieved total score of SF-36 showed no correlation with rGFR, but there was a correlation of SF-36 score with CRP, creatinine, CTR, albumin, and ultrafiltration volume. These results suggested that there was no correlation between RRF and QOL in CAPD patients, but chronic inflammation, fluid overload, and malnutrition were considered as the main factors that affect patients' QOL. .

Fungal peritonitis in continuous ambulatory peritoneal dialysis patients; a study from South of India

Introduction: Fungal peritonitis is a potential life-threatening complication for patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Objectives: To assess the incidence and outcome of fungal peritonitis in CAPD patients. Patients and Methods: Dialysis records of all end-stage renal disease patients initiated on CAPD treatment were reviewed retrospectively. The study was conducted during January 2010 to December 2016. Mann–Whitney U test was applied for data analysis. Results: Out of 265 dialysis patients, a total of 36 fungal peritonitis were recorded. The incidence rate of fungal peritonitis was 13.6%. The majority of cases was affected by Candida albicans was 41.6%. Moreover, the major cause of end-stage renal disease (ESRD) in our study was diabetic nephropathy in 38.8% of cases. Conclusion: In this study, we found initiation of antifungal therapy and early removal of catheter reduced the mortality rate of fungal peritonitis in CAPD patients.

Intraperitoneal Amikacine Provoked Perceptive Deafness in CAPD - Continuous Ambulatory Peritoneal Dialysis Patient

Peritonitis (P) is the main complication and primary limiting factor in the extension of continuous ambulatory peritoneal dialysis(CAPD) in developing countries, because of exposure to potential external contamination, especially in people with unsatisfactory hygiene habits. We will present a case of peritonitis in 62 years old woman after the first three months of CAPD treatment. The peritoneal infection is confirmed by a cloudy fluid with increased WBC in the dialysis solution (2300..1300..1100 cells/mm; polymorphonuclears between 60% to 80%), augmented fluid protein content(cca.2.4 g/l), presence of microorganisms and symptoms of acute peritoneal infection(isolated Enterobacteria species, abdominal pain and diarrhoea). The peritonitis was treated following the Oreopoulos group’s recommendations and after a report of the sensitivity of the isolated Enterobacteria, with an appropriate antibiotic (Amikacine) in recommended intraperitoneal dose. Three days after successful treatment of peritonitis, the definite deafness is developed.

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

BackgroundIn peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously.MethodsThis retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk.ResultsUsing joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients.ConclusionThe results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients.

Bachground:Peritonitis and exit site (ES) infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing.Materials and Methods:This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection.Results:A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02). Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months). In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months), and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months) (P = 0.03). Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025) and in dressing group (52% vs. 15%, P = 0.003). In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01). Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 − 84.4; P = 0.045), and 4.4 in men (95% CI = 1.26 − 15.19; P = 0.02).Conclusion:In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.