Continuous Cycling Peritoneal Dialysis Patients Research Articles

Nutritional supplements and elevated serum vitamin A levels in children on chronic dialysis

Vitamin A is known to accumulate in patients with chronic renal failure (CRF), but it is present in many micronutrient and all complete nutritional supplements. Measurements were made of serum vitamin A concentrations in eight children (mean age 6 years, range 2–15 years) on chronic dialysis six continuous cyclic peritoneal dialysis patients (CCPD) and two haemodialysis (HD) patients, before and 6 months and 12 months after commencing a daily supplement containing vitamins A and D (Ketovite Liquid; Paines & Byrne Ltd, West Byfleet, Surrey, UK). Seven children were receiving complete nutritional supplements (two oral, five via gastrostomy buttons). Dietary energy and vitamin A intakes were determined by 3‐day dietary records. Prior to Ketovite Liquid supplementation, a mean of 68% (range 28–103%) of the reference nutrient intake (RNI) for vitamin A was provided by the diet, with a significant contribution from complete nutritional supplements. When receiving Ketovite Liquid supplementation, mean vitamin A intakes exceeded twice the RNI. Mean serum vitamin A concentrations (2.7±0.8 μmol/l) at baseline were above the revised normal reference range. Levels rose significantly post Ketovite Liquid supplementation at 6 months (mean 4.2±0.6 μmol/l, P<0.05) and 12 months (mean 4.8±0.8 μmol/l, P<0.05). This study confirms that vitamin A supplementation should be avoided in children on chronic dialysis. Any dietary supplement, either micronutrient or complete, must be carefully analysed for its potential contribution to total vitamin A intake.

A randomized trial of staphylococcus aureus prophylaxis in peritoneal dialysis patients: Mupirocin calcium ointment 2% applied to the exit site versus cyclic oral rifampin

The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71% white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin ( P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study ( P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin ( P = NS), both significantly lower than the center's historical rate of 0.16/yr ( P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin ( P = NS), both significantly lower than the center's historical rate of 0.12/yr ( P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.

Continuous Cycling Peritoneal Dialysis Is Associated With Lower Rates of Catheter Infections Than Continuous Ambulatory Peritoneal Dialysis

Continuous cycling peritoneal dialysis (CCPD), unlike continuous ambulatory peritoneal dialysis (CAPD), provides freedom from daytime exchanges and is associated with lower rates of peritonitis. However, catheter infection (CI) rates have not been reported for CCPD. Previous data suggested that a CAPD disconnect system (Y-set) was associated with lower rates of CI. These results suggested that patients on CCPD, which is also a disconnect system, might also have low CI rates. We evaluated our CCPD patients for infection rates and compared them with two groups of matched control CAPD patients, one using a spike system and one a Y-set disconnect system to evaluate this hypothesis. The CCPD patients had the lowest rates of CIs (0.5 episodes per year or one episode every 25 months), followed by the CAPD patients using the Y-set (0.8 episodes per year or one episode every 14 months). CAPD patients using the spike system had the highest rates of CIs (1.2 episodes per year or one episode every 10 months). Peritonitis rates followed the same pattern among the patient groups: CCPD, 0.3 episodes per year; CAPD, Y-set 0.5 episodes per year; CAPD, spike system 1.3 episodes per year. Our data suggest that disconnect systems, such as the CAPD Y-set and CCPD, reduce CIs, as well as peritonitis.

Peritoneal Macrophages in Short Dwell Time Effluent Show Diminished Phagocytosis

We investigated the effect of different i.p. dwell times of dialysis fluid on the composition and phagocytic capacity of the peritoneal cells. We examined dialysate after 1.5 and 15 h dwell time in 10 continuous cyclic peritoneal dialysis (CCPD) patients and after 8 h dwell time in 14 continuous ambulatory peritoneal dialysis (CAPD) patients. There was no significant difference in viability, composition, and Fc receptor positive cells among the peritoneal cells in the studied effluents of CCPD and CAPD patients. However, the yield of peritoneal cells and the phagocytic capacity of IgG-coated sheep red blood cells ([lgG]SRBC) by peritoneal macro phages in 1.5 h dwell time dialysate was significantly decreased when compared with 15 h dwell time dialysates. In addition, the total phagocytic capacity of peritoneal cells in 1.5 h dwell time dialysate is dramatically decreased when compared with the 15 h dwell time dialysate and 8 h dwell time dialysate of CAPD patients. These findings must be taken in consideration by performing three rapid exchanges after the diagnosis of a peritonitis.

Continuous ambulatory and continuous cycling peritoneal dialysis in children. A report of the Southwest Pediatric Nephrology Study Group

Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have become acceptable methods of treatment for children with endstage renal disease (ESRD). In this study we have compared the effectiveness of these two modalities of prolonged dwell peritoneal dialysis in 82 children treated at home with CAPD and/or CCPD for a mean of 10.2 months. Forty variables were evaluated during 92 patient periods (63 CAPD, 29 CCPD). There was no difference between the two groups with regard to sex, race, original disease, duration of dialysis, or volume of dialysis fluid. The only difference in biochemical profiles between the two groups was a higher serum creatinine in CCPD patients due in part to this group's greater age. The rate of peritonitis was not different (CAPD 1/4.6, CCPD 1/5.2 months), but the number of patient periods devoid of peritonitis was greater in the CCPD group (14/29 vs. 17/63, P = 0.04). Growth velocity index (GVI) and standard deviation scores (SD scores) were used to evaluate growth in the total group and subsets according to age. Overall GVI was 88% of expected and did not differ between PD groups (CAPD 88% vs. CCPD 89%). There were no significant changes in SD scores for growth during the course of prolonged dwell peritoneal dialysis indicating that the children did not experience further deterioration in growth. Children less than 4 years of age also did not have significant changes in SD scores. We conclude that CAPD and CCPD provide acceptable and comparable modes of dialytic therapy for children with ESRD.