Continuous Peritoneal Dialysis Research Articles

Continuous flow peritoneal dialysis in a paediatric intensive care unit

Continuous flow peritoneal dialysis in a paediatric intensive care unit

Emergency Continuous Peritoneal Dialysis using Flexible Tenckhoff Catheter inserted with Reinforced Purse String Suture : An efficient substitute of renal replacement therapy in Critically Ill Patients with AKI when Intermittent Hemodialysis, Sustained lo

Introduction : Renal replacement therapy (RRT) is often used to treat critically ill patients associated with acute or chronic renal failure. Peritoneal dialysis (PD) is an option when intermittent hemodialysis (IHD), sustained low efficiency dialysis (SLED) or Continuous renal replacement therapy (CRRT) are not feasible. PD customarily uses rigid catheter and cannot be used for more than 3 days as there is increased chance of infection and it can cause perforation of hollow viscera and often there is hemorrhage due to trauma to the adjacent organs. In this study we used Tenckhoff flexible PD catheter with double cuff and reinforced purse string suture1, So it can be used on an emergency basis and for indefinite period with minimal chances of complications commonly associated with rigid PD catheter. In this observational study emergency CPD using the procedure mentioned above in a compromised group of renal insufficiency patients was explored.Objectives : To determine if emergency RRT can be achieved by CPD using flexible Tenckhoff catheter placed with special reinforced sutures when IHD, SLED or CRRT is not feasible in critically ill patients.Material and Methods : Patients who failed to tolerate IHD, SLED or CRRT because of resulting hemodynamic instability and those who required dialysis urgently and for a prolonged period in Intensive Care Unit (ICU) were selected. There were 58 study cases who received emergency CPD after fulfilling inclusion criteria using flexible Tenckhoff catheter placed with special reinforced suture. These patients were on various life-support modalities having multiple co-morbidities. Regular exchanges were started manually with small volume on the day or the next day of catheter implantation, initially with 0.5-1 liter/session and subsequently with 2 liters per session after 15 days. Serum creatinine of study subjects were followed for 45 days and study subjects were followed for up to a year to check for survivability.Results : In 58 critically ill cases that fulfilled the criteria were included in the study. Average age was 67.05±14.43 years and 66% were male. Majority were diabetic 48 (82.75%) and the cause of AKI were sepsis in 39 cases (67.2%) acute cardiovascular insufficiency in 9 cases (AMI & NSTEMI 15.5%), gastroenteritis in 3 cases (5.2%), stroke in 4 cases (6.9%) and multi organ failure in 7 cases (12.1%). Average creatinine at the initiation of dialysis was 7.68 ± 3.15 and after 5 days it was 5.86± 2.8, after 10 days 4.08 ± 2.61, after 15 days 2.87 ± 2.1, one month 2.32± 1.90 and after one and a half months 2.31± 1.88. Volume overload was the indication of CPD in 22 (37.93%) patients but main indication was uremia in 36 (62.06%) cases. In ICU 23 (39.7%) patients expired within a short (within 7 days) period. In the remaining 30(42.9%) survived beyond 4 weeks (51.7); 22 (37.9%) beyond 12 weeks; 14(24.1%) beyond 24 weeks and 5(8.6)% beyond 1 year. In 4 (2.32%) patients PD catheter was removed as renal function improved. 35 patients were on mechanical ventilator and out of them 18 patients were weaned of mechanical ventilator (MV). 26 MV patents (including weaned off) survived beyond 4 weeks. Mechanical complications from PD catheter in situ were very low and there was catheter related infection only in two cases.Conclusion : Emergency CPD can be an alternate mode of renal replacement therapy (RRT) in critically ill patients where emergency IHD, SLED or CRRT are not feasible. It was accompanied with low risk of procedure related complications and well tolerated.Bangladesh Crit Care J March 2016; 4 (1): 3-8

The Role of RRT in Hyperammonemic Patients.

Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body's own mechanisms for clearing ammonia as well as the dialytic properties of ammonia. We review the available literature on the use of continuous venovenous hemofiltration, peritoneal dialysis, and hemodialysis in neonates and adults with conditions characterized by hyperammonemia and discuss some of the controversies that exist over selecting one modality over another.

We Use Kt/V Urea as a Measure of Adequacy of Peritoneal Dialysis.

In the early days of chronic dialysis therapy, there was recognition that patients on continuous peritoneal dialysis enjoyed improvement in symptoms and signs of kidney failure similar to those receiving hemodialysis, despite slower removal rates of small solutes such as urea and creatinine. It was suggested that removal of toxic middle molecular weight solutes by the peritoneal membrane compensated for this difference. The publication of the National Cooperative Dialysis Study then focused attention on urea clearance as a significant predictor of hospitalization in hemodialysis patients. The peritoneal dialysis community made a mistake in adopting urea kinetics to the peritoneal dialysis process, while ignoring the benefits incumbent in continuous dialysis therapy and middle molecular weight solute removal. Sadly, to this day, despite the publication of many studies that have been unable to find an association between peritoneal small solute kinetics and outcome, Kt/V urea is employed as a marker of adequacy in these patients.

High glucose concentration-induced expression of pentraxin-3 in a rat model of continuous peritoneal dialysis.

Continuous exposure to peritoneal dialysis fluids (PDFs) is associated with pathological responses such as persistent micro-inflammation, which leads to ultrafiltration failure. Pentraxin-3 (PTX3), a multifunctional soluble pattern recognition receptor, is produced at sites of inflammation by a wide range of cell types. This study investigates the in vivo expression of PTX3 in the peritoneal membrane of a rat continuous peritoneal dialysis (PD) model, as well as the effect of high glucose on the in vitro expression of PTX3. The expression of PTX3 was analyzed using RT-PCR, real-time PCR, immunohistochemistry and western blotting in a PD rat model receiving saline or conventional PDF containing 3.86% glucose for 8 weeks. The effects of high glucose on the expression of PTX3 were examined in cultured rat peritoneal mesothelial cells (RPMCs), mouse macrophage-like cells, and mouse fibroblasts. In a rat model of PD, eight-week instillation of the conventional PDF produced increased submesothelial thickening, followed by substantially enhanced PTX3 protein levels in the submesothelial layer of peritoneal membrane. PTX3 was detected in peritoneal mesothelial cells, macrophages and fibroblasts in the thickened submesothelial area. Glucose was found to induce PTX3 protein expression in RPMCs as well as macrophage-like cells and fibroblasts. Continuous exposure to conventional PDF induces PTX3 expression in the peritoneal membrane of rats. High glucose may be involved in the mechanism of PDF-induced local micro-inflammation in the peritoneum.

Continuous flow peritoneal dialysis (CFPD) improves ultrafiltration in children with acute kidney injury on conventional PD using a 4.25 % dextrose solution

Criticism against the use of acute peritoneal dialysis (PD) has been its low clearance and low ultrafiltration (UF) volumes compared to extracorporeal techniques. The aim of our study was to determine whether continuous flow peritoneal dialysis (CFPD) would improve UF in children with acute kidney injury (AKI) in cases where UF on conventional PD was inadequate using 4.25% glucose concentrations. Five infants were prospectively studied. All had AKI with fluid overload. The median age of the patients was 6 (range 0.43-9) months; the median weight was 6.5 (range 2.7-8.4) kg. Each patient served as his or her own control, undergoing both CFPD and conventional PD. CFPD was performed with two bedside-placed catheters using a 2.5% glucose concentration. After initial filling, a dialysate flow rate of 100ml/min/1.73m(2) was maintained with an adapted continuous venovenous haemofiltration machine. The UF flow rate was set at 2.5ml/min/1.73m(2) and adapted as necessary. UF and clearance rates were measured for both PD and CFPD. The median UF rate achieved was 1.7 (range 0.01-5.30) mg/kg/h with conventional PD versus 6.7 (range 2.17-15.7) mg/kg/h with CFPD (p = 0.042). The clearances of urea and creatinine were 6.89(range 4.50-7.55) and 7.46 (range 4.79-10.50)mL/min/1.73m(2), respectively, with conventional PD and 19 (17.0-30.0) and 41 (standard deviation17.4, range 12.0-52.0) mL/min/1.73m(2), respectively, with CFPD (both p = 0.043). Continuous flow peritoneal dialysis improves UF in fluid overloaded infants who are not achieving adequate UF on conventional PD.

Comparison of Peritoneal Low-Molecular-Weight-Protein-Removal in CCPD and CAPD Patients Based on C-Terminal Agrin Fragment Clearance

Background/Aims: This study compares the peritoneal elimination of the low-molecular-weight-protein (LMWP) C-terminal agrin fragment (tCAF, size 22 kDa), a promising biomarker for kidney function, in continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: 103 sets of serum, 24h-urine and dialysate samples were obtained in 15 CCPD (63 sets) and 11 CAPD (40 sets) patients. Total, renal and peritoneal substrate removals/clearances were measured/calculated for tCAF, creatinine, blood-urea-nitrogen (BUN), cystatin C and albumin and correlated with the peritoneal transport type. Results: Serum und urine concentrations of all biomarkers did not differ between both groups, urinary substrate removal was higher in CAPD patients for all biomarkers due to better residual renal function. Peritoneal substrate removal of tCAF and albumin were significantly higher in CAPD (tCAF: 35.3 vs. 19.3 µg/d, p<0.001; albumin: 4.3 vs. 3.7 g/d, p=0.001), whereas cystatin C and creatinine did not differ between CAPD and CCPD (cystatin: 7.7 vs. 6.1 mg/d, p=0.08, creatinine: 423.9 vs. 456.7 mg/d, p=0.241). BUN was better removed by CCPD (4846.6 vs. 3393.4 mg/d, p<0.001). CAPD patients with high-transporter characteristics had a higher peritoneal tCAF removal compared to high-average-transporters (49.8 vs. 28.4 µg/d, p<0.001), no differences could be detected in CCPD patients between these groups. CAPD patients using icodextrin twice/day had higher peritoneal clearance of tCAF compared to once daily (4.4 vs. 2.8 l/wk/1.73 m2 body-surface-area, p<0.001). Conclusions: CAPD was superior to CCPD concerning peritoneal tCAF removal. This finding was pronounced in high-transporters and CAPD patients using icodextrin twice daily.

Successful Continuation of Peritoneal Dialysis after "Sweet" Hydrothorax

Abstract A 44-year-old woman with end-stage renal disease presented with dyspnea on exertion and a vague chest pain about two weeks after commencing continuous ambulatory peritoneal dialysis (CAPD) four months ago. A chest x-ray revealed massive unilateral right-sided pleural effusion. Laboratory analysis of the effusion revealed low protein and lactate dehydrogenase but elevated glucose levels were consistent with transudate and pleuroperitoneal leakage. Pleural glucose concentration was much higher than patients’ serum glucose concentration, which was suggestive of "sweet" hydrothorax because of this high glucose concentration. It is advisable to keep this condition in mind among the differenttial diagnoses of hydrothorax in patients on CAPD.

Simultaneous abdominal wall defect repair and Tenckhoff catheter placement in candidates for peritoneal dialysis.

IntroductionThe presence of pre-existing abdominal wall defect (AWD) could represent a potential contraindication for peritoneal dialysis (PD) treatment. We report the results of our 6-year experience involving simultaneous repair of pre-existing AWD and catheter insertion for PD.MethodsPatients with estimated glomerular filtration rate (e-GFR) 7–10 ml/min attending a single nephrology clinic between January 2008 and December 2014 were evaluated. Simultaneous AWD repair and catheter placement was performed. For inguinal (IH) or umbilical hernia (UH), a prolene mesh repair technique was adopted. Except for one case of total anaesthesia, the surgical procedure was performed under either spinal or local anaesthesia. Ceftazidime alone or in association with quinolones was administered 1 h before surgery in a single dose. Patients were discharged 2 days after surgery, and returned to the clinic twice during the 1st week for peritoneum washing (first volume of peritoneal dialysis solution: 300 ml). From week 3, volume (2000 ml) and dwells were personalized according to the patient’s clinical condition; options were: incremental PD, standard PD, or continuous cycling PD. Surgical follow-up was planned at 1, 6, and 12 months.ResultsPeritoneal catheters were inserted in 170 patients. IH, UH and incisional hernia were found in 18, 2 and 1 patients, respectively. IH was bilateral in 4 patients; concomitant IH and UH occurred in 1 patient. There were no deaths, nor intra-operative complications apart from scrotal haematoma in 1 patient. Over a mean follow-up of 551 days (range 342–1274) no hernia recurrence was registered and the peritoneal catheter continued functioning without problems.ConclusionsSimultaneous AWD repair and peritoneal catheter placement seems a reliable and safe surgical procedure that allows patients with AWD to benefit from PD treatment.

Peritoneal dialysis for acute renal failure in premature infants

Objective To investigate the effectiveness and safety of peritoneal dialysis(PD) in premature infants with acute renal failure(ARF). Methods In the neonatal intensive care unit (NICU) of Guangdong Province Maternal and Children Hospital, 12 premature infants underwent continuous PD due to ARF from March 2012 to March 2015, without using any antibiotics in the dialysis fluid. Before and after dialysis, the changes of serum urea nitrogen, creatinine, potassium and pH were compared. The complications (blockage, leakage, infection and necrotizing enterocolitis) and gastrointestinal nutrition situation were observed. Wilcoxon signed rank sum test was used for statistical analysis. Results Among the 12 premature infants, the underlying causes of ARF were sepsis (n=9), perinatal asphyxia (n=2), twin-twin transfusion syndrome (n=1). The average gestational age was (30.9±3.2) weeks, the average body weight (before PD) was (1 461±525) g, the duration of PD was (3.8±2.6) d. Complications associated with PD included leakage (n=3) and peritonitis (n=2) in which Candids albicans and Klebsiella pneumonia were identified in ascites. Gastrointestinal nutrition was built up in six cases within one to four days after dialysis, among which one developing necrotizing enterocolitis on the 7th d after feeding. Finally, eight babies died (six died after initiative discontinued treatment and two died because of critically illness) and four patients were cured and discharged. Lower serum urea nitrogen and potassium levels and higher pH value were shown after dialysis than before [(9.16±3.15) vs (12.71±6.98) mmol/L; (4.36±0.82) vs (6.24±1.72) mmol/L; 7.32±0.17 vs 7.21±0.17; Z=-2.118, -2.197 and -2.981, all P<0.05). Conclusion PD is an alternative safe and effective treatment for premature infants with ARF due to its simplicity both in manipulation and equipment requirement. Key words: Acute kidney injury; Peritoneal dialysis; Infant, premature

Update on Peritoneal Dialysis: Core Curriculum 2016

Update on Peritoneal Dialysis: Core Curriculum 2016

The Effect of Glycated Hemoglobin and Albumin-Corrected Glycated Serum Protein on Mortality in Diabetic Patients Receiving Continuous Peritoneal Dialysis.

To explore the effect of glycated hemoglobin (HbA1c) and albumin-corrected glycated serum proteins (Alb-GSP) on the mortality of diabetic patients receiving continuous peritoneal dialysis (PD). In this single-center retrospective cohort study, incident diabetic PD patients from January 1, 2006, to December 31, 2010, were recruited, and followed up until December 31, 2011. The effect of HbA1c and Alb-GSP on mortality was evaluated by Cox proportional hazards models. A total of 200 patients (60% male, mean age 60.3 ± 10.6 years) with a mean follow-up of 29.0 months (range: 4.3 - 71.5 months) were recruited. Sixty-four patients died during the follow-up period, of whom 21 died of cardiovascular disease (CVD). Mean values for HbA1c, GSP and Alb-GSP were 6.7% (range: 4.1 - 12.5%), 202 μmol/L (range: 69 - 459 μmol/L), and 5.78 μmol/g (range: 2.16 - 14.98 μmol/g), respectively. The concentrations of GSP and Alb-GSP were closely correlated with HbA1c (r = 0.41, p < 0.001 and r = 0.45, p < 0.001, respectively). In multivariate Cox proportional hazards models, patients with HbA1c ≥ 8% were associated with increased risk of all-cause mortality (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.06 - 4.96, p = 0.04), but no increased mortality in patients with 6.0% ≤ HbA1c ≤ 7.9%. Patients with Alb-GSP ≤ 4.50 μmol/g had increased all-cause and non-cardiovascular mortality (HR = 2.42, 95% CI: 1.13 - 5.19, p = 0.02; and HR = 2.98, 95% CI: 1.05 - 8.48, p = 0.04 respectively). Increased HbA1c and decreased Alb-GSP may be associated with poorer survival in diabetic PD patients, with a non-significant trend observed for poorer survival with the highest level of Alb-GSP.

Telmisartan attenuates peritoneal fibrosis via peroxisome proliferator-activated receptor-γ activation in rats.

Peritoneal dialysis (PD) is an effective treatment for patients with end-stage renal diseases, but long-term continuous PD causes peritoneal fibrosis (PF). This study aims to evaluate the anti-fibrotic effect of telmisartan on a rat model of PF and to investigate the underlying mechanisms. Five-sixths kidney nephrectomy and PD were used to establish the PF rat model. Glucose (2.5%) was used to establish an invitro model in rat peritoneal mesothelial cells (PMC). Haematoxylin-eosin staining was used to examine the structural alterations. Masson's trichrome staining was used to observe the tissue fibrosis in peritoneal membrane of rats. Real-time polymerase chain reaction was used to measure messenger RNA expressions of profibrotic factors. Western blotting was used to determine protein expressions of profibrotic factors, peroxisome proliferator-activated receptor-γ, and mitogen-activated protein kinases (MAPK). Results demonstrated that administration of telmisartan dose-dependently attenuated the thickening of the peritoneal membrane and the fibrosis induced by long-term PD fluid exposure in rats. In addition, telmisartan treatment inhibited the upregulation of profibrotic factors induced by PD in the peritoneum of rats and by high-concentration glucose in PMC. Telmisartan was also effective in inhibiting PD and high-concentration, glucose-induced phosphorylation of MAPK in the peritoneum and PMC. Furthermore, peroxisome proliferator-activated receptor-γ (PPARγ) inhibitor GW9662 blocked these protective effects of telmisartan in PMC. The results suggest that telmisartan is effective in attenuating PD-induced PF, and this effect may be associated with the inhibition of profibrotic factor expression and MAPK phosphorylation via PPARγ activation.

G485(P) Acquired hypothyroidism in infantile peritoneal dialysis: the role of iatrogenic iodine exposure

Povidine–iodine within disconnect caps of peritoneal dialysis (PD) sets have been reported to potentially contribute to hypothyroidism1–3. The Medicines and Healthcare Products Regulatory Agency (UK) alert (2006) for PD caps, suggests this is more likely to affect infants and children with smaller peritoneal fill volumes, where higher dialysate iodine concentrations can result. We report two infants with end–stage renal failure (ESRF) receiving continuous cycling peritoneal dialysis (CCPD) who developed hypothyroidism. Both infants had normal newborn blood spot screening (TSH Case 1, a male infant with ESRF secondary to posterior urethral valves, commenced PD on day 6. He received manual PD for 6 weeks, followed by automated CCPD when minimum fill volumes were achieved. Case 2, a male infant with ESRF secondary to congenital obstructive uropathy commenced manual PD, from day 7 to 9 and subsequently aged 7 weeks. Manual PD was continued for 4 weeks followed by automated CCPD. Manual PD potentially allows for increased iodine exposure from both long–line connexion shields and PD caps. Profound primary hypothyroidism was identified in both individuals, with free T4 levels 100mu/L (day 54, case 1; day 85, case 2), necessitating levothyroxine treatment. Symptoms were masked by significant comorbidity. Both patients had negative thyroid peroxidase antibodies and were noted to have bulky thyroid glands on ultrasound, consistent with iodine toxicity. They remain on levothyroxine treatment, aged 4 and 5 months respectively. These cases highlight the potential role of povidine–iodine in PD caps and long–line connexion shields in the development of primary hypothyroidism. Given the significant morbidity associated with hypothyroidism in this age group, increased awareness of the associated risk is essential, with regular screening of this at–risk group to ensure early detection and treatment.

Peritoneal Dialysis is Limited by Kidney and Liver Volume in Autosomal Dominant Polycystic Kidney Disease.

We evaluated the influence of kidney volume (KV) and liver volume (LV) on continuation of peritoneal dialysis (PD) in patients with autosomal dominant polycystic kidney disease (PKD). Twenty-two PKD patients on PD were retrospectively investigated after being divided into two groups. Group 1 comprised 15 patients who started PD at our hospital and group 2 was composed of seven patients referred from other hospitals for treatment of renomegaly by transcatheter arterial embolization (TAE) at 47.1 ± 21.8 months after commencing PD. In group 1, KV for both kidneys (mean ± SD) was 2787 ± 1945 mL (range: 1043 to 6816 mL), LV was 2198 ± 1139 mL (1005 to 4116 mL), and the total organ volume (TV=KV+LV) was 4985 ± 1815 mL (2320 to 8912 mL). In the patient with the largest TV from group 1 (KV of 6816 mL, TV of 8912 mL, and TV/BMI ratio of 426, PD was stopped due to dialysate leakage. However, dialysate leakage did not occur in the other 14 patients (TV ≦ 7963 mL and TV/BMI ratio of 353 at the start of PD). In group 2, KV was 5822 ± 1597 mL (3832 to 8862 mL), LV was 1776 ± 519 mL (1271 to 2671 mL), and TV was 7597 ± 1431 mL (5505 to 10358) before TAE. Leakage of dialysate did not occur with a mean infusion volume of 1530 ± 370 mL (1000 mL to 2000 mL), even after renomegaly and hepatomegaly progressed to the maximum TV/BMI ratio of 359. Six patients from the two groups developed new abdominal hernias at 36 ± 5 months (6-55 months) after starting PD. These findings suggest that performance of PD may be limited by renomegaly and hepatomegaly in patients with PKD.

Staged Hand-Assisted Bilateral Native Nephrectomy for Management of Posttransplant Polyuria in an Adult with Dent's Disease.

Polyuria after kidney transplantation causes graft dysfunction and increased thrombotic risk. We present a case of a polyuric adult with Dent's disease who underwent staged bilateral native nephrectomies, the first operation before transplant and the second four months after transplant. This led to improved allograft function maintained during four years of follow-up. The retroperitoneal laparoscopic approach was well tolerated and allowed continuation of peritoneal dialysis before transplantation. A staged approach helps regulate fluid balance perioperatively and may be tailored to individual need according to posttransplant urine output. This novel approach should be considered for polyuric patients with tubular dysfunction including Dent's disease.

Clinical outcomes of acute kidney injury patients treated in a single-center, sub-urban satellite hospital.

Acute kidney injury (AKI) is a common diagnosis among critically ill patients. Although the etiology of AKI will determine the appropriate initial management, the definitive management of established AKI is still debatable. This is a retrospective, observational, single-center analysis of a cohort of patients referred to the nephrology unit for AKI from 1st August 2010 to 31st January 2011. Those patients with indications for dialysis were treated with continuous renal replacement therapy, intermittent hemodialysis or stiff-catheter peritoneal dialysis as determined by their hemodynamic status and the technical availability of the method. The 30-day mortality rate, renal outcomes and independent prognostic factors were analyzed statistically. Seventy-five patients were reviewed. The mean age was 52.9 ± 14.5 years. Two-thirds were males and 75% were Malays. 53.3% were referred from intensive wards. Pre-renal AKI and intra-renal AKI were diagnosed in 21.3% and 73.3% patients, respectively. Sepsis was the most common cause (n = 59). The pathogens were successfully cultured in 42.3% of the cases. The median urea and creatinine were 30.4 [interquartile range (IQR) 20.3] mmol/L and 474 (IQR 398.0) μmol/L, respectively. Seventy-six percent had metabolic acidosis. Oliguria was only noted in 38.7% of the patients. Sixty percent (n = 45) of the referrals were treated with conventional, intermittent hemodialysis and 22.7% (n = 17) with continuous veno-venous hemofiltration. The 30-day mortality rate was 28%, and was higher in intensive wards (37.5% versus 17.1%). Thirty-one percent (n = 20) had complete recovery, 17 (26.6%) had partial recovery without dialysis and seven (10.9%) became dialysis dependent. The 30-day mortality rate was 28%. Referral from intensive wards was the only significant poor prognostic factor in our patients and not the dialysis modalities.

Automated cyclers used in peritoneal dialysis: technical aspects for the clinician.

Peritoneal dialysis (PD) is a widely accepted and increasingly popular form of dialysis. The invention and technological advancement of the PD cycler further makes PD a convenient option. Prescription-specific parameters are entered into the cycler, which then automatically carries out the steps involved in continuous cycling PD. We review the basics, technical aspects, challenges, and advancements of the cycler.

Successful renal transplantation in the setting of Alcaligenes xylosoxidans peritonitis treatment

We report a patient with continuous cycling peritoneal dialysis (CCPD)-associated peritonitis caused by A. xylosoxidans who successfully received a renal transplant during his peritonitis treatment course and cleared his peritoneal infection. This is the first case of A. xylosoxidans-related CCPD peritonitis who was successfully transplanted.

Peritoneal Dialysis in China: A Story of Growth and Innovation

Peritoneal Dialysis in China: A Story of Growth and Innovation