First Episode Of Peritonitis Research Articles

Longitudinal changes of solute transport in peritonitis-free peritoneal dialysis patients.

The aim of this study was to evaluate the longitudinal changes in peritoneal transport in patients on long-term, peritonitis-free, continuous ambulatory peritoneal dialysis (CAPD) therapy. Results were longitudinally recorded for the standard peritoneal equilibration test (PET) in 76 consecutive, nondiabetic, adult patients from the beginning of CAPD therapy until their first episodes of peritonitis, abdominal surgery, or any cause of drop out. The PET results were evaluated once annually using the dialysate-to-plasma ratio of creati-nine (D/PCr) and the dialysate-to-instilled dextrose ratio (D4/D0) at 4 hours after beginning dialysis. A total of 168 PET results were obtained. A statistically significant tendency toward decreased D/PCr and increased D4/D0 values over time for up to 3 years was found. This study shows a tendency toward progressive decline in small molecular transport over time in nondiabetic patients with uneventful CAPD therapy. Sequential PET follow-up cannot be overlooked in peritonitis-free CAPD patients.

A Prospective Randomized Study of the Effect of a Subcutaneously “Buried” Peritoneal Dialysis Catheter Technique versus Standard Technique on the Incidence of Peritonitis and Exit-Site Infection

A new method for implantation of peritoneal dialysis (PD) catheters was described in 1991. The distal part of the catheter is buried subcutaneously and exteriorized at the start of PD. This study was designed to evaluate the effect of such a subcutaneous rest period on the incidence of peritonitis and exit-site infections (ESI). Sixty patients were randomized to either the new method (B group; n = 30) or to not having the distal part buried subcutaneously (NB group; n = 30). Sixty-five patients (NS group) were not randomized as they had to start PD within 1-2 weeks after implantation. The Moncrief-Popovich catheter was used in the B and NB groups and a standard Tenckhoff catheter was used in the NS group. Patients scheduled for PD treatment, judged not in need of PD for at least 6 weeks after implantation. There was no statistically significant difference in the cumulative probability of not developing peritonitis during the first 6, 12, and 24 months. The incidence of the first episode of peritonitis was 1/40, 1/26, and 1/33 treatment-months in the B, NB, and NS groups, respectively. The incidence of ESI was 1/103 and 1/95 treatment-months in the B and NS groups, respectively. The cumulative probability of not developing ESI was similar in both groups. There were no episodes of ESI in the NB group. The difference in the number of ESI between the NB and NS groups was significant (p < 0.05). Subcutaneous burying of the distal catheter segment prior to starting PD does not reduce the risk of contracting peritonitis or exit-site infection.

Peritonitis Prevention in CAPD: To Mask or Not?

To assess the efficacy of wearing a face mask to prevent peritonitis during continuous ambulatory peritoneal dialysis (CAPD) bag exchange. Renal unit at a university hospital. Two groups of patients on CAPD were compared: those performing bag exchange with (n = 24) and those without a face mask (n = 40). Occurrence of first episode of peritonitis and total number of episodes. No difference was found between groups with respect to probability of developing the first episode of peritonitis (p = 0.757). Patients holding university degrees had evidence of protection, with borderline significance [relative risk (RR) 0.52; confidence interval (CI) 95%, 0.23 -1.18; p= 0.109]. Cox's proportional hazard regression analysis also demonstrated a significant protective factor for patients with university level education (RR 0.42; Cl 95%, 0.18 - 0.98; p = 0.04). Incidence of peritonitis was not significantly different between groups: with-mask group had 1.0 episode/year, and without-mask group had 0.94 episodes/year. Staphylococcus epidermidis was the most commonly identified agent. Staphylococcus aureus was found more frequently in the with-mask group (p = 0.003). Peritonitis due to Streptococcus viridans and Enterococci were detected only in the without-mask group. The current study suggests that routine use of face masks during CAPD bag exchanges may be unnecessary and could be discontinued.

OERSKOVIA XANTHINEOLYTICA PERITONITIS: CASE REPORT AND REVIEW

OERSKOVIA XANTHINEOLYTICA PERITONITIS: CASE REPORT AND REVIEW

Race and the risk of peritonitis: An analysis of factors associated with the initial episode

To study how clinical characteristics influence the risk of peritonitis in African American patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (CAPD), we examined the risk of developing a first episode of peritonitis among 1,595 new dialysis patients initially treated by CAPD over a two year period in North Carolina, South Carolina, and Georgia (Network 6). Characteristics examined were demographic and socioeconomic factors, functional status, serum albumin and comorbid conditions. There were 538 initial episodes of peritonitis during an average of 8.8 patient months of follow-up; the time to peritonitis for the entire cohort was 26 months. Factors found to be independently associated with a risk for peritonitis were student status (Odds Ratio and 95% Confidence Interval = 2.4; 1.4 to 4.3), rental housing (1.2; 1.0 to 1.5), and substance abuse (1.9; 1.1 to 3.2). African Americans were 60% more likely to have an initial episode of peritonitis during follow-up than whites (1.6; 1.3 to 1.8). The time to the initial episode was 21 months for African Americans versus 32 months for whites (P < 0.001). Even after adjusting for other factors, African Americans were significantly more likely to develop peritonitis (1.5; 1.2 to 1.8). Thus, the increased risk of peritonitis of African American patients treated by CAPD is independent of other demographic, socioeconomic and comorbid characteristics.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

Peritoneal Dialysis in the Geriatric Patient

Elderly patients on chronic peritoneal dialysis (CPD) from two large chronic peritoneal dialysis programs were compared with younger patients in regard to peritonitis rates, catheter problems, hospital days, transfers to other forms of therapy, and mortality. Peritonitis rates and organisms were similar in younger and older patients. Catheter replacements were less common in the elderly. Differences in hospital days were attributable to hospitalization for vascular disease. The elderly were more likely to have the first episode of peritonitis, to die and to change dialysis modalities at all times after the first year of continuous ambulatory peritoneal dialysis (CAPD) treatment, although other than increased mortality, differences between the two groups were small. CPD appears to be an acceptable form of renal replacement therapy in the elderly.

Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a "flush-before-fill" concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study. We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit-site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.

Statistical Analysis of the Incidence of Peritonitis on Continuous Ambulatory Peritoneal Dialysis

In order to understand and eventually prevent peritonitis, which still is the most frequent complication of CAPD, workers in this field must agree on which statistical methods will be applied to the study of this complication. After a trial of various methods among our CAPD patients, we have concluded that life-table analysis, considering the first episode of peritonitis as an end event, provides the simplest method of expressing the probability of developing peritonitis. The comparison of two subpopulations of dialysis patients or of the performance of two units can be done by the comparison of the two peritonitis probability curves calculated from the respective data. Finally, regression analysis be tween the probability to develop peritonitis within a specific interval on CAPD and calendar time of entrance into the program ot Ters a simple way to assess changes in the performance of a dialysis center over time.