Intermittent Peritoneal Dialysis Research Articles

Cardiac Surgery Outcomes in Patients Receiving Hemodialysis Versus Peritoneal Dialysis

Rationale & ObjectiveWe sought to compare outcomes of dialysis patients post cardiothoracic surgery based on dialysis modality (intermittent hemodialysis (HD) vs peritoneal dialysis (PD)). Study DesignRetrospective Analysis Setting & Participants590 patients with kidney failure receiving intermittent HD or PD undergoing Coronary Artery Bypass Graft (CABG) and/or valvular cardiac surgery at Cleveland Clinic. ExposurePeritoneal Dialysis versus Hemodialysis (Intermittent or Continuous) OutcomesOur primary outcomes were in-hospital and 30-day mortality. Secondary outcomes were length of stay (LOS), days in the ICU, number of intra-operative blood transfusions, post-surgical pericardial effusion, and sternal wound infection, and the composite of 4 in-hospital events: death, cardiac arrest, effusion, and sternal wound infection. Analytical ApproachChi-square, Fisher’s exact, Wilcoxon rank-sum, and t-tests, Kaplan-Meier survival, and plots. ResultsAmong 590 patients undergoing cardiac surgery, 62 (11%) were receiving PD, and 528 (89%) were receiving intermittent HD. 30-day Kaplan-Meier survival was 95.7% (95% CI: 93.9, 97.5) for HD and 98.2% (95% CI: 94.7, 100) for PD (P=0.30). 75 (14.2%) HD and 1 (1.6%) PD had composite of 4 in-hospital events (death, cardiac arrest, effusion, and sternal wound infection) (P=0.005). Out of 62 PD patients, 16 (26%) were converted to HD. LimitationsRetrospective analyses are prone to residual confounding. We lacked details about nutritional data. ICU length of stay was used as a surrogate for volume status control. Patients have been followed in a single health care system. The HD cohort outnumbers the PD cohort significantly. ConclusionsWhen compared to PD, HD does not appear to improve outcomes of patients with kidney failure undergoing cardiothoracic surgery. Patients receiving PD had a lower incidence of a composite outcome of 4 in-hospital events: (death, cardiac arrest, pericardial effusion, and sternal wound infections).

Performance characteristics of a prototype dialysate turbidity monitoring system to detect peritonitis in patients receiving peritoneal dialysis.

The risk of peritonitis has limited wider adoption of peritoneal dialysis (PD) in the United States. We developed a prototype bedside dialysate turbidity monitoring system, aiming to improve diagnostic accuracy relative to conventional approaches which depend on visual inspection and reporting of insensitive and non-specific symptoms. The prototype system was tested in a single-centre, proof-of-principle clinical study in patients receiving intermittent PD. We obtained multiple effluent dialysate samples from each consenting participant. We compared turbidity measurements with diagnostic criteria endorsed by the International Society of Peritoneal Dialysis (ISPD). Overall, we analysed 983 specimens from 65 patients, including 105 samples from patients with peritonitis and 878 samples from patients without peritonitis. An operating point derived from a previous in vitro study yielded an unadjusted sensitivity and specificity of 95.2% and 91.5%, respectively. The majority of samples that did not meet ISPD diagnostic criteria were either cases detected before criteria were met or were related to active peritonitis treatment and resolution. This proof-of-principle study demonstrates the feasibility and diagnostic accuracy of a prototype dialysate turbidity monitoring system for peritonitis surveillance.

#4687 CORRELATION OF FRAILTY SELF-ASSESSMENT WITH MEASURED FRAILTY USING THE FRIED CRITERIA IN PATIENTS ON DIALYSIS

Abstract Background and Aims Frailty describes a complex syndrome of reduced resistance to stress factors as a consequence of age-related degeneration in various organ systems and is associated with poor clinical outcomes [1]. The European Renal Best Practice Guideline on the management of older patients with CKD recommends a regular assessment of functional status with the intention to identify those who would benefit from a more in-depth geriatric assessment and rehabilitation program [2]. Different frailty screening tools have been evaluated in CKD patients whereas the optimal tool for routine clinical application is not defined. The aim of this study was to evaluate an instrument that can be easily implemented in clinical practice and that can simplify the identification of vulnerable patients on dialysis. Method This cross-sectional, multicenter, prospective study included 123 adult patients on hemodialysis. Frailty status was assessed based on modified Fried criteria: self-reported exhaustion, weakness, slow walking speed, low physical activity level and unintentional weight loss [1]. Patients were categorized as frail meeting 3 of the 5 criteria. Patients were also asked to self-assess their frailty status on a 5-point visual analogue scale (VAS). Patients were considered robust selecting “1”, pre-frail “2 and 3”, and frail “4 and 5”. For data-analysis pre-frail and robust patients both using self-assessment and Fried criteria were categorized as “non-frail”. Correlation between Fried-criteria and self-assessment was measured using a contingency table and rank correlation (spearman´s coefficient). Results The median age was 68 years, 71% were male and 40% were considered frail using the Fried criteria (Table 1). One patient was on intermittent peritoneal dialysis, all other patients received hemodialysis. There was no difference in frailty status assessed by Fried-criteria according to age, sex, body mass index (BMI) or dialysis vintage. Patients receiving dialysis using a central venous dialysis catheter were more likely to be frail than patients with an arterio-venous fistula or graft. Patients who assessed themselves as frail on the basis of the VAS were significantly more likely to be assigned to this group when measured according to the Fried-criteria. The same applies to the non-frail group (Table 2). The specificity of the VAS was 95%, the sensitivity 39%. This means agreement with the Fried-criteria for patients who considered themselves as non-frail was very high, whereas patients frequently misjudged themselves as frail although they were assigned to the non-frail group when measured according to Fried. Spearman's correlation showed a positive correlation coefficient (0.419) and a significant correlation (2-sided, p < 0.001) between patient self-assessment using the VAS and the Fried-criteria. Conclusion Frailty is very common among patients on dialysis and occurs independent of age. The self-assessment by VAS simplifies frailty-screening in patients on dialysis by identifying more robust patients who do not need a time-consuming further evaluation.

Peritoneal Dialysis Care in Mainland China: Nationwide Survey.

Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand.

POS-025 PREVALENCE, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH COVID-19 ASSOCIATED ACUTE KIDNEY INJURY – A TERTIARY CENTRE EXPERIENCE FROM SOUTH INDIA

The recent COVID-19 pandemic has caused a deleterious effect on health and all organ systems. The quintessential manifestation of renal involvement is acute kidney injury (AKI). In our study, we aim to estimate the prevalence, clinical profile and outcomes in patients with Covid-19 associated AKI. This was a retrospective observational study amongst hospitalized COVID-19 patients admitted at our tertiary care centre between April 1 and December 31, 2021. We estimated the prevalence of AKI, requirement of renal replacement therapy (RRT), outcomes including mortality and acute kidney disease (AKD) at the time of discharge. The data of all patients including AKI, Acute worsening of preexisting chronic kidney disease (CKD) and renal transplants were also included. ESRD on maintenance hemodialysis were excluded from the study. Regression analysis was done to study the factors associated with mortality and AKD. Out of 12,450 hospitalized patients with COVID-19, 578 (4.6%) patients had AKI. Mean age of patients with AKI was 58 years, out of which 60.7% were males. Comorbidities include diabetes mellitus in 59.5%, hypertension in 64.9%, heart disease in 35.3%, old cerebrovascular accident (CVA) in 23.5%, Chronic obstructive pulmonary disease (COPD) in 19.4%, Chronic Liver Disease (CLD) in 11.2% and Chronic Kidney Disease (CKD) in 32.9%. Patients having KDIGO Stage 1, 2 and 3 AKI were 15.5%, 20.5% and 63.8% respectively. RRT was warranted in 40.7% of patients, out of which 24.6% underwent hemodialysis (HD) and 16.1% acute intermittent peritoneal dialysis(PD). Severity of Covid-19 was classified as mild, moderate, severe, and very severe in 35.6%; 32.8% ,15.7% and 15.7% respectively depending on CT severity. Overall mortality in patients with AKI was 28.5%. Mortality in those requiring HD was 61.2% and in those requiring acute intermittent PD was 32.1%. AKI resolved in 35.6% and among survivors without preexisting CKD, 28.7% patients had acute kidney disease at the time of discharge. The need for inotrope support, mechanical ventilation, hemodialysis, acute intermittent PD and preexisting CKD were the multivariate predictors of mortality. Diabetes mellitus, need for hemodialysis and ionotropic support were multivariate predictors of AKD. The prevalence of AKI in our study population was low (4.6%). Mortality in Covid-19 associated AKI was 28.7% and it was particularly high in patients with pre-existing CKD, hypoxemia, hypotension, higher CT severity, secondary sepsis, stage 3 AKI, need for RRT and need for mechanical ventilation. It is found that higher the severity of AKI, worse the prognosis. Among survivors, a significant percentage had AKD at the time of discharge.

Assessment of microbiological profile in peritoneal dialysis in patients with chronic kidney disease

Peritonitis is a serious complication of peritoneal dialysis (PD). It is the primary reason for hospitalization and switching over to hemodialysis. In the present study, we aimed to determine the microbiological profile of peritoneal dialysis fluid in patients with acute and chronic renal failure and identify these organisms' susceptibility patterns. This cross-sectional study was conducted in the Institute of Microbiology and Institute of Nephrology in the Rajiv Gandhi Government General Hospital from April 2016 to March 2017. A total of 100 patients who were &amp;#62;18 years of age, acute and chronic renal failure patients who underwent Peritoneal Dialysis and patients on Continuous and Intermittent Peritoneal Dialysis were included. The study population included 100 patients who satisfied the inclusion criteria. 63% were males, and 37% were females. The patients had a mean age of 44.15±13.89. 28 samples were culture positive, out of which 13 (46.4%) were Gram-negative, 10 (35.7%) were Gram-positive and 5 (17.9%) were Fungal isolates. Among them, the majority were Acinetobacter baumannii (20%) and Candida non-albicans (20%), followed by Staphylococcus aureus (16%), Coagulase-negative Staphylococcus (16%), Klebsiella oxytoca (8%), Klebsiella pneumoniae (4%), Enterococcus faecalis (4%).Peritoneal infections were more common in patients with longer duration of dialysis and diabetes mellitus. CAPD patients were having a higher risk of infections compared to IPD. As the number of infections associated with peritoneal dialysis rises, routine PD fluid microbiological analysis after the procedure will help improve patient care by using appropriate antibiotics as soon as possible before any major clinical problem arises.

Acute Intermittent Peritoneal Dialysis in Critically Ill COVID-19 Patients with Renal Failure: Saviour or Succourer

Background: The COVID-19 pandemic has led to an increase in critically ill patients with renal failure, with many requiring renal replacement therapies. Unfortunately, many of them are too critically ill to tolerate intermittent hemodialysis. In the setting of limited resources, we did bedside acute intermittent peritoneal dialysis for critically ill COVID-19 patients with hemodynamic instability with or without ventilator support admitted to our intensive care unit. Objective: The aim of the study was to determine the outcome of intermittent peritoneal dialysis in critically ill COVID-19 patients. Methods: Our retrospective observational study included 91 patients with critically ill SARS-CoV2 infection and renal failure admitted to the intensive care unit of our hospital from July 2020 to September 2021, who underwent acute intermittent peritoneal dialysis. Results: The demographic, laboratory, and treatment parameters were compared between survivors and non-survivors. Variables, like increased mean age (49.88 vs. 59.07 years), presence of diabetes mellitus (36.4% vs. 63.8%), increased lung involvement (57.3% vs. 75.0%), mechanical ventilation (15.2% vs. 70.7%), systolic (84.3 vs. 77.5 mm of Hg) and diastolic (59.09 vs. 42.93 mm of Hg) blood pressures, were associated with poor outcomes. The use of hypertonic PD (63.6% vs. 37.9%), better urea reduction ratios (44.33 vs. 39.84), and increased PD cycles (66.52 vs. 44.26) were associated with a better outcome. Complications, like haemorrhage and peritonitis, occurred in 10.9%. Conclusion: PD is a cost-effective bedside RRT that can be considered an effective option in critically ill COVID-19 patients. Good urea clearance, hemodynamic stability, and minimal resource requirements are also the features that favour peritoneal dialysis.

Acute Intermittent Peritoneal Dialysis in Critically Ill COVID-19 Patients with Renal Failure: Saviour or Succourer

Background: The COVID-19 pandemic has led to an increase in critically ill patients with renal failure, with many requiring renal replacement therapies. Unfortunately, many of them are too critically ill to tolerate intermittent hemodialysis. In the setting of limited resources, we did bedside acute intermittent peritoneal dialysis for critically ill COVID-19 patients with hemodynamic instability with or without ventilator support admitted to our intensive care unit. Objective: The aim of the study was to determine the outcome of intermittent peritoneal dialysis in critically ill COVID-19 patients. Methods: Our retrospective observational study included 91 patients with critically ill SARS-CoV2 infection and renal failure admitted to the intensive care unit of our hospital from July 2020 to September 2021, who underwent acute intermittent peritoneal dialysis. Results: The demographic, laboratory, and treatment parameters were compared between survivors and non-survivors. Variables, like increased mean age (49.88 vs. 59.07 years), presence of diabetes mellitus (36.4% vs. 63.8%), increased lung involvement (57.3% vs. 75.0%), mechanical ventilation (15.2% vs. 70.7%), systolic (84.3 vs. 77.5 mm of Hg) and diastolic (59.09 vs. 42.93 mm of Hg) blood pressures, were associated with poor outcomes. The use of hypertonic PD (63.6% vs. 37.9%), better urea reduction ratios (44.33 vs. 39.84), and increased PD cycles (66.52 vs. 44.26) were associated with a better outcome. Complications, like haemorrhage and peritonitis, occurred in 10.9%. Conclusion: PD is a cost-effective bedside RRT that can be considered an effective option in critically ill COVID-19 patients. Good urea clearance, hemodynamic stability, and minimal resource requirements are also the features that favour peritoneal dialysis.

Acute Kidney Injury Complicating Severe Acute Pancreatitis: Clinical Profile and Factors Predicting Mortality.

Acute kidney injury (AKI) frequently complicates severe acute pancreatitis (SAP) among the critically ill. We studied clinical profile and risk factors predicting mortality in SAP-AKI. We conducted a prospective observational study of 68 patients with SAP-AKI from September 2015 to September 2019. Patient data and outcomes grouped as survivors and deceased were analyzed. SAP-AKI constituted 2.14% (68 of 3,169) of all AKIs with 1.5%, 20.6%, and 77.9% in Kidney Disease Improving Global Outcomes (KDIGO) Stages I, II and III respectively. The mean age was 39.93 ± 11.79 years with males 65 (95.6%). The causes of acute pancreatitis were alcohol addiction 59 (86.8%), highly active antiretroviral therapy 1 (1.4%), hypercalcemia 1 (1.4%), IgG4-related disease 1 (1.4%), and unidentified 6 (8.8%). Complications were volume overload, shock, respiratory failure, and necrotizing pancreatitis in 21 (30.9%), 10 (14.7%), 6 (8.8%), and 14 (20.5%), respectively. Kidney replacement therapy done in 40 (58%), with intermittent hemodialysis 36 (53%) and acute intermittent peritoneal dialysis 4 (6%). The overall mortality was 23 (33.8%), three progressed to chronic kidney disease (thrombotic microangiopathy 2; biopsy inconclusive 1). In 45 survivors, AKI recovered in 22.7 ± 9.6 days. Death occurred within first 6 days. The risk factors associated with in-hospital mortality was necrotizing pancreatitis (odds ratio [OR] = 5.143; 95% confidence interval 1.472-17.972; P = 0.01), circulatory failure (OR = 6.125; P = 0.016), peak creatinine >3 mg/dL (OR = 7.118; P = 0.068), Bedside Index of Severity for Acute Pancreatitis score >3 (OR = 8.472; P = 0.001), need for kidney replacement therapy (OR = 3.764; P = 0.024), KDIGO III (OR = 9.935; P = 0.03). Alcohol addiction was the commonest cause of severe acute pancreatitis. The overall mortality was 33.8%. Necrotizing pancreatitis, circulatory failure, peak creatinine >3 mg/dL, BISAPs >3, KDIGO III, and the need for kidney replacement therapy were independent risk factors for mortality.

POS-028 OUTCOMES OF INTERMITTENT PERITONEAL DIALYSIS IN PAEDIATRIC POPULATION

Acute kidney injury is a common condition among paediatric population which may be due to varied etiology and treatment includes proper balance of fluids and electrolytes , if indicated renal replacement therapy. In resource limited settings and in young children where equipments and trained dialysis personnel are not available, Intermittent peritoneal dialysis(IPD) serves as a promising modality to improve outcomes and prevent mortality in children suffering from AKI.

Management of severe hypernatremic dehydration and acute kidney injury in children in a critical care nephrology and dialysis unit.

Our study aimed to manage the children presented with severe hypernatremic dehydration and acute kidney injury (AKI) an updated fluid management protocol was used to find out the rate of decline of serum sodium per day and their outcome. This is a prospective interventional study was conducted from November 2015 up to October 2016 in the Critical Care Nephrology and Dialysis Unit of Dhaka Shishu (Children) Hospital, Bangladesh. A total of 45 children with hypernatremia and AKI were evaluated. Patients were treated by the calculated amount of dextrose in normal saline mixed with various dilutions of 3% NaCl with a difference of serum to infusate sodium concentration around 10 mEq/L as per the American Academy of Pediatrics - 2005. Intermittent peritoneal dialysis was done when in the failure stage of AKI or when serum sodium (Na+) >180 mEq/L. Depending on the outcome samples were divided into survival and death groups. Data were processed by software STATA 13 and analysis was done by one-way ANOVA, Tukey test, Chi-square test, F-test, and Student's t-test. Age ranged from one month to 6½ years and 91% were infants. Total 64% of patients were in the failure stage of AKI and majority were in the death group, 31% in injury and 4.4% patient in the risk stage. Out of 45 cases, 30 (67%) had severe hypernatremia. Significant reduction of serum Na+ was found and the rate of decline between days was optimum (8.4 mmol/L/day). Overall 60% survived with normal renal functions and 40% died. The calculated amount of dextrose in normal saline mixed with various dilutions of 3% NaCl is safe in severe hypernatremic dehydration with AKI.

Favorable effects of peritoneal dialysis in patients with refractory heart failure and overhydration.

Patients with refractory to optimal pharmacological treatment heart failure (HF) require frequent hospitalization. Peritoneal dialysis (PD) has been part of the management of such patients mainly for promoting ultrafiltration and management of overhydration independently of kidney function. The aim of this study was to evaluate the efficacy of PD, especially the use of icodextrin solutions and intermittent PD, in the hospitalization rate and cardiac functional status of patients with HF. We conducted a retrospective study involving patients with New York Heart Association (NYHA) class IV HF and preserved renal function (estimated glomerular filtration rate (eGFR) > 25 ml/min), who were refractory to conservative treatment. Clinical data on weight loss, hospitalization rate before and after PD initiation, cardiac functional status, and technique complications during a 6-month observational period were analyzed. PD treatment was performed in 32 patients with a mean age of 63.8 ± 11.9 years and a follow-up of 20.78 ± 14.24 months. Hospitalizations were significantly reduced from 20.7 ± 13.7 to 7.7 ± 8.9 days/patients at 6 months. All patients showed improvement in NYHA class as well as in left ventricular ejection fraction. Overall, eGFR showed a significant decrease but only six patients reached end-stage renal disease. Complications included 18 cases of peritonitis. PD was well tolerated and no patient dropped out of the method. Survival rate reached 72% at 12 months but mortality rate was high with 23 patients dying at 16.65 ± 12.3 months after the initiation of treatment. Patients survival was not influenced by the type of PD modality or weight reduction achieved. PD showed to be a viable option for the treatment of patients with refractory HF leading to a better cardiac functional status and diminishing the number of hospital admissions.

Acute kidney injury with cardiorenal syndrome; experience from a tertiary care renal unit in Pakistan

Introduction: Acute kidney injury (AKI) is a commonly recognized clinical problem after many morbid conditions related to heart like congenital heart disease surgery, acute or chronic congestive heart failure, acute myocardial infarction, infective endocarditis or cardiomyopathies. Cardio-renal syndrome (CRS) includes a spectrum of disorders involving both the heart and kidneys simultaneously; here acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other. Objectives: To report here, case series of patients with AKI developing in association with CRS. We aim to report different causes of CRS and outcome of patients in this group of patients. Patients and Methods: Subjects for the study reported here comprised a cohort of 34 patients coming to this institution with AKI in association of CRS. AKI was defined according to KDIGO guidelines and CRS based on consensus conference of ADQI in 2012. Type 1or type2 CRS are included in the study. All patients had normal size kidneys on ultrasonography. Results: Thirty-four patients with AKI and CRS were brought to this institute from January 1990 to December 2014; this was contributing 1% to medical causes of total AKI. Among these 25 were males and 9 females; mean age of these patients was 54.06±14.106 years. Causes of CRS were acute myocardial infarction (ST elevated), congestive cardiac failure, infective endocarditis and dilated cardiomyopathy. More than two third of patients were either oliguric or anuric on presentation. Fluid replacement and/or inotropic support required in 79%. Renal replacement therapy in form of hemodialysis was conducted in 64.7% and intermittent peritoneal dialysis in one patient. Complete renal recovery was observed in 19 (56%) patients, while 12 (35%) died during acute phase of illness. CKD-V developed in one patient, 2 patients lost long term follow up, but became dialysis free and renal functions were in improving trends, they were labeled as partial recovery. Secondary insults like hypotension, aggressive diuresis, and volume loss from gastro-intestinal tract or infection were evaluated for any co-relation with outcome but statistically no significant difference was found. Conclusion: CRS can be severe life-threatening condition especially when patients present with circulatory collapse. Diuretics must be used cautiously in patients with congestive cardiac failure. Infective endocarditis with acute right heart failure can lead to CRS.

History of Medicine: The Emergence of Intestinal Dialysis.

Abstract In 1923, Georg Ganter at the University of Würzburg performed the first peritoneal dialysis for patients with chronic kidney disease. During the period from 1924 to 1938, intermittent peritoneal dialysis was used in the USA and Germany as a short-term replacement for the renal functions. In 1946, Fine and colleagues described the use of peritoneal irrigation in a patient with severe anuria, who survived after four days of continuous peritoneal lavage. In 1943, a Dutch physician named Willem Kolff developed the first dialyzer which was called “Artificial kidney” with aim of cleaning the blood of patients with acute renal failure. Kolff moved to the USA and improved the early design of the dialyzer and was manufactured in the early 1950s. During the 1980s and 1990s, experimental studies on animals suggested that dietary fibers including acacia gum have a urea lowering effect (Yatzidis et al., 1980; Rampton et al., 1984; Tetens et al., 1996). In 1996, in 1996, Bliss et al. reported that the use of acacia gum supplementation in adult patients with asymptomatic early chronic renal failure on low protein diet was associated with urea lowering effect. The use of Intestinal dialysis in symptomatic chronic renal failure patients was first described by Aamir Jalal Al-Mosawi in 2002. The achievement of six-year dialysis freedom with the use of intestinal dialysis in patients with end-stage renal failure was described by Aamir Jalal Al-Mosawi in 2009. Late during the 2000s, “Only medical talks” web site included Aamir Jalal Al-Mosawi in the list of famous physicians of all time for describing intestinal dialysis [9]. During the previous two decades there have been a plethora of publications describing the concepts, principles and use of intestinal dialysis including journal articles, conference papers and books. Some of these publications have been translated to eight languages confirming that intestinal dialysis has become an established medical therapeutic technology. The aim of this paper is to review the milestones associated with intestinal dialysis which was considered by many experts as a Nobel Prize winning technology.

Comment prendre en charge une hernie abdominale en dialyse péritonéale ?

Abdominal hernias are a frequent complication in peritoneal dialysis, representing up to 60.4% of anatomical complications. Their prevalence varies between 7 and 27.5%. Established risk factors are male gender, an older age, multiparity, a low body mass index and a paramedian approach for the catheter insertion. Polykystic renal disease and the intra-peritoneal volume are controversial risk factors. The diagnosis is mainly clinical, though peritoneography imaging can be useful in difficult cases. Hernia's complications, of strangulation, incarceration, bowel occlusion and peritonitis; can be very serious, leading to technique failure and may result in death. The complication risk varies from 4 to 20% in the literature review. There are no guidelines regarding hernia's prevention or treatment. A surgical repair is recommended, by implementing a synthetic prothesis with an inguinal approach for inguinal and femoral hernias, with a simple stitch or a bioprothesis for ombilical hernias. The management of peritoneal dialysis after hernia repair is not codified. After an initial 48h interruption, an intermittent peritoneal dialysis program using low volume seems efficient at low risk, preventing a temporary transfer to haemodialysis.

Pregnancy in a peritoneal dialysis patient undergoing intermittent peritoneal dialysis during the third trimester of pregnancy: a case report and literature review

For patients undergoing peritoneal dialysis (PD), the rate of successfully carrying a pregnancy to term is low. Herein, we describe the pregnancy course of a patient with end-stage renal disease on peritoneal dialysis. The information presented may make better undestanding in the knowledge and management of such high-risk pregnancies in this patient population. We report the successful completion of pregnancy in a patient who underwent continuous ambulatory peritoneal dialysis (CAPD) and then switched to intermittent peritoneal dialysis (IPD) during her third trimester. She became pregnant after undergoing CAPD for almost 1 year, using four 1.5 L exchanges of 1.5% bags per day. At 30 weeks of gestation, she switched from CAPD to IPD, using six 0.5 L exchanges of 1.5% bags per day with daily ultrafiltration of 100-300 mL. Her total Kt/V was 1.72 (dialysate 1.2, residual kidney 0.5) during her first and second trimesters and her total Kt/V decreased to 1.63 (dialysate 1.15, residual kidney 0.48) during her third trimester. She was admitted to our hospital at 35 weeks of gestation for a planned lower segment caesarian section. We report the successful completion of pregnancy in a patient on IPD. We have shown that rather than pursuing an adequate weekly default value of Kt/V, the most important criterion for the optimization of dialysis treatment for pregnant patients is their medical condition.

Efficacy and outcome of intermittent peritoneal dialysis in patients with acute kidney injury: A single-center experience.

There are only a few reports on the role of peritoneal dialysis (PD) in critically ill patients requiring continuous renal replacement therapies (RRT). This study aimed to determine the efficacy and outcome of intermittent PD in acute kidney injury (AKI) patients in intensive care unit setting and to assess the procedure-related complications. This was a prospective, observational study conducted from March 1, 2015, to February 29, 2016, which included patients of either sex, aged ≥18 years, diagnosed with AKI, and undergoing RRT with intermittent PD sessions with more than 48 h of hospital stay. Patients were later shifted to sustained low- efficiency dialysis or hemodialysis, when they became hemodynamically stable. Hence, the patients who received at least 48 h of PD were included in the study. A total of 75 patients were enrolled. Overall, the mean age was 55.75 years, and around 64% were men. The most common indication to start PD was metabolic acidosis, and the most common cause of AKI was sepsis. A total of 21 patients survived, and the mortality rate was 72%. The average peritoneal urea clearance and creatinine clearance were 14.81 mL/min and 12.59 mL/min, respectively. Of the 66 patients on inotropes, 28 patients were tapered from inotropic support. Thirty-nine patients had hyperkalemia, and 27 patients had correction within 1 day of the start of PD. Forty-seven patients had correction of acidosis, and 33 of these achieved pH ≥7.25 within one day of PD. The most common complication that occurred was peri-catheter leaks followed by peritonitis. Acute PD can be an effective, simple, and safe bridge RRT in hemodynamically unstable patients until the achievement of hemodynamic stability to shift them to other modalities of RRT.

Tension-free mesh repair of inguinal hernia in patients on continuous ambulatory peritoneal dialysis.

Peritoneal dialysis (PD) is the first-line renal replacement therapy for end-stage renal failure patients in Hong Kong. Abdominal wall hernia is a common mechanical complication of PD, and early surgical repair has been advocated to reduce complications. This study aims to review the outcomes of tension-free mesh repair of inguinal hernia in PD patients. All PD patients who underwent elective repair of inguinal hernia from 2009 to 2015 were identified from a single centre for retrospective analysis. Primary outcomes included surgical complications, perioperative dialysis technique and recurrence. Twenty-one patients with a total of 26 inguinal hernia repairs were included in this 7-year retrospective study. All were males, and the mean age was 68 ± 10 years. Diabetic nephropathy (n = 9, 42.9%) and glomerulonephritis (n = 7, 33.3%) were the two most common causes of renal failure. All hernias were detected after the initiation of PD, and the mean duration of PD to hernia detection was 16 months (range 1-65 months). Lichtenstein open mesh repair was performed in all patients. Complications included seroma (n = 3, 11.5%) and ischaemic orchitis (n = 1, 3.8%). There were no mesh infection or recurrence. Twenty patients (95.2%) received intermittent peritoneal dialysis post-operatively and returned to continuous ambulatory PD in 15 to 30 days. Only one patient (4.8%) required bridging haemodialysis due to Tenckhoff catheter blockage. Tension-free mesh repair is associated with low morbidity and low recurrence rates in PD patients. Timely management and close collaboration with renal physicians are essential to continue PD after repair.

Recent Advances in the Management of End-Stage Renal Disease (ESRD) in Children

It has been almost 20 years since the initial report were published detailing the use of the dual treatment modalities of dialysis and renal transplantation to treat children with ESRD. During this time, the outlook for the infant, child and adolescent with ESRD has changed dramatically from abject pessimism to cautious optimism.&#x0D; Initially, hemodialysis was the principle dialytic technique utilized; however, intermittent peritoneal dialysis was used occasionally in selected centers. The latter required less technical expertise, but necessitated considerably more dialysis time and was significantly less efficient at alleviating the clinical and biochemical consequences of uremia.

Effects of prophylactic antibiotics before peritoneal dialysis catheter implantation on the clinical outcomes of peritoneal dialysis patients

Background: Peritoneal dialysis (PD) related infections, such as peritonitis, are still the main obstacle for the development of PD. Prophylactic antibiotic as one of the interventions to prevent early peritonitis was recommended to use before PD catheter insertion by International Society for Peritoneal Dialysis (ISPD) guidelines, In our hospital, however, since 2012, the prophylactic antibiotics for insertion of PD catheters were not allowed to use because of our hospital’s regulation. In order to analyze the outcomes of PD patients without using prophylactic antibiotics before the PD catheter insertion, we compared the PD patients with or without prophylactic antibiotics before PD catheter insertion.Methods: This retrospective study included 247 patients undergoing permanent PD catheter placement with conventional open surgical method consecutively between February 2008 and June 2013. Of these, 154 patients were given intravenous cefazolin, 1.0 g, 0.5–2 h before the procedure (antibiotic group) and 93 patients were not given prophylactic antibiotics (nonantibiotic group). All the patients were administered intermittent PD within 24 h after PD catheter insertion. The early complications and long-term outcomes were recorded respectively.Results: There was no significant difference in the incidence of peritonitis and exit-site/tunnel infection and mechanical complications between the two groups in the first 30 days after the PD catheter implantation. In addition, after 6 years of follow-up, no difference was seen between the two groups in patient survival, technique survival, and peritonitis-free survival.Conclusions: Our study does not show any beneficial effect of antibiotic prophylaxis in reducing the postoperative peritonitis.