Maintenance Peritoneal Dialysis Research Articles

Associations of metabolic syndrome and its components with cardiovascular outcomes among non-diabetic patients undergoing maintenance peritoneal dialysis

Metabolic syndrome (MS) is thought to be a risk marker for cardiovascular diseases in the general population and in patients with chronic kidney disease. This study investigated whether the presence of MS also modifies cardiovascular (CV) outcomes among non-diabetic patients undergoing long-term peritoneal dialysis (PD). We enrolled 280 patients from a medical centre in North Taiwan who began PD between January 1999 and December 2005 and followed them until December 2009. MS was defined by the modified National Cholesterol Educational Programme (Adult Treatment Panel III) criteria. All parameters and biochemical data were collected by chart review. Patient outcomes (overall and CV death, fatal or non-fatal CV events) were recorded during the follow-up period. Survival was analysed by the Kaplan-Meier method, and the influence of MS and its components on outcomes were analysed by Cox regression models. The average follow-up period was 49.2 months. Non-diabetic patients with MS had worse outcomes than those without MS or at risk for MS, but better than their diabetic counterparts. By multivariate analysis, MS was independently associated with increased risk for CV death (hazard ratio, HR = 13.27) and fatal or non-fatal CV events (HR = 10.50). Among five MS components, hypertriglyceridaemia, low high-density lipoprotein levels and hyperglycaemia were significant risk factors for adverse CV outcomes. MS is a potent risk marker for adverse CV outcomes in non-diabetic patients on PD. Timely interventions targeting specific component of this syndrome may be required in this subset of patients.

Impaired Fasting Glucose Association With Mortality in Nondiabetic Patients on Maintenance Peritoneal Dialysis

IntroductionThe aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). MethodsIn total, 362 maintenance PD patients were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into 3 groups: diabetic (n = 85), nondiabetic with IFG (n = 62) and nondiabetic with normal fasting glucose levels (n = 215). After basal data were collected for cross-sectional analyses, mortality and cause of death were recorded for longitudinal analyses. ResultsAfter adjusting for related variables by multivariate logistic regression analysis, IFG was found to be positively associated with age but negatively associated with normalized protein nitrogen appearance and transferrin saturation in nondiabetic maintenance PD patients. Thirty nondiabetic patients had died after the 2-year follow-up. Cox multivariate analysis showed that age (hazard ratio: 1.037; 95% confidence interval: 1.0021.073; P = 0.036) and presence of IFG (hazard ratio: 2.719; 95% confidence interval: 1.082-6.833; P = 0.033) were significant risk factors for all-cause 2-year mortality in nondiabetic maintenance PD patients. ConclusionsIFG, a preventable and treatable condition, was associated with all-cause 2-year mortality in nondiabetic maintenance PD patients.

The research of carotid atherosclerosis and its relative factors of maintenance peritoneal dialysis patients

Objective To explore carotid atherosclerosis and its relative factors of maintenance peritoneal dialysis patients. Methods The general clinical conditions,hematobiochemical parameters and color ultrasound parameters of 27 maintenance peritoneal dialysis patients and 24 controll patients were collecled. General clinical conditions included body weight, height and BMI. Hematobiochemical paremeters included Hb, Alb, LP (a), TC, TG, HDL-C,LDL-C, CRP, plasma fibrinogen, C3, Apo-A 1, Apo-B, LP (a). Color ultrasound parameters included plaque incidence rate,thickness of vascularendothelium(IMT). Results Compared with the controll group,maintenance peritoneal dialysis patients: plaque incidence rate, thickness of vascularendothelium (IMT) increased significantly, Age, TC, TG,LDL-C,LP (a), dialysis time increased significantly in plaque-positive group(all p ＜ 0. 05), while Hb, Alb andPAB decreased significantly (all P ＜ 0.0 5) , CRP increased significantly (P ＜ 0.0 1) . Conclusions In maintenance peritoneal dialysis group,CRP,LP(a) had positive relationship with C-IMT. CRP had negative relationship with ALb. CRP had not relationship with age and dialysis time. There were relationships among malnutrition,inflammation and atherosclerosis in maintenance peritoneal dialysis patients. Interdiction of the relationship may played a very important role in ameliorating the prognosis of the maintenance peritoneal patients. Key words: Peritoneal dialysis; Atherosclerosis; Inflammation; Malnutrition

Superior mesenteric artery syndrome complicating dialysis patients with peritoneal failure – report of 3 cases

We report 3 cases of superior mesenteric artery syndrome in patients previously on maintenance peritoneal dialysis converted to hemodialysis after peritoneal failure. All 3 patients presented with repeated vomiting and severe malnutrition. It is postulated that complications arising from peritoneal dialysis such as peritoneal sclerosis, adhesions and collections after CAPD peritonitis may be important contributing factors for the SMA syndrome in these 3 patients. All of them succumbed within six months of diagnosis. The first 2 patients received gastrointestinal bypass surgery and died post-operatively due to impaired wound healing and nosocomial sepsis. The 3rd patient was treated conservatively with nasoduodenal feeding but succumbed to aspiration pneumonia. It is postulated that complications arising from peritoneal dialysis including peritoneal sclerosis, adhesions and collections after CAPD peritonitis may contribute to the SMA syndrome in these patients. Our experience suggests that SMA syndrome in end-stage renal disease patients is associated with high surgical morbidity and mortality possibly related to their poor pre-morbid condition and pre-existing malnutrition. Aggressive parenteral nutrition should be considered to build up the general status before proceeding to surgical intervention.

1004 Rescue Treatment with Hemodiafiltration in Infants with End-Stage Renal Failure After Complications on Peritoneal Dialyses

Objective: Mortality in infants with end-stage renal disease (ESRD) during early life is still high. The aim is the presentation of the efficacy of hemodiafiltration (HDF) in infants with ESRD and complications on peritoneal dialysis (PD). Patients and Methods: We show the alternative treatment with HDF in 4 infants requiring renal replacement therapy for ESRD before 28 days of life at a tertiary University Hospital from 1999 to 2010. Diagnoses leading to ESRD were cortical necrosis after perinatal shock, renal dysplasia in prune belly syndrome, neonatal Shigatoxinassociated hemolytic uremic syndrome, and bilateral nephrectomy in autosomal recessive polycystic kidney disease. Results and Discussion: Initially, 3/4 patients were started with HDF. Reasons were abdominal surgery in two patients and presumed acute renal failure in one patient. Thereafter all patients were switched to PD. If complications occurred on PD, patients were switched back to HDF. In case of severe volume overload we started with cHDF and continued with iHDF. During the first year of life, 3/4 patients required 1 to 3 HDF rescue treatment periods (major abdominal surgery in 5 periods, recurrent peritonitis in 1 period). 1/4 patients had to be switched to maintenance iHDF due to multiple abdominal leaks at 8 months of age. All 4 patients survived the first year of life. One patient is on maintenance PD at 23 months. Two patients were transplanted successfully at 22 and 35 months, respectively. In conclusion, in case of complications on PD, HDF is an option to achieve long-term survival and kidney transplantation.

Clinical Outcome of Preemptive Kidney Transplantation in Patients With Diabetes Mellitus

End-stage renal disease (ESRD) caused by diabetic nephropathy is increasing throughout the world. The survival of diabetic patients treated by transplantation has improved nowadays. Although recent studies have demonstrated preemptive kidney transplantation to be associated with better graft survival in CKD patients, the effect of pre-transplantation dialysis on graft outcomes among diabetic ESRD patients is unclear. This analysis summarized our experience with preemptive kidney transplantation in diabetic ESRD patients by retrospectively comparing 70 such patients transplanted between 1995 and 2009. These 70 patients were divided into two groups: 30 patients underwent preemptive and the other 40 transplantation after maintenance hemodialysis or peritoneal dialysis. We compared graft survivals, acute rejection episodes, postoperative complications, and delayed graft function rates. The 10-year patient survival of 100% in the preemptive group was similar to that of the nonpreemptive group (85%, P = .11). But the 10 year graft survival was higher among the preemptive than the nonpreemptive group (100% vs 75%, P = .02). Pre-transplantation modality did not affect graft survival. Therefore, preemptive kidney transplantation should be applied to eligible patients with diabetic ESRD.

Cardiothoracic Ratio Association With Mortality in Patients on Maintenance Peritoneal Dialysis

The cardiothoracic ratio (CTR) indicates the left ventricular size; however, the significance of the CTR in patients on maintenance peritoneal dialysis (PD) remains unclear. In this study, 335 PD patients were enrolled and demographic, biochemical, co-morbidity, and dialysis-related data were obtained. The factors determining CTR were further analyzed. All patients were followed up for two years to investigate the mortality risks. We defined a normal CTR as less than the mean CTR value, mild cardiomegaly as a CTR between the mean and mean + 1 SD, and moderate-to-severe cardiomegaly as more than the mean CTR + 1 SD. Among the 335 patients, 163 patients were classified as having a normal CTR (<49.2%), 112 patients as having mild cardiomegaly (CTR 49.2-55.7%), and 60 patients as having moderate-to-severe cardiomegaly (CTR > 55.7%). χ(2) -analysis showed that the incidences of malnutrition and anemia were significantly higher in patients with severe cardiomegaly than in patients of the other groups. The CTR was positively correlated with age, but negatively correlated with albumin and hemoglobin levels. Twenty-six patients (7.7%) had died by the end of the study. Cox multivariate analysis revealed that the CTR significantly predicts all-cause two-year mortality in PD patients on maintenance PD; therefore, the CTR correlates with the nutritional and anemic status of PD patients and is a reliable predictor for all-cause two-year mortality. The analytical results of this study support continued efforts to reduce the CTR and treat underlying causes in patients with cardiomegaly.

Prevalence and Risk Factors for Peripheral Artery Disease among Patients on Maintenance Peritoneal Dialysis

Background: Cardiovascular disease is common in end-stage renal disease patients and accounts for more than half of the mortalities. Peripheral artery disease (PAD) is frequently found in this population and is an independent predictor of cardiovascular mortality. However, there have been limited studies reporting the prevalence and risk factors for PAD among patients on maintenance continuous ambulatory peritoneal dialysis (CAPD) therapy. Methods: 343 CAPD patients from our clinic were recruited, and PAD was diagnosed using a value of ankle-brachial index <0.9. Both traditional and dialysis-related factors were evaluated. Results: The prevalence of PAD was 27.4% in all patients, which increased to 45% in patients aged >70 years. In age- and gender-adjusted logistic regression, diabetes mellitus (OR 2.354, 95% CI 1.288–4.3), diastolic blood pressure (OR 0.964, 95% CI 0.939–0.989), extracellular/intracellular water ratio (OR 2.504, 95% CI 1.067–5.804), and lnCRP (OR 1.251, 95% CI 1.031–1.518) were independently associated with PAD. Conclusion: Our study suggested that PAD is a common problem in patients on maintenance peritoneal dialysis, especially in elderly dialysis subjects. Diabetes mellitus, elevated hsCRP level, and extracellular/intracellular water ratio are all independent risk factors for PAD. It also suggested that aggressive risk factor management for PAD should be undertaken in CAPD patients.

Anti-erythropoietin antibodies followed by endogenous erythropoietin production in a dialysis patient

We present a case of a young girl with end-stage renal disease secondary to anti-glomerular basement membrane disease who was receiving maintenance peritoneal dialysis and developed pure red cell aplasia secondary to anti-erythropoietin (EPO) antibodies. This occurred 13 months after the initiation of EPO alfa therapy for anemia. Initially, the patient required intermittent red blood cell transfusions. After immunosuppressive therapy had been initiated with corticosteroids and cyclosporine, the EPO antibody levels decreased precipitously, associated with an increased level of endogenous EPO production. For the following 6 months, the patient maintained adequate (>10 g/dL) hemoglobin levels and did not require red cell transfusions.

Successful engraftment after PBSCT from HLA-haploidentical son for severe aplastic anemia during maintenance peritoneal dialysis

Successful engraftment after PBSCT from HLA-haploidentical son for severe aplastic anemia during maintenance peritoneal dialysis

Peritoneal Adipocytes and Their Role in Inflammation during Peritoneal Dialysis

Adipose tissue is a major site of chronic inflammation associated with peritoneal dialysis (PD) frequently complicating peritonitis. Adiposity-associated inflammation plays a significant contributory role in the development of chronic inflammation in patients undergoing maintenance PD. However, the molecular and cellular mechanisms of this link remain uncertain. Adipose tissue synthesizes different adipokines and cytokines that orchestrate and regulate inflammation, insulin action, and glucose metabolism locally and systemically. In return, inflammation retards adipocyte differentiation and further exacerbates adipose dysfunction and inflammation. An understanding of the inflammatory roles played by adipose tissue during PD and the healing mechanism of injured mesothelium will help to devise new therapeutic approach to slow the progression of peritoneal damage during peritoneal dialysis. This article reviews the roles of peritoneal adipose tissue in chronic peritoneal inflammation under PD and in serosal repair during PD.

Mysterious PTH values after parathyroidectomy in a patient on maintenance dialysis

A 25-year-old patient with end-stage renal disease on maintenance peritoneal dialysis underwent parathyroidectomy when his secondary hyperparathyroidism did not respond to medical management. However, over the subsequent months he developed extremely raised parathyroid hormone (PTH) levels. When surgical removal of the autotransplant was considered, preoperative work-up revealed a PTH level within the target range. It became apparent that the very high PTH values were due to the location of the blood draw close to the autotransplant, thus measuring a local rather than the systemic PTH value. The multiple causes of varying PTH measurements other than clinical and physiological reasons are reviewed.

Retroperitoneal Leakage as a Cause of Acute Ultrafiltration Failure: Its Associated Risk Factors in Peritoneal Dialysis

Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors. After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed. During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP (n = 16) or MRP (n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 +/- 24.5 (range 0.5 - 87.9) months and 0.70 +/- 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35 - 18.69, p < 0.001] and 6.23 (95% CI 1.83 - 21.19, p = 0.003) respectively. RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF.

Seven-Year Follow-Up of Peritoneal Dialysis Patients in Taiwan

There are no Taiwanese publications and only a few Asian publications on the long-term outcome of peritoneal dialysis (PD) patients. The aim of this study was to evaluate the outcome of PD patients in Taiwan during a 7-year follow-up period. This study enrolled 67 patients (23 males, mean age 46.2 +/- 14.5 years) on maintenance PD. We administered the Short-Form questionnaire on 30 September 1998 and recorded major events and outcomes until 30 September 2005. We compared differences in initial parameters between groups categorized by PD patient survival and PD technique survival. Causes of mortality and transfer to hemodialysis were determined. PD patient and PD technique survival rates were measured and risk factors for patient mortality and PD technique failure were analyzed. Those in patient survival or PD technique survival groups had lower mean age (p < 0.001 and 0.018 respectively) and higher serum albumin level (p = 0.015 and 0.041 respectively) compared to those that died or failed PD. The 7-year patient survival rate was 77% and the PD technique survival rate was 58%. The independent predictors for PD technique failure included lower Mental Component Summary scores [hazard ratio (HR) = 0.85, p = 0.031] and diabetes mellitus (HR = 4.63, p < 0.001), whereas lower serum albumin level (HR = 0.22, p = 0.031), lower Physical Component Summary scores (HR = 0.67, p = 0.047), and presence of diabetes mellitus (HR = 5.123, p = 0.009) were the independent predictors for patient mortality. For our PD patients, both patient and technique survival rates are good. Better glycemic control, adequate nutrition, and enhancement of health-related quality of life are all of potential prognostic benefit.

Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report

We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +/- 4.5 years) and in 36 healthy subjects. Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocysteine (P = 0.001), HS-CRP (P = 0.000) and CIMT (P = 0.000) were significantly elevated in the patients. Left ventricular hypertrophy (LVH) was prevalent in 68% of the patients. Patients with LVH had higher levels of HS-CRP (P = 0.001) and CIMT (P = 0.028) than those without LVH. Haemoglobin was an independent predictor of LVMI (beta: -8.9, P = 0.001), while residual diuresis and CIMT were independent predictors of diastolic dysfunction (beta: -0.45, P = 0.034 and beta: 5.90, P = 0.008, respectively). Albumin (beta: -0.72, P = 0.018) and Kt/V urea (beta: -0.48, P = 0.012) were significant predictors of CIMT. There were positive correlations between LVMI and CIMT. HS-CRP was positively correlated with LVMI as well as CIMT. Elevated levels of atherosclerotic/ inflammatory risk factors, low haemoglobin levels and loss of residual renal function and their negative effects on heart are of remarkable importance in paediatric patients on maintenance peritoneal dialysis. Achieving recommended targets for haemoglobin, blood pressure and Kt/V urea, preserving residual renal function as well as managing inflammation and subsequent arteriosclerosis is obviously essential to improve the patients' prognosis.

Methotrexate Clearance by High-Flux Hemodialysis and Peritoneal Dialysis: A Case Report

We report a case of a patient on maintenance peritoneal dialysis therapy treated with a high-dose methotrexate regimen for central nervous system lymphoma. For the initial methotrexate cycles, he had received temporary daily high-flux hemodialysis starting 24 hours after the infusion of methotrexate to avoid toxicity. However, on account of issues with vascular access, he was treated with continuous multiple-exchange peritoneal dialysis for the last 2 cycles of chemotherapy. Time-averaged clearances (dose divided by area under the curve, combination of endogenous and dialysis clearance) during treatment with high-flux hemodialysis and continuous multiple-exchange peritoneal dialysis were 0.77 mL/min/kg (0.013 mL/s/kg) and 0.65 mL/min/kg (0.011 mL/s/kg), respectively. Peritoneal clearance of methotrexate was estimated to be 0.124 +/- 0.037 mL/min/kg (0.00207 +/- 0.00062 mL/s/kg). Despite lower clearance by means of peritoneal dialysis compared with hemodialysis, the patient did not develop clinical evidence of methotrexate toxicity.

Intravenous iron sucrose in maintenance dialysis patients with renal anemia: a clinical study

To explore the safety and efficacy of intravenous iron sucrose in maintenance dialysis and to establish the optimal administration frequency and dose. One hundred and ninety-four patients on maintenance dialysis with the hemoglobin (Hb) level of 60 - 100 g/L and hematocrit (Hct) of 18% - 30% were randomly divided into 2 sex, age, duration of dialysis, weekly erythropoietin dosage, and hematological parameters-matched groups: intravenous iron sucrose group (n = 102) and oral medication group (n = 92). The intravenous iron sucrose group were sub-divided into 2 subgroups: (1) hemodialysis (HD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 100 mg once a week for a further 8 weeks, and (2) peritoneal dialysis (PD) subgroup receiving intravenous iron sucrose 200 mg once a week for 4 weeks and then 200 mg once every other week for a further 8 weeks. The oral medication group received ferrous succinate 200 mg tid for 12 weeks. The levels of serum ferritin (SF), transferrin saturation (TSAT), Hb, and Hct were examined before treatment and 4, 8, and 12 weeks after treatment. (1) Compared with baseline levels, the levels of Hb, Hct, SF, and TSAT significantly increased 2 weeks after treatment in the intravenous iron sucrose group, and 4 weeks after treatment in the oral medication group (all P < 0.05). (2) The Hb, Hct, SF, and TSAT levels 4, 6, 8, and 12 weeks after treatment of the 2 intravenous iron sucrose subgroups were all significantly higher than those of the oral medication group (all P < 0.05). (3) The Hb, Hct, SF, and TSAT levels 12 weeks after treatment 6, 8, and 12 weeks after treatment were not significantly different from those 4 weeks after treatment in the intravenous iron sucrose group (all P > 0.05). (4) The response rate of the intravenous iron sucrose group was 95.09%, significantly higher than that of the oral medication group (55.44%, P < 0.05). (5) The mean EPO doses 6, 8 and 12 weeks after treatment of the intravenous iron sucrose group were significantly lower than that before treatment and those of the oral medication group (all P < 0.05). (6) The Hb, Hct, SF, and TSAT levels maintained stable during the period 6, 8, and 12 weeks after treatment in the intravenous iron sucrose group despite the decrease in dose and frequency. (7) The Hb, Hct, SF, and TSAT levels were significantly higher in the intravenous PD subgroup than in the intravenous HD subgroup. (8) No adverse event was found in the intravenous iron sucrose group, and adverse gastrointestinal effects occurred in 12 patients of the oral medication group. (9) After 12 weeks, the cost of EPO + intravenous iron sucrose was significantly higher than that of EPO + ferrous succinate. Intravenous iron sucrose effectively increases the serum iron parameters and hemoglobin levels during maintenance peritoneal dialysis and is well tolerated. Infusing intravenous iron sucrose 200 mg every two weeks can maintain the serum iron parameters and hemoglobin level in maintenance peritoneal dialysis patients and n permits reduction of the required dose of EPO. However, the total cost of intravenous iron treatment is relatively high.

Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care

The main aim of this review is to evaluate and summarise the best available evidence about peritoneal catheter exit site care to minimise the risk of infection. The specific review questions to be addressed are: •What is the most effective approach to managing peritoneal catheter exit sites during the initial post-operative period? •What is the most effective approach to the long term management of peritoneal catheter exit sites? Inclusion Criteria Types of participants Participants of interests are both adults and children (under 18) with chronic renal failure on maintenance peritoneal dialysis. Studies which analyse diabetic patients separately will be considered for inclusion as a subgroup analysis. Types of interventions Interventions of interest are those used to manage peritoneal catheter exit sites, both in the early post-operative period (from 0 to 14 days post insertion of the catheter), and the long term period (15 or more days post insertion). Interventions of interest include: •Dressing of exit sites, including type of dressing, frequency of dressing and technique (aseptic vs. clean) •Exit site skin care, frequency and type of skin care (or product used). •Education of the person with a peritoneal catheter, or a carer, on exit site management. •Prophylactic treatments involving topic antimicrobial agents or antiseptic and devices. Types of outcome measures The outcomes of interest are those related to the effectiveness of peritoneal catheter exit site care. These outcomes will include incidence of exit site infection and peritonitis.Outcome measures: •Incidence of tunnel or exit site infection: Number of patients with infection inside the tunnel or at the exit site. Infection can be defined as the presence of redness, inflammation, exuberant granulation tissue and purulent/bloody exudate associated with erythema and oedema. •Incidence of peritonitis: two positive (post dialysis cell count > 100 cells/ mm³ with >50% of polimorfonuclear leukocytes), peritoneal liquid cultures in an asymptomatic PD catheter carrier or a single positive in a PD catheter carrier with symptoms of peritonitis (such as abdominal pain, fever and cloudy peritoneal liquid). •Reappearance of the peritonitis (after two to four weeks, due to the same microorganism). •Lapse of time to the first episode of peritonitis. •PD Catheter removal. •Readmission rates related to peritonitis. •Failure of the procedure (transfer from PD to haemodialysis). •Death caused by peritonitis

Relationship between Plasma Fibroblast Growth Factor-23 Concentration and Bone Mineralization in Children with Renal Failure on Peritoneal Dialysis

Fibroblast growth factor (FGF)-23 is produced in bone, and circulating levels are markedly elevated in patients with end-stage kidney disease, but the relationship between plasma levels of FGF-23 and bone histology in dialysis patients with secondary hyperparathyroidism is unknown. The aim of the study was to evaluate the correlation between plasma levels of FGF-23 and bone histology in pediatric patients with end-stage kidney disease who display biochemical evidence of secondary hyperparathyroidism. We performed a cross-sectional analysis of the relationship between plasma FGF-23 levels and bone histomorphometry. The study was conducted in a referral center. Participants consisted of forty-nine pediatric patients who were treated with maintenance peritoneal dialysis and who had serum PTH levels (1st generation Nichols assay) greater than 400 pg/ml. There were no interventions. Plasma FGF-23 levels and bone histomorphometry were measured. No correlation existed between values of PTH and FGF-23. Bone formation rates correlated with PTH (r = 0.44; P < 0.01), but not with FGF-23. Higher FGF-23 concentrations were associated with decreased osteoid thickness (r = -0.49; P < 0.01) and shorter osteoid maturation time (r = -0.48; P < 0.01). High levels of FGF-23 are associated with improved indices of skeletal mineralization in dialyzed pediatric patients with high turnover renal osteodystrophy. Together with other biomarkers, FGF-23 measurements may indicate skeletal mineralization status in this patient population.

Interrelationships between B-Type Natriuretic Peptides and Vitamin D in Patients on Maintenance Peritoneal Dialysis

Experimental evidence suggests that vitamin D deficiency impairs cardiac structure and function. Our objective was to observe relationships between circulating levels of the cardiac natriuretic peptides and vitamin D levels in patients on chronic peritoneal dialysis. Measurements were made of circulating levels of 25-hydroxyvitamin D [25(OH)D] and plasma B-type natriuretic peptide (BNP) levels in patients receiving chronic peritoneal dialysis. Both BNP and the 1-76 amino-terminal fragment of pro-BNP correlated inversely with 25(OH)D levels (rs = -0.60, p = 0.007, and rs = -0.64, p = 0.003, respectively) in patients on peritoneal dialysis. Vitamin D deficiency in chronic renal failure may impair cardiac function, as manifested by elevated levels of B-type cardiac natriuretic peptides.