Start Of Continuous Ambulatory Peritoneal Dialysis Research Articles

Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study.

Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been rare. We investigated the risk of severe infections after start of continuous ambulatory PD (CAPD) and automated PD (APD) as compared to home HD. All adult patients (n = 536), who were on home dialysis at day 90 from starting kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district, were included. We defined severe infection as an infection with C-reactive protein of 100 mg/l or higher. Cumulative incidence of first severe infection was assessed considering death as a competing risk. Hazard ratios were estimated using Cox regression with propensity score adjustment. The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6-4.8] for CAPD and 2.2 [95% CI 1.4-3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients. When excluding peritonitis, the incidence rate was not higher among PD than home HD patients. CAPD and APD patients had higher risk of severe infections than home HD patients. This was explained by PD-associated peritonitis.

Hyperlipidemia and mortality in patients on peritoneal dialysis

BackgroundNew lipid-lowering therapy at the start of dialysis and measurement of lipid parameters over the follow-up period is not recommended in dialysis patients, which seems unappropriated in clinical practice. We aimed to examine the effect of hyperlipidemia on mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodsA retrospective cohort study was performed, including 2939 incident CAPD patients from five dialysis facilities between January 1, 2005, and December 31, 2018. The primary outcome was all-cause mortality. The association between hyperlipidemia at the start of CAPD and all-cause mortality was evaluated using Cox proportional hazards regression.ResultsOf 2939 with a median age of 50.0 (interquartile range, 39.0–61.0), 1697 (57.7%) were men, 533 (18.1%) had hyperlipidemia, 549 (18.7%) had diabetes mellitus, 1915 (65.2%) had hypertension, and 410 (14.0%) had a history of CVD. During the median follow-up period of 35.1 months, 519 (17.7%) died, including 402 (16.7%, 47.4/1000 patient-years) in the non-hyperlipidemia group and 117 (22.0%, 71.1/1000 patient-years) in the hyperlipidemia group. Over the overall follow-up period, patients with hyperlipidemia had an equally high risk of all-cause mortality throughout follow-up as those without hyperlipidemia ([HR] 1.04, 95% confidence interval [CI] 0.83 to 1.31). However, from the 48-month follow-up onwards, hyperlipidemia was associated with a 2.26 (95% CI 1.49 to 3.43)-time higher risk of all-cause mortality than non-hyperlipidemia. Hypertension modified the association between hyperlipidemia and all-cause mortality (P for interaction < 0.001). A significantly increased risk of all-cause mortality was observed among patients with hypertension (HR 2.27, 95%CI 1.44–3.58).ConclusionAmong CAPD patients, hyperlipidemia at the beginning of CAPD was associated with a high risk of long-term mortality. Hypertension may mediate the association. Our findings suggested that long-term lipid-lowering treatment should be used in those patients with hyperlipidemia.

Peritoneal dialysis in Dalmatian County, Croatia: 21 years of a single-center experience.

With end-stage renal disease becoming more prevalent, the importance of continuous ambulatory peritoneal dialysis (CAPD) is expected to rise even more. However, CAPD is associated with several infections with peritonitis being of the biggest importance. We collected data regarding acute peritonitis episodes (APEs), date of birth and CAPD start, BMI, diabetes mellitus (DM) prevalence, year of renal disease discovery, and details about renal replacement therapies. Primary outcomes included death, transplantation, and a switch to hemodialysis (HD). Hundred and twenty-nine men and 123 women were analyzed. 63 patients had DM. The median age at the start of CAPD was 56. The median length of CAPD treatment was 24 months. In the end, 147 patients were still alive of which 97 were transplanted, 33 were on CAPD, and 26 were switched to HD. A total of 327 APE were observed. Although the incidence is decreasing, efforts are required to enhance the prevention and treatment of APE.

MO668: An Increase of Free Fatty Acids on Patients Starting Peritoneal Dialysis Suggests an Increased Cardiovascular Risk Beyond Classical Dyslipidemia Biomarkers

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) produces profound changes in lipid metabolism, and these associated lipid disorders, in turn, contribute to the progression of CKD and its cardiovascular complications. Patients on peritoneal dialysis have a more atherogenic lipid profile than non-dialysis-dependent CKD patients or on HD. In the general population, the reduction of total cholesterol and LDL levels is associated with improved clinical outcomes in terms of morbidity and mortality; however, several studies have failed to obtain these same results in patients on dialysis. The use of lipidomics to detect a broader panel of lipid species can improve the prediction of the different alterations that influence cardiovascular mortality. METHOD This is a single-center prospective observational study of a cohort of CKD patients who start renal replacement therapy with continuous ambulatory peritoneal dialysis (CAPD). Data from 39 patients were examined. All samples for routine laboratories and lipidomics studies were obtained the day before starting CAPD (T0) and 6 months after (T1). Samples were analysed on an Ultra-Performance Liquid Chromatography system. The differences in the lipid profile analytical variables between baseline and 6 months after the start of CAPD were analysed. For the lipidomic analysis, each compound was grouped with its possible adducts and compound class based on the International Lipid Classification. RESULTS Thirty-nine patients were enrolled the study. Their mean age was 57.9 ± 16.3 years. The underlying renal diseases were glomerular disease (15 patients), diabetic kidney disease (10), congenital kidney disease (4), hypertensive kidney disease (2), interstitial nephropathy (2) and others (6). Hypertension was present in 96.3% of the patients, diabetes mellitus in 30.8% and 30 of the 39 patients had dyslipidemia (76.9%). Of the group of patients with dyslipidemia, only one of them was not on statin treatment. Table 1 shows the results of the analytical variables of lipid profile, serum glucose and renal function before and 6 months after initiating CAPD. The levels of CT and LDL were lower 6 months after CAPD initiation, but these were not statistically significant. Using the plasma lipid profile, with a mass spectrometry approach, a significant increase (P &amp;lt; 0.05) in total free fatty acids (FFA) was observed from T0 to T1. FFA (16:1) and FFA (18:0) were the FFAs with the highest peak response (Fig. 1). CONCLUSION Our LC-QTOF/MS-based lipidomics approach to study the effect of starting renal replacement therapy with CAPD in patients with CKD shows that total FFAs increased after 6 months on this technique. Within this group of lipids, FA 16:1 (palmitoleic acid) and FA 18:0 (stearic acid) were the ones that increased the most. An earlier study demonstrated that FFA levels are increased in the plasma of CKD patients; moreover, they have reported that higher levels of saturated fatty acids in serum correlate with sudden cardiac death in patients starting HD. Likewise, monounsaturated fatty acids are the products of stearoyl-CoA desaturase (SCD) catalyzed reactions and act as substrates to synthesize phospholipids and triglycerides. The activity of SCD is very high in patients with cardiovascular disease, hypertension and diabetes.

Coexistence of diabetes mellitus and pre-existing cardiovascular disease and mortality in Chinese patients on peritoneal dialysis

BackgroundLittle is known about the association between the coexistence of diabetes mellitus (DM) and pre-existing cardiovascular disease (CVD) and mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodsA retrospective cohort study of 2939 Chinese incident CAPD patients was conducted between January 1, 2005, and December 31, 2018. The primary and secondary outcomes were all-cause and CVD mortality. The association between the coexistence of DM and pre-existing CVD and mortality was evaluated using Cox proportional hazards regression.ResultsOver a median of 35.1 months of follow-up, 519 patients (17.7%) died, with 258 (8.8%) being CVD-related deaths. DM plus pre-existing CVD, DM, and pre-existing CVD were associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 2.85; 95% confidence interval [CI], 2.18 to 3.72; adjusted HR, 1.89; 95% CI, 1.50 to 2.38; and HR, 1.43; 95% CI, 1.07 to 1.92; P for tend < 0.001) and CVD mortality (adjusted HR, 2.79; 95% CI, 1.91 to 4.08; HR, 1.88; 95% CI, 1.35 to 2.61; and HR, 1.82; 95% CI, 1.23 to 2.68; P for trend < 0.001) than no DM or pre-existing CVD. Subgroup analyses stratified by sex, hypertension status, and hyperlipidemia status showed a similar pattern.ConclusionsThe coexistence of DM and pre-existing CVD at the start of CAPD was more strongly associated with a higher risk of all-cause and CVD mortality than DM or pre-existing CVD alone.

Relationship between uric acid and technique failure in patients on continuous ambulatory peritoneal dialysis: a long-term observational cohort study

ObjectivesUric acid (UA) is the product of purine or nucleotide metabolism via the pathway of xanthine oxidase or xanthine dehydrogenase. Although epidemiological studies assessing the role of UA in cardiovascular...

Risk factors and outcomes of high peritonitis rate in continuous ambulatory peritoneal dialysis patients: A retrospective study.

Peritonitis remains a major complication of peritoneal dialysis (PD). A high peritonitis rate (HPR) affects continuous ambulatory peritoneal dialysis (CAPD) patients' technique survival and mortality. Predictors and outcomes of HPR, rather than the first peritonitis episode, were rarely studied in the Chinese population. In this study, we examined the risk factors associated with HPR and its effects on clinical outcomes in CAPD patients.This is a single center, retrospective, observational cohort study. A total of 294 patients who developing at least 1 episode of peritonitis were followed up from March 1st, 2002, to July 31, 2014, in our PD center. Multivariate logistic regression was used to determine the factors associated with HPR, and the Cox proportional hazard model was conducted to assess the effects of HPR on clinical outcomes.During the study period of 2917.5 patient-years, 489 episodes of peritonitis were recorded, and the total peritonitis rate was 0.168 episodes per patient-year. The multivariate analysis showed that factors associated with HPR include a quick occurrence of peritonitis after CAPD initiation (shorter than 12 months), and a low serum albumin level at the start of CAPD. In the Cox proportional hazard model, HPR was a significant predictor of technique failure. There were no differences between HPR and low peritonitis rate (LPR) group for all-cause mortality. However, when the peritonitis rate was considered as a continuous variable, a positive correlation was observed between the peritonitis rate and mortality.We found the quick peritonitis occurrence after CAPD and the low serum albumin level before CAPD were strongly associated with an HPR. Also, our results verified that HPR was positively correlated with technique failure. More importantly, the increase in the peritonitis rate suggested a higher risk of all-cause mortality.These results may help to identify and target patients who are at higher risk of HPR at the start of CAPD and to take interventions to reduce peritonitis incidence and improve clinical outcomes.

Evaluation of continuous ambulatory peritoneal dialysis fluid C-reactive protein in patients with peritonitis.

Severe peritonitis causing death is one of the most devastating complications of peritoneal dialysis (PD). Since the predictive value of C-reactive protein (CRP) in PD fluid has not been assessed, the objective of the present study is to evaluate its predictive value and clinical correlation in patients on PD with peritonitis. One hundred and twenty patients on continuous ambulatory PD (CAPD) were enrolled and their serum and fluid CRP (Fl. CRP) were evaluated at the start of CAPD. All patients who developed peritonitis were further evaluated for serum and fluid CRP. The patients were categorized into four groups, namely: normal patients (control group), patients with peritonitis, patients with peritonitis leading to catheter removal, and death due to peritonitis. Sixty-five patients developed peritonitis of whom, catheter removal was performed in eight patients. Five patients died due to peritonitis-related complications. Fl. CRP showed a significant difference among the three groups, unlike S. CRP. Estimation of CRP in the peritoneal fluid may be a useful marker to monitor the onset of peritonitis.

Predictors for and impact of high peritonitis rate in Taiwanese continuous ambulatory peritoneal dialysis patients

The influence of high peritonitis rate (HPR) on clinical outcomes of continuous ambulatory peritoneal dialysis (CAPD) patients has been far less studied in the Chinese population than in those of the USA, Australia and Europe. Furthermore, concerning the peritonitis risk, most studies primarily examined the risk of developing the first peritonitis episode, rather than a HPR. A single-center, retrospective, observational study was carried out over 10years in Taiwan. A total of 124 patients with at least one peritonitis episode were the study subjects. The Cox proportional hazard model was used to assess the impact of HPR on clinical outcomes. Multivariate logistic regression was conducted to determine the independent factors associated with a HPR. In the multivariate Cox regression model, HPR was still a significant predictor for technique failure, patient mortality and dropout from peritoneal dialysis (PD). Factors independently associated with a HPR were peritonitis occurrence during the first year after the start of CAPD and the first peritonitis infected with streptococcus species. Peritonitis during the first year after PD commencement and the first peritonitis infected by streptococcus species were significantly associated with an increased risk of a HPR. Our data also indicate that HPR was correlated with technique failure, patient mortality and dropout from PD, thus highlighting the need and role of future studies to reduce this complication.

EVALUATION OF CAPD AS RENAL REPLACEMENT THERAPY IN CHILDREN

Objective: To evaluate the outcome of pediatric patients treated with continuous ambulatory peritoneal dialysis (CAPD) performed by experienced pediatric urologists. Material &amp; Method: A retrospective study of children with end-stage renal disease (ESRD) by peritoneal dialysis (PD) in Division of Nephrology Department of Child Health, Faculty of Medicine Airlangga University, Soetomo Hospital, Surabaya, from January 2003 to February 2012 was conducted. Children with acute kidney injury treated by PD were excluded.Data reviewed were age, sex, primary renal disease, age at start of CAPD, duration of CAPD, outcome and cause of death. Descriptive statistics were used to analyze the data.Results: Twenty seven cases of children with CAPD within 9-year period were included. Most patients were 11-15 years old with 62,9% being male. Chronic glomerulonephritis and nephrotic syndrome were the main primary renal diseases. Fifteen (55,6%) patients had peritonitis. The longest duration on CAPD was 53 months. Outcome of 27 children was as follows, 11 patients died (40,8%), 8 patients survived (29,6%), and another 8 were lost to follow-up (29,6%). All (100%) patients had cardiovascular abnormalities as cause of death. Conclusion: The outcome and mortality rate of children with CAPD remain unfavourable. This is a challenge still to be overcomed. Keywords: Continuous ambulatory peritoneal dialysis, children, outcome.

A Risk Analysis of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis. Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 +/- 10.5 vs 82.3 +/- 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus (p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 - 2.40 (p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 - 2.60 (p = 0.021). Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.

Changes in Water Transport across the Peritoneum during Treatment with Continuous Ambulatory Peritoneal Dialysis in Selected Patients with and without Peritonitis

The natural course of longitudinal changes in peritoneal permeability and membrane area has been studied mostly by performing single-dwell studies in selected patients during treatment with peritoneal dialysis. To evaluate the permeability characteristics of the peritoneal membrane by measuring drained ultrafiltration volume relative to initial glucose concentration in dialysis fluid from the start to the end of continuous ambulatory peritoneal dialysis (CAPD) treatment in a selected cohort of patients with and without peritonitis. A retrospective analysis of a group of patients whose peritoneal function was prospectively followed by recording drained ultrafiltration volume and glucose concentration in dialysis fluid for each dwell time, every day, during the time in CAPD treatment. Mean values from a 1-month period starting after the first 3 weeks of CAPD treatment were compared with the mean values from the last month of treatment. Approximately 11 500 exchanges were analyzed. Evaluations were done separately for short (day) and long (night) dwell times. PATIENTS AND STATISTICS: Of 132 patients commencing CAPD treatment in the time period selected for inclusion, 51 had enough data to be included in this study. Of these, 29 patients experienced one or more episodes of successfully treated peritonitis. The selection of patients was not based upon patient characteristics, but upon criteria to satisfy predefined demands, such as number of measurements in each period, time since an episode of peritonitis, and time on CAPD treatment. Data were analyzed in three different groups: patients with episodes of peritonitis, patients without peritonitis, and both groups together. To assess changes between monthly mean at the start and at the end of CAPD, paired t-test was performed. Patients were also stratified into two groups according to low and high glucose in dialysis fluid at the start of CAPD (cutoff = 2 g/dL). Additionally, we used linear regression analyses to predict the level of drained ultrafiltration volume for a given level and change in glucose concentration. Mean treatment time for the entire group was 20 months (median 14.3 months), ranging from 6 to 69 months. No statistical differences in glucose concentrations were found between the periods compared. In the entire group there was an increase in ultrafiltration volume from the start to the end of CAPD treatment, for both day (p = 0.009) and night (p = 0.013) exchanges. Also, for patients without peritonitis, an increase appeared for day (p = 0.046) and night exchanges (p = 0.053). However, for the cohort with peritonitis, only an insignificant increase was indicated. Patient characteristics, diabetic patients, the need for glucose in dialysis fluid when commencing CAPD treatment, the number of episodes of peritonitis, and time on CAPD did not influence the change in ultrafiltration. Regression analyses showed higher ultrafiltration response to a given level and change in glucose concentration at the end of CAPD treatment compared to the start values, also for the cohort with peritonitis. The regression coefficient between these variables was also significantly changed for both day (p < 0.0001) and night (p = 0.027) exchanges. A significant change in the regression coefficient between glucose in dialysis fluid and ultrafiltration volume reflects an increase in ultrafiltration response to a given level and change in glucose concentration during time on CAPD treatment. A parallel change after 5- and 9-hour dwells can be explained by a decrease in peritoneal surface area combined with a lesser decrease in peritoneal conductivity. However, changes in Starling forces across the peritoneal membrane are possible even in the absence of changes in peritoneal membrane characteristics.

Persistent elevation of C-reactive protein and ischemic heart disease in patients with continuous ambulatory peritoneal dialysis.

We evaluated the association between a persistent elevation of C-reactive protein (CRP) level and the presence or severity of ischemic heart disease (IHD) in patients with continuous ambulatory peritoneal dialysis (CAPD). Seventy-three patients, who were over 40 years old, underwent dipyridamole thallium single photon emission computed tomography (SPECT), and followed-up for more than 1 year were enrolled. We measured stored plasma for CRP every 3 months. Elevation of CRP was defined as greater than or equal to 5 mg/L and persistent elevation of CRP as elevated CRP levels that lasted longer than 6 months. Serum albumin, cholesterol, lipoprotein(a), and plasma fibrinogen were measured at 3 months after the start of CAPD. Twenty-six patients showed an elevation of CRP for more than 6 months during the follow-up period. Twenty-eight patients showed positive findings on thallium SPECT. Coronary angiography showed significant stenosis (narrowing of the diameter more than 50%) in 23 of the 25 patients studied. Seventeen (65%) of 26 patients who had an elevated CRP level for longer than 6 months had positive thallium SPECT. The presence of diabetes, albumin, fibrinogen, and the presence of a persistent elevation of CRP were different between the patients with positive (n = 28) or negative thallium SPECT (n = 45). A multivariate logistic regression analysis showed that a persistent elevation of CRP is the only predictor of positive thallium SPECT (P = 0.002). There was a tendency of association, although it was not statistically significant, between the persistence of CRP elevation and the severity of IHD (P = 0.066). Three of 9 patients who had a persistent elevation of CRP and a negative thallium SPECT had a history of cerebral infarction or peripheral vascular disease. Therefore, 77% (20/26) of an elevated CRP level that lasted longer than 6 months can be explained by the presence of IHD or other atherosclerotic vascular disease. In conclusion, a persistent elevation of CRP level in patients with CAPD was strongly associated with IHD. For patients who have a persistent elevation of CRP without an apparent cause, we recommend a workup for IHD or other atherosclerotic cardiovascular disease.

Mesothelial Paracrystalline Inclusions in Continuous Ambulatory Peritoneal Dialysis Patients

Uremia is known to be followed by changes in the serous membranes of pleura, pericardium, and peritoneum. During continuous ambulatory peritoneal dialysis (CAPD), the peritoneum is exposed to altered body conditions as well as to the influence of dialysate. The aim of the present study was to examine the ultrastructure of the mesothelial cells in CAPD patients, and to compare the findings with those from studies of the peritoneum in uremic controls. Paracrystalline intracytoplasmic inclusions in mesothelial cells were objects of special interest. Biopsies of human parietal peritoneum were studied. These were taken from 12 uremic patients during catheter implantation before the start of CAPD, and from 7 CAPD patients during catheter removal for infection or malfunction. The samples were prepared in the standard way to be studied by transmission electron microscopy (TEM). Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. They appear as filamentous structures at the outer part of the inclusions, and as pearl-like structures at the core of the inclusions. Sacculate dilatations of rough endoplasmic reticulum cisternae with partly destroyed membranes and only few ribosomes were also seen, with and without densely osmiophilic filaments within the cisternae. We have found paracrystalline intracytoplasmic inclusions in mesothelial cells from uremic and CAPD patients both. According to the literature, these changes are present in one third of biopsies from uremic patients. Until now, however, they have not been mentioned in CAPD patients.

Hemoperitoneum due to acute cytomegalovirus infection in a patient receiving peritoneal dialysis

A 27-year-old man receiving continuous ambulatory peritoneal dialysis (CAPD) developed high-grade fever, dyspnea, and hemoperitoneum 32 months after the start of CAPD. A chest computed tomograph showed fine reticular shadows in the bilateral lower lung fields. Cytomegalovirus (CMV) antigenemia were detected, and immunoglobulin (Ig) M and IgG antibodies for CMV were also positive. The absolute counts of helper T cells (478/μL) and the ratio of helper T cells/suppressor T cells (0.25) decreased, despite no evidence of hematologic or immunologic diseases, including human immunodeficiency virus (HIV) or human T cell lymphoma virus-1 (HTLV-1) infection, or the use of immunosuppressive drugs. All symptoms, including hemoperitoneum and the ratio of helper T cells/suppressor T cells, improved gradually and spontaneously. Acute and primary cytomegalovirus (CMV) infection induced hemoperitoneum in a patient who was receiving CAPD.

Exit-Site Care with Ciprofloxacin Otologic Solution Prevents Polyurethane Catheter Infection in Peritoneal Dialysis Patients

Mupirocin ointment and antiseptics are standard cleansing agents in routine exit-site care of peritoneal dialysis (PD) catheters, but these agents have a deleterious effect on polyurethane devices. We assessed the effectiveness of topical use of ciprofloxacin otologic solution for preventing exit-site infection (ESI) in PD patients with polyurethane catheters. Prospective study. Service of Nephrology of an acute-care teaching hospital in Galdácano, Bizkaia, Spain. A total of 164 patients with polyurethane catheters inserted was studied from start of continuous ambulatory PD to the end of a 24-month period. Patients were divided into two groups according to exit-site treatment protocols. Patients in group 1 (n = 86) were instructed on daily exit-site care with soap and water only; whereas patients in group 2 (n = 78) cleansed with soap and water, followed by application of a single-dose vial of 0.5 mL ciprofloxacin (1 mg) for application around the insertion site. Episodes of ESI and peritonitis. There were 67 episodes of ESI among patients in group 1 versus 9 episodes among patients in group 2 (p < 0.05), resulting in a rate of 0.41 and 0.06 episodes per patient-year of exposure, respectively (p < 0.001). Staphylococcus aureus ESI rate was 0.34 in group 1 versus 0.06 in group 2 (p = 0.001). Infections caused by Pseudomonas aeruginosa and other pathogens occurred in 11 patients in group 1 and in no patients in group 2 (p = 0.05). Peritonitis due to S. aureus ESI was significantly less frequent among patients treated with ciprofloxacin (1 vs 9 cases, p = 0.001). Removal of the catheter was necessary in 5 patients in group 1 and in no patients in group 2 (p < 0.05). Daily application of ciprofloxacin otologic solution at the exit site of PD patients with polyurethane catheters inserted significantly reduces the rate of ESI caused by S. aureus and other organisms, particularly P. aeruginosa.

Acquired cystic kidney disease in children undergoing continuous ambulatory peritoneal dialysis. Kyushu Pediatric Nephrology Study Group.

Our cross-sectional study aims to elucidate the prevalence of acquired cystic kidney disease (ACKD), time of occurrence of ACKD, relationship between the prevalence of ACKD and duration of dialysis, progression of cysts, and ACKD-related complications in 54 children undergoing continuous ambulatory peritoneal dialysis (CAPD). ACKD was defined as four or more cysts detected in each kidney by ultrasonography, computed tomography (CT), or magnetic resonance imaging. The presence of less than four cysts was diagnosed as solitary cysts (SCs). Noncystic primary disease was present as glomerulonephritis in 23 patients (42.6%); hypoplastic kidney, 7 patients (13.0%); reflux nephropathy, 6 patients (11.1%); and other, 18 patients (33.3%). ACKD was evident in 16 patients (29.6%) during the 57.9 +/- 39.8 months after the start of CAPD. Nine patients (16. 7%) had SCs. SCs and ACKD were detected initially in patients with 1 and 3 years of CAPD, respectively. The mean duration of CAPD for patients with ACKD (96.1 +/- 36.6 months) differed from that of patients with SCs (49.8 +/- 29.9 months) and no cysts (38.3 +/- 25.8 months). The groups were classified according to time after the start of CAPD: 0 to 4 years (n = 33), 5 to 9 years (n = 16), and longer than 10 years (n = 5). The prevalence of ACKD among these three groups was 9.1%, 50%, and 80%, respectively, and this prevalence increased significantly with increasing duration of CAPD. Of 15 patients examined two to four times by ultrasonography or CT, the number and size of cysts increased in 7 patients with ACKD and 2 patients with SC. Two patients with many and large cysts experienced gross hematuria, and one of those patients had intracystic and retroperitoneal bleeding caused by cyst rupture. No solid mass lesion was found by imaging diagnostic modalities in the 54 patients. In conclusion, the prevalence of ACKD in children undergoing CAPD is just as high as that in adults. The prevalence of ACKD and number and size of cysts increased with increasing duration of CAPD.

Increased Plasma Lipoprotein(a) in Continuous Ambulatory Peritoneal Dialysis Is Related to Peritoneal Transport of Proteins and Glucose

Markedly increased plasma lipoprotein(a) [Lp(a)] levels have recently been reported in continuous ambulatory peritoneal dialysis (CAPD) patients but the genesis is obscure. Lp(a) levels in CAPD are in general higher than in hemodialysis (HD) patients, suggesting that the dialysis procedure might be of importance. In the present study, we investigated relationships between Lp(a) and parameters related to the dialysis procedure per se (dialysis dose, peritoneal glucose absorption, protein losses and protein clearances) in 32 adult CAPD patients. Uremic patients treated with HD (n = 73) as well as a group of 43 healthy subjects served as control groups. The plasma level of Lp(a) was significantly higher in the CAPD patients (median 28.2 mg/dl) than in the HD patients (median 9.2 mg/dl) and the healthy controls (median 7.0 mg/dl), whereas Lp(a) levels in the HD patients did not differ from the healthy controls. In the CAPD patients, significant correlations were found between Lp(a) and 24-hour peritoneal and total clearance for albumin (r = 0.472 and r = 0.368, p < 0.01 and p < 0.05, respectively), and between Lp(a) and 24-hour peritoneal clearance for beta(2)-microglobulin (r = 0.421; p < 0.05). Similar correlations were found between Lp(a) and 24-hour peritoneal albumin excretion, total albumin excretion and peritoneal beta(2)-microglobulin excretion. Furthermore, a significant correlation was found between Lp(a) and peritoneal glucose absorption (r = 0.352; p < 0.05). Serum cholesterol showed significant correlations with 24-hour .peritoneal albumin loss and 24-hour peritoneal beta(2)-microglobulin clearance, whereas LDL cholesterol showed a significant correlation with 24-hour peritoneal beta(2)-microglobulin clearance. In a longitudinal study of 12 CAPD patients, Lp(a) levels increased significantly between the start of CAPD and at follow-up 3-5 months later. The correlation of the markedly increased levels of Lp(a) with peritoneal albumin and beta(2)-microglobulin clearance suggests that the mechanism behind the increased Lp(a) levels may be related to the large protein losses in CAPD, perhaps via an increased synthesis rate of apolipoprotein (a) in the liver or via decreased Lp(a) catabolism in CAPD patients. Finally, the correlation between Lp(a) and peritoneal glucose absorption also indicates that the increased plasma Lp(a) levels in CAPD are related to the dialysis procedure, in particular peritoneal transport of proteins and glucose.

Growth, development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis

We examined the growth, development and nutritional status over a period of 10 years of 15 young children (< 2 years old) on continuous ambulatory peritoneal dialysis (CAPD). There were 6 males and 9 females with a mean age of 12.5 months, mean weight of 6.3 kg, mean height of 66.2 cm at the start of CAPD and a mean duration of therapy of 2.6 years. Height, weight, head circumference, development quotient (DQ), blood chemistry and dietary intake were assessed over a period of 10 years. The patients' mean height standard deviation score (SDS) did not change significantly (from -2.51 to -2.74) during CAPD therapy. The mean growth velocity index (GVI) during CAPD was 76.5% and correlated positively with energy intake but not with protein intake. The mean DQ was low (67.0%) at the start of CAPD and 69.3% at the end of CAPD. DQ did not correlate with energy intake, GVI, head circumference SDS or with the weight/height ratio; however, 2 patients with low DQ (< 60%) had a low energy intakes. Although most patients had a low DQ, the IQ at 5-6 years of age was normal in all patients except 1 without cerebral disease. Our study showed minimal growth (delta SDS) and mental developmental (IQ) delays during CAPD therapy, but an adequate nutritional intake must be assured to obtain the above results.

The Influence of Continuous Ambulatory Peritoneal Dialysis Connection Technique on Peritonitis Rate and Technique Survival

Peritonitis is still the most common complication of continuous ambulatory peritoneal dialysis (CAPD). Several measures have been used to prevent peritonitis, including prophylactic antibiotics and a variety of connection techniques. This study was designed to evaluate the effects of different connection techniques, age at the start of CAPD, sex, and diabetic status on peritonitis rate and technique survival. Three hundred twenty-seven patients treated with CAPD and followed for 8,804.4 patient-months at the Vancouver General Hospital between February 13, 1978, and August 31, 1992, were reviewed. The mean age of the patients was 57.1 +/- 16.3 years. The overall peritonitis rate was 16.6 patient-months per episode. The overall technique survival was 79.6%, 60.2%, and 41.8%, at 1, 2, and 3 years, respectively. Patients using "standard" spike technique (group A, n = 87), Luer lock connector (group B, n = 77), and Luer lock with iodine instillation at the dialysis bag connection site (group C, n = 120) had peritonitis rates of 10.4, 14.7, and 33.3 patient-months per episode, respectively. The relative risk (RR) of peritonitis was 3.5 for group A (95% confidence interval, 2.1 to 4.5) and 2.6 for group B (95% confidence interval, 1.7 to 3.9) compared with group C. Patient age at the start of CAPD, sex, and diabetic status had no effect on the RR of peritonitis. None of the variables studied, except patient age, affected technique survival.(ABSTRACT TRUNCATED AT 250 WORDS)