The Putative Role of Human Peritoneal Adipocytes in the Fight against Bacteria: Synthesis of the Antimicrobial Active Peptide DEFA1–3
Georgios PaslakisChristian KeunekeHermann-Josef GroeneBernd SchröppelHolger SchmidDetlef Schloendorff
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<i>Background:</i> Spontaneous peritonitis is a rather rare event, even in peritoneal dialysis (PD). As defensins are natural antimicrobial peptides, we hypothesized that adipocytes as the major constituents of the omentum could play an important role in protecting against infection by generating defensin (DEFA1–3). <i>Methods:</i> We isolated adipocytes from the omentum majus and conducted qualitative and quantitative RT-PCR and immunohistochemical analyses. <i>Results:</i> For the first time described, we were able to detect DEFA1–3 mRNA in highly purified isolated omental adipocytes. The expression of DEFA1–3 in adipocytes was confirmed on the protein level by immunohistochemistry. <i>Conclusion:</i> Our report of DEFA1–3 expression by human omental adipocytes adds to the role of adipocytes in the primary defense against bacterial infection. This may include PD, where the presence of the catheter as a foreign body and the nonphysiological dialysis solution may require constant defense measures to prevent peritonitis, a hypothesis that will require further testing.Peritoneal dialysis is the major form of renal replacement therapy for children awaiting renal transplantation. Peritonitis is the major associated morbidity. We retrospectively identified the pathogens, co-morbid factors and outcome of peritonitis in children on peritoneal dialysis from 1980-1989. Seventy-three children, mean age 12.4 years, received 1,234 patient months of chronic peritoneal dialysis. Twenty-four patients (33%) remained peritonitis free until their dialysis catheters were removed after transplantation. Forty-nine children (67%) developed 219 episodes of peritonitis. Peritoneal fluid cultures were positive in 169 episodes (77%). Of the pathogens identified, 73% were gram positive cocci, 22% gram negative rods, 3% were fungus, and 2% other organisms. The incidence of peritonitis was one episode per 5.6 months. Over a 10 year period: 1) 67% of children on peritoneal dialysis developed peritonitis; 2) gram positive cocci accounted for most episodes; 3) the incidence in children was higher than that reported for adults; 4) there were no deaths attributable to peritonitis.
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Peritonitis is the most serious complication of peritoneal dialysis treatment for ESRD. There is no unanimous attitude yet concerning the influence of PD adequacy on the frequency of peritonitis.The paper reports on a study of interrelation of peritonitis frequency and PD adequacy in 61 patients (27 women, 34 men) during a 5-year period. The group included 88% of all PD patients (61 of totally 69).The patients experienced a total of 71 peritonitis episodes over a total of 1615 months of PD treatment. There was one peritonitis episode per 23 months of treatment on an average. When a patient who experienced 11 peritonitis episodes was excluded, the average frequency of peritonitis turned to one in 26 months. Peritonitis frequency and PD adequacy showed a significant negative correlation (r = 0.25, p < 0.05). PD adequacy expressed as total weekly Kt/V did not differ between the patients with and those without a history of peritonitis (Kt/V+ = 1.87 +/- 0.21, Kt/V- = 1.88 +/- 0.24; t = 0.17, p > 0.05). The frequency of peritonitis in men was twofold that in women, i.e. one peritonitis in every 17.24 +/- 11.67 months of treatment in men, and one peritonitis in every 37.81 +/- 13.11 months in women. The difference was statistically significant (t = 6.39, p < 0.01). However, PD adequacy did not differ between men and women (Kt/V = 1.84 +/- 0.21: 1.92 +/- 0.23, t = 1.40, p > 0.05). Patients with more adequate dialysis (n = 51) (Kt/V = 1.70) had one peritonitis in every 23.16 +/- 20.07 months on an average, and those with less adequate dialysis one peritonitis in 21.82 +/- 18.12 months of treatment. The difference was not statistically significant (t = 0.21, p > 0.05). The patients in whom PD was the first method of ESRD treatment (n = 55) experienced one peritonitis in every 24.04 +/- 12.51 months of treatment on an average, and those in whom PD was the second method of ESRD treatment (n = 6) had one peritonitis in 15.68 +/- 13.54 months of treatment. The difference was not significant (t = 1.45, p > 0.05). The difference in dialysis adequacy between these two groups was not significant either, even though the patients with PD as the first method had more adequate dialysis (1.88 +/- 0.22: 1.83 +/- 0.27; t = 0.44, p > 0.05).Peritonitis frequency and PD adequacy are significantly negatively correlated. The patients with higher peritonitis frequency had less adequate dialysis, while the patients with less adequate dialysis had peritonitis more frequently. However, the patients with a history of peritonitis had not significantly less adequate dialysis, nor the patients with less adequate dialysis had a significantly higher frequency of peritonitis.
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Peritoneal dialysis (PD) is an effective and frequent dialysis modality in adults, particularly preferred in infants and young children with end stage kidney disease. Peritonitis in patients undergoing peritoneal dialysis (PD) remains a common complication. The aim of this study is to investigate the role of climatic factors in dialysis-related peritonitis.
End-stage kidney disease
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Peritoneal infection and poor ultrafiltration continue to be the major causes of treatment failure in CAPD. The combined effects of peritonitis and the continuous exposure to dialysis fluid remain the most likely candidates affecting the peritoneum in the long term. The purpose of this study was to observe the effects of peritonitis and dialysis on longitudinal peritoneal function.The peritoneal equilibration test (PET) was utilized to quantify longitudinal changes in low-molecular-weight solute transfer (D/P(creat)) and ultrafiltration (UF) in 233 patients treated with CAPD. Of these, 166 represented an unselected cohort (Group 1) studied prospectively from commencing treatment for up to 54 months, and 67 were selected patients (Group 2) with PET data available at commencement of the study, having been on dialysis for a minimum of 18 months. PETs were performed either 6-monthly or following peritonitis episodes.Data on the short-term effect of peritonitis kinetics were pooled for groups 1 and 2. Single, isolated episodes (n = 86) had no significant effect on D/P(creat) or UF, whereas recurrences or clusters of infection (n = 70) caused increases in D/P(creat) and reductions in UF, the significance of which increased with the number of episodes. There were significant correlations between both changes in D/P(creat) and UF with the cumulative dialysate leukocyte count, regardless of infecting organism, suggesting that intensity of peritoneal inflammation is also important. Those organisms associated with greater change in peritoneal kinetics, e.g. S. aureus, Pseudomonas, also had the highest neutrophil counts. The longitudinal changes in peritoneal kinetics were analysed for patients in group 1 only. There was a highly significant increase in D/P(creat) after 6 months treatment; this increased further with time on treatment, reaching further significance at 42 and 48 months. There was an associated reduction in UF. In view of the short-term effects of peritonitis on kinetics group 1 was further subdivided into patients who were either peritonitis free or only experienced isolated infections, group 1a, and those that had multiple infection episodes, group 1b. Treatment drop-out, due to death or technical failure occurred at double the rate in group 1b, who also had significantly higher D/P(creat) and lower UF at 1, 6, 12, 18 and 24 months of treatment. Group 1a subsequently caught up, however, indicating that peritonitis is not the only factor influencing long-term changes in peritoneal kinetics.These data suggest that solute transfer increases and UF declines with time on peritoneal dialysis. This process is exacerbated and accelerated by peritonitis, and appears to be proportional to the degree of associated inflammation and number of infections in close proximity.
Peritoneal fluid
Ultrafiltration (renal)
Longitudinal Study
Peritoneal equilibration test
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Peritoneal dialysis (PD)-associated peritonitis is a significant source of morbidity, dialysis-related treatment costs, and is the leading cause of permanent transfer to hemodialysis (HD). Here, we sought to understand if the risks of peritonitis and peritonitis-related outcomes differ by country and to identify patient and clinic/facility predictors of peritonitis.
Clinical Practice
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Objective In order to find out the primary complication of Peritoneal dialysis and chief factor reacted on it, so as to prevent and treat the complication effectively and raise the effect of Peritoneal Dialysis, prolong the survive time. Methods According the device and time of Peritoneal Dialysis, We divide 168 patients into three group: group 1, used the straight tube - set, group 2 used the 'O'type- set and group 3 used the double link- set. We have compared the incidence of peritonitis, channel and orifice inflammation and the outcomes survive time of Peritoneal Dialysis patient among the group. Results The incidence of peritonitis, channel and orifice inflammation are decrease obviously, and the outcome.,survive time are improved in the both group of 2 and 3 group (P 0.01) .Conclusion In the tropic area of Hainan,the 'O'type- set and double link- set are the good device of Peritoneal Dialysis, which can obviously reduce the incidence of peritonitis; the tube face - on side can prevent channel and orifice inflammation and peritonitis.
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The lack of specific information on the peritoneal-function consequences of late peritonitis episodes, and the concern about long-term consequences of peritoneal dialysis (PD), have prompted us to study the peritoneal function of long-term PD patients after a late peritonitis episode. The question is: Is the peritoneum more vulnerable to infections, in terms of functional effects, after a long time on PD? Forty-nine patients observed from baseline to the first year of PD with no peritonitis constituted the "early" control group; 31 other patients had one episode of peritonitis in the same period. Twenty-seven patients with no peritonitis from the fourth to fifth years comprised the "late" control group; 15 other patients had one episode during the same period. The results presented here suggest that peritoneal vulnerability to infectious episodes depends on the PD stage in which they appeared. Certainly, episodes with similar aggressive capacity in terms of inflammation duration (3-4 days) happening during the fifth year led to a loss of ultrafiltration (UF) capacity that does not appear in patients who suffer an episode during the first PD year. A remarkable feature is that this UF-capacity decrease is not accompanied by the usual creatinine mass transfer coefficient increase. This fact suggests that the dependence between peritoneal-glucose-gradient maintenance and water transport has been partially modified over time on PD. In conclusion, late mild peritonitis has distinct peritoneal-function consequences relative to early peritonitis. Patients who continue PD after one late episode showed an accentuation of the usual change which happens on long-term PD, the loss of peritoneal ultrafiltration capacity.
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Chronic peritoneal dialysis (CPD) is the most commonly used method of pediatric dialysis. The preservation of peritoneal membrane function is essential for successful peritoneal dialysis. Two main factors are responsible for long-term loss of membrane function. Peritonitis, the major complication of CAPD, can be life-threatening and lead to more rapid failure of the technique. The other factor is continuous exposure of peritoneal membrane to bioincompatible dialysis solutions. To investigate the role of repeated peritonitis on peritoneal membrane function, we performed a retrospective study to elucidate the association between peritonitis episodes and peritoneal membrane solute transport characteristics.From 1996-2000, 32 pediatric peritoneal dialysis patients were included in this study. According to the peritonitis occurrence frequency, 8 patients were divided into HPO group (peritonitis occurrence rate > or = 5 times/year), and 24 patients were divided into LPO group (peritonitis occurrence rate < or = 1 time/year). The mean age of study patients was 13.95 +/- 5.27 years. The peritoneal equilibration test was performed to evaluate the peritoneal membrane dialyzing function.The mean duration of peritoneal dialysis was 3.31 +/- 1.08 years. The change of peritoneal solute transport (AD/P), computed by subtraction of 4-hour D/P at baseline PET study from that at the last follow-up PET study, showed significant difference (p < 0.05) between HPO (-0.234 + 0.074) and LPO (-0.040 +/- 0.079) groups of children. There was also a significant correlation between repeated peritonitis occurrence and PET deterioration(p < 0.05). The relative risk was 2.63.Children with frequent peritonitis occurrence have significant decreasing peritoneal solute transport and decreasing PET scaling in follow-up period.
Peritoneal equilibration test
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Peritoneal dialysis (PD) allows solute and water transport. Adequate PD depends on a good function of the peritoneal membrane. Peritoneal morphological and functional alterations mostly develop with time on PD. Glucose based dialysis solutions, inflammation and infections are conceivable enemies for peritoneal integrity. In this thesis, the effects of potential enemies on the peritoneal membrane have been described. Furthermore, the experience with peritonitis in the AMC has been discussed with regard to important treatment changes over 32-years of clinical practice. Peritonitis is a manageable complication of PD. Peritonitis rates have improved significantly over the years because of several changes in PD treatment, but the need to change the initial antibiotic increased, because the most frequent cause of peritonitis, coagulase-negative Staphylococcus, showed a decreased susceptibility for the initial empiric antibiotic over time. On top of the natural course of peritoneal function, peritonitis episodes influenced to some extent the time-course of small solute and fluid transport. These modifications will increase the risk of overhydration, especially in patients without urine production. In contrast to the number or timing of the peritonitis episodes, severe peritonitis had a negative effect on the time-course of peritoneal transport. Patients who experienced frequent peritonitis episodes in the first three years of PD, had low dialysate IgG concentrations at the start of PD. This may lead to a lower opsonic activity, which is a risk factor for peritonitis. This thesis contributes to a better understanding of the causes and effects of peritoneal alterations, including consequences for prevention and treatment.
Feline infectious peritonitis
Peritoneal fluid
Peritoneal cavity
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Peritonitis is a frequent complication of peritoneal dialysis. Infection is most commonly introduced into the peritoneal cavity through the indwelling catheter during the dialysis procedure. Occasionally peritonitis is associated with underlying abdominal pathology rather than secondary to the dialysis procedure itself. Here we present a case of polymicrobial peritonitis in a patient on automated peritoneal dialysis (APD) in the setting of uterine perforation by an intrauterine device (IUD). Clinicians involved in the care of patients on peritoneal dialysis should remain vigilant for underlying abdominal pathology in cases of complicated peritonitis.
Peritoneal cavity
Perforation
Dialysis catheter
Abdominal cavity
Intrauterine device
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