Trichodermia koningii peritonitis in a patient undergoing peritoneal dialysis
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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 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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Summary Two cases of peritonitis following insertion of an aortofemoral bypass graft are reported. In both, treatment with peritoneal lavage and postoperative dialysis was successful.
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Objective:To study the result of peritoneal dialysis in the elderly patients with chronic renal failure.Methods:A prospective observational study was conducted.Forty-one patients,aged 60 to 82 years,were investigated.The dosage of rHuEPO was 2000IU～3000IU time,2～3time/week or 10000IU a time/week.Results:Recommendation regarding type of peritoneal dialysis must be individualized.After rHuEPO and peritoneal dialysis treatment,BUN、Scr were decreased and CO2CP and Hb increased significantly(P0.001).Conclusion:Appropriate peritoneal dialysis and rHuEPO treatment show a relatively good therapeutic effect for elderly patients with chronic renal failure.
Chronic renal failure
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We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.
Mupirocin
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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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SUMMARY The relation of various demographic, clinical and biochemical parameters of peritoneal dialysis patients with peritonitis and other infections was evaluated. The age, gender, peritoneal dialysis (PD) period, educational status, peritonitis, exit site score, serum albumin, C‐reactive protein (CRP), and triglyceride levels at the beginning and the last visit were recorded. Mean age of 32 patients was 45.1 years; PD period was 13.1 months. Albumin level was inversely proportional to the frequency of peritonitis. Patients with peritonitis had albumin levels that were lower at the last visit, and were independent of the CRP values at the start of PD and during follow‐up. Significant correlation was detected between females and exit site scores. There was significant correlation between educational status and peritonitis. Albumin level at first visit was a factor that reduced the likelihood of peritonitis, and low levels obtained during follow‐up constituted a risk for peritonitis. It was also shown that peritonitis risk tended to decrease inversely with education level.
Serum Albumin
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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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