Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients

Encapsulating peritoneal sclerosis (EPS) is a serious complication of chronic peritoneal dialysis (CPD). In contrast to the adult population, there are few studies regarding EPS in paediatric CPD patients, and the majority of reported patients are from Japan. The aim of the present report is to define the incidence of EPS in our paediatric CPD patients and to describe the clinical and laboratory characteristics. A total of 104 paediatric patients were followed from November 1989 to November 2003 and two were diagnosed as EPS (1.9%). The dialysis periods of these patients were 45 and 53 months with 6 and 8 peritonitis episodes, respectively. Clinical signs of EPS developed 7 and 14 days after the removal of the dialysis catheter, and CPD was replaced by haemodialysis because of persistent peritonitis. One patient was well after surgical management but died 6 months later. The second patient who was treated with prednisolone remained well at 16 months. In conclusion, EPS is a rare but important complication of CPD. We recommend that all patients on CPD who develop ultrafiltration failure be evaluated radiologically for the occurrence of EPS. Management should be tailored to the individual patient.     

A ten-year single-centre experience in children on chronic peritoneal dialysis--significance of percutaneous placement of peritoneal dialysis catheters.

BACKGROUND: Chronic peritoneal dialysis (CPD) in children is an important modality of renal replacement therapy. The ideal method for inserting CPD catheters remains still controversial. Minimal invasive techniques are becoming more popular. This study was performed in order to evaluate the efficiency, the complication profile and the survey of percutaneously placed CPD catheters in children, retrospectively. METHODS: This study was carried out on 108 peritoneal catheters implanted in 93 patients (45 girls, 48 boys), aged 8.0+/-4.2 years (range: 3 months to 16 years) during the period between December 1995 and November 2005. In the study group, 32 children were transplanted, 15 were transferred to haemodialysis and 18 patients died. All catheters implanted by percutaneous route were Tenckhoff swan-neck double-cuff paediatric catheters. Placement procedure was performed in our unit by us. Statistical analysis was made by chi-square and Kaplan-Meier methods. RESULTS: During 2670 CPD months we observed a total of 108 catheter-related complications: 82 catheter infections including exit-site and/or tunnel infection (1/32.5 patient-months), 10 dislocations, six drainage problems and six kinks. The incidence of all complications was one complication every 24.72 dialysis months. Overall, the incidence of peritonitis was one episode per 18.1 patient-months. Pseudomonas spp. and Staphylococcus aureus were the two most common causes of infections. Fifteen catheters were removed due to catheter-related causes: drainage problems (six patients), catheter dislocation (three patients), omental capture (two patients) kink (two patients) and tunnel infection (two patients). The catheter survival rate was 92.4% at 1 year, 83% at 2 years and 63% at 10 years; patient survival in the 93 children was 91% at 1 year, 84% at 2 years and 48% at 10 years. Younger patients were at increased risk of exit-site and tunnel infections (P<0.05) but the difference in catheter survival time between the age groups was not significant (P>0.05). In complications, no statistical difference was observed between early and delayed catheter use groups (P>0.05). We compared the two periods (period 1, December 1995 to November 2000; period 2, December 2000 to November 2005), for complications of CPD. The risk of catheter migration was greater in period 1 than in period 2 (P=0.04). CONCLUSIONS: The percutaneous technique performed by experienced nephrologists is a reliable, safe and cost-effective method for placement of PD catheters. In our opinion, the skill for CPD catheter placement must be part of the paediatric nephrologist training.     

Chronic peritoneal dialysis in Turkish children: a multicenter study

Chronic peritoneal dialysis (CPD) has been utilized in the treatment of children since 1989 in Turkey. The aims of this study were to summarize our experience with CPD in children and to establish a pediatric registry data system in Turkey. Standard questionnaires were sent to all pediatric CPD centers. 514 patients treated between 1989 and 2002 in 12 pediatric centers were enrolled in the study. Reflux nephropathy was the most common (18.1%) cause of renal failure. Mean age at dialysis initiation was 10.1±4.6 years. Mean duration of dialysis was 24.1±20.5 months. Continuous ambulatory peritoneal dialysis (CAPD) was the first CPD modality for 476 (92.6%) patients, 142 of whom switched to automated peritoneal dialysis (APD) during follow-up. Currently, 47.3% of the patients are still on CPD, 15.4% were transplanted, 13.2% switched to hemodialysis, 16.7% died. The patient and technique survivals were 90% and 95% at one year and 70% and 69% at five years, respectively. The survival was significantly shorter in the youngest age group (0–24 months) compared to those in older age groups (p=0.000). We herein report the first results of the TUPEPD study providing information on demographic data and survival of pediatric CPD patients. As opposed to clear recommendations in favor of APD, there is a clear preponderance of CAPD in our pediatric CPD population. That vesicoureteral reflux (VUR) is still the leading cause of renal failure is a distressing finding. Remarkably lower survival rates and transplantation ratios are as striking and distressing as the high incidence of VUR among the causes of ESRD. We conclude that we must make a great effort to achieve better results and to change these undesirable events.     

Paediatric dialysis and renal transplantation in the state of Rio Grande do Sul,Brazil

Renal replacement therapy (RRT) for Brazilian children with uraemia has been utilized since 1970 in the state of Rio Grande do Sul. One hundred and eighty patients receiving this therapy between 1970 and 1988 have been reviewed. The annual acceptance rate of new paediatric patients in this period increased from 0.6 to 6.5 patients per million child population. Glomerulonephritis (36.1%) and pyelonephritis including urological anomalies (31.7%) were the most frequent causes of end-stage renal disease. Outpatient hospital haemodialysis was the primary form of dialytic treatment in patients 5–15 years of age. Continuous ambulatory peritoneal dialysis was more often used in patients less than 5 years of age. The survival after 1 year on dialysis was 79.9% for children aged 5–15 years starting dialysis during the period 1985–1988. Fluid overload with congestive heart failure and infection were the main causes of death in children on dialysis. Eighty-four children received 93 grafts; only 14 (15%) were from cadaveric donors. One-year patient and graft survival of first living-related donor transplants were 92.2% and 78.5% respectively during the period 1985–1988. Infection accounted for 43.5% of deaths after transplantation. We conclude that RRT is becoming increasingly successful for children in our region but that greater emphasis upon patient compliance with all forms of RRT and upon cadaver kidney donation is needed.     

Continuous peritoneal dialysis in children: a single-centre experience in a developing country

Continuous peritoneal dialysis (CPD) is the most commonly used modality of dialysis in children. Continuous ambulatory peritoneal dialysis (CAPD) has been an established form of therapy in adult patients with end-stage renal failure in India for more than a decade. There is a paucity of published experience of CPD in children from developing countries. We retrospectively studied children with end-stage renal failure (ESRD) that had been on CAPD over the past 10 years. Thirty patients with ESRD, mean age 13±8 years (range 5–21 years), male 18, were started on CAPD from 1994 to October 2004. The mean break-in period was 12±3 days. Of these 30 patients, 15 had a total of 21 episodes of peritonitis. The peritonitis rate was 0.58 episodes per patient year. E. coli was the commonest organism causing peritonitis. On outcome analysis, 7/30 (23.3%) patients received a renal transplant, while 11/30 (36.6%) continued on CAPD, awaiting a kidney transplant. Of the rest, eight (26.6%) patients died, two (6.7%) suffered technique failure and were changed to haemodialysis, and two (6.7%) were lost to follow-up after 2 months. The mean cumulative survival time of patient on CPD was 42 months. We conclude that CPD is a viable option for dialysis in ESRD children in a developing country and is a successful bridge between ESRD and renal transplantation     

Survival analysis of pediatric dialysis patients in Taiwan

Aim: The long‐term survival of Taiwanese children with end‐stage renal disease (ESRD) has not been reported before. This study aimed to determine the long‐term survival, mortality hazards and causes of death in paediatric patients receiving dialysis. Methods: Paediatric patients (aged 19 years and younger) with incident ESRD who were reported to the Taiwan Renal Registry from 1995 to 2004 were included. A total of 319 haemodialysis (HD) and 156 peritoneal dialysis (PD) patients formed the database. After stratification by dialysis modality, multivariate Cox proportional‐hazards model was constructed with age, sex and co‐morbidity as predictive variables. Results: The annual paediatric ESRD incidence rate was 8.12 per million of age‐related populations. The overall 1‐, 5‐, and 10‐year survival rates for PD patients were 98.1%, 88.0% and 68.4%, respectively, and were 96.9%, 87.3% and 78.5% for HD patients. The survival analysis showed no significant difference between HD and PD (P = 0.4878). Using ‘15–19 years’ as a reference group, the relative risk (RR) of the youngest group (0–4 years) was 6.60 (95% CI: 2.50–17.38) for HD, and 5.03 (95% CI: 1.23–20.67) for PD. The death rate was 24.66 per 1000 dialysis patient‐years. The three major causes of death were infection (23.4%), cardiovascular disease (13.0%) and cerebrovascular disease (10.4%). Hemorrhagic stroke (87.5%) was the main type of foetal cerebrovascular accident. Conclusion: We conclude that there was no significant difference of paediatric ESRD patient survival between HD and PD treatment in Taiwan. The older paediatric ESRD patients had better survival than younger patients.     

Longitudinal changes in peritoneal equilibration test with or without peritonitis in children

This study was conducted to evaluate longitudinal changes in the peritoneal equilibration test (PET) in children treated with continuous peritoneal dialysis (CPD). The effects of prolonged CPD and episodes of peritonitis on the PET were examined. PET was repeated up to five times in 12 paediatric patients who were subdivided into groups with and without peritonitis. In the peritonitis group (n=6), the dialysate/plasma (D/P) creatinine ratio at a 4-h dwell time decreased progressively with time on CPD in five of six patients. In a comparison of the initial and final PETs performed at a mean interval of 22.8±11.6 months, the D/P creatinine ratio in the final PET was significantly lower than in the initial PET (P<0.01). In contrast, in the non-peritonitis group (n=6), the D/P creatinine ratio in the final PET was unchanged for 28.2±12.3 months from the initial PET. The D/Do glucose ratio at a 4-h dwell time was unchanged over time in each group. Thus, repeated PET measurements revealed that membrane permeability for creatinine was not affected by prolonged CPD itself, but decreased with time after episodes of peritonitis. Although the protocol for PET is not standardised in children, PET was useful for determining the sequential changes in peritoneal function in such patients on CPD.     

Renal replacement therapy for end-stage renal failure before 2 years of age.

This report concerns 296 children (67% males and 33% females) from 24 countries who started renal replacement therapy (RRT) for end-stage renal failure between 1969 and 1988. Children under 2 years of age represented 3.6%, 4.4%, and 8.9% of all children under 15 years of age who started RRT in 1978-1982, 1983-1985, and 1986-1988 respectively. During the first 2 years of life, the most frequent causes of end-stage renal failure were renal hypoplasia and dysplasia (24%), and haemolytic-uraemic syndrome (17%). During 1986-1988 the initial therapy for ESRF was continuous ambulatory peritoneal dialysis (CAPD) in 60%, haemodialysis 25%, intermittent peritoneal dialysis 8%, and 7% were transplanted without prior dialysis. Between 1978 and 1988, 139 of these children were grafted; 53 received a graft (39 cadaveric, 10 living donor, 4 donor uncertain) below, and 86 (71 cadaveric, 14 living donor, 1 donor uncertain) above 2 years of age. One-year graft survival was 54% in the 53 children grafted below 2 years of age and 65% in the 86 grafted above 2 years of age. Only two of the 24 living donor grafts were lost during the first year after grafting. These results compare favourably with the 67% 1-year graft survival of all 278 children aged 2 to less than 6 years at grafting in 1978-1988 on the Registry's file. The 3-year survival of all children aged less than 2 years at start of RRT was 65% in 1978-1982 and rose to 78% in 1986-1988. Twenty-three percent of all deaths were caused by infections.(ABSTRACT TRUNCATED AT 250 WORDS)     

Demography of Dialysis and Transplantation in Europe in 1985 and 1986: Trends over the Previous Decade

The demography of renal replacement therapy for 1985 and 1986is presented, based on returns of individual patient questionnairesto the EDTA Registry, supplemented by some data from the centrequestion-naire. Patient questionnaires for 1985 were receivedfrom 83% of known centres and for 1986 from 79% of known centresin 33 countries. Of 244 497 individually registered patients,116 892 were known to be alive on defined forms of renal replacementtherapy on 31 December 1985 and 121 755 on 31 December 1986. Countries covered by the EDTA Registry include onethird of theworld's population on renal replacement therapy. Individualcountries exemplify different strat-egies with variable proportionalcontributions from home haemodialysis, CAPD and transplantation,and varying levels of achievement in numbers of patients ontreatment. Trends in patient populations demonstrate that standardrisk patients (aged under 55 and non-diabetic) are mostly receivingtreatment in countries with advanced programmes, whereas thegrowth in numbers of new patients is due largely to increasein the acceptance of high-risk patients (aged over 55 or withdiabetes mellitus). These trends have implications for the future;predictions must take account of the variable mixture of standardand high-risk patients, the different results achieved in thesecategories and the rates at which the mixture between them ischanging.     

Peritoneal dialysis in children under two years of age

Background. Although results of peritoneal dialysis (PD) insmall children have improved during recent years, the youngestchildren have poorer growth, more infections and higher mortalitythan do older children. Methods. In this retrospective study, we analysed patient recordsof all children under age 2 treated with continuous peritonealdialysis (CPD) between 1995 and 2000 in Finland. Diagnoses leadingto renal failure in these 23 children were congenital nephroticsyndrome of the Finnish type (13), polycystic kidney disease(4), a urethral valve (3), renal insufficiency due to neonatalasphyxia (2) and Prune-Belly syndrome (1). Of these 23, 17 (74%)were anuric. Results. The mean age at the onset of PD was 0.4 years and themean time on dialysis 1.4 years. Hernias were diagnosed in 57%.The peritonitis rate was 1:14.5 patient-months, and 30% wereperitonitis-free. Hypertension was common, and 70% had at leastone period on antihypertensive medication. None of the patientshad pulmonary oedema or dialysis-related seizures. The meanheight standard deviation score (hSDS) at the start of PD (n= 16) was –2.0 and after 9 months –1.6. Catch-upgrowth was documented in 64% of the patients during dialysis.Hospitalization time was 124 days/patient-year. Two patients(9%) died. Conclusions. Our results are reassuring. Mortality was low,laboratory parameters were acceptable and growth was good. Peritonitisrate was comparable to that in older children. Correction ofinguinal hernia should be routinely performed; high blood pressureis still a problem.     

One year's experience with recombinant erythropoietin in children undergoing continuous ambulatory or cycling peritoneal dialysis

Fourteen patients (aged 5.9–22.1 years) undergoing continuous ambulatory or cycling peritoneal dialysis were treated with recombinant human erythropoietin (rhEPO), which was given intravenously once a week at a dosage of 300 units/kg. The mean haematocrit level increased from 18.5% to 27.5% and the reticulocyte count from 19 to 62 within 1 month. After an average time of 3.1 months rhEPO dosage could be adjusted to 100 units/kg per week to keep the haematocrit level at 30%. Only 1 patient had an exacerbation of hypertension, which required a dosage reduction; other side-effects were not noted.     

A multicenter experience on patient and technique survival in children on chronic dialysis

In this study we compared patient and technique survival of 163 new hemodialysis (HD) patients (age 11.4±3.1 years) and 295 peritoneal dialysis patients (7.7±4.8 years. P< 0.001), treated in 23 dialysis centers participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) during the years 1989–2000. Three HD (1.8%) and 17 CPD (5.8%) patients died; the overall average death rate was 9.8/1,000 patient-years in HD and 29.8/1,000 patient-years in CPD patients. No statistically significant difference in patient survival between CPD and HD was found, while the survival of 102 CPD children younger than 5 years at the start of dialysis was lower (P=0.0001) than that of 193 CPD and 160 HD patients aged 5–15 years. We registered 12 modality failures among HD (7.4%) patients and 44 among CPD (14.9%) patients. The main causes were vascular access failure and patient choice in HD, and infection in CPD patients. Technique survival was lower (P=0.007) in CPD than in HD patients; a statistically significant difference (P=0.01) was also observed between both the 0- to 5- and the 5- to 15-year-old CPD patients and the HD patients aged 5–15 years. Logistic regression analysis confirmed age at initiation of dialysis to be a predictor of patient death (P=0.0001) in the whole patient population, and of technique failure in HD (P=0.006) but not in CPD patients (P=0.16).Dialysis centers and investigators participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis: Unità Operativa (U.O.) di Nefrologia, Ospedale San Lazzaro, Alba (G. Viglino); Servizio di Nefrologia, Ospedale Policlinico, Anzio (F. Della Grotta); Servizio Nefrologia Pediatrica, Clinica Pediatria, Ancona (I. Rätsch); Servizio di Nefrologia, Ospedale Mazzoni, Ascoli Piceno (M. Ragaiolo); U.O. di Nefrologia e Dialisi, Ospedale Giovanni XXIII, Bari (A.D. Caringella, P. Sorino); Istituto di Pediatrica Clinica, Bari (R. Penza); U.O. di Nefrologia e Dialisi, Ospedale Malpighi, Bologna (L. Catizone); U.O. di Nefrologia, Ospedale Umberto I, Brescia (S. Bassi); U.O. di Nefrologia, Ospedale Civile, Brescia (G. Cancarini); Servizio Nefrologia e Dialisi, Clinica Pediatrica, Ospedale Meyer, Firenze (G. Lavoratti); U.O. di Nefrologia Dialisi e Trapianto, Istituto G. Gaslini, Genova (F. Perfumo, E. Verrina); Clinica Pediatrica, Messina (C. Fede); U.O. di Nefrologia Dialisi e Trapianto, Clinica Pediatrica De Marchi, Milano (A. Edefonti, G. Ardissino); Nefrologia Adulto e Bambino, Università di Napoli (G. Capasso); U.O. di Nefrologia e Dialisi, Ospedale Santobono, Napoli (C. Pecoraro); U.O. di Nefrologia, Dialisi e Trapianto, Clinica Pediatrica, Università di Padova (G. Zacchello, B. Andreetta); U.O. di Nefrologia e Dialisi, Ospedale Di Cristina, Palermo (S. Maringhini); U.O. di Nefrologia, Ospedale Civico, Palermo (F. Caputo); U.O. di Nefrologia e Dialisi, Ospedale Silvestrini, Perugia (U. Buoncristiani); U.O. di Nefrologia, Ospedale Santo Spirito, Pescara (A. Ciofani); Dipartimento di Nefrologia e Urologia, Ospedale Bambino Gesù, Roma (G. Rizzoni, S. Rinaldi); Clinica Pediatrica, Policlinico Gemelli, Roma (E. Salvaggio); U.O. di Nefrologia Dialisi e Trapianto, Ospedale Regina Margherita, Torino (R. Coppo, B. Gianoglio)     

Growth of children following the initiation of dialysis: a comparison of three dialysis modalities

Maintenance dialysis usually serves as an interim treatment for children with end-stage renal disease (ESRD) until transplantation can take place. Some children, however, may require dialytic support for an extended period of time. Although dialysis improves some of the problems associated with growth failure in ESRD (acidosis, uremia, calcium, and phosphorus imbalance), many children continue to grow poorly. Therefore, three different dialysis modalities, continuous ambulatory peritoneal dialysis (CAPD), cycler/intermittent peritoneal dialysis (CPD), and hemodialysis (HD), were evaluated with regard to their effects on the growth of children initiating dialysis and remaining on that modality for 6–12 months. Growth was best for children undergoing CAPD when compared with the other two modalities with regard to the following growth parameters: incremental height standard deviation score for chronological age [–0.55±2.06 vs. –1.69±1.22 for CPD (P<0.05) and –1.80±1.13 for HD (P<0.05)]; incremental height standard deviation score for bone age [–1.68±1.71 vs. –2.45±1.43 for CPD (P=NS) and –2.03±1.28 for HD (P=NS)]; change in height standard deviation score during the dialysis period [0.00±0.67 vs. –0.15±.29 for CPD (P=NS) and –0.23±.23 for HD (P=NS)]. The reasons why growth appears to be best in children receiving CAPD may be related to its metabolic benefits: lower levels of uremia, as reflected by the blood urea nitrogen [50±12 vs. 69±16 mg/dl for CPD (P<0.5) and 89±17 for HD (P<0.05)], improved metabolic acidosis, as indicated by a higher serum bicarbonate concentration [24±2 mEq/l vs. 22±2 for CPD (P<0.05) and 21±2 for HD (P<0.05)]. In addition, children undergoing CAPD receive significant supplemental calories from the glucose absorbed during dialysis. CAPD, and possibly, other types of prolonged-dwell daily peritoneal dialysis appear to be most beneficial for growth, which may be of particular importance for the smaller child undergoing dialysis while awaiting transplantation.     

Prognosis of diabetic patients on dialysis: analysis of Lombardy Registry data

METHODS.: This 1993 Lombardy Registry Report refers to all of the dataregarding treated diabetics collected between 1 January 1983and 31 December 1992 by means of individual patient questionnairessent to all of Lombardy's 44 Renal Units (100% replies). RESULTS.: The acceptance rate of diabetics for dialysis increased from5.6 in 1983 to 10.4 patients per million population in 1992for a total of 731 patients (379 type I, 352 type II). The yearlypercentage of new diabetics increased from 9 to 11%, and theproportion of patients with two or more risk factors increasedfrom 14.7% in 1983–1987 to 22.0% in 1988–1992. Theuse of peritoneal dialysis declined over the 10-year periodfrom 50% in 1983–1984 to 30% in the last 2 years. Thedifference in age of the patients on peritoneal and haemodialysistended to decrease. The survival of all diabetic patients was82% at 1 year, 48% at 3 years, and 28% at 5 years. The relativedeath risk of the patients on peritoneal dialysis compared tothose on haemodialysis, after taking into account age and themain comorbid conditions (type of diabetes, severe vasculardisease, cirrhosis and the generic other risk factors), didnot differ significantly from one, as estimated by the Cox proportionalhazard regression model (344 events). The main causes of deathof these patients were cardiovascular diseases (about 50.0%),cachexia (from 17.2% in 1983/1984 to 22% in 1991/1992), andinfections (about 11%). The mean hospitalization rate was higherin diabetics than in patients with standard nephropathies (i.e.in 45–64-year-old patients: 32.8 versus 13.9 days/patient-year). CONCLUSION.: Multivariate analysis showed that age, type of diabetes, severevascular disease, cirrhosis, and the generic other risk factorswere significantly related to survival; but diabetic patientswithout any baseline risk factors also had a poor prognosisand morbidity was very high in absolute terms. Medical caretherefore needs to be improved in order to reverse prognosticrisk factors and prevent cardiovascular and non-cardiovascularevents.     

Swan neck presternal catheter for continuous ambulatory peritoneal dialysis in children

Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2–11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exit site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.     

Patient-related and centre-related factors influencing technique survival of peritoneal dialysis in The Netherlands.

BACKGROUND: Although technique failure occurs relatively frequently in peritoneal dialysis (PD), few data have been published on differences in technique failure between centres. METHODS: Using data from RENINE, the comprehensive dialysis registry of The Netherlands, we analysed PD technique failure rates in the period 1994-1999, with life table methods and Cox multiple regression analysis. Patient age, sex, and the presence or absence of diabetes were included in the analysis, as well as time of initiation of PD and the following centre characteristics: number of PD patients treated in the centre and percentage of patients on PD. RESULTS: Technique failure was higher in older patients: 2-year technique survival was 75% in those younger than 45 years, 68% in the group aged 45-64 years, and 60% in those over 64 years (P<0.0001). Sex and diabetes made no difference in technique survival. Mean annual technique failure rates varied greatly between centres (10-59%) and correlated with the number of patients on PD in the centre (r=-0.396, P=0.009) and with the fraction of patients on PD (r=-0.410, P=0.006). Low technique survival rates occurred mainly in centres with less than 20 patients on PD: relative risk for technique failure 1.68 as compared with larger centres. Patients starting PD in the period 1997-1999 had better technique survival than those starting in 1994-1996 (P=0.001). CONCLUSION: PD technique survival in The Netherlands has increased in recent years. Having less than 20 PD patients in a centre or having a small fraction of patients on PD carries an increased risk of technique failure. The variability in PD technique survival between centres indicates that in many centres further improvements should be possible.     

Baseline hyponatremia does not predict two-year mortality in patients with chronic peritoneal dialysis

Purpose: Hyponatremia is a common electrolyte abnormality in a variety of medical conditions. Lower predialysis serum sodium concentration is associated with an increased risk of death in oligoanuric patients on hemodialysis. However, whether hyponatremia affects the short-term mortality in chronic peritoneal dialysis (CPD) patients remains unclear. Methods: We conducted a cross-sectional and two-year follow-up review retrospectively, and 318 patients with CPD were enrolled in a medical center. Serum sodium levels were measured at baseline and categorized as quartile of Na: quartile 1 (124–135?mEq/L), quartile 2 (136–139), quartile 3 (140–141) and quartile 4 (142–148). Mortality and cause of death were recorded for longitudinal analyses. Results: The patients with higher quartile (higher serum sodium) had a trend of lower age, peritoneal dialysis (PD) duration, co-morbidity index, D/P Cr and white blood cell counts and higher renal Kt/Vurea (Kt/V) and serum albumin level. Stepwise multiple linear regression analysis showed that serum sodium level was positively associated with albumin, residual renal Kt/V and negatively associated with age and PD duration in CPD patients. After two-year follow-up, stepwise multivariate Cox proportional hazards model demonstrated that age, co-morbidity index and serum albumin were the significant risk factors for all-cause two-year mortality, but not serum sodium levels. Conclusions: Serum sodium level in CPD patients is associated with nutritional status, residual renal function and duration of PD. However, baseline serum sodium level is not an independent predictor of two-year mortality in CPD patients.     

Demography of Dialysis and Transplantation in Europe, 1984: Report from the European Dialysis and Transplant Association Registry

The demography of renal replacement therapy up until the closeof 1984 in Europe is presented, based on return of individualpatient questionnaires to the EDTA Registry. These were completedby 84.7% of known centres in 33 countries. Of 187 267 individuallyregistered patients, 102 276 were known to be alive on definedforms of renal replacement therapy on 31 December 1984. Thestock of patients alive on treatment by dialysis and transplantationin Europe continued to grow and exceeded 200 per million populationin 14 European countries at the end of 1984. During the sameyear, 21 198 new patients were accepted for treatment in Europe,and crude acceptance rates for new patients exceeded 60 permillion population in four countries. Acceptance rates for elderlypatients continued to increase and age specific acceptance ratesfor males aged 65 and over exceeded 100 per million populationin 12 countries. A total of 6802 renal transplants were reportedduring 1984. Regrafting accounted for a higher proportion oftransplants in Nordic countries and in the United Kingdom, comparedwith other nations. During 1984 the total number of transplantsreported to the Registry passed 50 000. The distribution ofprimary renal disease amongst adult patients commencing treatmentin 1984 is presented. Amongst elderly patients commencing treatment,a strikingly high proportion have chronic renal failure of uncertainaetiology. Finally, causes of death have been analysed amongstadult patients dying during 1984, showing myocardial ischaemiaand infarction to be the leading cause of mortality.     

Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry.

BACKGROUND: In France, 48% of home-based peritoneal dialysis (PD) patients require assistance to perform their exchange and manage their treatment. A total of 7% are aided by their family, and 41% by a private nurse. Of all the continuous ambulatory peritoneal dialysis (CAPD) patients, 61.7%, and among automated peritoneal dialysis (APD) patients 23%, are assisted at home for their bag exchanges and connections. Assisted APD patients (AAPD) are more comorbid and elderly so that a home helper is not always available: this explains why most helpers at home are private visiting nurses paid by the National Social Security. In addition to the home helper (nurse or family), 58% of centres make regular additional home visits to check the respect of procedures previously taught during the initial training of the nurse or the family helper. The aim of this study was to evaluate whether the type of home assistance received by dependent patients had an influence on peritonitis rates, and if home visits done by nurses of training centres may improve results. METHODS: Peritonitis rates and the probability of being peritonitis free were analysed for 1624 new APD patients recorded in the French PD Registry (RDPLF) between 2000 and 2004, and followed-up until early 2005. RESULTS: Nurse-assisted APD patients had a peritonitis rate of one episode every 36 months, and family-assisted patients one episode every 45 months; using Poisson analysis this trend was not significant (P=0.11). However, the probability of being peritonitis free was significantly higher for family-assisted (69.8% at 2 year) compared with home nurse-aided persons (54.4%) after adjustment for age, diabetes and the Charlson comorbidity index. This difference disappeared when nurses from the training centre regularly visited PD patients at their home in the presence of their helper, whichever type of assistance they received. In addition, when the nurses from the training centres visited private nurse-assisted patients, the probability of being peritonitis free was significantly improved in comparison with those persons who did not receive home visits, from 33.9% to 50.8% at 3 years (P=0.028). CONCLUSIONS: APD patients assisted at home by a private nurse have a higher risk of developing peritonitis than family-assisted patients, unless additional regular home visits are organized by the original training centre. Therefore, we recommend that home visits be regularly made for dependent PD patients to optimize the quality of care provided by the helper.