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     

Comparison of the oxidant-antioxidant parameters and sialic acid levels in renal transplant patients and peritoneal dialysis patients

Objective

Several studies have shown that in end-stage renal failure, increased oxidative stress and reduced antioxidant system functions may play an important role in inflammation, atherosclerosis, and many other complications. Paraoxonase (PON) and arylesterase (ARE) are antioxidant and malondialdehyde (MDA) an oxidant agent. Increased sialic acid (SyA) levels in uremic patients is an acute-phase response showing tissue and organ damage. The aim of this study was to compare PON, ARE, MDA, and SyA among continuous ambulatory peritoneal dialysis (CAPD) and renal transplant patients.

Methods

Twenty-six CAPD patients including 7 women and 19 men of overall mean age 40.5 ± 10.66 years were included in this study. There were 28 preemptive transplant patients, namely 6 women and 22 men of overall mean age 36.5 ± 10.97 years. CAPD was the initial sole replacement therapy. Serum PON, ATE, MDA, and SyA levels were measured at 13-15 months of treatment.

Results

Higher PON (P = .015) and ARE (P = .002) and lower MDA (P = .002) and SyA (P = .000) values were determined among transplanted compared with CAPD patients.

Conclusions

In the transplant group, antioxidant parameters were higher and oxidant parameters lower with less activation of SyA than in the CAPD group. We observed that renal transplantation had a constructive effect on the oxidant-antioxidant system and consequent tissue destruction, which were impaired in uremic subjects. This study showed that renal transplantation is a more appropriate replacement treatment than CAPD.     

CAPD versus haemodialysis: A comparison in the same patients

Most studies comparing CAPD and haemodialysis (HD) were done in different populations, matched for sex and age. The present report compared 13 non-diabetic end-stage renal failure patients who were treated for at least six months with each type of therapy. Analysis of the data revealed a higher haemoglobin during CAPD but no differences in the blood transfusion requirements. Serum creatinine, BUN and potassium were lower during CAPD and serum calcium was higher during HD. Serum cholesterol levels were higher during CAPD and returned to pre-CAPD levels during the fourth month after being transferred to HD. Hospitalization rates were similar with the two treatments. Our study confirmed previous sex- and age-matched studies comparing CAPD and HD therapy.     

The Effect of Renal Replacement Therapies on Serum Gastrointestinal System Hormones

Background. The kidney is a major site for the inactivation, degradation, and clearance of a variety of peptide hormones. It has been shown that the uremia increases or decreases gastrointestinal system (GIS) hormones. Moreover, studies investigating the serum GIS hormones levels in chronic renal failure (CRF) were conducted mainly in a particular period of the renal replacement therapy, and the changes caused by continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) could not be fully demonstrated. In this study, we investigated the effect of CAPD and HD on serum GIS hormones (amylase, lipase, trypsinogen, and gastrin) levels in CRF patients who were diagnosed for the first time. Methods. Serum amylase, lipase, trypsinogen, and gastrin levels were measured in 36 patients who were just diagnosed with CRF, 22 patients with CAPD and 14 patients with HD. GIS hormones of these patients were measured before treatment and three months from the beginning of CAPD and HD treatment. As the control group, 20 normal healthy cases with well-matched age and gender were used. Results. The mean serum amylase, lipase, secretin, and gastrin levels were found meaningfully decreased according to the beginning values at third months of the CAPD and HD treatment. However, they were higher than control group. Conclusion. In patients receiving CAPD or HD as renal replacement therapy, GIS hormone levels were found to be lower, albeit higher than the healthy control group.     

Malnutrition–Inflammation–Atherosclerosis (MIA) Syndrome Components in Hemodialysis and Peritoneal Dialysis Patients

Background. Malnutrition, inflammation, and atherosclerosis (MIA syndrome) are common in end-stage renal disease (ESRD) patients. Each component of MIA syndrome is the predictor of outcomes in ESRD patients. In this cross-sectional study, we aimed to compare both dialysis modalities for MIA syndrome components. Material and Methods. Thirty hemodialysis (HD) (mean age 44 ± 11 years, 14 male and 16 female, mean time on dialysis: 31.0 ± 19.0 months) and 30 continuous ambulatory peritoneal dialysis (CAPD) patients (41 ± 9 years, 12 male and 18 female, mean time on dialysis: 25.5 ± 21.5 months) were included. In order to determine malnutrition in ESRD patients, serum albumin level and anthropometric measurements were used. For inflammation, serum C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen levels were measured. Mean-carotid artery intima media thickness (m-CIMT), presence of carotid plaque and serum homocysteine level were used to determine atherosclerosis. Results. Five CAPD patients (16%) and one HD patient (3%) was hypoalbuminemic. HD and CAPD groups were similar for inflammation. Mean-CIMT and serum homocysteine level were higher in HD patients than CAPD patients. There was a positive correlation between homocysteine and m-CIMT. Conclusion. Before choosing renal replacement therapy, malnutrition, inflammation, and atherosclerosis parameters must be investigated in ESRD patients. Hemodialysis seems to be more advantageous for malnutrition components than CAPD. Both dialysis modalities seem to be similar for inflammation, and CAPD modality has superiority for atherosclerosis. Before choosing the type of renal replacement therapy, assessment of MIA syndrome components could be useful for individualization of the decision on which dialytic modality is appropriate in ESRD patients.     

Peritoneal transport status influence on atherosclerosis/inflammation in CAPD patients.

OBJECTIVE: Peritoneal transport status is one of the main determinants of dialysis adequacy and dialysis-related complications in end-stage renal disease patients receiving continuous ambulatory peritoneal dialysis (CAPD). In this study we aimed to investigate the relationship between peritoneal transport characteristics and known promoters of atherosclerosis in a group of patients receiving CAPD for a minimum of 36 months. DESIGN AND PARTICIPANTS: We performed a cross-sectional study of a cohort of 84 patients with end-stage renal disease (37 men, 47 women; age, 44.0 +/- 15.7 years; dialysis duration, 40.3 +/- 8.1 months) who were receiving CAPD for minimum 36 months. Peritoneal transport characteristics were identified after a peritoneal equilibration test (PET) determined at the third month of CAPD using Dialysate/Plasma (D/P) reference values. Patients were classified according to one of four peritoneal transport types: high (H), high-average (HA), low-average (LA), and low (L). After PET, patients were grouped as high (H/HA group, n = 51) or low (L/LA group, n = 33) transporters. The patient groups' clinical and laboratory data before dialysis and after initiation of the CAPD were collected retrospectively. The patients' follow-up data were retrieved for the diagnosis of any atherosclerosis-related event after the initiation of CAPD. The following events were collected, including myocardial infarction, having been diagnosed as having coronary artery disease by angiography or myocardium scintigraphy, cerebrovascular accident, and development of clinically evident peripheral arterial disease. RESULTS: A comparison of follow-up data revealed that the H/HA transport characteristic was associated with lower albumin (P < .01), higher C-reactive protein (CRP) (P < .0001) levels, and higher recombinant human erythropoietin (rHuEPO) needs (P < .001) when compared with the L/LA type. During follow-up, 28 patients showed an atherosclerosis-related event. Twenty-two of these were in the H/HA group (43.1%), whereas only six were in the L/LA group (18.1%, P < .01). Reanalysis of 18 patients with atherosclerosis-related events and high CRP levels (> 10 mg/L) showed that 15 were in the H/HA and 3 were in the L/LA group. Sixty-eight percent of the H/HA patients with atherosclerosis and 50% of the L/LA patients with an atherosclerotic event also had chronic inflammation (P < .001). A Pearson correlation analysis showed that there was a positive correlation between D/P creatinine levels and 36-month mean CRP levels (r = 0.608, P < .0001), and a negative correlation between D/P creatinine levels and 36-month mean albumin levels (r = -0.299, P < .005). CONCLUSIONS: This study shows that the high transporter peritoneal membrane characteristic is a risk factor for inflammatory state in patients with end-stage renal disease. High-transporter patients are at an increased risk of atherosclerosis when compared with their low-transporter counterparts through chronic inflammation.     

Oxalate elimination via hemodialysis or peritoneal dialysis in children with chronic renal failure

. Oxalate elimination and oxalate dialysance via hemodialysis (HD) or peritoneal dialysis (CAPD) has not been studied in detail in pediatric patients. We studied plasma oxalate, oxalate elimination, and oxalate dialysance in 15 infants and children undergoing CAPD (9 female, 6 male, aged 9 months to 18 years) and in 10 children on HD (4 female, 6 male, aged 7 – 18 years). Two children in each group had primary hyperoxaluria (PH). The mean duration of dialysis prior to examination was 12±11 months in CAPD and 31±23 months in HD patients. Bicarbonate HD was performed 5 h three times a week, CAPD consisted of five daily exchanges in 5 patients and four changes in the remaining 10 children (dwell volume 40 ml/kg body weight, 2.3 g/l glucose). Although oxalate dialysance was significantly higher in HD (mean 115.6 ml/min per 1.73 m² in HD versus 7.14 ml/min in CAPD), mean oxalate elimination per week was not different between both renal replacement therapies (3,478 μmol/1.73 m² surface area/week in CAPD versus 3,915 μmol/1.73 m² per week in HD). Oxalate elimination in patients with PH was between 6,650 and 9,900 μmol/week. Plasma oxalate remained elevated in both procedures [28 – 84 μmol/l in CAPD (92/148 in PH) and 33 – 101 μmol/l in HD (70/93 in PH)]. Oxalate elimination can be increased by a more frequent hemodialysis regimen. Received May 24, 1995; received in revised form and accepted October 31, 1995     

The effect of renal replacement therapies on serum gastrointestinal system hormones

BACKGROUND: The kidney is a major site for the inactivation, degradation, and clearance of a variety of peptide hormones. It has been shown that the uremia increases or decreases gastrointestinal system (GIS) hormones. Moreover, studies investigating the serum GIS hormones levels in chronic renal failure (CRF) were conducted mainly in a particular period of the renal replacement therapy, and the changes caused by continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) could not be fully demonstrated. In this study, we investigated the effect of CAPD and HD on serum GIS hormones (amylase, lipase, trypsinogen, and gastrin) levels in CRF patients who were diagnosed for the first time. METHODS: Serum amylase, lipase, trypsinogen, and gastrin levels were measured in 36 patients who were just diagnosed with CRF, 22 patients with CAPD and 14 patients with HD. GIS hormones of these patients were measured before treatment and three months from the beginning of CAPD and HD treatment. As the control group, 20 normal healthy cases with well-matched age and gender were used. RESULTS: The mean serum amylase, lipase, secretin, and gastrin levels were found meaningfully decreased according to the beginning values at third months of the CAPD and HD treatment. However, they were higher than control group. CONCLUSION: In patients receiving CAPD or HD as renal replacement therapy, GIS hormone levels were found to be lower, albeit higher than the healthy control group.     

The periodontal status of pre-dialysis chronic kidney disease and maintenance dialysis patients.

BACKGROUND: Periodontitis contributes to generalized inflammation and development of systemic diseases, including atherosclerosis and cardiovascular disease. Its extent in maintenance haemodialysis (HD) patients is disputable and not known in continuous ambulatory peritoneal dialysis (CAPD) and pre-dialysis chronic kidney disease (CKD) patients. METHODS: One hundred and six patients (35 on HD, mean age, 56 years; 33 on CAPD, mean age 51 years; and 38 pre-dialysis CKD stage 2-5, mean age 51 years) from north-eastern Poland were enrolled. Dialysis subjects were recruited from a cohort of 141 HD and 61 CAPD patients. Two control groups comprised 26 generally healthy individuals with advanced periodontitis requiring specialized treatment, and 30 subjects from general population. Gingival index (GI), papillary bleeding index (PBI), plaque index (PI), loss of clinical attachment level (CAL) and community periodontal index of treatment needs (CPITN) were determined according to WHO recommendations. RESULTS: Average values of the indices in HD, CAPD, pre-dialysis CKD, advanced periodontitis and general population subjects were as follows: GI-1.37, 0.95, 1, 2 and 1; PBI-1.45, 0, 0, 2.20 and 1; PI-2.05, 1.59, 1, 2 and 1; and CAL loss-5.11, 3.47, 2.50, 4.68 and 1.40 mm, respectively. CPITN, analysed separately as community periodontal index and periodontal treatment needs, further indicated a high severity of periodontitis in all renal failure groups as compared with general population subjects. The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects. CONCLUSIONS: Periodontal disease is prevalent, severe and under recognized in renal failure patients. Prophylaxis and early dental treatment should be intensified in these subjects, and may be of interdisciplinary importance.     

Malnutrition-inflammation-atherosclerosis (MIA) syndrome components in hemodialysis and peritoneal dialysis patients

BACKGROUND: Malnutrition, inflammation, and atherosclerosis (MIA syndrome) are common in end-stage renal disease (ESRD) patients. Each component of MIA syndrome is the predictor of outcomes in ESRD patients. In this cross-sectional study, we aimed to compare both dialysis modalities for MIA syndrome components. MATERIAL AND METHODS: Thirty hemodialysis (HD) (mean age 44 +/- 11 years, 14 male and 16 female, mean time on dialysis: 31.0 +/- 19.0 months) and 30 continuous ambulatory peritoneal dialysis (CAPD) patients (41 +/- 9 years, 12 male and 18 female, mean time on dialysis: 25.5 +/- 21.5 months) were included. In order to determine malnutrition in ESRD patients, serum albumin level and anthropometric measurements were used. For inflammation, serum C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen levels were measured. Mean-carotid artery intima media thickness (m-CIMT), presence of carotid plaque and serum homocysteine level were used to determine atherosclerosis. RESULTS: Five CAPD patients (16%) and one HD patient (3%) was hypoalbuminemic. HD and CAPD groups were similar for inflammation. Mean-CIMT and serum homocysteine level were higher in HD patients than CAPD patients. There was a positive correlation between homocysteine and m-CIMT. CONCLUSION: Before choosing renal replacement therapy, malnutrition, inflammation, and atherosclerosis parameters must be investigated in ESRD patients. Hemodialysis seems to be more advantageous for malnutrition components than CAPD. Both dialysis modalities seem to be similar for inflammation, and CAPD modality has superiority for atherosclerosis. Before choosing the type of renal replacement therapy, assessment of MIA syndrome components could be useful for individualization of the decision on which dialytic modality is appropriate in ESRD patients.     

Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

Infants with mild postnatal renal dilatation but without vesicoureteral reflux pose a challenge. For how long and in what way should they be followed? From May 1989 to December 2006, we prospectively followed 1,795 pregnancies in which the foetal renal pelvis measured 4 mm or greater. Voiding cystourethrography (VCUG) and renal ultrasound were performed on 1,315 infants at 6 weeks of age. Our study group comprised 208 (167 male) infants with normal VCUG findings who had a renal pelvis of 6–11 mm. We followed them for 1–17 years (mean 11 years). Medical and radiological records were reviewed to determine any urinary symptoms and final outcome. They underwent, on average, four further imaging tests. The renal dilatation had resolved by 24 months in approximately 70%. Urinary tract infection (UTI) developed in 16 (8%). Calyceal dilatation was more likely in those developing UTI (P?=?0.02). Twenty-two (10.6%) had a radiologically demonstrated urinary tract abnormality. Of the five who had renal scarring or severe obstruction, four became symptomatic. Most infants with mild postnatal renal dilatation can be investigated with only one further sonogram at 24 months of age. Mild postnatal renal dilatation is associated with subsequent UTI or renal tract abnormality in 18%. Severe renal abnormality occurred in 2.4%.     

Inguinal herniorrhaphy in the continuous ambulatory peritoneal dialysis patient.

Inguinal hernia repair in the patient on continuous ambulatory peritoneal dialysis (CAPD) is complicated in theory by an increased potential for recurrence. In addition to the constant increased intraabdominal pressure, chronic renal failure has been shown to impair tissue healing. Controversy exists regarding the waiting period before resuming CAPD postoperatively. A retrospective review of all CAPD patients undergoing inguinal herniorrhaphy was performed. The patient's age, type of repair, duration of renal failure preoperatively, length of time on CAPD postoperatively, and date of resumption of CAPD were recorded. An inpatient and outpatient chart review was performed on all patients. Telephone follow-up was performed on surviving patients. From April 1981 to June 1989, 30 patients underwent 36 inguinal herniorrhaphies while on CAPD. One immediate postoperative death occurred due to underlying cardiac disease. The mean follow-up for surviving patients was 34 months (range, 16 to 91) and for those deceased was 25 months (range, 1 to 60). No recurrent hernias were identified either by extensive inpatient and outpatient chart review, or by direct patient telephone contact in all surviving patients. We conclude that inguinal herniorrhaphy can be safely performed in CAPD patients. Peritoneal dialysis can be initiated immediately after repair in this high-risk group of patients. There is a low risk of recurrence; however, long-term patient survival is not expected due to concurrent underlying medical problems.     

Disadvantage of long-term CAPD for preserving cardiac performance: an echocardiographic study

The indices of cardiac performances were compared between 31 continuous ambulatory peritoneal dialysis (CAPD) and 20 long-term hemodialysis (HD) patients. They were subdivided into three groups according to dialysis duration: L-CAPD (n = 16, mean age and CAPD duration were, respectively, 53 +/- 8 [SD] years and 77 +/- 13 months); S-CAPD (n = 15; 52 +/- 12 years, 28 +/- 12 months); HD (n = 20; 51 +/- 10 years, 162 +/- 52 months). The diabetic HD patients (DM-HD; n = 13; 60 +/- 13 years of age, 22 +/- 11 months) were chosen separately. Thirteen normotensive subjects with normal kidney function (mean age, 57 +/- 9 years) were selected as an age-matched control group. There were no significant differences between groups in age, gender, incidence of original kidney disease, or serum biochemical data. The blood pressure and the cardiothoracic ratio in L-CAPD were highest among groups. The indices of left ventricular (LV) hypertrophy as well as LV performance by means of echocardiography or pulsed Doppler were compared. Among nondiabetic dialysis patients, the calculated LV mass index (LVMI) of 166.4 +/- 84.3 g/m2 and the ratio of the peak atrial filling velocity to the peak diastolic flow velocity of 1.25 +/- 0.4 in L-CAPD were greatest, and the left ventricular fractional shortening (%FS) of 34.2 +/- 10.8% in L-CAPD was smallest. LVMI or %FS of L-CAPD was the same as DM-HD of 161.0 +/- 40.7 g/m2 or 31.6 +/- 8.2%. Possibly, poor control of hypervolemia, which is caused by peritoneal problems induced by either peritonitis or chronic exposure to high-glucose dialysate, causes a substantial cardiac preload leading to incipient cardiac failure in L-CAPD. According to the similar results of L-CAPD and DM-HD, it may be that hypertension, hyperlipidemia, or long-term constant glucose loading of CAPD fluids in addition to impaired glucose tolerance by chronic renal failure is more or less related to the progression of LV hypertrophy and latent cardiac dysfunction in long-term CAPD patients. In this context, CAPD of more than 5 years' duration is disadvantageous for preserving cardiac function as compared with HD.     

腹膜透析与血液透析患者血清钙磷及甲状旁腺激素水平控制及其影响因素的对比研究

目的对比血液透析及腹膜透析患者钙磷及甲状旁腺激素水平控制情况并分析相关影响因素。方法单中心横断面观察研究纳入2013年3月至2015年3月在我院接受规律维持性透析治疗3个月以上、临床状况稳定的患者。收集患者临床资料,分析比较不同透析方式的患者血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)达标率及相关影响因素。结果(1)共纳入患者448例,其中持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者355例,间歇性血液透析(intermittent hemodialysis,IHD)患者93例。CAPD患者,男性182例(51.5%),平均年龄52.9岁,中位透析龄17.7个月,其中糖尿病肾脏病76例(21.4%)。IHD患者,男性55例(59.1%),平均年龄52.1岁,中位透析龄21.1个月,糖尿病肾脏病18例(19.3%)。(2)CAPD组和IHD组患者的血清校正钙达标率分别为65.7%、65.6%(P=0.99);血清磷达标率分别为53.2%、32.3%(P=0.31);iPTH达标率分别为47.3%、53.8%(P=0.30)。(3)IHD患者低钙血症的发生率明显高于CAPD患者(17.2%比2.8%,P<0.01),高磷血症的发生率也高于CAPD患者(59.1%比43.1%,P<0.01);CAPD患者的高钙血症明显高于IHD患者(31.5%比17.2%,P<0.01)。(4)不同透析患者钙、磷、iPTH不达标的风险因素比较:对于CAPD组患者,高龄、较长的透析龄是血钙未达标的独立危险因素;未服用磷结合剂、残余肾功能的降低是血清磷未达标的独立危险因素;高龄、较长的透析龄、高血磷是iPTH未达标的独立危险因素。对于IHD组患者,高iPTH是血钙未达标的独立危险因素;高iPTH、未服用磷结合剂是血清磷未达标的独立危险因素;高血磷、低血红蛋白水平是iPTH未达标的独立危险因素。结论腹膜透析高钙血症发生率较高,而血液透析患者低钙、高磷的发生率较高。保护残余肾功能、降低血清磷水平、提高血红蛋白水平、规范服用磷结合剂可能有助于钙磷代谢紊乱的纠正,提高透析患者生存质量。     

Vitamin A losses during continuous ambulatory peritoneal dialysis

Since continuous ambulatory peritoneal dialysis (CAPD) causes losses of certain plasma proteins and their ligands, we examined the serum concentrations of vitamin A and retinol-binding protein (RBP), as well as the concentrations of vitamin A in the skin and dialysis fluid from 32 patients on CAPD over a period of 1-30 months (mean 7.5). The mean values of vitamin A and RBP in serum were 2-4 times higher than those in the healthy controls; a consistent finding in patients with chronic renal failure. Similarly, the vitamin A concentrations in skin were elevated in the CAPD patients (p less than 0.01). The vitamin A content of the dialysate (mean 1.4 mumol/24 h), which correlated significantly with the serum vitamin A concentration (r = 0.67), was constant during CAPD treatment. RBP was present in the dialysate and its concentration closely correlated with that of vitamin A (r = 0.95), indicating that the transperitoneal diffusion involved retinol-RBP. This conclusion was supported by calculations of clearance rates. Despite the considerable losses of vitamin A in CAPD fluid, the patients' vitamin A concentrations in serum and skin remained elevated. Whether extended CAPD treatment (greater than 30 months) may eventually affect the vitamin A situation in chronic renal failure warrants further observations.     

Effect of radio contrast media on residual renal function in peritoneal dialysis patients--a prospective study.

BACKGROUND: Residual renal function is an independent predictor of survival in peritoneal dialysis patients. Systemic administration of radio contrast media (CM) may increase the risk of acute renal failure in patients with impaired renal function not on dialysis. There are few data on the influence of CM administration in dialysis patients. METHODS: We investigated residual renal function in 10 continuous ambulatory peritoneal dialysis (CAPD) patients who underwent elective diagnostic intravenous or intra-arterial administration of CM (study group). Iopromide (a iodinated, non-ionic hypo-osmolar CM) was used for all interventions. The median dose of CM given was 107.5 ml/patient. Residual renal function (calculated as the average of renal creatinine and renal urea clearance) was measured on the day before the intervention (baseline), on days 1-7, day 10 and day 30 after intervention. Eight CAPD patients without exposure to CM acted as the control group. RESULTS: There was no significant difference between the two groups in age, gender, diabetes, duration of dialysis and renal clearance at baseline. In the study group, we observed a temporary decline of residual renal clearance after administration of CM (P<0.05; Friedman test). On day 30, clearances were not significantly different from baseline. In the control group, there was no significant change of residual clearance during the observation period. Repeated measures ANOVA revealed no significant difference in the course of residual renal function between study and control groups. The decline of residual renal clearance between baseline and a routine visit after 4 months was comparable between groups. CONCLUSION: Administration of iopromide did not lead to a persistent decline of residual renal function in CAPD patients. Nevertheless, non-ionic hypo-osmolar CM should be given to these patients with the lowest possible dose and only if there is a real clinical indication.     

Abnormal diastolic left ventricular filling by pulsed Doppler echocardiography in patients on continuous ambulatory peritoneal dialysis.

To determine characteristics of diastolic left ventricular (LV) function in patients on continuous ambulatory peritoneal dialysis (CAPD), two groups of CAPD patients without (n = 23; group 1) vs with (n = 25; group 2) LV hypertrophy (greater than 13 mm) were compared with a group of untreated non-renal hypertensive patients with LV hypertrophy (n = 11; group 3) using Doppler-echocardiography. Age and body surface area were comparable in all three groups, mean CAPD-duration (32 +/- 28 vs 26 +/- 23 months; p = NS) was comparable in renal patients. LV systolic function in echocardiography (LVEF: 62 vs 64 vs 63%) and systolic time intervals were normal and comparable in all three groups. Atrial maximum filling velocities (96 +/- 25 vs 91 +/- 25 vs 67 +/- 8 cm/s) were comparably increased, the ratio of maximal early/atrial filling velocities was comparably decreased (0.73 +/- 0.25 vs 0.77 +/- 0.21 vs 0.99 +/- 0.05) in both groups of renal patients as compared to group 3 (p less than 0.05-0.01). Atrial filling fractions were increased in all three groups, more pronounced in group 1 than in group 3 (50 +/- 11 vs 40 +/- 7%; p less than 0.05). The normal correlation of Doppler parameters with age and with LV radius/thickness ratio was altered in renal patients such that high patient age tended to have an additional negative influence on LV diastolic function of hypertrophied, but not of normal myocardium. Isovolumic relaxation time was prolonged in all three groups (134 +/- 38 vs 131 +/- 34 vs 116 +/- 17 ms; p = NS). We conclude that in patients on CAPD, diastolic LV filling is impaired both in normal and hypertrophied myocardium. High age is a factor that further attributes to diastolic dysfunction of hypertrophied myocardium in CAPD.     

Multi-Centre Study on Outcome of Treatment in Patients on Continuous Ambulatory Peritoneal Dialysis and Haemodialysis

In a multi-centre study by seven large renal units in the UnitedKingdom, the morbidity and mortality of all patients startingCAPD and haemodialysis during a 2-year period (1983–1984)has been monitored prospectively and related to reasons forchoice of therapy and potential risk factors. Over this period 338 new patients (mean age 48; range 3–77years) started CAPD; 17% had diabetes mellitus and 25% had cerebro/cardiovasculardisease. One hundred and seventy-five patients (mean age 45;range 5–73 years) started haemodialysis; 6% had diabetesmellitus and 14% had cerebro/cardiovascular disease. The Kaplan-Meieractuarial patient survival estimates at 2 years were haemodialysis84% and CAPD 83%, whilst technique survival figures for thesame period were haemodialysis 92% and CAPD .80%. Cox's regressionanalysis showed that cerebro/cardiovascular disease and age>60 years were most important predictors for survival inCAPD patients, in whom smoking appeared to be a significantrisk factor, for permanent change of therapy to haemodialysis.The major cause of ‘drop out’ in both groups wastransplantation, whilst hospitalisation was 14.9 days per patientyear for CAPD and 12.8 for haemodialysis patients. Within theCAPD group a temporary change to haemodialysis (<2 months)occurred on 106 occasions (each of mean of 19 days duration),amounting to 10 days per patient year of therapy. CAPD was used twice as often as haemodialysis for managing newpatients. After 2 years hospitalisation technique and patientsurvival were comparable in the two groups, with cerebro/cardiovasculardisease, age, and smoking being significant predictors of outcome.     

The role of continuous ambulatory peritoneal dialysis in end-stage renal failure due to multiple myeloma

A study in 10 patients (eight male, two female; mean age 61.9 +/- 10.7 years) suffering from multiple myeloma (MM) and end-stage renal failure (ESRF) is detailed. Continuous ambulatory peritoneal dialysis (CAPD) was the preferred mode of chronic dialysis in all the patients. Survival after diagnosis was 32.2 +/- 23.9 months. Survival after starting dialysis was 24.6 +/- 20.6 months. All patients on CAPD were adequately dialyzed and in good fluid control. Peritonitis was the main problem on CAPD (one episode per 5.6 patient-months). The majority of peritonitis episodes responded to intraperitoneal antibiotic therapy. One patient with Staphylococcus aureus peritonitis, septicemia, and neutropenia secondary to chemotherapy, died. Recommendations for prophylaxis and treatment of peritonitis are given. Three patients were transferred to hemodialysis. The use of subclavian vein catheters during hemodialysis was associated with a high incidence of gram-positive septicemia. Alkylating agent-based chemotherapy resulted in hematological responses in five patients. Survival after diagnosis in those responders was 47.4 +/- 25.6 months, compared with 17.0 +/- 7.2 months in the nonresponders (P less than 0.05). All responders subsequently relapsed. Four patients died with progressive myeloma. Bone marrow suppression resulted in a high blood transfusion requirement, neutropenia, and thrombocytopenia associated with bleeding into the gastrointestinal tract and central nervous system. Uremic myeloma patients can be adequately dialyzed using CAPD. Those patients who do not have an initial hematological response have a poor prognosis.     

Gastric emptying in diabetic and non-diabetic patients on continuous ambulatory peritoneal dialysis

Summary: As anorexia is common in continuous ambulatory peritoneal dialysis (CAPD) particularly in diabetic patients, we conducted this study to investigate gastric motility and the effect of 2 L of intraperitoneal dialysate in diabetic (DM) and non-diabetic (NDM) CAPD patients. A standard test meal labeled with technetium-99m was given after an overnight fast to 11 DM and 10 asymptomatic NDM CAPD patients (matched for age and sex) on two occasions, each 1 week apart, with an empty (postdrainage) and 2 L dialysate-lilled (pre-drainage) peritoneal cavity. Serial anterior images of the abdomen were taken in a standard manner for up to 2 h. the percentage of radioactivity retained at the end of 2 h (%2h), half emptying time (ET_1/2), and emptying rate (ER) were determined. These three parameters were also obtained from six normal individuals matched for age and sex. the mean age was 53.9 for NDM and 54 for DM patients; the mean dialysis duration was 37.9 and 22.3 months, respectively. the mean age in the control group was 49.5. Comparing the DM and NDM groups individually and with the control group, there were no statistical differences in the three gastric emptying parameters, but the latter were slightly more often abnormal in DM (8) than in NDM (6) patients. There was also a significant difference in the fractional changes of all three parameters pre- and postdrainage in the DM group, but not in the NDM group. We conclude that gastric emptying is impaired in the presence of peritoneal dialysate in DM but not in NDM patients. These findings may explain the higher prevalence of anorexia among DM CAPD patients.