Indigenous automatic peritoneal dialysis unit

Automatic peritoneal dialysis unit has been developed and fabricated indigenously from multiple electronic and electro-magnetic components available in India. Flow of fluid in and out of the peritoneal cavity is controlled automatically. Dialysis fluid of each cycle is weighed mechanically. If flow of fluid is inadequate the unit gives both audio and visual alarm for immediate attention. Number of cycles and total return of the fluid can be observed at any time. Risk of infection has been minimised as there is no need to change the dialysis fluid at each cycle. There is no need to autoclave the unit as the dialysis fluid does not come in direct contact with the unit. Running cost of the unit is only the cost of dialysis fluid. With easy availability of this unit the peritoneal dialysis facilities can be made avialable in each hospital and even at home in children with chronic ronal failure. This will improve the health care of children with renal failure. The approximate cost of the unit will be Rs. 10,000 only.     

Peritonitis with continuous ambulatory peritoneal dialysis and continuous cycling peritoneal dialysis

The frequency and cause of peritonitis in 18 children receiving continuous ambulatory peritoneal dialysis (CAPD) and nine children receiving continuous cycling peritoneal dialysis (CCPD) are described. Cumulative CAPD and CCPD experience demonstrated 58 episodes of peritonitis in 294 patient treatment months (one case per 5.1 patient treatment months). Total hospitalization for the treatment of peritonitis was 0.18 days per patient treatment month. Life table analysis revealed no significant difference in the peritonitis-free "survival" between the two modalities. Gram-negative organisms accounted for a significantly increased percentage of the peritonitis in CAPD compared with CCPD (65% vs 17%) (P less than 0.001). Thirty-seven percent of the gram-negative infections in the CAPD population were in children with nephrostomies. Factors predisposing to peritonitis were identified in 76% of cases occurring with CAPD. Peritonitis remains the major contributor to the morbidity associated with peritoneal dialysis, regardless of the technique. The resultant frequency of hospitalization is not prohibitive. Attention to the "high-risk" pediatric patient and education directed at several well-recognized predisposing factors may yield improved results.     

Peritonitis rates and common microorganisms in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

Background:  The aim of the present study was to perform a multicenter investigation in Turkish children on chronic peritoneal dialysis by examining the rates of peritonitis as well as causative organisms according to year.
Methods:  Twelve pediatric renal units participated in this study and data were obtained by review of the medical records.
Results:  One hundred and thirty-two patients were on continuous ambulatory peritoneal dialysis (CAPD), 21 were on automated peritoneal dialysis (APD) and 59 were on CAPD and APD at different times. Mean durations of CAPD and APD were 24.2 ± 21.1 months and 22.9 ± 12.8 months, respectively. Seventy-one (33%) out of 212 patients had no peritonitis episode. Overall peritonitis rate was one episode per 15.5 patient-months. The peritonitis rate was one episode per 15.4 patient-months for APD and one episode per 15.6 patient-months for CAPD. Coagulase-negative staphylococcus was the most common cause of peritonitis among patients with positive culture (20.6%). While the incidence of Gram-negative infection remained unchanged according to year in patients on CAPD ( P  = 0.68), the rate of Gram-negative peritonitis in children on APD was significantly higher ( P  = 0.03).
Conclusions:  Peritonitis rate was similar in CAPD and APD, but the risk of Gram-negative peritonitis in APD was higher than that of CAPD.     

Paediatric continuous ambulatory peritoneal dialysis

Ten children in end-stage renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). This represents a total of 3.4 patient years. Biochemical control was good, and parent and patient acceptability high. Peritonitis was the chief complication, but after the institution of a specific CAPD education and training programme the incidence declined 10-fold. We regard CAPD as an effective short- and medium-term treatment for children with end-stage renal failure as part of an integrated dialysis and transplant programme, but it requires a devoted and enthusiastic trained staff to ensure success.     

Modification of peritoneal ultrafiltration capacity in children undergoing peritoneal dialysis

Eleven children (7 girls and 4 boys) 2 1/2 to 17 years and 8 months of age were treated with CAPD for periods ranging from 6 to 31 months. All children were treated with commercially available dialysate solutions containing lactate. Peritoneal ultrafiltration capacity (PUFC) decreased progressively in all children without accompanying decrease in peritoneal urea and creatinine clearances. Five children developed membrane failure with negative ultrafiltration. One episode of peritonitis occurred in one of these 5 children and in 4 of them only 1.5% glucose solutions had been used. After an initial period (ranging from 14 to 31 months) of CAPD, 2 children were treated with Intermittent Ambulatory Peritoneal Dialysis (IAPD) and two others with Intermittent Cycling Peritoneal Dialysis (ICPD). In these 4 children, PUFC increased within one month from -3.75 ml/kg/day to + 5 ml/kg/day. By providing a shorter dwell time, IAPD and ICPD may allow a reduction in net inward transport of glucose, the maintenance of osmolar gradient and preservation of ultrafiltration capacity. Furthermore, periods of rest may allow some recovery from the progressive deterioration of the peritoneum resulting from long-term irrigation of the peritoneal cavity. These results indicate that IAPD and CPD may be superior to CAPD to maintain the ultrafiltration capacity of the peritoneum.     

Paediatric continuous ambulatory peritoneal dialysis.

Ten children in end-stage renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). This represents a total of 3.4 patient years. Biochemical control was good, and parent and patient acceptability high. Peritonitis was the chief complication, but after the institution of a specific CAPD education and training programme the incidence declined 10-fold. We regard CAPD as an effective short- and medium-term treatment for children with end-stage renal failure as part of an integrated dialysis and transplant programme, but it requires a devoted and enthusiastic trained staff to ensure success.     

Acute peritoneal dialysis in neonatal intensive care unit: An 8-year experience of a referral hospital

Background

The aim of present study was to evaluate the indications, complications and outcomes of acute peritoneal dialysis (APD) in neonates at a referral university hospital during the previous 8 years.

儿童终末期肾病全自动腹膜透析并发症与休整期相关性分析

目的：分析儿童终末期肾病腹腔镜及开放手术置管腹膜透析并发症的危险因素。方法：复旦大学附属儿科医院（我院）诊断为终末期肾病、符合慢性腹膜透析（CPD）的适应证、行腹膜透析置管术且术后接受休整期（置管术后至开始腹膜透析的间隔时间）观察并起始透析的患儿。根据腹膜透析后6个月内有无并发症（导管移位、堵塞、渗漏,疝,腹膜透析相关腹膜炎,出口感染,隧道感染等）分为2组,考察并发症与休整期和不同置管方式（腹腔镜和开放手术）相关性。结果：符合本文纳入标准的CPD患儿144例,男84例,平均年龄（8.8±3.8）岁,腹腔镜置管83例,开放手术置管61例,透析前白蛋白（35.8±7.8）g·L-1。有并发症组（n=54)和无并发症组（n=90)性别、年龄、BMI、休整期、原发病、透析前白蛋白、是否大网膜切除差异均无统计学意义,与腹腔镜和开放手术置管差异有统计学意义（30.1% vs 47.5%,P＝0.03）。腹腔镜较开放手术置管腹膜透析相关腹膜炎发生率低（6.0% vs 18.0%, P＝0.02）,导管移位、堵塞、渗漏,疝,出口感染,隧道感染等发生率差异均无统计学意义。结论：腹腔镜与开放手术置管比较,腹膜透析相关并发症少,休整期不影响腹膜透析相关并发症。     

腹膜透析疗法在儿科临床的应用

腹膜为一天然半透膜 ,细胞间隙约 5 0 0 ,具有分泌、吸收、扩散和渗透功能 ,利用腹膜的这些特性 ,向腹腔内输入透析液 ,通过腹膜的弥散作用和透析液的超滤作用 ,使体内过多的水分、电解质、内源性和外源性毒物经透析液排出体外 ,如此反复不断地更换透析液 ,使血液生化成分恢复