Differences in survival on peritoneal dialysis between oriental Asians and Caucasians: One center's experience

BACKGROUND: Recently it has been suggested that the survival of dialysis patients may differ among different races. Both registry data and data from Asian countries indicates that Asians on peritoneal dialysis may survive longer than their Caucasian counterparts. In the present study, we performed a detailed analysis of survival differences between oriental Asians and Caucasians on peritoneal dialysis in our multiethnic, multicultural program. METHODS: Retrospectively we analyzed the survival data for patients who started peritoneal dialysis after January 1, 1996 and before December 31, 1999, in our hospital. They were followed for at least for two years. Excluded from the present analysis were those who survived for less than three months on peritoneal dialysis. The patient demographic characteristics, comorbidities, and residual renal function at the start of dialysis were collected. Indices for adequacy of dialysis were collected 1-3 months after the initiation of dialysis. Actuarial survival rates were determined by the Kaplan-Meier method. The Cox proportional hazards model was used to classify risk factors for a high mortality. RESULTS: There were 87 Caucasians and 29 Oriental Asian peritoneal dialysis patients. No differences were found in age, gender, primary renal disease, and residual renal function between the two groups. The Caucasians had significantly higher body surface area and urea volume and higher incidence of cardiovascular diseases. Even with slightly higher dialysis dose, the peritoneal creatinine clearance was significantly lower among the Caucasians than among Asians. There was no difference in the peritoneal D/P value between the two groups. However, compared to the Caucasians, the 24hr peritoneal fluid removal and total fluid removal volumes were significantly lower in the Asian patients. The one, two, three and four year survival rates were 95.8%, 91%, 86% and 80% for Asians and 91.3%, 78.1%, 64.7% and 54.1% for Caucasians. Significant predictors for a higher mortality were the presence of cardiovascular disease (42% increase in risk), Caucasians (39% increase in risk) and older age (37% increase in risk for age older than 65). CONCLUSIONS: Our study confirms that oriental Asians on peritoneal dialysis patients survive much longer than their Caucasian counterparts; this was partly due to the fact that Asian patients have less cardiovascular disease when they began peritoneal dialysis. Due to their smaller body size, the Asians tended to have a higher peritoneal small solute clearances despite their smaller dialysis doses, indicating that, to achieve the same solute clearance targets, Asians need a smaller dialysis dose compared to Caucasians.     

Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review.

Hemoperitoneum is a well-recognized, if uncommon, complication of chronic peritoneal dialysis. In this review of 424 patients maintained on peritoneal dialysis at a single center during an 11-year period, 26 patients (6.1%) developed one or more episodes of hemoperitoneum. Three patients had hemoperitoneum on two separate occasions with different etiologies. One additional patient was seen on a hospital consultative service. Three types of bleeding episodes were observed. Twenty-one of 30 (70%) were benign, consisting of pink-tinged dialysate with little clinical consequence (group 1). Three (10%) consisted of minor hemoperitoneum associated with significant intra-abdominal pathology (group 2), and six (20%) required active intervention (group 3). The most frequent cause of hemoperitoneum was bleeding related to menstruation or ovulation; hemoperitoneum was more common in women than in men. Two patients had hemoperitoneum occurring after more than 6 years on dialysis. In both, the etiology was sclerosing peritonitis, an association not previously noted. The less common etiologies of hemoperitoneum encountered in our patients were similar to those in reports from other centers and are compiled here.     

Reverse epidemiology in peritoneal dialysis patients: the Canadian experience and review of the literature

High Body Mass Index (BMI) has been associated with improved survival of End-Stage Renal Disease (ESRD) patients on chronic hemodialysis (HD); however, studies on the relationship of BMI with survival in Peritoneal Dialysis (PD) patients have yielded conflicting results. The purpose of this study was to evaluate the impact of BMI on survival of Canadian ESRD patients on PD, correcting for their age, sex, race, diabetes mellitus, and arterial hypertension. In an intent to treat study, we reviewed data of the Canadian Organ Replacement Register (CORR), of incident patients, starting PD between 1994 and 1998 and followed up from their initial PD treatment to the end of 2003. Patients were censored at loss to follow up, transplantation, and the end of the observation period. Cox regression (multivariate) analysis was performed and adjustments were made for age, gender, race, primary renal disease and BMI. During these years, 4054 patients commenced PD, 1742 (43%) of them were females and 1471 (36.3%) were diabetics. The majority were Caucasians (n=3058, 75.4%); 120 (3%) belonged to the First Nations, 137 (3.4%) were black, and the rest (739 pts—18.2%) belonged to various other ethnicities. Based on quartiles of the BMI distribution, 1130 patients (28%) had a BMI < 18.5 kg/m²; 1163 (28.7%), 18.5–24.9 kg/m²; 1214 (30%), 25–29.9 kg/m²; 547 (13.5%) > 30 kg/m². Intent to treat Cox regression analysis showed that being underweight was a strong risk factor for death. Specifically, a BMI less than 18.5 was associated with a death hazard ratio (HR) 1.3, (CI: 1.1–1.6). On the contrary, BMI > 30 was not associated with worse survival than those with normal BMI (HR = 1.009, CI = 0.89–1.14). High-BMI patients should not be discouraged from PD just because of their size.     

Hyponatremia and hypokalemia in patients on peritoneal dialysis

Hypokalemia occurs in up to 60% of patients on peritoneal dialysis (PD) for end-stage renal disease. It can be associated with poor clinical outcomes, including malnutrition and death. New evidence points to a link between hypokalemia and the risk of peritonitis. The serum Na(+) concentration is determined by the ratio of exchangeable Na(+) and K(+) to total body water. Hyponatremia may be caused by excessive thirst, a particular problem in patients on PD. Consistent with the relationship among the serum sodium concentration, total body cation content, and total body water, hyponatremia may also be caused by total body potassium depletion. Ultra-low sodium dialysis fluid may prove to have an important role in management of fluid overload and hypertension in patients on PD. Surprisingly, it is not associated with significant hyponatremia, for reasons that remain to be elucidated.     

Patient and technique survival of diabetics on peritoneal dialysis: one-center's experience and review of the literature

BACKGROUND: Diabetes is the leading cause of end-stage renal disease (ESRD). This retrospective study investigated the long-term patient and technique survival and sought to identify the predictors of mortality in diabetic patients receiving PD. METHODS: Patients, aged 17 years or more who commenced home PD between January 31, 1994, and December 31, 2001 were included. Clinical data were available for 358 patients out of 418 total patients who started PD during this period. They were followed until cessation of PD, death, or to January 31, 2003. Survival probabilities were generated according to the Kaplan-Meier method, and multivariate Cox proportional hazards models were used to assess predictors of survival. RESULTS: A total of 358 patients were enrolled in the study. Among them, 139 patients (38.8%) were diabetics. The 1-, 2-, 3- and 5-year patient survival rates were 91%, 76%, 66% and 47% in diabetics and 94%, 89%, 84% and 69% in non-diabetics, respectively. Median actuarial patient survival for diabetic patients (51.8 months; 95% CI 36.0 a 67.5 months) was significantly shorter than that of non-diabetic patients (log rank 14.117, p < 0.001). Death-censored technique survival rates at 1-, 2-, 3- and 5-year were 90%, 83%, 67% and 58% in diabetic, and 94%, 87%, 77% and 70% in non-diabetic patients, respectively. Similar to patient survival, the median technique survival time was significantly shorter for diabetic patients (63.9 months; 95% CI 35.7 - 92.2 months) than that of non-diabetic patients (log rank 4.884, p = 0.027). Multivariate Cox regression analysis showed that advancing age was the only independent predictor of death in the diabetic patients, whereas higher age and wider pulse pressure were associated with mortality in non-diabetic patients. CONCLUSION: Long-term patient and technique survival for diabetic patients on PD seem to be improved compared to our previous report and other studies. The mortality of diabetic patients was predicted predominantly by advancing age. PD remains a viable form of long-term renal replacement therapy for diabetic patients with ESRD.     

Fluoroscopically guided percutaneous peritoneal dialysis catheter placement: single center experience and review of the literature

Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report.

We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008. Patients underwent PD catheter placement in an interventional radiology suite by the radiologist using a percutaneous Seldinger technique that was guided by fluoroscopy.

Sixty-four patients between the ages of 25 and 90 were referred for fluoroscopic PD catheter placement by an interventional radiologist. If clinically indicated, PD was initiated within days of catheter placement. Minor complications were noted: four with minor bleeding, three with catheter migration, and one with temporary exit-site leakage. No bowel or bladder perforations were encountered.

Fluoroscopically guided PD catheter placement by interventional radiologists can be a safe and cost-effective strategy to initiate acute or chronic PD. This approach could reduce the need for temporary vascular access and expedite the initiation of PD therapy by eliminating the delays in catheter placement often associated with surgical consultation and operating room scheduling.     

Clinical outcomes of elderly patients undergoing chronic peritoneal dialysis: experiences from one center and a review of the literature

Objectives The purpose of this study was to evaluate the outcome and to identify predictors of mortality in elderly patients on chronic peritoneal dialysis (CPD). Methods We retrospectively reviewed the charts of patients who started on CPD at the Division of Nephrology, University Health Network (UHN), Toronto, from 1 January 1994 to 31 December 2001. Patients were divided into three different age groups (≤64 years, 65–74 years, and ≥75 years). Baseline variables included demographics, information on primary kidney disease, comorbidities when dialysis was first started, and initial biochemical data such as serum albumin, serum calcium (corrected for protein), phosphate, hemoglobin (Hb), total cholesterol, and triglyceride. The effects of these variables on survival were studied using a univariate procedure and then analyzed using multivariate Cox proportional hazards models in order to evaluate their independent relation to mortality. Results This study included 358 patients, among whom 213 (59.5%) were ≤64 years old; 88 (24.6%) were 65–74, and 57 (15.9%) were ≥75 years old. Mean actuarial (death-censored) technique survival for the overall study population was 72.4 months (95% confidence interval [CI]: 66.3–78.5); in the ≤64, 65–74, and ≥75 year-old groups mean survivals were 74.4, 62.0, and 64.5 months, respectively. The death-censored technique survival for the elderly patients was not statistically significantly different from that in young patients (P = 0.778). In the overall study population, the mean patient survival was 70.4 months (95% CI 64.2–76.6), while the mean survivals for the ≤64, 65–74, and ≥75 year-old groups were 82.3, 54.0, and 50.0 months, respectively. The overall survival rates at 12 months were 98%, 84%, and 85% for the ≤64, 65–74, and ≥75 year-old groups, respectively. Not surprisingly, the survival of elderly patients on CPD is shorter than that of younger patients (P = 0.000). There were no significant differences between the two elderly groups (P = 0.439). Mortality was predicted by lower initial serum total cholesterol and albumin as well as higher serum calcium levels. Conclusion Our study shows that elderly patients starting CPD had a death-censored technique survival comparable to that of younger patients. As expected, the survival of elderly patients on CPD was shorter than the survival of younger patients. Lower initial serum total cholesterol and albumin as well as higher initial serum calcium were associated with mortality in the elderly population. Our findings indicate that chronic peritoneal dialysis is a successful dialysis option for elderly patients with end stage renal disease. Measures to improve their nutritional state and achieve normalization of serum calcium might improve their survival.     

Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long termdialysis patients that may influence theirquality of life. The present study was carriedout in order to evaluate the prevalence andcourse of fatigue in a group of chronic PDpatients and to find the possible factor(s)related to its development. We retrospectivelyreviewed 100 charts of the patients previouslyon PD. The presence or absence of fatigue inthe 1st and last clinic visits and the 1st and2nd changes in fatigue state were studiedaccording to the monthly clinical records ofthe primary nurses. Data regarding dialysatevolume, urine volume, weekly erythropoietin(EPO) dose, hemoglobin, hematocrit, blood urea,serum creatinine, residual renal creatinine andurea clearances, dialysate to peritonealcreatinine ratio (D/P Cr), total weekly Kt/Vand total creatinine clearance/l.73 m² bodysurface area (TCrCl) were collected. Fifty-fivepatients were male and 45 female. The mean ageat the 1st clinic visit was 61.3 ± 16 years.At the 1st visit 55 patients had fatigue and 45did not. In 32 of the 55 patients fatiguedisappeared after a mean duration of 7.9 ± 8.4months and in 31 of the 45 patients fatigueappeared after a mean duration of 8 ± 6.8months. So at the last visit the frequency offatigue increased significantly from 55% to67% (p < 0.001). In patients with fatigue themean age and female percentage were higher(64.2 ± 14.1 vs 57.8 ± 17.6, p = 0.05 and 1.2vs 0.5, p < 0.05 respectively), mean hemoglobinconcentration was lower (104.4 ± 14.7 vs110.6 ± 14.2 g/L, p < 0.04) and mean EPO dosewas higher (6379.6 ± 7142 vs 3395.4 ± 4337.8units/week, p < 0.02) at the 1st clinic visit.EPO dose was also higher in patients withfatigue at the last visit (8253.7 ± 10317.3units/wk vs 4736.4 ± 5432.5, p < 0.03). Nocorrelation was found between dialysis adequacyaccording to either weekly Kt/V or TCrCl andnutritional state according to nPCR andfrequency of fatigue. We conclude that fatigueis a common symptom in PD patients and it'sprevalence increases over time. Anemia seemsto be the most important factor associated withfatigue. Dialysis adequacy and nutritionalstate did not show any correlation with thefrequency of fatigue in our study.     

Hyperkalemia in chronic peritoneal dialysis patients

Background. Chronic peritoneal dialysis (PD) patients often develop hypokalemia but less commonly hyperkalemia.Methods. We explored incidence and mechanisms of hyperkalemia in 779 serum samples from 33 patients on PD for 1 − 59 months. Normal serum potassium concentration was defined as 3.5 − 5.1 meq/l.Results. Mean monthly serum potassium concentrations were normal (except for 1 month), but we observed hypokalemia (<3.5 meq/l) in 5% and hyperkalemia (>5.1 meq/l) in 14% of 779 serum samples. Incidence of hyperkalemia did not change over time on PD: Year 1 (15%), Year 2 (11%), Year 3 (19%), Years 4–5 (22%). Hyperkalemia was mostly modest but occasionally extreme [5.2–5.4 meq/l (55%), 5.5–5.7 meq/l (21%), 5.8–6.0 meq/l (10%), >6.0 meq/l (14%)]. Of 31 patients (2 excluded due to brief PD time), 39% displayed hyperkalemia only, 23% displayed hypokalemia only, and the remainder (38%) displayed both or neither. Comparing hypokalemia-only with hyperkalemia-only patients, we found no difference in potassium chloride therapy, medications interrupting the renin-angiotensin system, small-molecule transport status, and renal urea clearance. We compared biochemical parameters from the hypokalemic and hyperkalemic serum samples and observed lower bicarbonate concentrations, higher creatinine concentrations, and higher urea nitrogen concentrations in the hyperkalemic samples (p < 0.001 for each), without difference in glucose concentrations.Conclusion. We observed hyperkalemia 3 times as frequently as hypokalemia in our PD population. High-potassium diet, PD noncompliance, increased muscle mass, potassium shifts, and/or the daytime period without PD might contribute to hyperkalemia.     

Prevalence and determinants of erectile dysfunction in patients on peritoneal dialysis

BACKGROUND: Sexual dysfunction including erectile dysfunction (ED) is common in patients with end stage renal disease on peritoneal dialysis (PD). Prevalence and determinants of ED in these patients has not been well characterized. PATIENTS AND METHODS: Prevalence of ED in 44 patients on chronic PD was assessed using the International Index of Erectile Function (IIEF-5) commonly called Sexual Health Inventory for Men (SHIM) score. The associations between ED and other medical conditions was also assessed. RESULTS: Prevalence of ED was high at 88%. Mean age of all patients was 61.8 +/- 13.9 years. Thirty-two patients were hypertensive, 19 of them had coronary artery disease and 13 patients were diabetics. All patients with diabetes had ED. Age and diabetes were found to be significantly associated with ED. CONCLUSION: ED is highly prevalent in patients on chronic PD. Increasing age and diabetes were associated with higher percentage of ED.     

Aspergillus peritonitis in peritoneal dialysis: case report and a review of the literature

Aspergillus peritonitis is a rare complication of continuousambulatory peritoneal dialysis. The case is described of a 68-year-oldman in whom Aspergillus fumigatus was isolated from the peritonealdialysate after recurrent peritonitis with Gram-negative rodsin association with diverticulosis. Treatment consisting ofremoval of the catheter and intravenous administration of amphotericinB followed by oral itraconazole was successful. A review of the sparse literature (12 cases) displays uncertaintiesregarding diagnostic awareness, culture diagnosis, and therapeuticmanagement. Next to institution of appropriate antifungal therapy,early removal the peritoneal dialysis catheter is recommended,as delayed removal of the catheter appears to be associatedwith increased mortality and morbidity.     

Renal transplantation of patients on chronic peritoneal dialysis

A retrospective review of patients transplanted from peritoneal dialysis was performed to assess the risk of this form of dialysis for patients awaiting renal transplantation. Eighteen transplants have been performed in 16 patients, ages 6 to 57 years, undergoing chronic peritoneal dialysis over the past 4 years. Sixteen were from cadaver donors, and two were from living related donors (LRD). The patients had been undergoing intermittent peritoneal dialysis or continuous ambulatory peritoneal dialysis (CAPD) using permanent silastic catheters, from five days to 4 years. No patient had clinical evidence for peritonitis at the time of transplantation. The peritoneal catheter was removed at the time of transplant in all cadaver donor recipients without complication. One recipient of a LRD kidney had the catheter removed two days prior to transplant. Cultures of the catheter were sterile in 16 cases. Two patients had positive peritoneal catheter cultures at the time of transplant but were treated with appropriate antibiotics and never developed clinical peritonitis. Fourteen transplants had postoperative fevers. No definite source was found in 13; one had fever in relation to acute graft rejection. The fevers resolved in all patients either spontaneously or subsequent to therapy. Other complications were similar to those seen in patients transplanted from hemodialysis. Hemodialysis was performed as needed pretransplant and posttransplant using a temporary femoral vein catheter or arteriovenous fistula without complication. Nine patients are alive with a functioning kidney 1 to 36 months posttransplant (mean 17 months). Six transplants rejected (five patients), and one failed secondary to renal vein thrombosis. Two patients died posttransplant, one after a cerebrovascular accident, and one due to an unknown cause 1 month postnephrectomy for rejection. In conclusion, patients undergoing chronic peritoneal dialysis can be successfully transplanted without a significant incidence of complications related to their peritoneal dialysis.     

Prevalence of pulmonary hypertension in peritoneal dialysis patients: a meta-analysis

Purpose

Recent epidemiological evidence indicates an association between peritoneal dialysis (PD) patients and pulmonary hypertension (PH). However, the true prevalence of PH associated with PD has not been well described. So we conducted a meta-analysis to summarize the point prevalence of PH in adults with PD.

Methods

PubMed, EMBASE, the Cochrane Collaboration, and the reference lists of relevant articles were searched to identify eligible studies. We used a random-effect meta-analysis model to estimate the prevalence of PH. We also performed sensitivity analyses and assessments of publishing bias.

Results

Fourteen observational studies (n?=?1483 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 21% (95% CI 16–28), with significant heterogeneity between these studies (I²?=?84%, p?<?0.01). Sensitivity analysis further demonstrated the results to be robust. Besides, the Egger’s test (p?=?0.287) showed no significant publication bias.

Conclusions

PH is highly prevalent in patients with PD. Further studies are encouraged to definitively clarify the relationship between PH and PD.

     

持续非卧床腹膜透析患者换液环境的研究进展

对国内外持续非卧床腹膜透析患者换液环境的研究现状、换液环境未达标的影响因素及干预措施进行综述,以期为降低患者腹膜透析相关腹膜炎等并发症发生率,提高患者生活质量提供参考。     

Prevalence and risk factors of sarcopenia in peritoneal dialysis patients

Objective To investigate the prevalence and risk factors of sarcopenia in peritoneal dialysis (PD) patients. Methods The patients who underwent regular peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between November 2016 and March 2018 were enrolled. Handgrip strength (HGS) was measured to assess muscle strength. Bioelectrical impedance spectroscopy (BIS) was applied to measure the lean tissue index (LTI). Reduced LTI plus decreased HGS was defined as sarcopenia. The prevalence of sarcopenia in PD patients was evaluated. According to the presence or absence of sarcopenia, they were divided into the sarcopenia group and the non-sarcopenia group, and the differences in clinical indicators between the two groups were compared. Multivariate logistic regression was used to explore the risk factors of sarcopenia in PD patients. Results A total of 207 patients were enrolled in the study with age of (55.3±13.7) years and a median PD duration of 22.9(7.3, 60.9) months. Of them, 122 patients (58.9%) were male, 45 patients (21.7%) had diabetics and 32 patients (15.5%) suffered from cardiovascular diseases. There were 27 patients (13.0%) diagnosed with sarcopenia. These patients presented with longer PD duration, more prevalent diabetics, lower residual renal function (RRF) and serum pre-albumin, greater ratio of extracellular water to intracellular water (ECW/ICW) and high sensitive C-reactive protein in contrast with those in the non-sarcopenia group (all P＜0.05). Multivariate logistic analysis showed that male (OR=3.94，95%CI 1.35-11.50，P=0.012), longer PD duration (OR=1.01, 95%CI 1.00-1.02，P=0.029) and higher ECW/ICW (OR=1.09, 95%CI 1.05-1.14，P＜0.001) were independent risk factors of sarcopenia in PD patients. Conclusions Sarcopenia is common in PD patients. Male, longer PD duration and higher ECW/ICW were independent risk factors of sarcopenia in PD patients.     

Pregnancy in patients on chronic ambulatory peritoneal dialysis.

Both conception and successful completion of pregnancy are rare occurrences in female patients on chronic renal replacement therapy. Only a handful of successful pregnancies and deliveries have been reported in patients receiving hemodialysis (HD). Even less common are reports of successful pregnancy and delivery in patients receiving chronic ambulatory peritoneal dialysis (CAPD). Among the more common causes of fetal loss are abruptio placentae and other causes of spontaneous miscarriage. We report here three cases of pregnancy in patients on CAPD; two of these pregnancies progressed successfully to spontaneous delivery, while the third terminated during an episode of acute peritonitis. Furthermore, we have reviewed the literature concerning the outcome of pregnancy in the dialysis population on CAPD.     

Encapsulating peritoneal sclerosis: a single-center experience and review of the literature

Encapsulating peritoneal sclerosis (EPS) is a serious and often fatal complication of long-term PD with severe malnutrition and poor prognosis. It causes progressive obstruction and encapsulation of the bowel. This retrospective study reviews our experience and that reviewed in the literature concerning EPS. It refers to a total of 1966 patients treated with chronic PD between 1974 and 2008. Twenty one of them (1.1%) developed EPS, with the incidence increasing with the duration of PD. Mean age of our patients with EPS was 43, ranging from 18 to 71 years, 8 were men and 13 women with a mean body mass index (BMI) of 21.6 kg/m². Only one patient had Type II diabetes, 15 patients had glomerular disease, and six of these 15 had an autoimmune disease such as Wegener’s granulomatosis and SLE. Thirteen patients developed EPS while on PD, 7 within 2 years after transfer to HD, and only one after renal transplantation. However, 7 patients had a previous renal transplant before returning to PD and subsequently developing EPS. Interestingly, we did not observe more episodes of EPS after transplantation. In the patients who developed EPS, the peritonitis rate over the period of observation was 1/15.6 pt-months and was due to Staphylococcus aureus, coagulase-negative staphylococcus, Pseudomonas and fungi. A history of peritonitis was not a prerequisite for developing EPS, since one patient had no episodes of peritonitis and 4 had just one previous episode. Fifteen patients presented with peritonitis within 4 months before the diagnosis of EPS with particularly virulent micro-organisms such as S. aureus, Candida, Pseudomonas, Corynebacterium, and Peptostreptococcus. Eleven patients were treated with hypertonic dextrose solutions (4.25 g/dl of dextrose) and seven with icodextrin, indirectly suggesting problems with ultrafiltration. Nine of 21 patients were on beta-blockers. The diagnosis of EPS was made either surgically or radiologically with signs of small bowel obstruction in combination with severe malnutrition. Eleven of our patients (52%) had evidence of small bowel obstruction and 14 patients required total parenteral nutrition (TPN). Tamoxifen (10–20 mg daily) was started in 6 patients, 4 of whom are alive and 2 deceased 3 and 5 years after EPS was diagnosed. Of the 12 patients who were not given tamoxifen, 2 are alive and 10 died. No side effects of tamoxifen were reported. Only 7 of our patients (33%) died during the first year after the diagnosis of EPS. Currently, 4 patients are on HD and 3 have had a renal transplant. Six patients of the fourteen who underwent surgery (42.8%) died within the first 6 months after operation and five died after an average of 6.6 years, mostly due to cardiovascular causes, three are still alive. As EPS becomes more prevalent with longer duration of PD, large multicenter prospective studies are needed to establish its incidence and identify risk factors, therapeutic approach, and prognosis.     

Value of scintigraphy in chronic peritoneal dialysis patients

BACKGROUND: A variety of factors can adversely impact chronic peritoneal dialysis (CPD) as an effective renal replacement therapy for patients with end-stage renal disease. These factors include peritonitis, poor clearances, loss of ultrafiltration, and a variety of anatomic problems, such as hernias, peritoneal fluid leaks, loculations, and catheter-related problems caused by omental blockage. This study reviews our experience with peritoneal scintigraphy for the evaluation of some of these difficulties. METHODS: From 1991 to 1996, 50 peritoneal scintigraphy scans were obtained in 48 CPD patients. Indications for scintigraphy were evaluated, and the patients were placed into four groups: group I, abdominal wall swelling; group II, inguinal or genital swelling; group III, pleural fluid; and group IV, poor drainage and/or poor ultrafiltration. A peritoneal scintigraphy protocol was established and the radiotracer isotope that was used was 2.0 mCi of 99mtechnetium sulfur colloid placed in two liters of 2.5% dextrose peritoneal dialysis solution. RESULTS: Ten scans were obtained to study abdominal wall swelling, with seven scans demonstrating leaks; six of these episodes improved with low-volume exchanges. Twenty scans were obtained to evaluate inguinal or genital swelling, and 10 of these had scintigraphic evidence for an inguinal hernia leak (9 of these were surgically corrected). One of four scans obtained to evaluate a pleural fluid collection demonstrated a peritoneal-pleural leak that corrected with a temporary discontinuation of CPD. Sixteen scans were obtained to assess poor drainage and/or ultrafiltration. Five of these scans demonstrated peritoneal location, and all of these patients required transfer to hemodialysis. The other 11 scans were normal; four patients underwent omentectomies, allowing three patients to continue with CPD. CONCLUSION: Peritoneal scintigraphy is useful in the evaluation and assessment of CPD patients who develop anatomical problems (such as anterior abdominal, pleural-peritoneal, inguinal, and genital leaks) and problems with ultrafiltration and/or drainage.     

Risk factors of severe peritoneal sclerosis in chronic peritoneal dialysis patients

Peritoneal dialysis (PD) offers the healthiest way for starting renal replacement therapy (RRT) in End Stage Renal Disease patients, however exposes long-term PD patients to a dangerous complication named encapsulating peritoneal sclerosis (EPS). In this study, we searched for possible risk factors of EPS. Data were collected from two PD centers covering period 1995–2012 and comprised 464 patients. Control group defined as PD patients stayed on PD >42 month (n?=?122), and case group was 12 confirmed EPS patients. Associations were analyzed using linear regression analysis. Prevalence and incidence of EPS were 2.59% and 8.9% with an incidence of 0.7% patient-years, respectively. The age at start of PD in EPS patients (32.75?±?10.8 year) was significantly lower compared with control group (49.61?±?16.18 year, p?=?.0001). The mean duration of PD in EPS and control group were 2494.4?±?940.9 and 1890.2?±?598.8 days (p?=?.002). Control group had 145 episodes of peritonitis during total duration of 7686 patient months (peritonitis rate of 1/53). This was 1/26 with a total 38 episodes of peritonitis during the total duration of 997 patient months (p?=?.01) for EPS group. In regression analysis, PD duration, age at PD start and duration of Ultrafiltration failure (UFF) were associated with EPS. Longer time being on PD, younger age, and higher UFF duration were the risk factors for EPS development.