Peritoneal Infection in Acute Intermittent Peritoneal Dialysis

A prospective study was done to evaluate the incidence and microbiological trend of peritoneal infection in patients undergoing acute intermittent peritoneal dialysis (PD). Complete sterile procedure was ensured and at the completion of the procedure PD fluid was sent for bacteriological culture, sensitivity, and total and differential cell count. During the period 09 2000 to 02 2001 a total of 100 patients were evaluated. Male female ratio was 72:28. Mean age was 43.17 ± 17.2 years. In 26 patients cyclers were used. Bacterial culture was positive in total of 30 cases (30%). Gram positive, Gram negative and mixed infection was found in 10%, 15%, and 5% respectively. Number of exchanges (31.61 ± 7.7 vs. 31.3 ± 6, p = 0.8) were similar and number of repositioning was significantly more in the infected group (23.3% vs. 11.4%, p<0.01). Total cell count was significantly higher in infected group (274.3 ± 502 vs. 31.25 ± 79.34, p<0.01). Among Gram +ve organisms Staphylococcus was found in 7, Enterococcus faecalis in 4 and Coryne bacterium sps. in 2 cases. Among Gram ?ve organisms, E. coli was found in 4, Enterobacter in 3, Klebsiella 1, Pseudomonas 1, Acinetobacter arinatus 5, Acinetobacter baumani 3, and Citrobacter freundii 3. Mixed flora comprised of Enterococcus faecalis 3, Enterobacter 1, Staphlococcus 1, E. coli 3, Citrobacter 1, Acinobacter baumani 1. Although with the cyclers using collapsible bags, staphylococcus was not isolated, the total incidence of infection (11/26 cases) was not decreased with the use of cyclers. We conclude that in acute intermittent peritoneal dialysis the incidence of bacterial infection is 30% with preponderance of Gram ?ve over Gram +ve organisms and organism of fecal origin being commoner than those of skin origin. Use of cycler-assisted over manual PD do not improve the incidence of infection. Repositioning of the stiff catheter significantly increases the incidence of infection.     

Tailoring the Peritoneal Dialysis Prescription

M. D., a 62-year-old female with renal disease secondary to bilateral polycystic kidneys and hypertension, opted for continuous ambulatory peritoneal diaiysis (CAPD) when her renal function deteriorated (24-hr urinary creatinine clearance of 6.8 ml/ min in a total urinary volume of 1200 ml) and uremic symptoms developed. The patient lived about a 3-hr drive from the nearest dialysis center. This factor weighed heavily in the patient's decision to choose home dialysis .
A Swan Neck Missouri peritoneal dialysis catheter was inserted by a surgeon under local anesthesia with no complications. Since the patient was symptomatic from the uremia, peritoneal dialysis using a cycler in the supine position was initiated about 18 hr after the catheter insertion. To avoid dialysis solution leak from the incision site, 1 1 volumes per exchange and a 0.5-hr cycle time were chosen. The cycler dialysis continued for 36 hr. The amount of ultrafiltration achieved was 2200 ml. The patient received two additional treatments using cycler dialysis during the next seven days before CAPD training was begun. CAPD training was accomplished in five working days. A baseline peritoneal equilibration test (PET) was carried out and thr residual renal function was determined. Based on the D/P creatinine ratio and the glucose results of the PET, the patient was classified as having a high peritoneal membrane transport rate. The renal creatinine and urea clearances were 5.7 and 4.2 ml/min, respectively (24-hr urine volume was 926 ml ).     

Hyper/Hypo-Osmotic Peritoneal Dialysis

This report concerns the augmentation of peritoneal dialysis using alternating hyper/hypoosmotic peritoneal dialysates, and covers a detailed examination of the longest lived, anephric goat to be maintained using this delivery system. Experimental results show that with this technique: 1) urea clearance can be increased some 200% over control values, 2) the convective transport of urea is unimportant and the increased urea clearance is due primarily to increased peritoneal permeability, 3) net ultrafiltration and electrolyte balance can be easily controlled by variation of total electrolyte and glucose about an appropriate mean. A detailed autopsy failed to demonstrate any gross or microscopic pathology.