Renal transplantation in patients with indwelling continuous ambulatory peritoneal dialysis catheters

Controversy exists regarding management of the continuous ambulatory peritoneal dialysis catheter in patients undergoing renal transplantation. We performed 30 transplants (23 cadaveric and 7 living related) in 27 patients with indwelling continuous ambulatory peritoneal dialysis catheters. Dialysis was necessary in the immediate post-transplantation period in 9 of 30 patients (30 per cent). Of these 9 patients 3 had temporary hemodialysis and 6 resumed continuous ambulatory peritoneal dialysis with the indwelling catheter. Two postoperative complications clearly were related to the continuous ambulatory peritoneal dialysis catheter: 1 patient required abdominal exploration for control of bleeding related to disruption of peritoneal adhesions at the time the continuous ambulatory peritoneal dialysis catheter was removed and 1 suffered an abscess at the catheter site 1 month after the catheter was removed. No patient experienced peritonitis during immunosuppression after transplantation. We support leaving the continuous ambulatory peritoneal dialysis catheter during and after transplantation to simplify pre-transplantation patient care and to avoid the possible need for temporary post-transplantation hemodialysis in many patients.     

Localized genital edema in patients undergoing continuous ambulatory peritoneal dialysis

Localized genital edema occurred in 8 of 81 patients (10 per cent) undergoing continuous ambulatory peritoneal dialysis. Underlying causes included defects in the inguinal canal and noninguinal peritoneal leaks that were localized with clinical, radiographic and scintigraphic techniques. Management included temporary cessation of continuous ambulatory peritoneal dialysis exchanges in half of the patients, particularly those with recently inserted catheters. Surgical repair was recommended in all cases when inguinal defects were identified. Edema resolved permanently in 6 patients and all patients were able to remain on continuous ambulatory peritoneal dialysis.     

腹膜透析患者微炎症与营养状况及贫血的关系

目的探讨持续不卧床腹膜透析患者体内炎症因子与营养状况及贫血的关系。方法测定87例持续不卧床腹膜透析患者的血红蛋白、血肌酐、血白蛋白及超敏C反应蛋白表达水平,按超敏C反应蛋白〈5mg／L和超敏C反应蛋白≥5mg／L将患者分为两组,并选择20例同龄健康人作为对照。同时进行改良主观综合营养评估,分析两组患者炎症指标与贫血及营养指标的变化的关系。结果持续不卧床腹膜透析患者微炎症发生率为45．97％,超敏C反应蛋白升高组患者血白蛋白、前白蛋白、血红蛋白水平明显低于超敏C反应蛋白正常组;促红细胞生成素每周用量及改良主观综合营养评估评分明显高于超敏C反应蛋白正常组,差异有统计学意义。超敏C反应蛋白水平与血白蛋白、前白蛋白、血红蛋白及血肌酐水平呈负相关（P〈0．05）,与改良主观综合营养评估评分呈正相关（P〈0．05）。结论持续不卧床腹膜透析患者存在微炎症状态。微炎症状态在持续不卧床腹膜透析患者营养不良及贫血中起重要作用。     

Long-term follow-up of thoracoscopic pleurodesis for hydrothorax complicating peritoneal dialysis

BACKGROUND: Massive hydrothorax is a significant complication of continuous ambulatory peritoneal dialysis (CAPD) and its ideal management remains undefined. Conservative management in the form of intermittent peritoneal dialysis had limited success. The use of conventional pleurodesis and open thoracotomy were associated with morbidities and limitations. We retrospectively reviewed the long-term outcome of 8 patients with massive hydrothorax complicating CAPD, 6 of whom received thoracoscopic pleurodesis. METHODS: Among 397 patients undergoing continuous ambulatory peritoneal dialysis during the period from 1994 to 1998, hydrothorax developed in 8 patients. Four patients were first treated with temporary intermittent peritoneal dialysis using 1-L exchange cycles. Three of them had a recurrence of the hydrothorax whereas only one could resume continuous ambulatory peritoneal dialysis successfully. Two patients then underwent conventional pleurodesis but failed. One of them was switched to hemodialysis. Thoracoscopic pleurodesis was performed for the remaining 2 patients together with 4 other patients with hydrothorax once this complication developed. There were no gross abnormalities including pleuroperitoneal communication sites identified. Talc poudrage was performed in 2 patients and mechanical rub pleurodesis in the other 4 patients. All had uncomplicated procedure and uneventful recovery. RESULTS: One patient after thoracoscopic pleurodesis was soon switched to hemodialysis for an unrelated reason. The other 5 patients resumed continuous ambulatory peritoneal dialysis with no recurrence of hydrothorax for a mean period of 50 months (range 19 to 84). CONCLUSIONS: With thoracoscopic pleurodesis, patients resumed continuous ambulatory peritoneal dialysis without recurrence of hydrothorax on long-term follow-up.     

Continuous ambulatory peritoneal dialysis: Technique of catheter insertion and management of associated surgical complications

Fifty-seven patients initiated continuous ambulatory peritoneal dialysis. All patients were generally pleased with this form of dialysis and particularly enjoyed the greater mobility and decreased dietary restriction. Complications associated with continuous ambulatory peritoneal dialysis include peritonitis, pericatheter infection, catheter malfunction, dialysate leak, and hernias of the abdominal wall.     

Vitamins and continuous ambulatory peritoneal dialysis (CAPD)

The authors assessed vitamin A, and its protein carriers vitamins C and E in serum and dialysis fluid of 10 patients with chronic renal failure during 6–12 months of continuous ambulatory peritoneal dialysis.Vitamin A and its protein carriers and serum vitamin E were elevated throughout the long-term investigation of continuous ambulatory peritoneal dialysis despite the fact that vitamin A and its protein carriers have a relatively great peritoneal transfer and loss into the dialysis fluid. The oral dose of 200 mg of vitamin C per day, despite the great peritoneal transfer and loss into the dialysis fluid, prevented the development of hypovitaminosis C. Assessment of vitamins B₁, B₂ and B₆ revealed that the supplementation with these vitamins is adequate for patients during continuous ambulatory peritoneal dialysis.     

Protein losses in children on continuous cycler peritoneal dialysis

. Peritoneal dialysis can result in significant protein losses through the dialysate effluent. Although protein loss in chronic ambulatory peritoneal dialysis has been examined, it has not been extensively studied in patients on continuous cycler peritoneal dialysis. Such losses can contribute to protein calorie malnutrition, especially in infants and children, many of whom are on continuous cycler peritoneal dialysis. We measured protein loss during continuous cycler peritoneal dialysis in patients ranging in age from 2 months to 18 years. There was an inverse correlation between body surface area and peritoneal protein loss, expressed both as milligrams of protein per kilogram body weight per day (P<0.000l) and as milligrams of protein per meter square body surface area per day (P<0.05). Peritoneal fluid protein losses in patients greater than 50 kg were similiar to those previously reported in adults treated with chronic ambulatory peritoneal dialysis. In contrast, infants had nearly twofold greater peritoneal protein losses per meter square body surface area than older children weighing more than 50 kg. Such protein losses in infants impair normal growth and may contribute to permanent loss of growth potential. Infants on peritoneal dialysis require early and aggressive nutritional supplementation with higher caloric and protein intake to compensate for such dialysate protein losses and maximize growth. Received August 21, 1995; received in revised form March 18, 1996; accepted April 8, 1996     

Short-term recombinant human growth hormone therapy does not modify growth hormone, thyrotropin and prolactin responses to thyrotropin-releasing hormone in adult dialysis patients.

BACKGROUND: We recently have reported the first randomized, controlled study on the effects of short-term recombinant human growth hormone (rhGH|| therapy on the nutritional status of a group of malnourished adult dialysis patients. In order to evaluate whether rhGH administration exerts any influence on GH, thyrotropin (TSH|| and prolactin (PRL|| responses to TSH-releasing hormone (TRH||, we assessed these responses before and after rhGH therapy. METHODS: GH, PRL and TSH responses to TRH before and 1 month after rhGH therapy in a group of adult dialysis patients were evaluated. Seventeen dialysis patients (11 on continuous ambulatory peritoneal dialysis/six on haemodialysis|| were studied (rhGH group, n=8; control group, n=9||. In the rhGH group, 0.2 IU/kg/day rhGH was administered subcutaneously. Each patient was tested with TRH (400 microg bolus i.v.|| on two separate occasions, just before and immediately after the treatment period. RESULTS: rhGH treatment did not modify baseline serum GH concentrations (6.6+/-2.7 vs 4.1+/-1.1 microg/l||, paradoxical GH responses to TRH (six out of eight patients||, GH peak (11.9+/-4.6 vs 11.2+/-5.3 microg/l, NS|| or area under the secretory curve of GH (GH AUC; 19.1+/-4.5 vs 12.1+/-3.1 microg/h/l||. Both basal PRL (35.5+/-7.1 vs 36.7+/-8.6 microg/l|| and TSH (2.3+/-1.1 vs 2.8+/-1.7 mU/l|| concentrations, as well as their responses to TRH stimulation (PRL peak, 59.9+/-16.6 vs 59. 5+/-11.8 microg/l; TSH peak, 6.2+/-2.6 vs 7.1+/-3.9 mU/l||, were also unaffected by rhGH therapy. CONCLUSION: These results suggest that short-term rhGH therapy does not significantly influence the magnitude of the somatotropic, lactotropic or thyrotropic response to TRH in adult dialysis patients. However, this finding has to be interpreted with caution due to the two different patient groups included in this study.     

Automated and continuous ambulatory peritoneal dialysis have similar outcomes

We compared survival and death-censored technique survival in patients on automated peritoneal dialysis (automated dialysis) or on continuous ambulatory peritoneal dialysis. All 4128 patients from the Australia and New Zealand Dialysis and Transplant Registry who started peritoneal dialysis over a 5-year period through March 2004 were included. Times to death and death-censored technique failure were analyzed by Cox proportional hazards models while a conditional risk set model computed technique failure. Compared to patients treated entirely with continuous ambulatory peritoneal dialysis, automated peritoneal dialysis patients were more likely to be young, Caucasian, have marginally lower body mass index, and were less likely to have baseline cardiovascular disease or diabetes. Using univariate and multivariate analysis, our study showed there were no significant differences in patient survival and death-censored technique failure between the two types of peritoneal dialysis modalities.     

Cellular response to peritonitis among peritoneal dialysis patients

White blood cell counts and differential cell counts were performed on 249 peritoneal dialysis effluents from 48 patients using chronic peritoneal dialysis. The finding of more than 50% polymorphonuclear leukocytes in the dialysate was a more sensitive indicator of peritonitis than was an absolute cell count of 100 cells/microL. This finding was true for patients using intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, and continuous cycling peritoneal dialysis.     

In vivo platelet hyperreactivity, another risk factor for patients under continuous ambulatory peritoneal dialysis

A high mortality rate due to thromboembolic accidents has been described in patients undergoing chronic haemodialysis. This type of complications, although recognized, has not been appropriately evaluated in continuous ambulatory peritoneal dialysis patients. The present study demonstrates that continuous ambulatory peritoneal dialysis patients present in vivo platelet hyperreactivity, as evidenced by enhanced platelet responses to epinephrine ex vivo and an increased MDA/MDAa index which traduces a decreased threshold for activation of the arachidonate pathway and subsequent thromboxane production. Since the etiopathogeny of this platelet abnormality seems to be related to abnormalities in lipid metabolism, compounds such as fish oil must be beneficial in the management of this risk factor.     

Abdominal wall and inguinal hernias in continuous ambulatory peritoneal dialysis patients

This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.     

Oxygen affinity of erythrocytes and pulmonary gas exchange in patients on continuous ambulatory peritoneal dialysis

In 11 patients on continuous ambulatory peritoneal dialysis 2,3-diphosphoglycerate, oxygen (O2) affinity of red cells (P50), blood gases, ventilation, and O2 consumption were studied. Contrary to patients on maintenance hemodialysis, 2,3-diphosphoglycerate and P50 were normal in patients on continuous ambulatory peritoneal dialysis; they were correlated with each other. Arterial O2 pressure was normal; under the conditions of dialysis with 35 mmol lactate per liter dialysis fluid a slight metabolic acidosis persisted; it was combined with a moderate respiratory alkalosis. Position had no influence upon pulmonary gas exchange with the exception of the alveolo-arterial gradient which was elevated when the abdominal cavity was filled with dialysis fluid and the patients assumed the supine position. Ventilation was in the normal range, whereas O2 consumption was low, possibly due to a reduction in muscle mass in some of the patients. It is concluded that pulmonary gas exchange and erythrocyte O2 transport were normal and that O2 requirements tended to be low in this group of patients on continuous ambulatory peritoneal dialysis.     

Cardiac surgery in patients with end-stage renal disease. Utility of continuous ambulatory peritoneal dialysis.

OBJECTIVES: The number of patients with end-stage renal disease undergoing open heart surgery continues to grow. We evaluated continuous ambulatory peritoneal dialysis and the extracorporeal ultrafiltration method during cardiopulmonary bypass in the management of these difficult patients. METHODS: These 2 methods were used in 4 patients with renal failure who underwent open heart surgery between July 1997 and March 1999. Preoperative continuous ambulatory peritoneal dialysis was conducted using standard protocols. Extracorporeal ultrafiltration method was used only during cardiopulmonary bypass. Continuous ambulatory peritoneal dialysis was initiated upon arrival at the intensive care unit. Mean follow-up was 12 months. RESULTS: Postoperative blood urea nitrogen and creatinine concentrations were lower than preoperative concentrations. No patients required hemodialysis. All 4 patients were discharged to their homes. No deaths occurred. CONCLUSIONS: Continuous ambulatory peritoneal dialysis and extracorporeal ultrafiltration method are combined to treat patients with end-stage renal disease who require open heart surgery. This combination is simple, and does not require specialized personnel, and obviates the hemodynamic instability associated with hemodialysis.     

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??Curative effect evaluation of 21 abdominal hernia patients with continuous ambulatory peritoneal dialysis undergoing tension-free hernia repair surgery without terminating peritoneal dialysis ZHAO Jian-xin??GAO Guo-xuan??LIU Yin-hua. Breast Disease Center??Peking University First Hospital??Beijing 100034??China
Corresponding author??ZHAO Jian-xin??E-mail??zjxcn@aliyun.com
Abstract Objective To investigate the curative effect of abdominal hernia patients with continuous ambulatory peritoneal dialysis undergoing tension-free hernia repair surgery without terminating peritoneal dialysis. Methods A total of 21 abdominal hernia patients who received continuous ambulatory peritoneal dialysis (CAPD) because of chronic kidney diseases (CKD) from May 2007 to August 2012 in Peking University First Hospital were included in the retrospective analysis. The curative effects were followed up. All of the patients didn’t switch to hemodialysis (HD) and resumed peritoneal dialysis on the first day after operation form low dose and gradually resumed to the dose before operation in 4 weeks. Results All the patients were performed 22 cases of tension-free hernia repair and had no complication. The follow-up was 16 to 79 months and the median of follow-up was 40.3 months. The follow-up rate was 100% and there was no case of recurrence. Among them, 1 case transferred to hemodialysis 1 year after operation because of peritoneal adhesion and died of lung infection 2 years after operation. Another 1 case transferred to hemodialysis 2 year after operation because of peritoneal adhesion Conclusion It is safe for abdominal hernia patients who received CAPD undergoing tension-free hernia repair surgery without transferring peritoneal dialysis to hematodialysis??and it won’t increase complications and recurrence rate after operations.     

Influence of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid axis in patients undergoing capd

OBJECTIVE: Treatment of anemia with recombinant human erythropoietin (rHuEpo) in hemodialysis patients has been associated with improvement of several abnormalities in hypothalamic-pituitary function. The aim of the present study is to investigate the effects of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid hormone axis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Single center, prospective study. PATIENTS AND METHODS: Ten patients who were clinically stable and had been on CAPD were evaluated. Eleven age and sex matched healthy volunteers were chosen as controls. All of the patients were clinically euthyroid. All patients were on CAPD therapy and none of them had received rHuEpo treatment previously. In all patients after basal estimations of free T3, free T4, TSH, GH and prolactin levels, a bolus of 400 microg TRH was administered intravenously. Levels of TSH, GH and prolactin were measured in blood samples collected every 30 min of the 3 h test period. After the treatment with rHuEpo, TRH test with the same protocol was repeated. RESULTS: Before the improvement in serum hemoglobin levels with rHuEpo treatment, the patients on CAPD showed abnormal hypothalamic-pituitary-thyroidal functions, including delayed and prolonged TSH (NS), paradoxically elevated GH (p < 0.001) and increased and prolonged prolactin (p = 0.001) responses to TRH. After improvement of anemia with rHuEpo no significant difference was found between the patients and control groups for baseline TSH levels. In the patients peak TSH level and AUC of TSH secretion were significantly reduced after the treatment (p < 0.05 for both). Furthermore the improvement in anemia did not eliminate the paradoxic GH and prolonged prolactin responses to TRH administration. CONCLUSION: Some hypothalamic-pituitary-thyroid function abnormalities including delayed and blunted TSH, increased and prolonged prolactin and paradoxical GH responses to TRH administration were observed in uremic patients treated with CAPD and the improvement in anemia with rHuEpo seems to cause slight changes on the hypothalamic-pituitary-thyroid axis and peripheral thyroid hormones.     

Thiol levels, protein carbonylation and anaerobic sulfur metabolism in erythrocytes of peritoneal dialysis and predialysis patients

Aim: The goal of the present study was to investigate the changes in sulfur metabolism in erythrocytes of end‐stage renal failure patients. Methods: The following substances were determined in erythrocytes of chronic kidney disease patients before dialysis, patients treated with continuous ambulatory peritoneal dialysis, and in a group of healthy volunteers: (i) sulfane sulfur level and activity of the enzymes involved in its metabolism and in cyanide detoxification; (ii) concentration of total and non‐protein sulfhydryl groups ‐SH; and (iii) protein carbonylation rate. Results: Erythrocytes of chronic kidney disease patients in predialysis period contained lower levels of sulfane sulfur, non‐protein thiols, total thiols and 3‐mercaptopyruvate sulfotransferase. On the other hand, in erythrocytes of end‐stage renal failure patients treated with continuous ambulatory peritoneal dialysis, sulfane sulfur, non‐protein thiols, total thiols and 3‐mercaptopyruvate sulfotransferase activity remained at the level observed in healthy controls. These changes indicate a disturbed thiol balance and anaerobic cysteine metabolism in non‐dialysis patients, whereas continuous ambulatory peritoneal dialysis patients did not show these disorders. γ‐Cystathionase activity was equally elevated in predialysis period and in peritoneal dialysis patients, which means that chronic kidney disease pathology is accompanied by an increased expression of this enzymatic activity in erythrocytes. Erythrocytic rhodanese activity was unchanged and stayed at the control level in both groups. Protein carbonylation rate was equally enhanced in both patient groups, which indicated acceleration of oxidative processes and inability of continuous ambulatory peritoneal dialysis to correct these changes in erythrocytes. Conclusion: The CAPD as a replacement therapy helps to preserve thiol levels and anaerobic sulfur metabolism in erythrocytes.     

Inguinal herniation in two patients with continuous ambulatory peritoneal dialysis

We report two cases of subacute inguinal swelling in uremic patients on continuous ambulatory peritoneal dialysis (CAPD). Computed tomography, scintigraphy demonstrated a mass in the right groin. Surgical repair of an inguinal hernia resulted in complete resolution of the inguinal swelling. Both patients could restart continuous ambulatory peritoneal dialysis, without complication.     

Patients treated by peritoneal dialysis: a heterogeneous group of patients. Profile of PD patients

Often, one gathers together under the denomination "peritoneal dialysis" patients with various clinical profiles. To quantify this "heterogeneity" we analysed the clinical characteristics of 32,975?patients treated by dialysis at 31?December 2008?in 22?French regions, participating to the REIN registry. This cross-sectional study confirms our initial hypothesis of a great heterogeneity of patients' profiles in peritoneal dialysis. As in hemodialysis, there is a gradation between modalities: from assisted continuous ambulatory peritoneal dialysis which concerns the frailty patients to autonomous automated peritoneal dialysis for more healthy patients, through assisted automated peritoneal dialysis and autonomous continuous ambulatory peritoneal dialysis.     

Peritoneal dialysis in Hungary

In 1991 the technical conditions and the number of patients receiving peritoneal dialysis were surveyed in the Hungarian nephrology and dialysing units. Not only the number of patients with chronic uraemia (undergoing dialysis + transplantation) is lower in this country as compared to the European average (106 and 236 per one million people, respectively), but also their distribution according to the type of treatment is different. For several years patients under intermittent peritoneal dialysis make up more than 10% of the cases and those under continuous ambulatory peritoneal dialysis less than 2% (in Europe: <2% and 4–43%, respectively). The survey also included the types of solution, disinfection and connecting devices used in peritoneal dialysis, as well as the incidence of peritonitis and the administration of antibiotics. The principles of biocompatibility, the function of interleukin, as well as the effectiveness and the conditions of continuous ambulatory peritoneal dialysis are summarized.