One year's experience with recombinant erythropoietin in children undergoing continuous ambulatory or cycling peritoneal dialysis

Fourteen patients (aged 5.9–22.1 years) undergoing continuous ambulatory or cycling peritoneal dialysis were treated with recombinant human erythropoietin (rhEPO), which was given intravenously once a week at a dosage of 300 units/kg. The mean haematocrit level increased from 18.5% to 27.5% and the reticulocyte count from 19 to 62 within 1 month. After an average time of 3.1 months rhEPO dosage could be adjusted to 100 units/kg per week to keep the haematocrit level at 30%. Only 1 patient had an exacerbation of hypertension, which required a dosage reduction; other side-effects were not noted.     

Recombinant human erythropoietin dosage in children undergoing hemodialysis and continuous ambulatory peritoneal dialysis

The efficacy of erythropoietin (EPO) in 11 children on hemodialysis (HD) and 8 on continuous ambulatory peritoneal dialysis (CAPD) (mean age 11.8 years) was compared. The initial EPO dose was 50 U/kg s.c. once a week; the time of observation was 24 weeks. In the CAPD group, the mean hemoglobin (Hb) level increased from 7.7±0.2 to 11.2±0.6 g/dl (P< 0.001) and hematocrit (Hct) from 22.3±1.0 to 32.6±1.4% (P<0.001), while in the HD group the mean Hb rose from 7.7±0.6 to 9.3±0.8 g/dl (P<0.001) and mean Hct from 22.7±2.3 to 27.6±2.8% (P<0.001) after 12 weeks of observation. An increase in Hb to over 10 g/dl was obtained in 87.5% of children on CAPD but in only 10% on HD after 8 weeks of EPO treatment. After 12 weeks of treatment, all children on CAPD had the target Hb level of more than 10 g/dl, while 7 children on HD required increased doses of EPO (100 U/kg per week). We conclude that the EPO dose of 50 U/kg given s.c. once a week is effective for children with anemia on CAPD but is insufficient for children on HD. Received June 17, 1996; received in revised form January 24, 1997; accepted March 4, 1997     

Zinc and copper balance in children on continuous ambulatory peritoneal dialysis

We monitored serum zinc and copper levels for 4 months in six patients treated with continuous ambulatory peritoneal dialysis (CAPD). Zinc and copper fluxes were studied during a single dialysis exchange and over a 3-day period. Routine oral trace element supplements were then discontinued for 2 months. Serum zinc levels declined but serum copper levels remained unchanged. One month after oral supplements had been restarted, serum zinc levels returned to normal and serum copper levels rose above initial values. Zinc and copper concentrations in dialysis exchange indicated that the patients absorbed zine and lost copper in significant amounts. The patients had poor dietary intakes of both minerals. These data suggest that patients treated with CAPD benefit from oral zinc supplementation.     

Tuberculosis in children undergoing continuous ambulatory peritoneal dialysis

The incidence of tuberculosis (TB) is increasing worldwide. Due to an impairment of cellular immunity, patients with chronic renal failure are susceptible to reactivation of TB. Seventy patients were treated by continuous ambulatory peritoneal dialysis (CAPD) in our pediatric nephrology department during the years 1989–1997. TB was diagnosed in 4 patients, representing 5.7% of all CAPD patients in our department. One patient had extrapulmonary (TB osteomyelitis) and the others had pulmonary TB. All patients were treated with antituberculous drugs.Two patients with pulmonary TB were cured. Symptoms improved in the other 2 patients but they died at home for unknown reasons. We recommend that all children in regions of high prevalence of TB should be investigated for TB, especially if they have a cough or fever of unknown etiology. Received: 13 January 1998 / Revised: 7 December 1998 / Accepted: 11 December 1998     

Long-term effect of amino-acid dialysis solution in children on continuous ambulatory peritoneal dialysis

The study involved eight metabolically stable children, with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) whom we followed for 12–18 months. For the first 6 months CAPD was performed with dextrose; for the subsequent 6–12 months the morning exchange was substituted with a 1% amino-acid (AA) solution. The following parameters did not change during the study: serum creatinine, uric acid, inorganic phosphate, serum bicarbonate, potassium, cholesterol, triglycerides, total protein, albumin and transferrin. The only parameter that changed was blood urea nitrogen, which increased moderately. The anthropometric parameters did not show significant variation before and after AA dialysis. The plasma AA profile, which under basal conditions showed lower levels of several essential AAs, improved during the treatment period, with a partial correction of the imbalance. It is possible that this correction of plasma AAs may positively influence the metabolism of some organs such as the brain, muscle and those of the hepatosplanchnic region. The intracellular pool of free AAs, measured in polymorphonuclear leucocytes, was severely altered before the treatment and after 6 and 12 months showed only minor variations. It is possible that some modifications in the proportion of the different AAs in the dialysis solution or an improvement in the concentration or in the number of exchanges per day are necessary in order to change the nutritional status and to modify the intracellular AA pool.     

Intraperitoneal production of erythropoietin with continuous ambulatory peritoneal dialysis

Higher hematocrit and serum erythropoietin (EPO) levels have previously been shown in end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) compared with hemodialysis. We investigated whether EPO was produced intraperitoneally in CAPD patients. EPO concentration was 3.5±0.3 mU/ml by radioimmunoassay in 26 samples of peritoneal dialysis effluent obtained from 15 CAPD patients. EPO was not detectable in the fresh unused dialysate. No correlation was observed between EPO levels in the serum and dialysis effluent. Peritoneal macrophages were isolated from the dialysis effluent of 9 CAPD patients after an overnight dwell. The culture supernatant obtained after 24 h of in vitro culture of a million cells yielded EPO of 3.5±0.3 mU/ml. Our study demonstrated that peritoneal macrophages from CAPD patients produce EPO on in vitro stimulation, and EPO is present in the dialysis effluent of CAPD patients.     

Swan neck presternal catheter for continuous ambulatory peritoneal dialysis in children

Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2–11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exit site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.     

Tuberculous lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis

The aim of this study was to review the clinical features of tuberculous (TB) lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine cases of TB lymphadenitis were diagnosed among 910 patients over a period of 10 years. There were five men and four women with a mean age of 51 ± 15.5 years. The TB lymphadenitis involved the cervical lymph nodes in six patients, supraclavicular lymph nodes in two patients and mediastinal lymph nodes in one patient. Six patients presented with clinically enlarged lymph nodes of whom four also had fever. Three other patients were incidentally found to have enlarged lymph nodes on routine chest X-ray or ultrasound examination of the neck. Diagnosis of TB lymphadenitis was made by demonstrating caseating granulomata with or without positive acid-fast bacilli on excisional lymph node biopsy. All patients were cured with standard anti-tuberculosis drugs for 12 months. No recurrence of the TB lymphadenitis was observed after a mean follow-up of 59 ± 30 months. We conclude that TB lymphadenitis is not uncommon among patients on CAPD. A high index of suspicion is needed for early diagnosis of this condition. Prompt initiation of anti-tuberculosis treatment is associated with good prognosis.     

糖尿病肾病尿毒症患者血液透析与腹膜透析的疗效对比观察

目的：探讨治疗糖尿病肾病（DN）尿毒症较理想的透析方法，方法：对62例作血液透析（HD）和34例作持续性非卧床腹膜透析（CAPD）和DN尿毒症患进行比较，观察两组患透析前后的血液生化指标；生存率，死亡原因，透析后主要并发症。结果：透析前合并有高血压，心脏肥大，冠心病或年龄大于60岁，行CAPD治疗后出现并发症的机会较HD少（P＜0．05）。结论：透析前合并有高血压，心脏肥大，冠心病或年龄大于60岁的DN尿毒症患以选择CAPD治疗较佳。     

Laparoscopic repositioning of a continuous ambulatory peritoneal dialysis (CAPD) catheter

We describe a laparoscopic technique for relieving obstruction of a continuous ambulatory peritoneal dialysis (CAPD) catheter. Laparoscopic repositioning of the catheter and omentectomy obviated the need for laparotomy in a patient with end-stage renal disease.     

Potassium metabolism in continuous ambulatory peritoneal dialysis patients

Background: Hypokalemia is common and may have contributed to the poor clinical outcome in peritoneal dialysis (PD) patients. In this study, we made a detailed investigation on the potassium metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients and tried to find out the possible factors associated with the high prevalence of hypokalemia in PD patients. Methods: A cross-sectional survey in 243 clinically stable CAPD patients was made in our PD center in 2010. Patients were divided into four groups according to whether they were anuric or not and different dialysis regimens. Patients’ demographic data and data on potassium metabolism including dietary potassium intakes, residual renal potassium, and peritoneal dialysis potassium removal were collected. Results: The average potassium intake in our 243 PD patients was 32.1?±?11.1?mmol/day. The total potassium removal was significantly higher in non-anuric patients as compared to anuric patients (33.2?±?9.1 vs. 23.0?±?4.7?mmol/day for 3 exchanges per day and 35.2?±?8.9 vs. 28.6?±?6.3?mmol/day for 4 exchanges per day, respectively, p?p?p?p?R² linear?=?0.645, p?Conclusions: Our study suggested that if potassium intake was limited in PD patients, we should be aware of the risk of hypokalemia with high doses of PD when patients have good RRF. Our study also suggested that potassium removal in PD patients may not necessarily reflect potassium intake even if serum potassium is normal, the effect of ICW should be considered when evaluating potassium homeostasis.     

Laparoscopic introduction of a continuous ambulatory peritoneal dialysis (capd) catheter by a two-puncture technique

We describe a laparoscopic two-puncture technique for the placement of a continuous ambulatory peritoneal dialysis catheter. With a mean follow-up period of 8 months the short-term results of the first 19 laparoscopic catheter insertions are evaluated and discussed. It appears to be a simple, safe, and viable procedure with a low morbidity and very good results in the short term. The same technique can also be used in catheter salvage in case of outflow obstruction or cathether migration, thus increasing catheter longevity.     

Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey

We conducted a retrospective, 7 year cohort survey to examine the natural changes in peritoneal equilibration test (PET) results in patients with long-term uneventful continuous ambulatory peritoneal dialysis (CAPD). Thirty-two (17 males, 15 females) patients on CAPD with two or more standard PETs performed more than 6 months apart, in the absence of peritoneal insult, were included. Changes and pattern of PET results were evaluated by the dialysate to plasma ratio of creatinine (D:P-cre), the fourth h dialysate to instilled glucose ratio (D4:Do) and ultrafiltration volume (UF, ml). The subgroups included high (H), high-average (HA), low-average (LA), or low (L) transporters with the dividing ratios (D:P-cre) of >0.81, >0. 65 to 0.81, >0.5 to 0.65, and <0.5, respectively. The median D:P-cre significantly decreased (p = 0.04), but neither the D4:Do nor the final median UF significantly decreased. The change in D:P-cre was strongly and inversely correlated with the initial D:P-cre value (r = -0.68; p < 0.05). A similar relationship was found between the change in the final D4:Do and the initial D4:Do (r = -0.752; p < 0. 01) and between the change in the final UF and the initial UF (r = -0.875; p < 0.01). No correlation was found between the change in D:P-cre and the age of the patient, the time interval between PETs, monthly dialysate glucose exposure, or underlying diabetes/non-diabetes. The final peritoneal transport pattern was altered with 5 (15.6%) patients remaining in the extreme subgroups (H or L) and, by contrast, 84.4% (27/32) of the patients now in the averaged (HA or LA) groups (p < 0.01, chi2 test). We demonstrated a natural "centralization" migration of PET results after long-term uneventful CAPD, which may help to explain why patients with extreme PET characteristics, that is, H or L, continued to do well on CAPD.     

Audit of a decade of continuous ambulatory peritoneal dialysis

We have reviewed the results of continuous ambulatory peritonealdialysis (CAPD) in a single renal unit over the period fromDecember 1979 to the end of 1990. Case records of 211 of the222 patients treated by CAPD over this period were obtainedand age, sex, diagnoses, duration of CAPD, and cause of deathdetermined. We found marked effects of age and a diagnosis ofatheromatous vascular disease at the start of CAPD on patientsurvival. For patients aged under 45 years 5-year patient survivalwas 78%, for those aged 45–65 it was 29% and for thoseaged over 65 years it was 32%. Patients with a diagnosis ofatheromatous vascular disease at the start of CAPD had a 3-yearsurvival of 25% compared with 69% for age- and sex-matched CAPDpatients without such a diagnosis. Five-year technique survivalwas 67% if failure was denned as transfer to haemodialysis ordeath as a direct result of CAPD, but only 11% of patients wereon CAPD continuously for 5 years. Attempts to compare our resultswith those from other reports were hindered by the variety ofmethods used to calculate patient and technique survival; wesuggest that standard methods should be agreed.     

Growth,development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis

We examined the growth, development and nutritional status over a period of 10 years of 15 young children (<2 years old) on continuous ambulatory peritoneal dialysis (CAPD). There were 6 males and 9 females with a mean age of 12.5 months, mean weight of 6.3 kg, mean height of 66.2 cm at the start of CAPD and a mean duration of therapy of 2.6 years. Height, weight, head circumference, development quotient (DQ), blood chemistry and dietary intake were assessed over a period of 10 years. The patients' mean height standard deviation score (SDS) did not change significantly (from –2.51 to –2.74) during CAPD therapy. The mean growth velocity index (GVI) during CAPD was 76.5% and correlated positively with energy intake but not with protein intake. The mean DQ was low (67.0%) at the start of CAPD and 69.3% at the end of CAPD. DQ did not correlate with energy intake, GVI, head circumference SDS or with the weight/height ratio; however, 2 patients with low DO (<60%) had a low energy intakes. Although most patients had a low DQ, the IQ at 5–6 years of age was normal in all patients except 1 without cerebral disease. Our study showed minimal growth (SDS) and mental developmental (IQ) delays during CAPD therapy, but an adequate nutritional intake must be assured to obtain the above results.     

Peritoneal nitric oxide is a marker of peritonitis in patients on continuous ambulatory peritoneal dialysis

Nitric oxide plays an important role in mediating the inflammatoryprocess. The aim of this study was to evaluate if nitric oxideproduction was increased during peritonitis in patients receivingcontinuous ambulatory peritoneal dialysis (CAPD), and the associationwith the prognosis. The study population comprised 21 patientswith 22 episodes of peritonitis. Fifteen patients without peritonitiswere controls. Nitrate was measured by HPLC and nitrite by theGriess method, to reflect nitric oxide production. Peritonealdialysate effluent and plasma were collected from six patientsduring peritonitis and 1 week after treatment to study changesin dialysate:plasma ratio. In 15 patients, nitrite was measuredduring peritonitis and every 3 days for 2 weeks or until normalizedfor evolutional changes. The dialysate plasma ratios of nitrateand nitrite during peritonitis were reduced 26% and 41.5%, respectively,after 1 week of treatment, indicating the peritoneal productionof nitric oxide during peritonitis. In the evolutional study,a 5.1-fold increase of peak nitrite levels in bacterial peritonitis(n=13) and a 2.5-fold increase in fungal peritonitis (n=3) wereobserved compared to controls. Nitrite gradually declined tocontrol levels (9.3±7.2 days) after effective antibiotictreatment, but took longer than to normalize leukocyte countin the peritoneal dialysate effluent (3.9±1.9 days).In four patients with refractory peritonitis (Candida infectionin three, Acinetobacter infection in one), the nitrite levelsremained elevated 2-fold despite treatment, and the catheterswere removed. It is concluded that nitrite levels in peritonealdialysate effluent may serve as a marker to assess treatmentefficacy in CAPD patients with peritonitis.     

Simple surgical treatment for pleuroperitoneal communication without interruption of continuous ambulatory peritoneal dialysis

Pleuroperitoneal communication is a complication of continuous ambulatory peritoneal dialysis (CAPD) that can necessitate cessation of CAPD. Hemodialysis was started on a 52-year-old woman and shifted to CAPD 1 month later. However, 18 days after initiation of CAPD, her chest radiograph showed a right-side hydrothorax. Thoracentesis yielded a colorless pleural effusion with markedly higher glucose levels than in her serum, indicating the presence of pleuroperitoneal communication. Three days later, thoracoscopic surgery was performed. A colored dialysis solution preoperatively injected into the abdominal cavity identified intraoperatively leakage from the diaphragm. The leakage points were closed by a no-knife-type automatic stapler with absorbable polyglycolic acid felt and fibrin glue. CAPD was restarted on the operative day, and there was no recurrence of the right hydrothorax. We conclude that this simple method can be used effectively to treat pleuroperitoneal communication.     

Peritonitis in continuous ambulatory peritoneal dialysis in children living in Saudi Arabia

The clinical aspects of peritonitis and catheter infections were reviewed in 64 children on continuous ambulatory peritoneal dialysis living in Saudi Arabia over a period of 6 years. Peritonitis occurred in 41 children (64%). The mean time from starting dialysis to the first episode of peritonitis was 7.2 months. The incidence of peritonitis was 1 episode in 9 treatment months. Gram-negative organisms were responsible for the majority of episodes (42%), followed by Gram-positive organisms (20%), and Candida albicans (6%); 32% were culture negative. Recurrent peritonitis was present in 20 cases. Catheter was replaced in 24 patients: 44% due to recurrent peritonitis. Peritoneal membrane loss occurred in 7 patients, 3 had Candida peritonitis and 3 had recurrent peritonitis due to Pseudomonas. The mortality rate was 4.6% but none of the deaths were related to peritonitis or dialysis. Received August 23, 1995; received in revised form October 2, 1996; accepted October 18, 1996     

Torulopsis glabrata peritonitis complicating continuous ambulatory peritoneal dialysis: successful management with oral 5-fluorocytosine

We report two cases of fungal peritonitis caused by Torulopsis glabrata, an uncommon opportunistic pathogen, in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis (CAPD). The general clinical characteristic of T glabrata peritonitis was comparable to previously reported cases of Candida peritonitis. Although appropriate therapy of fungal peritonitis in patients undergoing CAPD still remains controversial, both for the drug of choice and for the dosage to be used, our study indicates that a 5-week course of oral 5-fluorocytosine (5-FC) may obviate the need to remove the peritoneal catheter during the management of peritonitis caused by susceptible strains of T glabrata.