Access to Cancer Care: Prevention and Screening for Females Post Kidney Transplantation Around the World.

Kidney transplantation offers recipients superior outcomes and improved quality of life compared with dialysis. However, the need for ongoing immunosuppression places recipients at increased risk of certain forms of cancer. Screening and early detection of precancerous lesions are one of the few proven ways to lower the risk of cancer morbidity and mortality in the transplant population. Women have additional barriers to cancer screening services globally, especially in low- and middle-income countries as well as within certain disadvantaged groups in high-income countries. There is a dearth of published data on screening guidelines and policies on post-transplant malignancy in female recipients. It is vital that health care providers and patients are educated regarding the risks of cancer at all post-transplant stages and that the recommended screening policies are adhered to in order to reduce associated morbidity and mortality in this at-risk group.

Listeria monocytogenes peritonitis in a patient on peritoneal dialysis: a case report and review of the literature.

Listeria monocytogenes (LM) is one of the rare microorganisms causing peritonitis in peritoneal dialysis (PD) patients. We report a sporadic case of peritonitis caused by LM in a young female PD patient with lupus receiving corticosteroid therapy, who presented with abdominal pain, cloudy PD effluent, nausea, and conjunctivitis. The effluent showed a high PD effluent white cell count and monocytosis, and gram staining showed gram-positive bacilli in single or short chains and PD effluent culture grew LM. She was treated successfully with beta lactum antibiotics. LM peritonitis should be suspected if a patient presents with gram-positive bacilli and monocytosis in dialysis effluent.

Peritoneal dialysis in congestive heart failure.

Heart failure is a major and growing health problem. Major advances leading to newer therapies are being made in understanding the pathophysiology of heart failure as a chronic progressive disorder. Whatever the cause, all heart failure patients eventually progress to a refractory stage characterized by worsening renal function and resistance to diuretic therapy with attending severe edema. A logical treatment for this "cardiorenal syndrome" is the use of dialysis, which is efficient in treating both the hypervolemia and azotemia of refractory heart failure. Although all modalities of dialysis have been tried, peritoneal dialysis (PD) is the simplest choice and offers several advantages. It is an already-established long-term home-based therapy and does not require complex machinery or hospital resources. It is associated with preservation of residual renal function, gentle continuous ultrafiltration, hemodynamic stability, better middle-molecule clearance, sodium sieving with maintenance of normonatremia and perhaps less inflammation than hemodialysis is, especially with newer PD solutions. In the present paper, we discuss the potential advantages of PD in the treatment of heart failure, review the available literature, and lay some foundations for future research.

Intravenous iron does not affect the rate of decline of residual renal function in patients on peritoneal dialysis.

The preservation residual renal function (RRF) is important for adequacy of peritoneal dialysis. Oxidative stress from intravenous (IV) iron has been shown to cause renal damage. The effect of IV iron on RRF has not been studied. Here, we report our experience during April 1999-March 2005 of the effect of IV iron on RRF. The study group included 24 patients (9 men, 15 women). The mean age of the group was 61 +/- 17.7 years. Diabetes mellitus and hypertension were the underlying cause of end-stage renal disease in 55% of the patients. We found serum creatinine, creatinine clearance, urea clearance, urine output, hemoglobin, transferrin saturation, and ferritin all to be statistically significantly different before and after administration of IV iron to the patients. However, the rate at which the glomerular filtration rate (GFR) declined over time did not change significantly when calculated for the period before and after the iron infusion, suggesting that the changes we observed after IV iron infusion were the result of the declining RRF--the rate of that decline being unaffected by the IV iron. Furthermore, the rate of GFR decline in this study was similar to that previously reported in our patients.