[Sepsis - still valid economic and epidemiological problem]. / Sepsa ­ wciaz aktualny problem epidemiologiczny i ekonomiczny.

The recognition of sepsis is connected with potentially bad prognosis, high mortality rate and high costs of the therapy. A new definition of sepsis was introduced in 2016. The main role of dysfunction of organs in the course of infection, the potential threat for life and necessity to perform quick diagnosis result from this definition. The review of worldwide literature on sepsis epidemiology and therapy costs was done in the current article. It was observed that the data concerning incidence of sepsis in Polish hospitals are incomplete, related to single observations, and in most cases they come from retrospective analyses. Therefore, the nation-wide registry comprising the data of the sepsis cases should be established.

Changes of peritoneal transport parameters with time on dialysis: assessment with sequential peritoneal equilibration test.

BACKGROUND: Sequential peritoneal equilibration test (sPET) is based on the consecutive performance of the peritoneal equilibration test (PET, 4-hour, glucose 2.27%) and the mini-PET (1-hour, glucose 3.86%), and the estimation of peritoneal transport parameters with the 2-pore model. It enables the assessment of the functional transport barrier for fluid and small solutes. The objective of this study was to check whether the estimated model parameters can serve as better and earlier indicators of the changes in the peritoneal transport characteristics than directly measured transport indices that depend on several transport processes. METHODS: 17 patients were examined using sPET twice with the interval of about 8 months (230 ± 60 days). RESULTS: There was no difference between the observational parameters measured in the 2 examinations. The indices for solute transport, but not net UF, were well correlated between the examinations. Among the estimated parameters, a significant decrease between the 2 examinations was found only for hydraulic permeability LpS, and osmotic conductance for glucose, whereas the other parameters remained unchanged. These fluid transport parameters did not correlate with D/P for creatinine, although the decrease in LpS values between the examinations was observed mostly for patients with low D/P for creatinine. CONCLUSIONS: We conclude that changes in fluid transport parameters, hydraulic permeability and osmotic conductance for glucose, as assessed by the pore model, may precede the changes in small solute transport. The systematic assessment of fluid transport status needs specific clinical and mathematical tools beside the standard PET tests.

Sequential peritoneal equilibration test: a new method for assessment and modelling of peritoneal transport.

BACKGROUND: In spite of many peritoneal tests proposed, there is still a need for a simple and reliable new approach for deriving detailed information about peritoneal membrane characteristics, especially those related to fluid transport. METHODS: The sequential peritoneal equilibration test (sPET) that includes PET (glucose 2.27%, 4 h) followed by miniPET (glucose 3.86%, 1 h) was performed in 27 stable continuous ambulatory peritoneal dialysis patients. Ultrafiltration volumes, glucose absorption, ratio of concentration in dialysis fluid to concentration in plasma (D/P), sodium dip (Dip D/P Sodium), free water fraction (FWF60) and the ultrafiltration passing through small pores at 60 min (UFSP60), were calculated using clinical data. Peritoneal transport parameters were estimated using the three-pore model (3p model) and clinical data. Osmotic conductance for glucose was calculated from the parameters of the model. RESULTS: D/P creatinine correlated with diffusive mass transport parameters for all considered solutes, but not with fluid transport characteristics. Hydraulic permeability (L(p)S) correlated with net ultrafiltration from miniPET, UFSP60, FWF60 and sodium dip. The fraction of ultrasmall pores correlated with FWF60 and sodium dip. CONCLUSIONS: The sequential PET described and interpreted mechanisms of ultrafiltration and solute transport. Fluid transport parameters from the 3p model were independent of the PET D/P creatinine, but correlated with fluid transport characteristics from PET and miniPET.

[Extended assessment of peritoneal transport kinetics of substances and water as an important element of integrated dialysis care]. / Rozszerzona ocena kinetyki transportu przezotrzewnowego czqsteczek i wody jako wazny element koncepcji zintegrowanej opieki dializacyjnej.

UNLABELLED: The concept of integrated dialysis care is based on the choice of the most optimal method of renal replacement therapy for particular patient in particular period of disease. In many cases peritoneal dialysis (PD) is the initial therapy. PD modalities and regimens are modified according to values of parameters of ultrafiltration and adequacy. The routinely used methods of analysis of peritoneal transport are very useful for general assessment of properties of peritoneum as a dialysis membrane. However, the application of these methods do not guarantee the full assessment of peritoneal transport kinetics of water and substances. Therefore, the capabilities of the most adequate modification are limited. The tests based on mathematical models taking into account the kinetics of intraperitoneal dialysate volume seem to be the right supplement of standard methods. MATERIALS AND METHODS: To illustrate the problem mentioned above, the aim of this study was comparison of peritoneal transport of substances and water in two groups of patients: group I with negative ultrafiltration (UF) (n=14) and group II with positive UF (n=6). In the studied groups peritoneal equilibration test (PET) was done, then the assessment of peritoneal water transport was performed using 125I-HSA as dialysate volume marker, and finally the velocity of peritoneal transport of small molecules expressed by solute mass transport rate (SMTR) coefficient was measured. Patients from both groups belonged to the same category of high-average transporters according to PET criteria. RESULTS: On the base of broaden assessment of peritoneal transport of water and substances it was proved that different, "therapeutic approach" should be applied in studied groups to reach the adequate dialysis. Although in group II the minor modification of continuous ambulatory peritoneal dialysis (CAPD) regimen was desired, the radical change of CAPD schedule or transfer to automated peritoneal dialysis was necessary in cases of patients from group I. CONCLUSIONS: The results of the study indicate that the extended assessment of peritoneal transport kinetics of water and substances increases the capabilities of individualisation of PD program. Therefore, it should be treated as an important element of integrated dialysis care.

[Empirical therapy of peritonitis in peritoneal dialysis patients--it is reasonable to use a new therapeutic schedule?]. / Empiryczne leczenie dializacyjnego zapalenia otrzewnej--czy uzasadnione jest stosowanie nowego schematu terapeutycznego?

The Ad Hoc Advisory Committee on Peritonitis Management recommended in the year 2000 a new protocol of empirical peritonitis therapy in patients on peritoneal dialysis with preserved residual renal function (RRF). This protocol comprises 1st and 3rd generation cephalosporins. According to these recommendations the old protocol of therapy, comprising 1st generation cephalosporin and aminoglycoside may be used only in patients with diuresis lower than 100 ml/day. The aim of the study was a retrospective assessment of the efficacy and cost of peritonitis therapy using "old" and "new" protocols. The analysed episodes of peritonitis were divided into two groups. Group 1 included 22 episodes of peritonitis in 13 patients treated with the old protocol, in whom RRF was lower than 100 ml/day. Group 2 included 6 episodes of peritonitis in 4 patients with preserved RRF treated with the new protocol. The efficacy of the treatment according to the old protocol was 64% and according to the new protocol--33%. The average cost of 14-day therapy with the old and new schedule was 67.1 and 247.2 Euro, respectively. In our studied population a considerably lower efficacy and higher cost were revealed of the new empirical schedule of peritonitis treatment in comparison to the old schedule. The results of the study indicate the need of further estimation of the usefulness of the new peritonitis empirical treatment protocol.