Clinical Profile and Complications of Continuous Ambulatory Peritoneal Dialysis in Kashmir

Introduction: Diabetes Mellitus is a syndrome characterizedby chronic hyperglycemia and disturbances of carbohydrate,fat and protein metabolism with absolute or relative deficiencyof insulin secretion and/or insulin action. It is one of themost common non-communicable diseases in the world.Adiponectin is a protein secreted exclusively by adipocytesthat regulates glucose and lipid metabolism. It has been foundto influence the body’s response to insulin thereby modulatinginsulin action and resistance. Several studies have found thatadiponectin levels are inversely associated with the severityof diabetes mellitus. Our study, thus, aims to compare theassociation between levels of adiponectin, fasting bloodglucose, body mass index and waist-hip ratio in patients ofdiabetes mellitus.Material and Methods: This case control study was done inpatients of type 2 diabetes mellitus attending Medicine OPDand ward from October 2016 to September 2018. A total of 88people were included in the study; 44 cases and 44 controls.Results: This study shows that serum adiponectin level issignificantly decreased in type 2 diabetes mellitus patients ascompared to controls and it also shows negative correlationwith fasting blood glucose, body mass index and waist-hipratio.Conclusion: It can be concluded that serum adiponectinestimation may be a useful biomarker for the diagnosis oftype 2 diabetes mellitus and it may be a useful adjunct in thetreatment of type 2 diabetes mellitus.

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

Introduction: Patients with end-stage renal disease (ESRD) are treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Aims and objectives: Our aim was to study the non-infectious complications in patients of ESRD on CAPD and to study the impact of the non-infectious complications in the survival of CAPD catheters. Materials and Methods: A prospective study has been conducted at Regional institute of medical science, Imphal in a total of 71patients of ESRD who are already on CAPD or newly diagnosed ESRD who have undergone CAPD catheter implantation. Their detailed history, clinical examination and relevant laboratory investigations were done and the different non-infectious complications were identified and analysed. Result: Out of the 71 patients studied 39 patients had complications like hypokalemia (15 patients), omental wrap (10 patients), catheter tip migration (6 patients), haemoperitonium (2 patients), hydrothorax (2patients), exit site leak(2patients), abdominal wall edema (1patient), catheter block(1patient). Conclusion: In our study the most common non-infectious complication was hypokalemia followed by omental wrap and catheter tip migration. Knowledge about the common prevalent non-infectious complications of CAPD alerts the treating doctor to take up the specific corrective steps at an earlier stage, thus preventing the morbidity associated with the same. We conclude that the majority of non-infectious complications in these patients were treatable and did not interfere with the catheter survival.

Laparoscopic Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Placement Using a Two-Port Method in Adult End-stage Renal Disease (ESRD) Patients: Early Experience

PURPOSE: Laparoscopy is being widely utilized beyond the field of surgery. We report on the early experience of laparoscopic CAPD catheter placement in adult ESRD patients. In addition, we investigate the question of whether laparoscopic CAPD catheter insertion can be used as a feasible long-term procedure. METHODS: Laparoscopic CAPD catheter placement was performed in 28 patients by one surgeon, between June, 2010 and October, 2013, and observed. A retrospective outcome study was conducted based on review of medical records. RESULTS: A total of 28 laparoscopic procedures were performed. The mean age of patients who underwent laparoscopic placement of a catheter was 60.3 years old. The most common cause of ESRD was uncontrolled hypertension combined with diabetes. The procedure took 45.7 minutes. Peritoneal dialysis was introduced on postoperative day eight, after one week of daily washing and no dialysate leaks were observed. Two incidences of catheter-related complications were observed: one incidence of catheter obstruction (due to its m igration and omental w rapping, w hich was m anaged with surgical removal) and one incidence of peritonitis (which was controlled with antibiotics). CONCLUSION: Laparoscopic CAPD catheter placement using tw o ports is a simple procedure with minimal complication. Laparoscopic CAPD catheter placement will gain greater acceptance as an alternative to the traditional method of CAPD catheter placement.

Effect of nursing interventions on quality of life for patients undergoing continuous ambulatory peritoneal dialysis: A Meta-analysis / 中国实用护理杂志

Objective To evaluate the effect of nursing interventions on the quality of life of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).Methods Randomized controlled trials (RCTs) involving nursing interventions were collected from the databases of Cochrane,PubMed,Elsevier Science Direct,VIP,CNKI and WanFang.Data were analyzed with RevMan 5.1 software.Results 8 articles met the inclusion criteria.The results of Meta-analysis showed that there was considerable heterogeneity across the analysis,which might be resulted from length of intervention and patients of different ages according to subgroup analysis,and that gender was not the factor causing heterogeneity.In the experimental group,both physical and emotional aspects after receiving nursing interventions were significantly improved than the control group.Conclusions Nursing interventions can improve the quality of life of patients with CAPD.

Melioidosis and Peritoneal Dialysis Related Peritonitis

We report a case of melioidosis presenting as peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). A 47-year-old man, a lorry driver, with end-stage renal disease due to diabetes mellitus on CAPD presented in PD-related peritonitis. He was started on intraperitoneal cloxacillin and ceftazidime, and changed to intraperitoneal vancomycin and meropenam after day 5 due to nonresponse. Burkholderia pseudomallei was identified from the dialysate culture. He was treated with intraperitoneal meropenam for two weeks, and IV ceftazidime for 4 weeks. He responded, and the Tenckhoff catheter was not removed. He was discharged well and continued on oral sulfamethoxazole/trimethoprim for six months. This patient had done his PD exchanges in a lorry.

Evaluation of DNA Extraction Methods and Their Clinical Application for Direct Detection of Causative Bacteria in Continuous Ambulatory Peritoneal Dialysis Culture Fluids from Patients with Peritonitis by Using Broad-Range PCR

BACKGROUND: The aims of this study were to compare several DNA extraction methods and 16S rDNA primers and to evaluate the clinical utility of broad-range PCR in continuous ambulatory peritoneal dialysis (CAPD) culture fluids. METHODS: Six type strains were used as model organisms in dilutions from 10(8) to 100 colony-forming units (CFU)/mL for the evaluation of 5 DNA extraction methods and 5 PCR primer pairs. Broad-range PCR was applied to 100 CAPD culture fluids, and the results were compared with conventional culture results. RESULTS: There were some differences between the various DNA extraction methods and primer sets with regard to the detection limits. The InstaGene Matrix (Bio-Rad Laboratories, USA) and Exgene Clinic SV kits (GeneAll Biotechnology Co. Ltd, Korea) seem to have higher sensitivities than the others. The results of broad-range PCR were concordant with the results from culture in 97% of all cases (97/100). Two culture-positive cases that were broad-range PCR-negative were identified as Candida albicans, and 1 PCR-positive but culture-negative sample was identified as Bacillus circulans by sequencing. Two samples among 54 broad-range PCR-positive products could not be sequenced. CONCLUSIONS: There were differences in the analytical sensitivity of various DNA extraction methods and primers for broad-range PCR. The broad-range PCR assay can be used to detect bacterial pathogens in CAPD culture fluid as a supplement to culture methods.

Laparoscopic internal fixation is a viable alternative option for continuous ambulatory peritoneal dialysis catheter insertion / 대한외과학회지

PURPOSE: One of the major drawbacks of peritoneal dialysis (PD) is catheter migration and dysfunction. Preventing catheter migration is one of the main concerns. We compared laparoscopic internal fixation method with open surgical method for catheter migration rates. METHODS: From January 2008 to August 2009, PD catheters were inserted by laparoscopic fixation (LF) method in 22 patients and by open surgery (OS) in 32 patients. Clinical data were reviewed retrospectively. The frequency of migration, peritonitis, and other complications were compared. Catheter and patient survival rates were also compared. RESULTS: The mean age and sex ratio were not different between groups. Mean follow-up duration was 29.1 months in LF group and 26.1 months in OS group. More patients in LF group (27.3%) had history of laparotomy than in OS group (3.1%) (P = 0.01). The mean operation time was significantly longer in LF group (101.6 +/- 30.4 minutes) than in OS group (72.4 +/- 26.03 minutes) (P = 0.00). The cumulative incidence of catheter migration was 65.6% in OS group and 13.6% in LF group (P = 0.00). Migration-free catheter survival was higher in LF group (P = 0.001). There were no differences in complication rates between groups. Overall catheter survival was similar (P = 0.93). Patient survival rate at 2 years was not different (P = 0.13). CONCLUSION: Laparoscopic internal fixation of continuous ambulatory peritoneal dialysis catheter significantly reduces migration rates without any addition of complications. Also, laparoscopic technique did not incur patient morbidity or mortality despite the requirement for general endotracheal anesthesia and longer operation time. Therefore, internal fixation can be afforded safely in patients with previous abdominal surgery as either a salvage or preventive measure in patients with repeated catheter migration.

Laparoscopic Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion in Children: Early Experience Comparison with Open CAPD Catheter Insertion / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter insertion is used instead of open CAPD insertion because additional measures to prevent complications can be made without a conventional laparotomy. This study compared the early experience of laparoscopic CAPD catheter insertion with open CAPD insertion in children. METHODS: Between January 2006 and May 2011, 52, 16 and 36 patients who underwent CAPD insertion, laparoscopic CAPD insertion and open CAPD insertion, respectively, for end stage renal disease at Seoul National University Children's Hospital were enrolled in this study. The clinicopathological factors, operative factors and outcomes were analyzed by a retrospective medical record review. RESULTS: The mean operative time of the laparoscopic group was longer than that of the open groups (78 minutes vs 60 minutesm, p value=0.079). In the laparoscopic group, 3 patients underwent closure of the processus vaginalis and the occurrence of an inguinal hernia was prevented, whereas 3 patients in the open group underwent herniorrhaphy for an inguinal hernia. The mean period of catheter use in the laparoscopic and open group was 201 and 984 days, respectively. Complications occurred more frequently in the open group than in the laparoscopic group (14 patients (38.9%) vs. 2 patients (12.5%), p value=0.059). Peritonitis (19.4%) was the most common complication, which occurred only in the open group, followed by catheter obstruction due to omental wrapping. Catheter migration occurred more frequently in the open group (20%) than the laparoscopic group (12.5%). CONCLUSION: These results suggest that laparoscopic CAPD catheter insertion can be a suitable method for CAPD catheter insertion in children.

Comparison of Blood Pressure Control and Left Ventricular Hypertrophy in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD)

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.

Intraperitoneal Paricalcitol Treatment for Secondary Hyperparathyroidism in CAPD patient: A Case Report / 대한신장학회지

Secondary hyperparathyroidism is a major complication in ESRD patients undergoing dialysis. In hemodialysis patients with secondary hyperparathyroidism, intravenous administration of paricalcitol became widely utilized. In CAPD patients, however, the intravenous administration of paricalcitol which requires frequent visits to the clinic is not practical. The subject of this study was one CAPD patient with secondary hyperparathyroidism. He had already received oral calcitriol pulse therapy for 6 months and thereafter refused parathyroidectomy and intravenous paricalcitol which required frequent visits to the hospital. Furthermore, paricalcitol capsule is not yet introduced in Korea. Consequently, intraperitoneal paricalcitol therapy was tried whereby the patient was taught how to inject the paricalcitol (5 ug) directly into the dialysate for three times per week before bedtime. Blood samples for measurement of intact parathyroid hormone (iPTH), serum ionized calcium, serum phosphate, serum total alkaline phosphatase levels were obtained at baseline and after 1, 2, 3 and 4 months of treatment. After usage of intraperitoneal paricalcitol for 2 months, there was a significant decrease in iPTH level. In conclusion, intraperitoneal paricalcitol therapy might be effective for suppressing iPTH in CAPD patients with secondary hyperparathyroidism. A large-scale and long-term study must be conducted for safety and clinical effect.

A Case of Trichosoporon insectorum Peritonitis in a Continous Ambulatory Peritoneal Dialysis Patient / 대한신장학회지

CAPD peritonitis caused by Trichosporon species is uncommon. We report a case of peritonitis due to T. insectorum in a 38-year-old man who had undergone CAPD for about 1 year. He presented with abdominal pain. The clinical signs and analysis of peritoneal fluid were consistent with CAPD peritonitis. Patient deteriorated despite empirical antibiotics therapy. Repeated peritoneal culture revealed Trichosporon species. The peritonitis was treated with CAPD catheter removal and administering amphotericin B and fluconazole. We isolated T. insectorum by DNA sequencing method. We hereby report the first case of T. insectorum CAPD peritonitis.

Comparison of the BACTEC Blood Culture and Conventional Culture Methods for Isolation of Microorganisms Causing Peritonitis in CAPD Patients / 대한내과학회지

BACKGROUND/AIMS: Peritonitis is the most frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Prompt recognition and treatment of peritonitis is important. The purpose of this study was to compare the effectiveness of isolation of the microorganisms causing CAPD peritonitis by the BACTEC blood culture and conventional methods. METHODS: We retrospectively reviewed 38 episodes of peritonitis in 34 CAPD patients between September 2007 and February 2010. Two methods of processing dialysate from patients on CAPD were used. Blood culture was performed using two 10-mL effluents, which were inoculated into a pair of BACTEC culture bottles. The conventional method was performed using 50 mL of centrifuged dialysate. The sedimented dialysate was inoculated onto blood agar and MacConkey agar plates or into thioglycollate broth. To evaluate effectiveness, we compared the rate of positive culture results and the time to identify the causative organism of the two culture methods. RESULTS: Use of the BACTEC bottle method resulted in more positive culture results than did conventional culture (86.8 vs. 57.9% p = 0.003). The time taken to identify the causative organism from culture-positive peritonitis was more rapid using the blood culture compared with the conventional culture method (90 vs. 109 hr, p = 0.03). CONCLUSIONS: Blood culture using the BACTEC bottle is more effective than the conventional culture technique for detection of causative microorganisms in CAPD peritonitis.

The Effect of an Anti-adhesion Agent in Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion Operation

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant complication of CAPD is malfunction of the catheter because of catheter adhesion that leads to catheter malposition. So we evaluated the effect of an anti-adhesive agent called Guardix-Sol(R). METHODS: We prospectively evaluated the clinical results of 78 patients who had received CAPD catheter insertion from Sep. 2007 to May 2009. A test group of 34 patients used the anti-adhesion agent and a control group of 44 patients did not use it. All the procedures were standardized and performed by a single surgeon. RESULTS: The patients consisted of 49 males and 29 females. The common reasons for CAPD insertion were diabetic nephropathy (47 patients) and hypertension (20 patients). Fifteen patients needed reposition operations during their postoperative course, which were done under spinal anesthesia. Out of 15 patients, 3 were from the test group (Guardix-Sol(R) group) and 12 from the control group (P=0.0526). All the repositioned patients had a malpositioned catheter because the greater omentum had adhered to the catheter, except for one patient in each group (P=0.0315). CONCLUSION: Using an anti-adhesive agent for CAPD insertion is an effective method to reduce the incidence of greater omental adhesion. So the rate of reoperation cases for catheter repositioning is decreased.

Clinical Comparison of Automated Peritoneal Dialysis with Continuous Ambulatory Peritoneal Dialysis / 대한신장학회지

PURPOSE: Automated peritoneal dialysis (APD) is increasingly used due to freedom from daytime exchanges and flexibility of prescription. In this study, we compared APD with continuous ambulatory peritoneal dialysis (CAPD) to assess the influence of mode of PD on various measures of clinical performance. METHODS: We followed 26 APD patients prospectively over a 12-month period and compared them with 16 CAPD patients in whom examinations of dialysis dose and residual renal function (RRF) at least twice during the 1st one year after dialysis were done. Weekly Kt/V urea (Kt/V) and standard creatinine clearance (SCCr) of PD, and RRF (24hr urine creatinine clearance) were measured at 1st month, 6th month and 12th month after start of dialysis. In addition, serial biochemical tests were analyzed every three months during this period. RESULTS: No statistically significant differences in baseline characteristics, RRF, SCCr and Kt/V were observed between APD and CAPD patients. Serum concentrations of bicarbonate, hemoglobin, and calcium tended to be higher in the APD group and actually serum bicarbonate levels at 9 months, calcium levels at 12 months and hemoglobin levels at 6 and 9 months were significantly higher in APD patients (p<0.05). There was no significant difference in serum sodium concentrations and peritonitis rate between the two groups. CONCLUSION: No significant differences were observed between APD and CAPD in Kt/V, SCCr and RRF for one year after start of PD. APD, however, may be advantageous in improving several biochemical markers such as blood levels of hemoglobin, bicarbonate, and calcium compared to CAPD.

A Case of Klebsiella pneumoniae Peritonitis in CAPD Patient with Liver Abscess / 대한신장학회지

A 42-year-old male was hospitalized with abdominal pain, dyspnea, and turbid peritoneal fluid. He was diagnosed with hypertension, diabetes and started continuous ambulatory peritoneal dialysis (CAPD) 11 months ago. He was treated with intraperitoneal cefazolin and ceftazidime, and then white blood cell counts of dialysate decreased. Incidentally, liver abscess was found in chest CT performed for the evaluation of dyspnea, and patient was febrile persistently. So percutaneous abscess drainage was done by pigtail catheter. We changed the antibiotics to ceftriaxone and metronidazole, and hemodialysis was started. Klebsiella pneumoniae was cultured from peritoneal fluid and blood simultaneously. We concluded that liver abscess is a primary cause of CAPD peritonitis.

A Case of Perforated Acute Cholecystitis in CAPD Patient who Returned to CAPD after Laparoscopic Cholecystectomy / 대한신장학회지

We experienced a 59 year-old female diabetic CAPD patient with severe peritonitis due to perforated acute cholecystitis. Because of heart failure due to old myocardial infarction and cerebral infarction she had been treated with CAPD for 5 years in bed-ridden state. Initial presentation was dark brown colored peritoneal dialysate effluent (changed greenish bile color later) and septic shock. We diagnosed perforated acute cholecystitis by computerized tomography three days after improvement of sepsis. She was received laparoscopic cholecystectomy and continuous venovenous hemodiafiltration for two weeks and returned to peritoneal dialysis without complication. Secondary CAPD peritonitis with cholecystitis or bowel disease should be carefully considered in patients with specific dialysate color, which could be cured with laparoscopic surgery, and then patients can be returned to CAPD again without complication.

A Case of Encapsulating Peritoneal Sclerosis, Presenting as Hemoperitoneum, Successfully Treated by Enterolysis / 대한신장학회지

Encapsulating peritoneal sclerosis (EPS) is an uncommon but fatal complication of peritoneal dialysis (PD). Recently, there were some reports of advanced EPS cases that were successfully treated by enterolysis although an intestinal perforation or leakage from intestinal anastomosis were associated with a high mortality. We experienced a case of EPS in a 53-year-old man on PD for 3.5 years without a previous history of episode of peritonitis who presented with hemoperitoneum during treatment of peritonitis. EPS was diagnosed radiologically according to typical CT findings; The series of CT scans revealed how to develop in sequence from a very subtle findings to full-blown findings of EPS. Enterolysis was performed because the patient did not respond to conservative management such as cessation of PD with transfer to hemodialysis, nutritional support and steroid therapy. In spite of intestinal perforation during surgery, he was successfully treated with enterolysis. Therefore, we report this case with review of the literature.

Guías de manejo hepatitis por virus B en insuficiencia renal crónica y hemodiálisis / Guidelines for the management of Hepatitis B virus in chronic renal insufficiency and hemodialysis

El riesgo de adquirir hepatitis B en pacientes con insuficiencia renal crónica depende del tipo y duración de la diálisis. El virus B puede producir glomerulonefritis y lesión renal relacionada con poliarteritis nodosa. La prevención de la infección en estos pacientes incluye medidas de protección durante la diálisis, esquemas de vacunación diferenciados, control riguroso de los productos sanguíneos utilizados y monitoreo serológico de pacientes y personal.

The risk to acquire hepatitis B in patients with chronic renal insufficiency depends on the type and duration of the dialysis. The HBV can cause glomerulonephritis and renal injury related with polyarteritis nodosa. Prevention of the infection in these patients includes: protective measures during dialysis, differentiated schemes of vaccination, rigorous control of blood products used and serologic monitoring of patients and personnel.

A Case of Vancomycin-Resistant Enterococci P eritonitis in a Pediatric P atient on CAPD Successfully Treated with Linezolid

Peritonitis is one of the major complications of CAPD(continuous ambulatory peritoneal dialysis). Recently, multidrug-resistant organisms, such as vancomycin-resistant enterococcus (VRE) have been rarely reported by the pathogen as of CAPD-associated peritonitis. But, there is limited information on choices of effective therapy for VRE peritonitis in patients undergoing CAPD. We present a pediatric case of successful treatment of CAPD-associated peritonitis due to VRE with linezolid, and review of the literature.

Peritonitis due to Trichosporon asahii in a continuous ambulatory peritoneal dialysis patient / 대한내과학회지

Fungal peritonitis is an important cause of intractable peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Candida species are the most common cause of fungal peritonitis, while Trichosporon asahii is rarely reported. Here, we report a case of peritonitis due to T. asahii in a 44-year-old woman who had undergone CAPD for 8 years. She was admitted to our hospital with diarrhea and fever. The clinical findings and analysis of the peritoneal fluid were consistent with peritonitis, and a culture of the peritoneal fluid revealed T. asahii. The peritonitis was treated by removing the peritoneal catheter and administering amphotericin B and fluconazole. T. asahii peritonitis is rare, but it should be considered as one of the important organism in fungal peritonitis in a CAPD patient.