Chronic peritoneal dialysis: seven-year experience in a large Hispanic program.

OBJECTIVE: To analyze the clinical results of our patient population on continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) in relation to treatment modality systems, compliance, rehabilitation characteristics, complications, and survivals. DESIGN: The medical records of all patients trained on CAPD or CCPD between 1985 and 1992 were reviewed for the above-mentioned outcome objectives. SETTING: Outpatient CAPD facility affiliated to a tertiary care community hospital. PATIENTS: The total of 305 patients trained during the study period were studied. MAIN OUTCOME MEASURES: The patients were studied for age, sex, primary renal disease, peritoneal dialysis modality, need of assistance from a partner during the dialysis procedure, causes of transfer and hospitalization, peritonitis, rehabilitation, patient compliance, and outcome including mortality. PATIENT POPULATION: 179 (58.7%) males and 126 (41.3%) females, aged 1-80 years (mean 47.2 +/- 15.09) with a total observation time of 15,753 patient-months. The most common diagnosis of the renal disease was diabetic nephropathy (41%). Peritonitis was the main cause of hospitalizations (36.7%) and of transfers (69.5%). Patient survival at one, two, and three years was 87.9%, 76.6%, and 67.0%, respectively. Likewise, technique survival was 65.5%, 45.5%, and 30.6%. Peritonitis rate for CAPD has improved from 1.9 episodes per patient-year to 1.2 episodes per patient-year and an overall rate of 1.5 episodes per patient-year. CONCLUSIONS: The experience in a large Hispanic program shows a good patient survival rate. Although there is a trend to a lower peritonitis rate, this continues to be the main cause of transfer, hospitalization, and one of the main causes of death.

Improved overall survival of elderly patients on peritoneal dialysis.

Clinical complications and outcome of 50 patients, age 65 or older, on dialysis during 1985-1990 were studied. There were three groups: Peritoneal Dialysis (PD-10 pts.), Hemodialysis (HD-28 pts.), and both for at least one month each (PD-HD 12 pts.) (8 HD to PD and 4 PD to HD). Analysis included sex, age, bacteremia associated to acute vascular accesses (AVA), peritonitis (PD), other illnesses, hospital days, blood chemistries, quality of life (active, sedentary or bedridden). The most frequent causes of death were septicemia and cardiac failure. No difference was found in age, chemistries, hemoglobin, illnesses or quality of life. The results showed a significant improved overall survival for those in the PD group (77.8%, p less than 0.05) as compared to HD or PD-HD group. Therefore, more emphasis should be placed on using PD for elderly patients.

Outcome of young and elderly diabetic patients on ambulatory peritoneal dialysis: the experience of a community hospital in Puerto Rico.

OBJECTIVE: To analyze the clinical results of a group of young and elderly diabetic patients on ambulatory peritoneal dialysis at a large comprehensive tertiary care community hospital in San Juan, Puerto Rico in relation to rehabilitation characteristics, compliance, complications and survival. DESIGN: The medical records of all patients with a diagnosis of diabetes mellitus trained between June 1985 and June 1992 were reviewed. This group of patients was subdivided according to age, in young (20-50 years) and elderly (50 or over). A comparable number of nondiabetics were selected at random for each of the two age groups. MAIN OUTCOME MEASURES: The patient were studied for age, sex, need of assistance from a partner during dialysis, causes of transfer and hospitalizations, peritonitis, rehabilitation, patients compliance and outcome including mortality. RESULTS: Young diabetics versus non-diabetics: There were 45 patients in the diabetic group (37.8% females) and 57 in the non-diabetic group (54.4% female) with a total observation time of 52.52 patient-months among the diabetics and 82.17 patient-months in the non-diabetic. Mean age of the diabetic patient was 39.9 +/- 8.8 and 36.7 +/- 8.7 for the non-diabetic. Assistance by a partner during the dialysis procedure was needed by 26.7% of the diabetics and by 3.7% of the non-diabetics (p < 0.01). Of the non-diabetics, 91.2% were classified as compliant versus 75.6% of the diabetics (p < 0.05). Peritonitis was the main cause of hospitalizations and of transfers in both groups. The two years patient survival for the diabetic was 81.7% and 100% for the non-diabetic and the two years technique survival was 32.5% for the diabetic and 43.5% for the non-diabetic. Elderly diabetics versus non-diabetics: There were 76 patients in the diabetic group (36.8% female) and 64 in the nondiabetic (43.8% female). The mean age of the diabetic group was 61.3 +/- 6.2 years and 59.3 +/- 7.3 years for the non-diabetic with a total observation time of 81.86 patients-months for the diabetic and 104.58 patient-months for the non-diabetic. Assistance by a partner during dialysis was needed in 63.5% of the diabetics and 19.45% of the non-diabetics (p < 0.01). No statistical difference was found in the rehabilitation or compliance evaluation. Peritonitis stands out again as the main cause of transfer out of the PD modality and main cause of hospitalization in both groups. The two year patient survival for the diabetic was 51.5% and 73.3% for the non-diabetic, while the two years technique survival was 49% for the diabetic and 52.9% for the non-diabetic. CONCLUSIONS: A shortened technique survival, problems of compliance, a high peritonitis rate plus dependency on a partner for dialysis are features of the diabetic group. These findings demonstrate that the diagnosis of diabetes mellitus provides for the development of complications and barriers to the PD modality in both the young and the elderly.

Incidence and prevalence of HIV-positive patients on chronic hemodialysis at the University and San Juan City Hospital.

There is controversy on whether or not patients with End Stage Renal Disease (ESRD) on chronic hemodialysis (HD) should be routinely tested for the presence of HIV-antibody (HIV-Ab) in their blood. Several reports have appeared in the literature reporting incidence from 0 to 11%. A total of 227 patients receiving chronic HD; at the University and San Juan City Hospital, from January to December 1987 were screened for the presence of HIV-Ab by the ELISA method. Those reported as positive were confirmed by the Western Blot method. HIV-Ab presence was reported and confirmed in 9 patients (4%). Five of these patients (2%) were IV drug abusers, 2 (0.9%) homosexual, 1 (0.4%) had history of sexual promiscuity and 1 (0.4%) had been exposed to multiple blood transfusion (MBT) prior to HIV testing of blood. Our prevalence was 7%. However when risk factors other than MBT were excluded the prevalence was 0.4%. The incidence and prevalence of HIV positive cases in our hemodialysis population is comparable to that previously reported.

Calcifying panniculitis associated with polycystic kidney disease and chronic renal failure.

Tender erythematous nodules and plaques developed on the abdomen and legs of two women, 45 and 48 years of age, with hyperparathyroidism as a result of chronic renal failure caused by polycystic kidney disease. The histopathologic findings of these lesions were characterized by a calcifying panniculitis. Laboratory tests disclosed normal calcium levels and hyperphosphatemia with an elevated level of calcium phosphate product. Calciphylaxis appeared to be the mechanism of soft tissue calcification in these patients.

Outcome of young and elderly diabetic patients on ambulatory peritoneal dialysis: the experience of a community hospital in Puerto Rico [see comments]

OBJECTIVE: To analyze the clinical results of a group of young and elderly diabetic patients on ambulatory peritoneal dialysis at a large comprehensive tertiary care community hospital in San Juan, Puerto Rico in relation to rehabilitation characteristics, compliance, complications and survival. DESIGN: The medical records of all patients with a diagnosis of diabetes mellitus trained between June 1985 and June 1992 were reviewed. This group of patients was subdivided according to age, in young (20-50 years) and elderly (50 or over). A comparable number of nondiabetics were selected at random for each of the two age groups. MAIN OUTCOME MEASURES: The patient were studied for age, sex, need of assistance from a partner during dialysis, causes of transfer and hospitalizations, peritonitis, rehabilitation, patients compliance and outcome including mortality. RESULTS: Young diabetics versus non-diabetics: There were 45 patients in the diabetic group (37.8 percent females) and 57 in the non-diabetic group (54.4percent female) with a total observation time of 52.52 patient-months among the diabetics and 82.17 patient-months in the non-diabetic. Mean age of the diabetic patient was 39.9 +/- 8.8 and 36.7 +/- 8.7 for the non-diabetic...