Isolation of organisms in CAPD peritonitis: use of nutrient broth cultures and Bactec blood culture media.

Cultures of the first cloudy dialysates from 51 consecutive episodes of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis were carried out using concentrated nutrient broth and Bactec blood culture media in addition to primary culture on solid media. Thirty-seven episodes (73%) were positive on solid media, and 42 episodes (82%) were positive by both nutrient broth and Bactec methods. The value of Gram-stained smears and WBC counts on dialysates is discussed.

A simple method of lessening the incidence of peritonitis in peritoneal dialysis using a photochemical reactor.

Peritoneal dialysis is becoming increasingly accepted as a definitive treatment for chronic renal failure. One of its major complications is peritonitis. Ultraviolet light is known to have a bactericidal action. A photochemical reactor is described which produces ultraviolet light and which can be inserted into a peritoneal dialysis circuit. It was initially successful tested on artificially infected peritoneal dialysis fluid in the laboratory. It was then used successfully in clinical peritoneal dialysis.

Partial correction of dialysis-associated anaemia does not reduce erythropoietin dose or the incidence of side effects.

We examined the hypothesis that administering epoetin to maintain a lower target haemoglobin (Hb) results in a reduced side effect profile and a lower maintenance epoetin dose. We report a prospective study of 14 haemodialysis patients assessing epoetin dose efficiency and side effect profile of partially correcting dialysis-associated anaemia. Initial Hb was 6.2 +/- 0.6 g/dl (mean +/- 1 SD). Intravenous epoetin was commenced at 120 IU/kg/week in 3 divided doses and titrated to achieve a target Hb of 8 g/dl. Follow-up was 24 weeks. The final Hb was 8.7 +/- 0.8 g/dl. The peak epoetin dose was 196 +/- 86 IU/kg/week with a maintenance dose of 141 +/- 71 IU/kg/week. Therapy was associated with hypertension--5 patients (32%); seizures--1 patient (6%) (withdrawn from therapy), and temporary iron deficiency--4 patients (35%). Iron deficiency was corrected with oral therapy. There was 1 treatment failure. Comparable conventional regimens use 100-200 IU/kg to maintain the Hb at 10-13 g/dl and have a similar incidence of side effects. We concluded that reducing the target Hb in order to decrease epoetin requirements is not justified as it offers no benefit over conventional Hb targets in terms of dose requirements or side effects.

Peritoneal dialysis catheters: a comparison between percutaneous and conventional surgical placement techniques.

Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed side-room procedure that allows the rapid initiation of dialysis without the delay imposed in co-ordinating a surgeon, theatre time, and theatre staff. We retrospectively reviewed the clinical outcome of 230 PDC inserted over a 30-month period. Fifty were placed percutaneously (group P) and 180 were placed using conventional surgical techniques, 107 in patients commencing CAPD (group A) and 73 in patients commencing CAPD (group A) and 73 in patients previously established on CAPD (group B). Total experience accumulated was 2563 patient months: 270 patient months group P, 1381 patient months group A, 912 patient months group B. Percutaneous PDC insertion was non-elective, and reserved for patients unfit for general anaesthesia or haemodialysis. Group P patients were older (P < 0.001) and had increased early mortality (P < 0.005) due to underlying pathology. Death and early mechanical failure contributed to a shorter mean duration of catheter use in group P (9.0 +/- 2.3 months compared to 15.3 +/- 9.6 months group A and 17.3 +/- 9.7 group B) (P < 0.05). The peritonitis rate was similar in group P (1 per 6.75 patient months) and group B (1 per 7.4 patient months) but significantly lower in group A (1 per 15.7 patient months) (P < 0.01). We conclude that percutaneous PDC placement provides a safe, reliable access for peritoneal dialysis and is especially suitable for ill patients who would not tolerate general anaesthesia.

Synovial amyloid in chronic haemodialysis contains beta 2 microglobulin.

A case of amyloid arthropathy occurring in a patient receiving long term chronic haemodialysis treatment is reported. He was found to have raised serum beta 2 microglobulin (beta 2M). and beta 2M was detected in the synovial amyloid deposits.

Glomerulonephritis associated with antibody to glomerular basement membrane.

Glomerulonephritis associated with antibody to glomerular basement membrane, shown by linear staining of the glomerular basement membrane with fluoresceinated anti-IgG antisera, was found in only 10 out of 400 (2.5%) renal biopsy specimens studied by immunofluorescence. Seven of these cases had rapidly progressive glomerulonephritis, five with lung haemorrhage (Goodpasture's syndrome) and two without, and three had less severe nephritis without lung haemorrhage. Circulating antibody to glomerular basement membrane, measured by a passive haemagglutination technique and by indirect immunofluorescence, was detected in the serum of all patients with rapidly progressive glomerulonephritis by both techniques but only by the passive haemagglutination method in two of the other three patients. Two patients died of their lung haemorrhage, one despite bilateral nephrectomy, and lung haemorrhage and circulating antibody to glomerular basement membrane persisted after bilateral nephrectomy in another patient.