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1.
Dentomaxillofac Radiol ; 50(1): 20200108, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706991

RESUMO

OBJECTIVE: The aim was to compare dental and skeletal indices in panoramic radiography between patients undergoing haemodialysis, peritoneal dialysis and age- and sex-matched control group. METHODS: In this comparative cross-sectional study, quantitative Indices including Antegonial Index (AI), Mental Index (MI), Panoramic Mandibular Index (PMI) and qualitative indices including Mandibular Cortical Index (MCI) and Trabecular Pattern (TP) were evaluated in panoramic images of 32 haemodialysis patients, 14 patients under peritoneal dialysis and 52 healthy individuals. The images were also investigated for pulp canal calcification, pulp stones, soft tissue calcification, changes in or loss of lamina dura, radiolucencies associated with brown tumour and ridge resorption. The indices were compared between the three groups and were investigated for association with the patients' blood test parameters and their diseases causing chronic renal failure (CRF). Intraobserver agreement for the 2-week interval of assessment was calculated for the indices. RESULTS: MI (p = 0.574) and PMI (p = 0.100) were not significantly different, but AI (p = 0.01), MCI (p < 0.001) and TP (p = 0.002) were significantly different between the two case groups and the control group. The prevalence of pulp calcification (p = 0.03) and ridge resorption (p = 0.005) was higher in the haemodialysis group. Soft tissue calcification (p = 0.85) and lamina dura changes (p = 0.9) showed no significant difference. Brown tumours were observed in only one case in the haemodialysis group. CONCLUSIONS: AI, MCI and TP showed a reduction in mineral density of the cortical and trabecular bone in CRF patients and more severely in patients under haemodialysis than those under peritoneal dialysis.


Assuntos
Densidade Óssea , Diálise Peritoneal , Estudos Transversais , Humanos , Mandíbula/diagnóstico por imagem , Diálise Peritoneal/efeitos adversos , Radiografia Panorâmica , Diálise Renal
2.
Cochrane Database Syst Rev ; 12: CD012913, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320346

RESUMO

BACKGROUND: Urgent-start peritoneal dialysis (PD), defined as initiation of PD within two weeks of catheter insertion, has been emerging as an alternative mode of dialysis initiation for patients with chronic kidney disease (CKD) requiring urgent dialysis without established permanent dialysis access. Recently, several small studies have reported comparable patient outcomes between urgent-start and conventional-start PD. OBJECTIVES: To examine the benefits and harms of urgent-start PD compared with conventional-start PD in adults and children with CKD requiring long-term kidney replacement therapy. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 27 June 2019), EMBASE (OVID) (1980 to 27 June 2019), Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov (up to 27 June 2019) were searched. SELECTION CRITERIA: All randomised controlled trials (RCTs) and non-RCTs comparing the outcomes of urgent-start PD (within 2 weeks of catheter insertion) and conventional-start PD ( ≥ 2 weeks of catheter insertion) treatment in children and adults CKD patients requiring long-term dialysis were included. Studies without a control group were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted and quality of studies were examined by two independent authors. The authors contacted investigators for additional information. Summary estimates of effect were examined using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI) as appropriate for the data. The certainty of evidence for individual outcome was assessed using the GRADE approach. MAIN RESULTS: A total of 16 studies (2953 participants) were included in this review, which included one multicentre RCT (122 participants) and 15 non-RCTs (2831 participants): 13 cohort studies (2671 participants) and 2 case-control studies (160 participants). The review included unadjusted data for analyses due to paucity of studies reporting adjusted data. In low certainty evidence, urgent-start PD may increase dialysate leak (1 RCT, 122 participants: RR 3.90, 95% CI 1.56 to 9.78) compared with conventional-start PD which translated into an absolute number of 210 more leaks per 1000 (95% CI 40 to 635). In very low certainty evidence, it is uncertain whether urgent-start PD increases catheter blockage (4 cohort studies, 1214 participants: RR 1.33, 95% CI 0.40 to 4.43; 2 case-control studies, 160 participants: RR 1.89, 95% CI 0.58 to 6.13), catheter malposition (6 cohort studies, 1353 participants: RR 1.63, 95% CI 0.80 to 3.32; 1 case-control study, 104 participants: RR 3.00, 95% CI 0.64 to 13.96), and PD dialysate flow problems (3 cohort studies, 937 participants: RR 1.44, 95% CI 0.34 to 6.14) compared to conventional-start PD. In very low certainty evidence, it is uncertain whether urgent-start PD increases exit-site infection (2 cohort studies, 337 participants: RR 1.43, 95% CI 0.24 to 8.61; 1 case-control study, 104 participants RR 1.20, 95% CI 0.41 to 3.50), exit-site bleeding (1 RCT, 122 participants: RR 0.70, 95% CI 0.03 to 16.81; 1 cohort study, 27 participants: RR 1.58, 95% CI 0.07 to 35.32), peritonitis (7 cohort studies, 1497 participants: RR 1.00, 95% CI 0.68 to 1.46; 2 case-control studies, participants: RR 1.09, 95% CI 0.12 to 9.51), catheter readjustment (2 cohort studies, 739 participants: RR 1.27, 95% CI 0.40 to 4.02), or reduces technique survival (1 RCT, 122 participants: RR 1.09, 95% CI 1.00 to 1.20; 8 cohort studies, 1668 participants: RR 0.90, 95% CI 0.76 to 1.07; 2 case-control studies, 160 participants: RR 0.92, 95% CI 0.79 to 1.06). In very low certainty evidence, it is uncertain whether urgent-start PD compared with conventional-start PD increased death (any cause) (1 RCT, 122 participants: RR 1.49, 95% CI 0.87 to 2.53; 7 cohort studies, 1509 participants: RR 1.89, 95% CI 1.07 to 3.3; 1 case-control study, 104 participants: RR 0.90, 95% CI 0.27 to 3.02; very low certainty evidence). None of the included studies reported on tunnel tract infection. AUTHORS' CONCLUSIONS: In patients with CKD who require dialysis urgently without ready-to-use dialysis access in place, urgent-start PD may increase the risk of dialysate leak and has uncertain effects on catheter blockage, malposition or readjustment, PD dialysate flow problems, infectious complications, exit-site bleeding, technique survival, and patient survival compared with conventional-start PD.


Assuntos
Obstrução do Cateter/etiologia , Infecções Relacionadas a Cateter/etiologia , Tratamento de Emergência/efeitos adversos , Diálise Peritoneal/efeitos adversos , Insuficiência Renal Crônica/terapia , Estudos de Casos e Controles , Estudos de Coortes , Soluções para Diálise , Tratamento de Emergência/métodos , Hemorragia/etiologia , Humanos , Diálise Peritoneal/métodos , Diálise Peritoneal/mortalidade , Peritonite/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Cicatrização
3.
Medicine (Baltimore) ; 99(48): e23311, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235089

RESUMO

BACKGROUND: The objective of this study was to compare the complications of low-site peritoneal dialysis (PD) catheter placement and traditional open surgery in peritoneal dialysis catheter insertion. METHODS: The following databases were searched from inception to September 6, 2019: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang. Eligible studies comparing low-site PD catheter placement and traditional open surgery in peritoneal dialysis catheter insertion were included. The data were analyzed using Review Manager Version 5.3. RESULTS: Seven studies were included in the meta-analysis. A total of 504 patients were included in the low-site PD catheter placement group, and 325 patients were included in the traditional open surgery group. Compared with traditional open surgery, low-site PD catheter placement had a lower incidence rate of catheter displacement (odds ratios [OR] 0.11, 95% CI 0.05-0.22, P < .01) and noncatheter displacement dysfunction (OR 0.11, 95% CI 0.04-0.31, P < .01). However, there was no difference between the 2 catheter insertion methods concerning bleeding (OR 0.53, 95% CI 0.23-1.22, P = .13), PD fluid leakage (OR 0.40, 95% CI 0.15-1.10, P = .07), hypogastralgia (OR 0.95, 95% CI 0.32-2.80, P = .93), peritonitis (OR 0.70, 95% CI 0.32-1.54, P = .38), or exit-site and tunnel infections (OR 0.39, 95% CI 0.14-1.03, P = .06). CONCLUSION: Low-site PD catheter placement reduced the risk of catheter displacement and noncatheter displacement dysfunction and did not increase the risk of bleeding, PD fluid leakage, hypogastralgia, peritonitis, or exit site and tunnel infections. Additional large multicenter randomized controlled trials are needed to confirm these conclusions.


Assuntos
Cateterismo/instrumentação , Cateteres de Demora/efeitos adversos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , China/epidemiologia , Gerenciamento de Dados , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/métodos , Peritonite/epidemiologia , Peritonite/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
4.
Eur Rev Med Pharmacol Sci ; 24(21): 11402-11408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33215462

RESUMO

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic. PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation. RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year. CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/prevenção & controle , Hemodiálise no Domicílio/normas , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Diálise Peritoneal/normas , Pneumonia Viral/prevenção & controle , Assistência ao Convalescente/normas , Betacoronavirus/patogenicidade , Cuidadores/psicologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Seguimentos , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/psicologia , Humanos , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/psicologia , Peritonite/epidemiologia , Peritonite/etiologia , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Autogestão/psicologia , Telemedicina/normas , Resultado do Tratamento
5.
J Mycol Med ; 30(4): 101037, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32893119

RESUMO

Fungal peritonitis in patients undergoing peritoneal dialysis (PD) is very difficult to treat and is associated with significant morbidity and mortality. Among fungal pathogens, Aspergillus peritonitis presents a higher mortality rate when compared to Candida peritonitis and its identification as well as appropriate treatment remains a challenge for the physicians. We critical reviewed all published cases in literature of Aspergillus peritonitis in PD patients. The results showed that a total of 55 cases (51% males) of Aspergillus peritonitis in PD patients were reported from 1968 to 2019. Mean patient age was 49.54±19.63years and mean PD duration prior to fungal infection was 33.31±32.45months. Aspergillus fumigatus was isolated in 17/55 patients, Aspergillus niger in 15, Aspergillus terreus in 9, unidentified Aspergillus spp. in 6, Aspergillus flavus in 4, whereas sporadic cases of other Aspergillus spp. were reported. As far as predisposing factors are concerned, 75% of patients suffered from prior bacterial peritonitis receiving antimicrobial therapy. Initial antifungal treatment was intravenous and/or intraperitoneal administration of amphotericin B formulations monotherapy in 47.2% of patients or in combination with fluconazole in 13.2%, or with itraconazole in 13.2%, or with caspofungin in 3.8%, or with ketoconazole or with 5-FC in 1.9%, each. Peritoneal catheter removal was performed in 85.5% of cases. Mortality rate was 38.2%, while 81.8% of the survived patients switched to hemodialysis. Conclusively, Aspergillus peritonitis diagnosis can be difficult, due to unspecific symptoms. Early treatment with appropriate antifungal agents can be determinant for patient prognosis. Despite appropriate treatment, reported mortality remains high.


Assuntos
Aspergilose/etiologia , Infecções Relacionadas a Cateter , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/epidemiologia , Aspergillus/classificação , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/efeitos adversos , Cateteres de Demora/microbiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Pessoa de Meia-Idade , Diálise Peritoneal/estatística & dados numéricos , Peritonite/tratamento farmacológico , Peritonite/epidemiologia , Peritonite/microbiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-32957502

RESUMO

This paper investigated the incidence and risk of newly diagnosed glaucoma after the initiation of maintenance dialysis in Taiwan. A case-control study was conducted using the National Health Insurance Research Database (NHIRD) in Taiwan. There were 3949 patients with dialysis in the study group and 78,980 non-dialysis subjects matched by age and sex in the comparison group. The incidence of newly diagnosed glaucoma after the initiation of maintenance dialysis was analyzed based on the diagnostic code for glaucoma. Patients with dialysis had a higher risk of glaucoma (adjusted hazard ratio (aHR): 1.270; 95% confidence interval (CI): 1.035-1.560) than patients without dialysis. The incidence rate of glaucoma was 8.18 per 10,000 person months in the dialysis group, which was higher than that in the non-dialysis group (5.01 per 10,000 person months). Patients with dialysis exhibited a significantly higher risk of angle-closure glaucoma (ACG) (aHR: 1.550; 95% CI: 1.074-2.239). In contrast, there was no significant risk of developing open-angle glaucoma or normal-tension glaucoma in dialysis patients. Our data suggest that dialysis patients are more susceptible to ACG. Regular ophthalmic examinations may be useful in patients with dialysis to identify high-risk individuals with glaucoma, and preventive measures can be applied to avoid permanent vision loss as soon as intraocular pressure (IOP) elevation is identified.


Assuntos
Glaucoma , Diálise Peritoneal , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Glaucoma/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , População , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
7.
PLoS One ; 15(9): e0238602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881941

RESUMO

INTRODUCTION: Albeit uncommon, hydrothorax is an important complication of peritoneal dialysis (PD). Due to paucity of evidence for optimal treatment, this study aimed to evaluate the effectiveness and safety of computed tomographic (CT) peritoneography and surgical intervention involving video-assisted thoracic surgery (VATS) for hydrothorax in a retrospective cohort of patients who underwent PD in Japan. METHODS: Of the 982 patients who underwent PD from six centers in Japan between 2007 and 2019, 25 (2.5%) with diagnosed hydrothorax were enrolled in this study. PD withdrawal rates were compared between patients who underwent VATS for diaphragm repair (surgical group) and those who did not (non-surgical group) using the Kaplan-Meier method and log-rank test. RESULTS: The surgical and non-surgical groups comprised a total of 11 (44%) and 14 (56%) patients, respectively. Following hydrothorax diagnosis by thoracentesis and detection of penetrated sites on the diaphragm using CT peritoneography, VATS was performed at a median time of 31 days (interquartile range [IQR], 20-96 days). During follow-up (median, 26 months; IQR, 10-51 months), 9 (64.3%) and 2 (18.2%) patients in the non-surgical and surgical groups, respectively, withdrew from PD (P = 0.021). There were no surgery-related complications or hydrothorax relapse in the surgical group. CONCLUSIONS: This study demonstrated the effectiveness and safety of CT peritoneography and VATS for hydrothorax. This approach may be useful in hydrothorax cases to avoid early drop out of PD and continue PD in the long term. Further studies are warranted to confirm these results.


Assuntos
Hidrotórax/cirurgia , Falência Renal Crônica/complicações , Diálise Peritoneal/efeitos adversos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Feminino , Humanos , Hidrotórax/etiologia , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Medicine (Baltimore) ; 99(32): e21029, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769864

RESUMO

A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential.Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions.The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed.Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired.Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest (P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted (P < .01).The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.


Assuntos
Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Cintilografia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia , Estudos Retrospectivos , Adulto Jovem
9.
Int J Infect Dis ; 99: 301-306, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32781164

RESUMO

OBJECTIVES: Early onset peritonitis (EOP) increases the risk of clinical complications in patients initializing peritoneal dialysis (PD). This study aimed to develop and validate a risk prediction model for EOP among patients initializing PD. METHODS: 3772 patients registered with the Henan Peritoneal Dialysis Registry (HPDR) between 2007 and 2015 were included. The main outcome, EOP, was defined as incident peritonitis occurring within 6 months of the initialization of PD. Multivariable logistic regression modeling was applied to derive the risk score. All accessible clinical measurements were screened as potential predictors. Assessment of the developed model in terms of model discrimination and calibration was performed using C statistics and a calibration slope, respectively, and validated internally through a bootstrapping (1000-fold) method to adjust for over-fitting. RESULTS: The absolute risk of EOP was 14.5%. Age, cardiac function measurements, serum electrolyte test items, lipid profiles, liver function test items, blood urea nitrogen, and white cell count were significant predictors of EOP in the final risk score. Good model discrimination, with C statistics above 0.70, and calibration of agreed observed and predicted risks were identified in the model. CONCLUSION: A prediction model that quantifies risks of EOP has been developed and validated. It is based on a small number of clinical metabolic measurements that are available for patients initializing PD in many developing countries, and could serve as a tool to screen the population at high risk of EOP.


Assuntos
Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Peritonite/epidemiologia , Medição de Risco
10.
Nephrol Nurs J ; 47(4): 343-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32830940

RESUMO

Peritoneal dialysis transfer sets (extension lines) are replaced every six to nine months to minimize peritoneal dialysis catheter complications. The aim of this study was to compare a revised non-bag transfer set exchange procedure with the standard bag exchange procedure on nursing time, costs, and safety. Thirty-three people were randomized to two groups - a standard bag exchange procedure group (n = 16) and a non-bag transfer set exchange procedure group (n = 17). The standard bag exchange procedure took a median of 32 minutes (interquartile range [IQR] 25 to 38 minutes) compared to the non-bag transfer set exchange procedure of 6 minutes (IQR 4 to 8 minutes) (p Ò 0.0001). There was one episode of peritonitis in each group within the 72-hour follow-up period. The average cost of the non-bag transfer set exchange procedure was $24.54 lower, a 37% cost reduction. This study has shown the revised non-bag transfer set replacement procedure appears to be safe, consume less participant and staff time, and decreases costs.


Assuntos
Diálise Peritoneal/métodos , Diálise Peritoneal/enfermagem , Cateterismo/efeitos adversos , Custos e Análise de Custo , Humanos , Pesquisa em Avaliação de Enfermagem , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/economia , Peritonite/etiologia , Peritonite/prevenção & controle , Resultado do Tratamento , Carga de Trabalho/estatística & dados numéricos
11.
Am J Nephrol ; 51(8): 669-674, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32731215

RESUMO

BACKGROUND: The COVID-19 pandemic has affected the end-stage kidney disease (ESKD) population, with high mortality rates reported among patients on hemodialysis. However, the degree to which it has affected the peritoneal dialysis (PD) population in the United States has not yet been elucidated. In this report, we describe the clinical characteristics, presentations, clinical course, and outcomes of ESKD patients on PD hospitalized with COVID-19. METHODS: We describe the characteristics, presentation, and outcomes of adult ESKD patients on chronic PD hospitalized with CO-VID-19 in our 13 major hospitals in the NY health system using descriptive statistical analysis. RESULTS: Of 419 hospitalized patients with ESKD, 11 were on chronic PD therapy (2.6%). Among those 11, 3 patients required mechanical ventilation, 2 of whom died. Of the entire cohort, 9 of the 11 patients (82%) were discharged alive. While fever was a common presentation, more than half of our patients also presented with diarrhea. Interestingly, 3 patients were diagnosed with culture-negative peritonitis during their hospitalization. Seven patients reported positive SARS-CoV-2 exposure from a member of their household. CONCLUSION: Hospitalized patients on PD with COVID-19 had a relatively mild course, and majority of them were discharged home.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus/genética , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Pandemias , Peritonite/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/isolamento & purificação
15.
J Nippon Med Sch ; 87(5): 304-308, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-32475900

RESUMO

Peritonitis is a common complication of peritoneal dialysis (PD) and can result in PD catheter removal, permanent hemodialysis, and, potentially, death. Prediction and prevention of PD-related peritonitis are thus extremely important. In 2016, the International Society for Peritoneal Dialysis published guidelines for patients with peritonitis undergoing PD. The guidelines cover most cases of PD-related peritonitis caused by bacteria and include clear indications for catheter removal. However, difficulties often arise when deciding the timing of catheter removal. When multiple enteric organisms are identified in a culture of dialysis effluent, peritonitis may be caused by intra-abdominal pathology, which is associated with substantial mortality. In such cases, catheter removal is considered. In this report, we describe a case in which, during antibiotic therapy for PD-related peritonitis due to Enterococcus faecalis alone, the patient developed a relapse of peritonitis caused by a newly detected Gram-negative, rod-like Pseudomonas aeruginosa. He required catheter removal because of the possibility of peritonitis recurrence. Although additional study is required, early catheter removal may be effective when a new organism is detected during antibiotic therapy for PD-related peritonitis caused by an organism not meeting the definition of refractory peritonitis.


Assuntos
Coinfecção/terapia , Remoção de Dispositivo/métodos , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Peritonite/terapia , Infecções por Pseudomonas , Pseudomonas aeruginosa , Idoso , Antibacterianos , Cateteres de Demora/efeitos adversos , Cateteres de Demora/microbiologia , Humanos , Masculino , Peritonite/etiologia , Recidiva
16.
Enferm. nefrol ; 23(2): 207-210, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194139

RESUMO

CASO CLÍNICO: Paciente que inició un Síndrome de Dress tras la colocación del catéter peritoneal. En la literatura se han reportado un número muy escaso de casos de reacción alérgica al catéter peritoneal e inicialmente se sospechó como causa un antibiótico profiláctico utilizado en el quirófano, pero tras sufrir en su domicilio una exacerbación de la sintomatología a la semana de la implantación, se planteó la posibilidad de que el catéter fuera el origen del cuadro, por lo que el paciente ingresó para monitorización y administración de medicación con una mejoría clínica significativa. El Plan de Cuidados se centraba en la resolución aguda del proceso alérgico y asistir al paciente en la técnica hasta que pudo realizarla autónomamente. Finalmente, el cuadro clínico se atribuyó a un Síndrome de Dress provocado por alopurinol. CONCLUSIONES: Tras una revisión bibliográfica y ante la falta de evidencia, se decidió no retirar el catéter y tratar el cuadro, que se solucionó, pudiendo iniciar el paciente la técnica en domicilio de forma autónoma


CLINICAL CASE: Patient suffering from Dress Syndrome after placement of the peritoneal catheter. A very few cases of allergic reaction to the peritoneal catheter have been reported in the literature. Initially, the use of a prophylactic antibiotic used in the operating room was suspected as a cause, but after suffering an exacerbation of symptoms one week after implantation at the patient's home, the possibility that the catheter was the origin of the condition was raised. Then, the patient was admitted for monitoring and administration of medication with significant clinical improvement. The care plan was focused on the acute resolution of the allergic process and on assisting the technique until the patient was able to perform it autonomously. Finally, the clinical picture was attributed to a Dress Syndrome caused by allopurinol. CONCLUSIONS: After a bibliographic review and in the absence of evidence, it was decided not to remove the catheter and treat the clinical picture, which was resolved, and the patient could start the technique at home autonomously


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Diálise Peritoneal/efeitos adversos , Cateteres/efeitos adversos , Hipersensibilidade a Drogas/complicações , Alopurinol/efeitos adversos , Edema/induzido quimicamente , Síndrome de Hipersensibilidade a Medicamentos/enfermagem , Cefazolina/administração & dosagem , Antibioticoprofilaxia , Corticosteroides , Administração Tópica
17.
Health Qual Life Outcomes ; 18(1): 191, 2020 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552800

RESUMO

OBJECTIVE: End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL). METHODOLOGY: Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied. RESULTS: A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function. CONCLUSION: Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.


Assuntos
Diálise Peritoneal/psicologia , Qualidade de Vida , Diálise Renal/psicologia , Adulto , Idoso , Progressão da Doença , Feminino , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Inquéritos e Questionários
18.
J Vasc Access ; 21(6): 1029-1033, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32364814

RESUMO

Peritoneal dialysis is a renal substitutive therapy used in an increasing number of patients with end-stage renal failure as it allows greater freedom to perform daily activities. Peritoneal dialysis catheter obstruction is a significant non-infectious complication of peritoneal dialysis. We describe three cases of peritoneal dialysis catheter obstruction with complete fibrin casts, its surgical management and a review of the literature in management techniques and have proposed an algorithm to guide clinical practise when a complete intraluminal peritoneal dialysis catheter obstruction is suspected.


Assuntos
Obstrução do Cateter/etiologia , Cateteres de Demora/efeitos adversos , Fibrina/metabolismo , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/instrumentação , Irrigação Terapêutica , Procedimentos Cirúrgicos Vasculares , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
Am J Kidney Dis ; 76(6): 889-892, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32471796

RESUMO

Children who receive peritoneal dialysis (PD) are at increased risk for thyroid dysfunction. A rarely appreciated cause is iodine overload. We report 4 children who developed iodine overload and secondary hypothyroidism. All had kidney failure treated by PD. Each previously had normal thyroid function screening test results. At the time hypothyroidism was detected, the duration of PD ranged from 1 week to 27 months (median, 6 months). Three children had high thyrotropin values and all had high serum iodine levels. The sole source of iodine exposure in each child was a povidone-iodine-impregnated gauze in the sterile transfer set cap associated with PD. Iodine overload is a poorly appreciated problem associated with the provision of PD in infants and small children and can lead to thyroid dysfunction. Increased awareness among pediatric nephrologists should lead to the development of optimal monitoring and prevention recommendations.


Assuntos
Hipotireoidismo/etiologia , Iodo/efeitos adversos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Biomarcadores/sangue , Pré-Escolar , Feminino , Humanos , Hipotireoidismo/sangue , Recém-Nascido , Masculino , Tireotropina/sangue
20.
Sci Rep ; 10(1): 7799, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32385311

RESUMO

The association between serious falls and dialysis modality [hemodialysis (HD) and peritoneal dialysis (PD)] is unclear. A nationwide population-based retrospective cohort study with 127,823 end-stage renal disease patients aged over 18 years was conducted with the unmatched cohort of 101,304 HD and 7,584 PD patients retrieved from Taiwan's National Health Insurance Research Database during 2000-2013. A total of 7,584 HD and 7,584 PD patients matched at 1:1 ratio by propensity score were enrolled to the study. Serious falls were defined by the diagnostic codes, E code, and image studies. Cox regression model and competing-risk model were used for statistical analysis. HD patients were older and had more comorbidities at baseline than PD patients. After matching and adjustment, HD patients had a higher risk of serious falls than PD patients [sHR 1.27 (95% CI 1.06-1.52)]. Females, elders, a history of falls before dialysis, comorbidity with stroke or visual problems, using diuretics, α-blockers, and mydriatics were associated with higher risks of serious falls among dialysis patients. The risk of serious falls was higher in HD patients than PD patients. Health professionals should create age-friendly environments, reduce unnecessary medications, and raise patients' awareness of falls in daily life.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Diálise Peritoneal , Diálise Renal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Vigilância da População , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto Jovem
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