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1.
BMC Complement Altern Med ; 19(1): 280, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647008

RESUMO

BACKGROUND: Peritoneal fibrosis (PF) remains a serious complication of long-term peritoneal dialysis (PD). The goal of this study was to investigate the anti-fibrotic effects of curcumin on the PF response to PD and its' mechanism. METHODS: Male Sprague-Dawley rats were infused with 20 mL of 4.25% glucose-based standard PD fluid for 8 consecutive weeks to establish PF model and then divided into five groups: Control, received sham operation and 0.9% physiological saline; PD, received 4.25% standard PD fluid; Curcumin, PD rats injected intraperitoeally with curcumin for 8 weeks at doses of 10, 20 or 40 mg/kg. Masson's staining was performed to evaluate the extent of PF. Peritoneal Equilibration Test (PET) was conducted to assess ultrafiltration volume (UFV) and mass transfer of glucose (MTG), quantitative RT-PCR, and immunohistochemistry or western blotting were performed to measure the expression levels of inflammation and fibrosis-associated factors. We also detected the TGF-ß1 in peritoneal fluid by ELISA. RESULTS: Compared with the control group, the PD rats showed decreased UFV (2.54 ± 0.48 to 9.87 ± 0.78 mL, p < 0.05] and increased MTG (18.99 ± 0.86 to 10.85 ± 0.65 mmol/kg, p < 0.05) as well as obvious fibroproliferative response, with markedly increased peritoneal thickness (178.33 ± 4.42 to 25.26 ± 0.32um, p < 0.05) and higher expression of a-SMA, collagen I and TGF-ß1. Treatment with curcumin significantly increased UFV, reduced MTG and peritoneal thickness of PD rats. The elevated TGF-ß1 in peritoneal fluid of PD rats was significantly decreased by curcumin. It attenuated the increase in protein and mRNA of TGF-ß1, α-SMA and collagen I in peritoneum of PD rats. The mRNA expressions of TAK1, JNK and p38, as well as the protein expressions of p-TAK1, p-JNK and p-p38 in peritoneum of PD rats were reduced by curcumin. CONCLUSIONS: Present results demonstrate that curcumin showed a protective effect on PD-related PF and suggest an implication of TAK1, p38 and JNK pathway in mediating the benefical effects of curcumin.


Assuntos
Curcumina/administração & dosagem , MAP Quinase Quinase Quinases/metabolismo , Diálise Peritoneal/efeitos adversos , Fibrose Peritoneal/tratamento farmacológico , Actinas/genética , Actinas/metabolismo , Animais , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Humanos , MAP Quinase Quinase Quinases/genética , Masculino , Fibrose Peritoneal/etiologia , Fibrose Peritoneal/genética , Fibrose Peritoneal/metabolismo , Peritônio/efeitos dos fármacos , Peritônio/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Fator de Crescimento Transformador beta1/metabolismo
2.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439572

RESUMO

Chylous ascites is a rare complication of peritoneal dialysis (PD) and is often mistaken for peritonitis. It usually resolves following conservative management and does not pose any risk to the dialysis procedure. We report the case of a 2-year-old boy, who developed chylous ascites at 36 hours of PD and spontaneously resolved within the next 48 hours.


Assuntos
Ascite Quilosa/diagnóstico , Diálise Peritoneal/efeitos adversos , Lesão Renal Aguda/terapia , Pré-Escolar , Ascite Quilosa/etiologia , Diagnóstico Diferencial , Humanos , Masculino
3.
Int J Mol Sci ; 20(15)2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31382656

RESUMO

Chronic kidney disease (CKD) is characterized by kidney damage with proteinuria, hematuria, and progressive loss of kidney function. The final stage of CKD is known as end-stage renal disease, which usually indicates that approximately 90% of normal renal function is lost, and necessitates renal replacement therapy for survival. The most widespread renal replacement therapy is dialysis, which includes peritoneal dialysis (PD) and hemodialysis (HD). However, despite the development of novel medical instruments and agents, both dialysis procedures have complications and disadvantages, such as cardiovascular disease due to excessive blood fluid and infections caused by impaired immunity. Periodontal disease is chronic inflammation induced by various pathogens and its frequency and severity in patients undergoing dialysis are higher compared to those in healthy individuals. Therefore, several investigators have paid special attention to the impact of periodontal disease on inflammation-, nutrient-, and bone metabolism-related markers; the immune system; and complications in patients undergoing dialysis. Furthermore, the influence of diabetes on the prevalence and severity of manifestations of periodontal disease, and the properties of saliva in HD patients with periodontitis have been reported. Conversely, there are few reviews discussing periodontal disease in patients with dialysis. In this review, we discuss the available studies and review the pathological roles and clinical significance of periodontal disease in patients receiving PD or HD. In addition, this review underlines the importance of oral health and adequate periodontal treatment to maintain quality of life and prolong survival in these patients.


Assuntos
Falência Renal Crônica/epidemiologia , Doenças Periodontais/epidemiologia , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/imunologia , Diabetes Mellitus/microbiologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/imunologia , Falência Renal Crônica/microbiologia , Saúde Bucal , Doenças Periodontais/complicações , Doenças Periodontais/imunologia , Doenças Periodontais/microbiologia , Qualidade de Vida
4.
Ren Fail ; 41(1): 650-656, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31296101

RESUMO

Objective: Accumulating evidence has demonstrated that dialysis patients are at increased risk for stroke. However, the impact of dialysis modalities on stroke risk remains controversial. We conducted a systematic review and meta-analysis to determine the effect of peritoneal dialysis (PD) and hemodialysis (HD) on stroke risk. Methods: A systematic search of PubMed, EMBASE, and Web of Science was performed to identify articles comparing the stroke outcomes of dialysis patients. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were extracted and synthesized to examine stroke outcomes, including ischemic stroke, hemorrhagic stroke, and overall stroke. Results: The search yielded five studies composed of 1,219,245 patients that were evaluated in the final analysis. The results showed that PD was associated with a lower risk for hemorrhagic stroke compared with HD (HR = 0.78; 95% CI: 0.69-0.88; p < 0.001). For ischemic stroke, the results showed that PD was associated with a higher risk compared with HD among the non-Asian patients (HR = 1.13; 95% CI: 1.05-1.23; p = 0.002), but there were no significant differences between PD and HD for the Asian patients. Similarly, there were no significant differences between the effects of the PD and HD approaches on overall stroke risk. Conclusions: We observed that PD patients were less likely to develop hemorrhagic stroke than HD patients, and the risk for ischemic stroke was significantly higher for PD patients than for HD patients among the non-Asian patients. However, our findings could be biased due to the heterogeneity of the included studies.


Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Humanos , Acidente Vascular Cerebral/etiologia
5.
J Bone Joint Surg Am ; 101(14): 1271-1277, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31318806

RESUMO

BACKGROUND: Dialysis has been associated with increased complication rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA). The current literature on this issue is limited and does not distinguish between hemodialysis and peritoneal dialysis. The purpose of this study was to determine (1) the differences in the infection and other complication rates after THA or TKA between patients on peritoneal dialysis and those on hemodialysis and (2) the differences in complication rates after THA or TKA between patients on peritoneal dialysis and matched controls without dialysis dependence. METHODS: Patients who had undergone primary THA or TKA from 2005 to 2014 were identified in the 100% Medicare files; 531 patients who underwent TKA and 572 patients who underwent THA were on peritoneal dialysis. These patients were matched 1:1 to patients on hemodialysis and 1:3 with patients who were not receiving either form of dialysis. Multivariate regression analysis was performed to examine several adverse events, including the prevalence of infection at 1 year and hospital readmission at 30 days. RESULTS: The infection rates at 1 year after THA were significantly lower in the peritoneal dialysis group than in the hemodialysis group: 1.57% (95% confidence interval [CI] = 0.7% to 3.0%) and 4.20% (95% CI = 2.7% to 6.2%), respectively, with an odds ratio (OR) of 0.30 (95% CI = 0.12 to 0.71). This was also the case for the infection rates 1 year after TKA (3.39% [95% CI = 2.0% to 5.3%] and 6.03% [95% CI = 4.2% to 8.4%], respectively; OR = 0.67 [95% CI = 0.49 to 0.93]). Peritoneal dialysis appears to result in a similar infection rate when compared with matched controls. The rates of other assessed complications, such as hospital readmission, emergency room visits, and mortality, were very similar between the peritoneal dialysis and hemodialysis groups but were often significantly higher than the rates in non-dialysis-dependent controls. CONCLUSIONS: The increased risk of complications in dialysis-dependent patients following THA or TKA depends on the mode of the dialysis. Whereas patients on hemodialysis have a significantly higher risk of infection, patients on peritoneal dialysis do not appear to have this same risk when compared with non-dialysis-dependent patients. These results suggest that the mode of dialysis should be considered when assessing the risk associated with THA or TKA. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia do Joelho , Diálise Peritoneal/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Diálise Renal/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologia
6.
J Med Microbiol ; 68(9): 1330-1340, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31347999

RESUMO

Purpose. This study aimed to characterize 27 Escherichia coli isolates obtained from peritoneal dialysis (PD)-related peritonitis that occurred at the University Hospital of Botucatu Medical School, Brazil, between 1997 and 2015.Methodology. These isolates were characterized regarding the occurrence of 22 virulence factor-encoding genes, antimicrobial resistance and biofilm production. We then evaluated whether these factors influenced the clinical outcome.Results. Over an 18-year period, 726 episodes of PD-related peritonitis were diagnosed, with 27 of them (3.7 %) being due to E. coli. The majority of the isolates were classified in phylogroups B1 (33.3 %), B2 (30.0 %) or F (18.0 %). fimH (100.0 %), ompT (66.7 %) and irp2 (51.9 %) were the most prevalent genes, while papA, papC, iha, sat, irp2, iucD, ireA, ibe10, ompT and kpsMTII were significantly more prevalent among isolates belonging to phylogroups B2 and F (P<0.05). Non-susceptibility to quinolones was detected in six isolates, which harboured chromosomal and/or plasmid-mediated quinolone resistance determinants, while two CTX-M extended-spectrum ß-lactamase-producing E. coli were identified. Virulence factor-encoding genes (alone or in combination) and antimicrobial resistance were not associated with non-resolution outcomes. However, there was a trend for the ability to produce biofilm to be associated with treatment failure, although this association was not statistically significant.Conclusion. The E. coli isolates were heterogeneous in terms of the features investigated, and were susceptible to most of the antimicrobial drugs tested, despite the unsuccessful treatment observed in more than 50.0 % of the patients. Studies including more cases could help to clarify if biofilm production can influence the outcome in patients with PD-related peritonitis.


Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/isolamento & purificação , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Biofilmes/crescimento & desenvolvimento , Variação Biológica da População , Brasil/epidemiologia , Criança , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/patogenicidade , Infecções por Escherichia coli/epidemiologia , Variação Genética , Técnicas de Genotipagem , Hospitais Universitários , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Peritonite/epidemiologia , Filogenia , Plasmídeos/análise , Fatores de Virulência/genética , Adulto Jovem
7.
Ren Fail ; 41(1): 434-438, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31162993

RESUMO

Objectives: The successful implantation of peritoneal dialysis (PD) catheters is a critical skill procedure with the potential to impact both the short- and long-term success of renal replacement therapy and the patients' survival. Methods: We retrospectively reviewed our single-center experience with nephrologist-placed minimally invasive, double-cuffed PD catheters (PDCs). Results: The recruitment period was March 2014 through December 2015. The follow-up period lasted until 2016. The mean age of the subjects was 60 ± 18 years and indications for the PD were diuretic resistant acutely decompensated chronic heart failure in seven patients (47%) and end-stage renal disease in eight (53%) patients. Comorbid conditions included diabetes (27%), ischemic heart disease (47%), advanced liver failure (27%), and a history of hypertension (73%). The cohort had a high mortality with five subjects only in severe heart failure group (33%) passing away during the index hospitalization; of the rest, two (13%) had heart transplantation, three (20%) changed modality to hemodialysis, and only five (33%) continued with maintenance PD beyond 1 month. Acute technical complications within the first month were infrequent: one catheter (6%) had drainage problems and one (6%) was lost due to extrusion. There were no serious complications (e.g., organ damage, peritonitis, etc.). Conclusions: In selected cases, particularly in severe diuretic refractory heart failure, PDC placement placed by a nephrologist is feasible with a low rate of complications even in a low-volume center setting. The catheters we placed were all functioning with only minor complications and PD could be started immediately.


Assuntos
Cateterismo/métodos , Cateteres de Demora/efeitos adversos , Insuficiência Cardíaca/terapia , Falência Renal Crônica/terapia , Diálise Peritoneal/instrumentação , Idoso , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Hungria , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Nefrologistas , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
8.
Ren Fail ; 41(1): 532-539, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31240974

RESUMO

Background: Studies have shown that the serum total bilirubin (TBil) is associated with the mortality of the general population and of hemodialysis patients. However, few studies have examined the associations of the direct bilirubin (DBil) and indirect bilirubin (IBil) with the mortality of peritoneal dialysis (PD) patients. Methods: This was a retrospective cohort study. Clinical and laboratory data were collected from 740 PD patients. The primary endpoint was 5-year all-cause mortality. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. The mortality hazard ratio was evaluated using Cox regression models. Results: Among the 740 PD patients, the mean age was 49.9 ± 15.0 years, 54.9% were men, and 20.3% had diabetes. During the median follow-up period of 28 months (interquartile range, 14-41 months), 178 patients died. Kaplan-Meier analysis revealed that all-cause mortality was higher in the patients in the higher TBil group than in the lower TBil group (25.6% vs. 18.3%, p = .017) and in patients in the higher IBil group than in the lower IBil group (24.3% vs. 19%, p = .026). Multivariate analysis showed that compared with the lower TBil group, the 5-year mortality risk was higher in the higher TBil group (HR = 1.69, 95% CI: 1.11-2.56, p = .014). Similarly, there was a 56% higher risk of 5-year mortality in the higher IBil group than in the lower IBil group (HR = 1.56, 95% CI: 1.04-2.34, p = .032). However, no such associations were observed between the DBil and the mortality risk. Conclusions: The baseline serum TBil and IBil levels were significantly associated with 5-year all-cause mortality among PD patients.


Assuntos
Bilirrubina/sangue , Falência Renal Crônica/mortalidade , Diálise Peritoneal/efeitos adversos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Saudi J Kidney Dis Transpl ; 30(3): 738-740, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249244

RESUMO

Peritoneal dialysis (PD) peritonitis has been decreasing in frequency in recent years. However, it still causes significant morbidity and mortality. Nearly 1%-6% of all peritonitis attacks result in death. Hospitalizations, loss of PD access, and intravascular catheter insertion for hemodialysis are some examples of morbidity. Approximately 15%-20% of the infectious mortality of PD patients is attributed to peritonitis. The responsible pathogens are usually Gram-positive bacteria, but unusual pathogens may be present. Prognosis is worse when Gram-negative and fungal pathogens are involved. We report a case of Serratia liquefaciens peritonitis due to defiance of hygienic practices which presented with severe abdominal pain and fever and led to loss of PD access.


Assuntos
Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Infecções por Serratia/microbiologia , Serratia liquefaciens/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Evolução Fatal , Humanos , Masculino , Peritonite/diagnóstico , Peritonite/tratamento farmacológico , Diálise Renal/efeitos adversos , Infecções por Serratia/diagnóstico , Infecções por Serratia/tratamento farmacológico , Resultado do Tratamento
10.
Wounds ; 31(6): 163-165, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31215869

RESUMO

Many patients with end-stage kidney disease prefer peritoneal dialysis (PD) to hemodialysis to replace kidney function1 but avoid PD due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the International Society for Peritoneal Dialysis (ISPD). Factors that increase the risk of PD-related peritonitis include patient nasal Staphylococcus aureus carriage, diabetes, advanced age, obesity, depression, cardiovascular disease, and catheter connection methods or exit site infection (ESI). A 2004 Cochrane systematic review reported 2 different significant effects of antimicrobial agents on patients receiving PD. One randomized clinical trial (RCT) on 2716 patients reported that, compared with placebo, intranasal mupirocin, bactericidal to S aureus, reduced PD catheter ESI and tunnel infections but not peritonitis rates. A meta-analysis of 4 RCTs on 335 patients revealed preoperative intravenous antibiotics reduced the incidence of early peritonitis, but it did not affect catheter ESI or tunnel infections. These results suggest peritonitis and ESI or tunnel infections are independent outcomes potentially responsive to different interventions. Herein, this Evidence Corner examines what can be learned about these 2 different PD-related infectious outcomes from an update3 to the earlier Cochrane review and a study of topical antimicrobial agents.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/prevenção & controle , Prevenção Primária/métodos , Administração Tópica , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Feminino , Humanos , Masculino , Diálise Peritoneal/métodos , Peritonite/etiologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento
11.
Int J Mol Sci ; 20(11)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31141909

RESUMO

BACKGROUND: Cardiac collagen remodeling is important in the progression of heart failure. Estimation of cardiac collagen turnover by serum levels of serological markers is used for monitoring cardiac tissue repair and fibrosis. Peritoneal dialysis (PD) is used for the long-term management of refractory congestive heart failure (CHF). In this study, we investigated the effect of PD treatment on circulating fibrosis markers levels in patients with refractory CHF and fluid overload. METHODS: Twenty-five patients with refractory CHF treated with PD were prospectively enrolled in the study. Circulating fibrosis markers procollagen type III C-peptide (PIIINP), matrix metalloproteinase 2 (MMP-2), and tissue inhibitor of metalloproteinases I (TIMP-1) levels were checked at baseline and after three and six months of treatment. RESULTS: The clinical benefit of PD manifested by improved NYHA functional class and reduced hospitalization rate. Serum brain natriuretic peptide (BNP) levels decreased significantly during the treatment. Serum MMP-2 and TIMP-1 decreased significantly on PD. Circulating PIIINP showed two patterns of change, either decreased or increased following PD treatment. Patients in whom circulating PIIINP decreased had significantly lower baseline serum albumin, lower baseline mean arterial blood pressure, higher serum CRP, and a less significant improvement in hospitalization rate compared to the patients in whom circulating PIIINP increased. Patients in whom all three markers decreased demonstrated a trend to longer survival compared to patients whose markers increased or did not change. CONCLUSION: In refractory CHF patients PD treatment was associated with a reduction in circulating fibrosis markers.


Assuntos
Insuficiência Cardíaca/sangue , Metaloproteinase 2 da Matriz/sangue , Fragmentos de Peptídeos/sangue , Diálise Peritoneal/efeitos adversos , Pró-Colágeno/sangue , Inibidor Tecidual de Metaloproteinase-1/sangue , Idoso , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade
12.
Blood Purif ; 48(2): 183-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039561

RESUMO

BACKGROUND/AIMS: To compare the serum concentration of Indoxyl sulfate (IS) in patients on continuous ambulatory peritoneal dialysis (CAPD) and low-flux hemodialysis (HD), and analyze the risk factors associated with IS. METHODS: We performed a single-center, cross-sectional observational study including 169 patients on CAPD and 115 patients on low-flux HD. Patients were divided into the anuric HD group, anuric peritoneal dialysis (PD) group, and non-anuric PD group on the basis of dialysis modality and residual urinary output. Serum concentration of IS was determined by high-performance liquid chromatography electrospray tandem mass spectrometry. RESULTS: After matching the urinary volume and dialysis vintage, 58 anuric patients on PD and 58 anuric patients on HD were enrolled. The serum level of IS was significantly lower in patients on PD than that in those on HD (28.05 ± 13.98 vs. 39.64 ± 18.25 µg/mL; p < 0.001). This result persisted even after adjustment for confounding risk factors including nutritional status (ß = 0.338, p < 0.001). In addition, the serum level of IS was significantly lower in non-anuric PD patients than that anuric PD patients (18.70 ± 11.21 vs. 28.05 ± 13.98 µg/mL; p < 0.001). After the adjustment for risk factors such as dialysis vintage, IS serum concentration in patients on PD was still significantly correlated with residual renal function (RRF; ß = -0.355, p < 0.001). CONCLUSIONS: Dialysis modality is the independent risk factor of IS serum concentration and it is substantially lower in patients on CAPD than that in those on low-flux HD. Additionally, RRF was independently associated with IS serum concentration in CAPD patients, and the better the RRF is, the lower IS serum concentration.


Assuntos
Indicã/sangue , Diálise Peritoneal , Diálise Renal , Insuficiência Renal Crônica/sangue , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/terapia
13.
Clin Nephrol ; 92(1): 44-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31131821

RESUMO

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) is one of the major causes of peritoneal dialysis (PD) failure and death. Therefore, it is important to determine how to effectively treat patients with PDAP. MATERIALS AND METHODS: We analyzed the pathogen spectrum and bacterial resistance in 203 PDAP cases that were enrolled in this study from January 1, 2015 to December 31, 2017. All patients were infected with peritonitis and had been treated with antibiotics while at our center. Bacterial culture results of PD fluid and pathogen drug resistance were collected and analyzed. A total of 159 cases (78.3%) had a positive bacterial culture of PD fluid. RESULTS: A total of 47 pathogens were identified, including 19 (40.4%) Gram-positive cocci strains (the most common was Staphylococcus spp.), 15 (31.9%) Gram-negative bacilli strains (the most common was Escherichia coli, 4 fungal strains, and 9 other strains. The drug sensitivity test showed that Gram-positive cocci were sensitive to vancomycin (94.9%), but had a high resistance to cefazolin (67.7%). Gram-negative bacilli were sensitive to imipenem (96.2%), but had a high resistance to ceftriaxone (60.0%). Voriconazole and itraconazole were sensitive in fungal infections. A total of 162 cases were cured, 37 cases were unresponsive to antibiotic treatment and converted to hemodialysis after Tenckhoff catheter removal, and 4 cases resulted in death. CONCLUSION: Gram-positive cocci are still the primary pathogen of PDAP cases in our center, but demonstrate a high resistance to first-generation cephalosporin, which is the suggested treatment per International Society for Peritoneal Dialysis 2016 Peritonitis Recommendations. Therefore, an individualized treatment based on the distribution of pathogens and drug resistance in different centers is more conducive to improve the cure rate of PDAP.


Assuntos
Antibacterianos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antifúngicos/uso terapêutico , Infecções Bacterianas , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Imipenem/uso terapêutico , Itraconazol/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/etiologia , Vancomicina/farmacologia , Voriconazol/uso terapêutico , Adulto Jovem
16.
Ren Fail ; 41(1): 267-277, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30982374

RESUMO

OBJECTIVE: To compare the anti-peritoneal fibrotic effects between a mammalian target of rapamycin complex 1-specific blocker and a phosphatidyl-inositol 3-kinase/mammalian target of rapamycin dual-blocker. METHODS: A total of 40 male Sprague-Dawley rats were randomly divided into five groups with eight animals per group. The normal group (N group) did not receive any intervention. The normal saline group (NS group) received an intraperitoneal injection of normal saline at 1 ml/100 g daily. The model group (3 W group), rapamycin (RAPA) group and BEZ235 (PI3K/mTOR dual-blocker) group all received an intraperitoneal injection of 0.1% chlorhexidine gluconate at 1 ml/100g daily. And the RAPA and BEZ235 groups also received a 0.5 mg/d RAPA or 2.5 mg/d BEZ235 gavage every day, respectively. Rats in each group were sacrificed after 3 weeks. RESULTS: Immunohistochemistry, real-time PCR and western blotting analysis of fibrosis-related indicators (FN, Col 1, and α-SMA) confirmed that RAPA and BEZ235 significantly inhibited peritoneal fibrosis and that these two drugs had similar effects. The p-Akt, p-mTOR, p-p70S6K expression levels were significantly up-regulated in the 3 W group compared to the NS group, confirming that the mTOR pathway was significantly activated during peritoneal fibrosis. RAPA significantly inhibited the phosphorylation of mTOR and p70S6K but did not have significant effects on p-Akt upstream of mTOR. BEZ235 had significant inhibitory effects on all signaling molecules (p-Akt, p-mTOR, and p-p70S6K) in the mTOR pathway. CONCLUSION: RAPA did not up-regulate p-Akt in a negative feedback fashion. Both drugs effectively inhibited peritoneal fibrosis.


Assuntos
Imidazóis/farmacologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Fibrose Peritoneal/prevenção & controle , Quinolinas/farmacologia , Sirolimo/farmacologia , Animais , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Clorexidina/toxicidade , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos , Humanos , Imidazóis/uso terapêutico , Injeções Intraperitoneais , Masculino , Alvo Mecanístico do Complexo 1 de Rapamicina/antagonistas & inibidores , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Fibrose Peritoneal/induzido quimicamente , Fibrose Peritoneal/patologia , Fosfatidilinositol 3-Quinases/metabolismo , Fosforilação/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Quinolinas/uso terapêutico , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Serina-Treonina Quinases TOR/metabolismo
17.
Saudi J Kidney Dis Transpl ; 30(2): 451-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31031381

RESUMO

Published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of PD in Tunisia is poor. The purpose of this study is to report long-term clinical outcomes of PD patients through a 10-year experience at a single unit. This is a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 to June 2016. All patients were followed till death, renal transplant, switch over to hemodialysis (HD) or the end of the study in June 2016. The mean age of the incident patients was 43.93 ± 16.95 years. Nineteen (10.4%) were aged >65 years and 59.3% were male. The average duration of follow-up was 27.75 ± 26.18 months. The mean duration of PD treatment was 27.75 ± 26.18 months. There were 186 episodes of peritonitis that occurred over the total study period (54 episodes during the 1st year). The overall incidence of peritonitis during the 10-year study period was 1 per 27.25 patient months. Mechanical complications were noted in 31.2% of cases. Thirty- two (17.6%) patients had catheter displacement. Only 26 cases of hemoperitoneum (14.3%) were recorded. Death occurred in 23.1% of cases. Twenty-two patients (27.5%) were transplanted; 56 patients (70%) were transferred to HD, one patient had renal recovery and one case had voluntarily interrupted PD. In Kaplan-Meier curves of residual renal function (RRF) loss, there was a significant difference between peritonitis group and peritonitis-free group (P = 0.01). Technique and patient survival were associated with diabetes with a significant difference. The main cause of technique failure was peritonitis (61.4%). Moreover, the main repertoried causes of death were cardiovascular and septic causes. The mortality of diabetic and elderly PD patients was higher than mortality in nondiabetic and nonelderly groups, respectively, in our study. Peritonitis was associated with loss of RRF and technique failure.


Assuntos
Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Diálise Peritoneal/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Cateteres de Demora/efeitos adversos , Diabetes Mellitus/epidemiologia , Falha de Equipamento , Feminino , Seguimentos , Hemoperitônio/etiologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/fisiopatologia , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Estudos Retrospectivos , Sepse/mortalidade , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Tunísia/epidemiologia , Adulto Jovem
18.
J Vasc Access ; 20(1_suppl): 60-64, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032729

RESUMO

INTRODUCTION: Long-term use of peritoneal dialysis catheter is associated with complications such as infection and malfunction, necessitating removal of catheter with subsequent reinsertion or permanent transfer to haemodialysis. This study aims to investigate the outcome in patients who underwent reinsertion. METHODS AND MATERIALS: A single-centre retrospective study was performed in Singapore General Hospital for all adult incident peritoneal dialysis patients between January 2011 and January 2016. Study data were retrieved from patient electronic medical records up till 1 January 2017. RESULTS: A total of 470 patients had peritoneal dialysis catheter insertion with median follow-up period of 29.2 (interquartile range = 16.7-49.7) months. A total of 92 patients required catheter removal. Thirty-six (39%) patients underwent catheter reinsertion. The overall technique survival at 3 and 12 months were 83% and 67%. Median time to technique failure of the second catheter was 6.74 (interquartile range = 0-50.2) months. The mean survival for patients who converted to haemodialysis and re-attempted peritoneal dialysis was comparable (54.9 ± 5.5 vs 57.3 ± 3.6 months; p = 0.75). Twelve (13%) patients had contraindication for peritoneal dialysis and were excluded from analysis. Of 11 patients who required catheter removal due to malfunction, 7 (64%) underwent catheter reinsertion and 6 (86%) patients ultimately converted to haemodialysis during study period. Of the 69 patients who had catheter removal due to infection, 29 (42%) underwent catheter reinsertion and 8 (28%) patients eventually converted to haemodialysis during the study period. CONCLUSION: Patient survival was comparable between patients who re-attempted peritoneal dialysis and patients who transferred to haemodialysis. Patients who had previous catheter removal due to infections had favourable technique survival than those due to catheter malfunction.


Assuntos
Infecções Relacionadas a Cateter/terapia , Cateteres de Demora , Remoção de Dispositivo , Nefropatias/terapia , Diálise Peritoneal/instrumentação , Diálise Renal , Adulto , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/etiologia , Remoção de Dispositivo/efeitos adversos , Registros Eletrônicos de Saúde , Falha de Equipamento , Feminino , Humanos , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Singapura , Fatores de Tempo , Resultado do Tratamento
19.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936360

RESUMO

A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.


Assuntos
Diafragma/cirurgia , Hidrotórax/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Derrame Pleural/etiologia , Toracostomia/métodos , Idoso , Dispneia , Feminino , Humanos , Hidrotórax/diagnóstico por imagem , Hidrotórax/cirurgia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/cirurgia , Resultado do Tratamento
20.
Blood Purif ; 47 Suppl 2: 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943477

RESUMO

BACKGROUND/AIMS: Aortic arch calcification (AoAC) is a fatal complication in dialysis. AoAC progression-related molecules in continuous ambulatory peritoneal dialysis (CAPD) remain unclear. METHODS: AoAC was estimated using plain chest radiography scoring (AoACS) in 30 CAPD patients (age 49.3 ± 13.4 years). AoAC progression was defined as increased AoACS on follow-up chest X-ray at the end of the study (progressors). Fibroblast growth factor-23 and osteoprotegerin (OPG) were measured. RESULTS: Median follow-up was 38.5 months. Progressors were older, had shorter PD vintage, higher body mass index, and higher serum OPG levels (255.6 ± 109.2 pg/mL) than nonprogressors (183.4 ± 68.2 pg/mL; p = 0.0400). Progressors also showed higher pulse pressure (62.4 ± 20.0 mm Hg) and pulse wave velocity (1,909.9 ± 310.6 cm/s) than nonprogressors (48.5 ± 13.6 mm Hg; p = 0.0030 and 1,390.1 ± 252.8 cm/s; p = 0.0005, respectively). CONCLUSION: AoAC progression was associated with increased aortic stiffness. OPG may be associated with AoAC progression in CAPD.


Assuntos
Valva Aórtica/patologia , Fatores de Crescimento de Fibroblastos/sangue , Falência Renal Crônica/complicações , Osteoprotegerina/sangue , Diálise Peritoneal , Calcificação Vascular/etiologia , Calcificação Vascular/patologia , Adulto , Progressão da Doença , Feminino , Seguimentos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/patologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Calcificação Vascular/sangue
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