48,190 research outputs found

    Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy.

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    Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarizes the available pharmacokinetic data used to inform optimal dosing in patients on CAPD or APD. The determinants of vancomycin disposition and pharmacodynamic effects are critically summarized, knowledge gaps explored, and a vancomycin dosing algorithm in PD patients is proposed

    Peritoneal Dialysis Catheters

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    In peritoneal dialysis, a well-functioning catheter is of great importance because a dysfunctional catheter may be associated with exit-site infection, peritonitis, reduced efficiency of dialysis, and overall quality of treatment, representing one of the main barriers to optimal use of peritoneal dialysis. This chapter reviews the literature on indications and contraindications for peritoneal dialysis, peritoneal dialysis catheter design and materials, the techniques of insertion, complications, and method of removal of dialysis catheters

    Clinical outcomes and mortality in elderly peritoneal dialysis patients

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    OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes

    A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all

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    Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.Dialysis adequacy is traditionally based on urea clearance, adjusted for total body volume (Kt/Vurea), and clinical guidelines recommend a Kt/Vurea target for peritoneal dialysis. We wished to determine whether adjusting dialysis dose by resting and total energy expenditure would alter the delivered dialysis dose. The resting and total energy expenditures were determined by equations based on doubly labeled isotopic water studies and adjusted Kturea for resting energy expenditure and total energy expenditure in 148 peritoneal dialysis patients (mean age, 60.6 years; 97 male [65.5%]; 54 diabetic [36.5%]). The mean resting energy expenditure was 1534 kcal/d, and the total energy expenditure was 1974 kcal/day. Using a weekly target Kt/V of 1.7, Kt was calculated using V measured by bioimpedance and the significantly associated (r = 0.67) Watson equation for total body water. Adjusting Kt for resting energy expenditure showed a reduced delivered dialysis dose (ml/kcal per day) for women versus men (5.5 vs. 6.2), age under versus over 65 years (5.6 vs. 6.4), weight 80 kg (5.8 vs. 6.1), low versus high comorbidity (5.9 vs. 6.2), all of which were significant. Adjusting for the total energy expenditure showed significantly reduced dosing for those employed versus not employed (4.3 vs. 4.8), a low versus high frailty score (4.5 vs. 5.0) and nondiabetic versus diabetic (4.6 vs. 4.9). Thus, the current paradigm for a single target Kt/Vurea for all peritoneal dialysis patients does not take into account energy expenditure and metabolic rate and may lead to lowered dialysis delivery for the younger, more active female patient.Peer reviewedFinal Accepted Versio

    Effect of Peritoneal Dialysis on Weight Change in Pediatric Patients

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    Obesity is associated with lower transplantation rate and higher mortality in pediatric end stage renal disease patients. Glucose-based peritoneal dialysis is the preferred method of dialysis for these patients, a therapy that can cause systemic glucose absorption. It is unknown whether this absorption leads to weight change in pediatric patients. We propose to examine whether Peritoneal Dialysis is associated with weight change in pediatric End Stage Renal Disease patients. We will prospectively observe a cohort of children aged 2-17 who are starting peritoneal dialysis. We will measure weight change after one year of dialysis, and compare these measurements to historical control groups. With this proposed study, we hope to gain insight into whether peritoneal dialysis contributes to obesity, leading to decreased eligibility for kidney transplantation. This knowledge will allow modification of renal replacement therapy and ultimately lead to improved outcomes in pediatric peritoneal dialysis patients

    Peritoneal dialysis in children after cardiopulmonary bypass

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    AbstractObjective: We reviewed 5 years' experience with peritoneal dialysis in children with acute renal failure after cardiac operations. We hypothesized that peritoneal dialysis is safe and effective in children with low-output cardiac failure after cardiac operations. Results: Mortality in these patients with renal failure (n = 32) was 46.9%. Fluid removed by peritoneal dialysis was 48 ± 28 ml/kg per 24 hours. Most complications of peritoneal dialysis were minor, hyperglycemia being the most frequent (53.1%). Peritoneal infection was suspected in 25%. Bowel perforation developed in two patients. None of the complications required early termination of dialysis. Hemodynamics and pulmonary function improved continuously during the study period. Conclusion: The early institution of peritoneal dialysis in acute renal failure and low cardiac output after cardiac operations not only removes fluid, thus easing fluid restriction, but may also improve cardiopulmonary function(J Thorac Cardiovasc Surg 1997;113:64-70

    The Influence of Centre Size on the Attitude of German Nephrologists towards Administering Peritoneal Dialysis to Comorbid Patients

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    Peritoneal dialysis (PD) is a method of renal replacement therapy that offers both medical and economic advantages. To patients it offers a safe therapy option that can be administered autonomously at home. Nevertheless, its adoption has remained slow, and most health care systems are still dominated by in-centre haemodialysis. One factor that determines overall prescription of peritoneal dialysis is the attitude of nephrologists towards the method and their confidence in administering peritoneal dialysis, especially in cases where patients present various comorbidities. This study analyses data gathered in the Mau-PD project between 2018 and 2019. A questionnaire that was sent to all nephrologists in Germany working in the ambulatory sector was analysed to determine how they perceive peritoneal dialysis, how they view their training and if they would prefer peritoneal dialysis or haemodialysis in certain cases. As a factor that may influence this inclination to favour one over the other, the size of dialysis centres in terms of absolute patient numbers was proposed as an explanatory variable in a linear regression model. So far, centre size has been studied in its effect on mortality and technique failure; however, its effect on nephrologist attitude and ultimately prescription habits, has so far not been studied. The main findings of this study are that most German nephrologists view peritoneal dialysis as an equivalent method to haemodialysis in terms of medical outcome (90.88%). Only 23.33% of German nephrologists considered their training in peritoneal dialysis to be thorough. When presented with patients presenting various comorbidities nephrologists, on the whole, preferred haemodialysis over peritoneal dialysis (3.42884; St. Err.: 0.0173021; 95%CI: 3.394856– 3.462824; on a 5-point scale where 1 = total preference for peritoneal dialysis and 5 = total preference for haemodialysis). This general inclination was shifted towards a preference for peritoneal dialysis as absolute numbers of PD patients increased (Coefficient: -0.1672043; Std. Err.: 0.0165543; 95% CI: -0.201291 -0.135801). According to the data gathered, between 40 and 50 patients in a dialysis centre seems to be the point where a preference for haemodialysis shifts to a preference for peritoneal dialysis

    Peritoneal dialysis

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    A brief history of the origin of peritoneal dialysis is given. The variations on the "intermittent" technique of peritoneal dialysis used on the Renal Unit, Cardiff Royal Infirmary are described. The ever-increasing importance of peritoneal dialysis as a therapeutic tool is outlined, and illustrative cases from personal experience at the CRI quoted. Additionally, possible complications of peritoneal dialysis are discussed, including peritonitis, abdominal discomfort, pulmonary problems, cardiac arrhythmias, losses of protein and amino-acids, overhydration and dehydration, hyperkalaemia and hypokalaemia, and hypocalcaemia. Further points of special clinical importance are indicated.peer-reviewe

    Hydrothorax Complicating Peritoneal Dialysis, a Case Report

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    Hydrothorax is a rare but serious complication of peritoneal dialysis. We report a recurrent pleural effusion in a case of ESRD (end stage renal disease) treated by pleurodesis using tetracycline. Key words: Sweet pleural effusion. Peritoneal Dialysis. Pleurodesis Keywords: Sweet pleural effusion; Peritoneal Dialysis; Pleurodesis; Child
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