Peritonitis in children on peritoneal dialysis in Cape Town, South Africa: epidemiology and risks

Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0–21.2). Median time to first infection was 2.03 months (range 0.1–21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socio-economic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socio-economic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success

Manifestaciones gastrointestinales de la enfermedad renal crónica

Introduction: There is a wide variety of gastrointestinal clinical manifestations that may increase the deterioration of the quality of life in patients with chronic kidney disease (CKD), which are manageable if properly detected.Objective: The objective of this work is to perform an updated and analytical re-view of the literature on the manifestations in the digestive tract of patients with chronic deterioration of renal function.Results: The results indicate that some of the signs and symptoms on the gastrointestinal tract of patients with CKD are individual, and non-specific symptoms such as anorexia, nausea and vomiting predominate, which can be controlled with adequate renal replacement therapy; while  thers, more rare, such as ascites associated with dialysis, impoverish the prognosis and illustrate the need for transplantation.Introducción: existe una amplia variedad de manifestaciones clínicas gastrointestinales que pueden aumentar el deterioro de la calidad de vida en los pacientes con enfermedad renal crónica (ERC), que son manejables si se detectan adecuadamente.Objetivo: el objetivo de este trabajo es realizar una actualización y revisión analítica de la literatura sobre las manifestaciones en el tracto digestivo de pacientes con deterioro crónico de la función renal.Resultados: los resultados indican que algunos de los signos y síntomas sobre el tracto gastrointestinal de los pacientes con ERC son individuales, y predominan los síntomas inespecíficos como la anorexia, las náuseas y el vómito, los cuales pueden controlarse con una adecuada terapia de reemplazo renal; mientras que otros, más raros, como la ascitis asociada a la diálisis, empobrece el pronóstico e ilustra la necesidad de trasplante

The effects of depression on treatment compliance among dialysis patients

The purpose of this study is to improve treatment methods and assist in providing the best quality of life to dialysis patients. This study analyzed if depression affects treatment compliance in dialysis patients. Being able to understand the causes of depression among dialysis patients would enable the agency and the professionals assisting with treatment in providing better resources and coping mechanisms to patients in dialysis

Capacity for the management of kidney failure in the International Society of Nephrology Latin America region:Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

Successful management of chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to high disease burden and geographic disparities and difficulties in terms of capacity, accessibility, equity, and quality of kidney failure care. Although LA has experienced significant social and economic progress over the past decades, there are still important inequities in healthcare access. Through this third iteration of the International Society of Nephrology Global Kidney Health Atlas, the indicators regarding kidney failure care in LA are updated. Survey responses were received from 22 (71%) of 31 countries in LA representing 96.5% of its total population. Median CKD prevalence was 10.2% (IQR 8.4 - 12.3), median CKD disability-adjusted life year (DALYs) were 753.4 days (IQR 581.3 -1,072.5), and median CKD mortality was 5.5% (IQR 3.2 - 6.3). Regarding dialysis modality, hemodialysis (HD) continued to be the most utilized therapy, while peritoneal dialysis (PD) reached a plateau and kidney transplantation increased steadily over the past 10 years. In 20 (91%) countries, >50% of people with kidney failure could access dialysis; and in only 2 (9%) countries, people who had access to dialysis could initiate dialysis with PD. A mix of public and private systems collectively funded most aspects of kidney replacement therapy (KRT; dialysis and transplantation) with many people incurring up to 50% of out-of-pocket costs. Few LA countries had CKD/KRT registries and almost no acute kidney injury (AKI) registries were reported. There was large variability in the nature and extent of kidney failure care in LA mainly related to countries’ funding structures and limited surveillance and management initiatives

Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home

Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance.Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015).Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment

VARIAÇÃO DE PESO CORPORAL DE PACIENTES EM DIÁLISE PERITONEAL

Este estudo teve como objetivo principal avaliar a variação de peso corporal de pacientes em diálise peritoneal (DP) durante o primeiro ano de tratamento e, como objetivo secundário, identificar pacientes com critério para síndrome metabólica (SM). Estudo observacional, com 35 pacientes, com o mínimo de um ano em DP, de um hospital universitário. Foram coletados dados quanto à situação clínica e demográfica, à variação de peso corporal e aos critérios para SM. Após doze meses do início da diálise, aproximadamente 40% dos pacientes apresentava sobrepeso e/ou obesidade. A média de variação de peso corporal após um ano foi de 3,7 kg, sendo que a maior variação foi encontrada nos primeiros três meses, com valores de 2,2 kg. A prevalência de SM foi de 30%. Conclui-se que a variação de peso corporal mais importante aconteceu no primeiro ano de tratamento e há uma alta prevalência de SM nos pacientes em DP.

Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home

Objetivo: analisar as complicações relacionadas à peritonite e infecção de orifício de saída do cateter, em pacientes em diálise peritoneal no domicílio.Método: estudo quantitativo e transversal, realizado com 90 pacientes em diálise peritoneal no domicílio, em um município do Nordeste brasileiro. Para coleta de dados utilizaram-se dois roteiros estruturados e consulta aos prontuários de saúde. Foram utilizadas análises descritivas e testes de comparação entre grupos independentes, considerando o nível de significância estatística de pObjetivo: analizar las complicaciones relacionadas con la peritonitis e infección del orificio de salida del catéter, en pacientes en diálisis peritoneal en casa.Método: estudio cuantitativo y transversal, realizado con 90 pacientes en diálisis peritoneal, en casa en una ciudad en el Nordeste de Brasil. Para la recogida de datos se utilizaron dos guiones estructurados y consulta de los registros médicos. Se utilizaron análisis descriptivos y pruebas de comparación entre grupos independientes, teniendo en cuenta el nivel de significación estadística de pObjective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering

Patient outcomes in a PD First Program in Cape Town, South Africa

Background: South Africa [SA] currently performs the most peritoneal dialysis [PD] in Africa. Yet, outcome data is limited. With the collision of epidemics of communicable and non-communicable diseases in Africa the need for chronic dialysis is escalating. PD remains a life-saving modality especially as haemodialysis is limited in the state sector. Methods: We retrospectively analysed all patients undergoing PD at Groote Schuur Hospital from January 2008 until June 2014 and thereafter prospectively until June 2015. Variables included demographics, adequacy, modality, fluid, cardiovascular risk and diabetes. The influences of these variables on peritonitis rate, technique and patient survival were assessed. Results: 230 patients were initiated on PD, 31 were excluded as they were on PD for < 90 days. The mean age was 39.7 +/- 10.4 years [SD], 49.8% were male and 63.8% were mixed ancestry. 9.8 % were diabetic at dialysis initiation. The average length of time on PD was 17 months (IQR 8 - 32). The peritonitis rate was 0.87 events per patient years. One, 2 and 5 year patient and technique survival was 94.4%, 84.3% and 60.2% and 82.5%, 69.0% and 37.4% respectively. Fluid overload (p=0.019) and low haemoglobin (p=0.001) were independent risk factors for poor survival. African race (HR 1.97, 95% CI (1.16 - 3.37) and fluid overload (p= 0.002) were both predictors of technique failure. Conclusions: In our PD-First programme the results are encouraging, despite lack of home visits due to safety, resource limitations and a high disease burden. Technique failure in African race needs further evaluation. Peritoneal dialysis remains a viable, life-saving alternative in an African setting

Diez años de experiencia de dialisis peritoneal aguda en el periodo 2007-2016 en el Instituto Nacional De Salud Del Niño de Lima-Perú

La Diálisis Peritoneal Aguda (DPA) es una alternativa de terapia de reemplazo renal (TRR) en niños con injuria renal aguda (IRA), enfermedad renal crónica (ERC) reagudizada y en condiciones críticas de enfermedad con afectación renal. Objetivo: Evaluar la experiencia en Diálisis Peritoneal Aguda (DPA) en niños con falla renal atendidos en el Instituto Nacional de Salud del Niño (INSN) a fin de determinar caracteres epidemiológicos, clínicos, de laboratorio, las indicaciones que las motivaron, evolución y complicaciones relacionadas a esta modalidad de Terapia de Reemplazo Renal. Material y métodos: Es un estudio es de tipo descriptivo, retrospectivo de revisión de historias clínicas de pacientes sometidos a DPA en el período 2007-2016 registrados en el Libro de Procedimientos del Servicio de Nefrología Pediátrica del INSN. Resultados: De un total de 191 pacientes el 54.9% fueron varones y el 45.1% mujeres. 59% menores de 5 años. La procedencia fue de Lima 52% y provincias 48%. La DPA se realizó en los Servicios de Nefrología en 52%, en UCI 27%, en Emergencia 13%, en la Unidad postoperatoria cardiovascular 7% y otros 1%. Se utilizó catéter rígido en el 69% de casos y la clínica evidenció edema en 96%, HTA en 72.5%, sobrecarga hídrica en 47%. 151 pacientes cursaron con IRA oligúrica y fue indicación de DPA en el 79 % de casos. Recuperaron diuresis 77%. Se reportó un 30.3% de complicaciones. La mortalidad fue 15% Conclusiones: La diálisis peritoneal aguda (DPA) es una modalidad de terapia de reemplazo renal frecuente en niños con IRA y de soporte en pacientes críticos. Se describe la experiencia de la DPA en el período de 10 años del 2007- 2016 en el INSN con la colocación del catéter rígido de urgencia y del catéter flexible de tipo thenckoff . El SUH, la ERC Reagudizada y la sepsis fueron las causas más frecuentes de IRA tributarias de DPA