Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake

Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake.BackgroundRenal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis.MethodWithin the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis.ResultsOverall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 ± 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 ± 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 ± 9.0 days; this duration was shorter in the non-survivors (7.0 ± 8.7 vs. 10.0 ± 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015).ConclusionSubstantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality

Alterations of erythrocyte rheology and cellular susceptibility in end stage renal disease: Effects of peritoneal dialysis.

In this study, we investigated the effects of peritoneal dialysis on hemorheological and hematological parameters and their relations with oxidant and antioxidant status of uremic patients. Hemorheological parameters (erythrocyte deformability, erythrocyte aggregation, osmotic deformability, blood and plasma viscosity) were measured in patients with renal insufficiency undergoing peritoneal dialysis (PD) and volunteers. Erythrocyte deformability, osmotic deformability and aggregation in both autologous plasma and 3% dextran 70 were measured by laser diffraction ektacytometry. Enzyme activities of glutathione peroxidase, superoxide dismutase and catalase were studied in erythrocytes; lipid peroxidation was studied by measuring the amount of malondialdehyde in both erythrocytes and plasma samples. Blood viscosity at native hematocrit was significantly lower in PD patients at all measured shear rates compared to controls, but it was high in PD patients at corrected (45%) hematocrit. Erythrocyte deformability did not show any difference between the two groups. Osmotic deformability was significantly lower in PD patients compared to controls. Aggregation index values were significantly high in PD patients in plasma Catalase and glutathione peroxidase activities in erythrocytes were decreased in PD patients whereas superoxide dismutase activity was increased compared to controls. Malondialdehyde was significantly increased in erythrocytes and plasma samples of PD patients which also shows correlations with aggregation parameters. It has been concluded that erythrocytes in PD patients are more prone to aggregation and this tendency could be influenced by lipid peroxidation activity in patient's plasma. These results imply that uremic conditions, loss of plasma proteins and an increased risk of oxidative stress because of decreasing levels of antioxidant enzymes affect erythrocyte rheology during peritoneal dialysis. This level of distortion may have crucial effects, impairing the blood flow dynamics and causing inadequate microcirculatory perfusion

The role of peritoneal scintigraphy in the detection of continuous ambulatory peritoneal dialysis complications

While continuous ambulatory peritoneal dialysis (CAPD) offers several advantages over hemodialysis in patients with endstage renal disease, several complications have been recognized. The intraperitoneal instillation of dialysate increases intra-abdominal pressure and consequently predisposes the patient to leaks and herniations through defects in the abdominal wall

Is decline in serum albumin an ominous sign for subsequent peritonitis in peritoneal dialysis patients?

Serum albumin levels have been used as a representative marker for morbidity and mortality in the dialysis population. We evaluated the significance of various biochemical values in peritoneal dialysis (PD) patients with a history of peritonitis. In 51 patients [27 women, 24 men; mean age: 42.6 years (range: 19 - 70 years); average duration of PD: 28.26 +/- 23.1 months] with history of peritonitis, we recorded serum albumin and cholesterol levels at the beginning of PD, at the last visit (1 month) before the peritonitis episode, and at months 1, 6, and 12 after the peritonitis episode. Routine data from peritoneal equilibration tests were also obtained. Serum albumin showed a significant decline from the basal measurement at the measurements 1 month before and after the peritonitis episode (p = 0.026 and 0.025 respectively). Serum cholesterol levels and dialysate-to-plasma creatinine at hours 2 and 4 revealed no significant alterations at the same time points. The decline in serum albumin relative to the first visit (basal level) may be a factor showing the likelihood of peritonitis. A decline in serum albumin during follow-up may be an indicator for subsequent peritonitis. The absence of a similar decline in serum cholesterol levels (mimicking albumin) may rule out low dietary intake or malnutrition. Pathophysiologic explanations for these relationships are not obvious. If the leading complication of PD is peritonitis, efforts should be focused on improving the factors that influence serum albumin levels

The relationship between peritoneal leukocyte count, fluid cultures, and clinical results in peritonitis among peritoneal dialysis patients: is there a geographic or ethnic difference?

We investigated peritoneal leukocyte count (PLC) and culture results for correlations with inflammation, nutrition, microbiologic parameters, and the effects of peritonitis on peritoneal equilibration tests (PETs) and clinical outcomes in peritoneal dialysis (PD) patients. The study group consisted of patients who had experienced peritonitis for the first time and who had been on PD for at least 6 months, with a PET performed both before and after the peritonitis episode. Only patients with an increased PLC were analyzed. In the 70 patients analyzed (35 men; mean age: 45.1 +/- 13.5 years), 7 (10.0%) underwent PD catheter removal, 60 (85.7%) responded well to treatment, and 3 (4.3%) died. Cultures of peritoneal fluid were positive in 25 patients (35.7%), and these patients had a significantly higher PLC than did the culture-negative patients. After the peritonitis episode, C-reactive protein (CRP) increased significantly in affected patients. Residual urine declined after peritonitis. We observed no significant difference in PET results. Clearly, more micro-organisms are present in the peritoneal fluid in patients with a positive culture than in those with a negative culture, meaning that they have severe peritonitis, which responds poorly to treatment. Beyond a consideration of possibly inappropriate culturing techniques, the variations in effluent culture results might reflect geographic or ethnic differences. Positive culture results and a high PLC should be considered risk factors for catheter loss and mortality in PD. Moreover, culture results might show geographic and ethnic differences. In peritonitis follow-up, CRP may be a better marker than erythrocyte sedimentation rate is