Comparison of two different Kt/V methods in continuous ambulatory peritoneal dialysis patients

Dialysis adequacy has gained particular interest for the assessment of the quality of dialysis in patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Kt/V is used as a test of dialysis adequacy in HD and CAPD patients. The aim of this study was to compare two different Kt/V methods in CAPD patients. A practical method for the calculation of Kt/V will be suggested at the end of this prospective study. The study group included 28 patients. Each patient received CAPD therapy four times per day. During the study, CAPD dialysate samples for a period of 24 hours were obtained by two different methods. One is a modified method for obtaining samples by the patient at home; the other is the conventional method. For study purposes only, we told the patients using the modified method to bring all the bags to the center (contrary to the aim of the modified method). In the first method (modified method), CAPD patients collected 24-hour dialysate and urine samples at home and brought all of the materials to the hospital. A 10 mm3 dialysate sample was drawn from each CAPD dialysate bag, and then a total of 40 mm3 dialysate was mixed in a beaker. A sample of 10 mm3 of dialysate was taken from the mixture in the beaker, and then this dialysate sample, urine, and 5 mm3 venous blood were sent to the laboratory for urea nitrogen (UN) and creatinine level determinations. In addition to these tests, 24-hour dialysate and urine volumes and the patients' weight and height were measured, and Kt/V values were calculated. In the second method (classic method), all the bags from the 24-hour period were collected and mixed in a big bucket, and then a 10 mm3 sample was taken. The remaining procedures were the same as for the first method. Mean Kt/V values were calculated separately for the two methods and were found to be 2.48 by the modified method and 2.52 by the classic method. The results of the two methods were compared with the Wilcoxon paired t-test, which showed no statistically significant difference (p = 0.5228). In conclusion, two different Kt/V methods can be used in CAPD patients. However, the modified method is easily performed, and CAPD patients can collect and take the dialysate and urine samples at home, and bring these materials to the renal unit without transportation problems

The effects of weekly mupirocin application on infections in continuous ambulatory peritoneal dialysis patients.

Application of mupirocin to the nares or catheter exit site and frequency of mupirocin administration in continuous ambulatory peritoneal dialysis (CAPD) patients remain controversial. The objective of our study was to evaluate, using a historical control group, the efficacy on CAPD-related infections of once-weekly application of mupirocin at the catheter exit site. We instructed 18 CAPD patients, who did not initially use prophylactic antibiotic treatment, about once-weekly application of mupirocin ointment to the exit site as part of their exit-site care. We recorded the incidence of catheter-related infections, the causative micro-organisms, and the rate of catheter loss. We observed 17 acute exit-site infections (AESIs: 0.45 episodes/patient-year) before mupirocin treatment and 2 AESIs (0.06 episodes/patient-year) after treatment. The relative rate of AESI reduction was 86%. Before application of mupirocin, 52% of AESIs were attributable to Staphylococcus-aureus; after mupirocin administration, no AESIs were staphylococcal. Peritonitis episodes were also reduced from 21 before mupirocin treatment (0.56 episodes/patient-year), to 9 after mupirocin administration (0.29 episodes/patient-year). The relative rate of peritonitis reduction was 48%. Once-weekly application of mupirocin to the exit site resulted in a reduction in exit-site infections and peritonitis episodes comparable to those obtained with daily application

The effects of once- or thrice-weekly mupirocin application on mupirocin resistance in patients on continuous ambulatory peritoneal dialysis--first 6 months' experience.

In the present study, we prospectively investigated the effects of once- or thrice-weekly prophylactic application of mupirocin to catheter exit sites on Staphylococcus aureus carriage, methicillin and mupirocin resistance, and catheter-related infections in continuous ambulatory peritoneal dialysis (CAPD) patients. We enrolled 36 CAPD patients (men/women: 21/ 15; mean age: 55.1 +/- 1.4 years) in the study. At the start of the study, patients had been on once-weekly mupirocin treatment for 3.1 +/- 2.0 years. They were then randomly assigned to use mupirocin either once weekly (group I; n = 18; men/women: 10/8; age: 55.3 +/- 1.8 years) or thrice weekly (group II; n = 18; men/women: 11/7; age: 55.0 +/- 2.3 years). During the study period, swabs were taken monthly from nares, axillae, the inguinal area, and the catheter exit site. We evaluated a total of 806 samples in the first 6 months of the study. The two study groups were similar in terms of age and sex. In group I, 5 isolations of S. aureus in 3 patients came from initial S. aureus carriers. During the first 6 months of the study, only 2 new S. aureus carriers were detected in group I, for a total of 7 isolations. Mupirocin resistance (MuR) was present in only 1 isolate and methicillin resistance (MeR) was not observed. In group II, no S. aureus carriers were present at the initial evaluation, and we encountered only 1 new S. aureus carrier during the first 6 months of the study. During the same period, MuR and MeR were absent in group II. During the 6 months, we observed 1 exit-site infection and 1 peritonitis episode attributable to coagulase-negative staphylococcus (CNS) in group I. In group II, we observed 1 exit-site infection attributable to CNS. During the first 6 months of the study, once- or thrice-weekly application of mupirocin to the catheter exit site has not led to any significant change in S. aureus carriage, MeR and MuR, or catheter-related infection in our CAPD patients