Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis - A case report

ABSTRACT Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Fortyeight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.

Effect of Modified Shenling Baizhusan on Gastrointestinal Dysfunction and Protein-energy Wasting in Continuous Ambulatory Peritoneal Dialysis Patients / 中国实验方剂学杂志

ObjectiveTo observe and analyze the effect of modified Shenling Baizhusan on gastrointestinal dysfunction and protein-energy wasting （PEW） of continuous ambulatory peritoneal dialysis （CAPD） patients with the syndrome of spleen deficiency， blood stasis， and dampness. MethodA total of 66 CAPD patients with the above syndrome were randomized into the observation group and control group， 33 cases in each group. However， 3 cases in each group dropped out， finally leaving 30 cases in each group. Both groups received CAPD and conventional symptomatic treatment. On this basis， the observation group was given modified Shenling Baizhusan （1 bag/day， once in the morning and again in the evening， 12 weeks）， and the control group the bifidobacterium capsules （1.05 g/time， twice/day， 12 weeks）. Before and after treatment， the traditional Chinese medicine （TCM） syndrome score， gastrointestinal symptom rating scale （GSRS） score， and malnutrition-inflammation score （MIS） in two groups were recorded， and the levels of serum albumin （ALB）， prealbumin （PA）， transferrin （TRF）， gastrin-17 （G-17）， tumor necrosis factor alpha （TNF-α）， interferon-γ （IFN-γ）， and interleukin-10 （IL-10） were detected. Moreover， body mass index （BMI） was calculated. ResultAfter treatment， the alleviation of the TCM syndrome in the observation group was better than that in the control group （Z=-2.591， P<0.05）， and the TCM syndrome score in the observation group was lower than that in the control （P<0.05）. The symptom scores， MIS， and G-17 of the observation group were significantly decreased compared with those before observation and in the control group （P<0.05）. After treatment， the GSRS scores of the two groups were significantly lower than those before treatment （P<0.05）， particularly the observation group （P<0.05）. ALB， PA， TRF， and BMI of the observation group after treatment were increased compared with those before treatment and those of the control group after treatment （P<0.05）. After treatment， serum TNF-α and IFN-γ of the two groups were significantly reduced compared with those before treatment （P<0.05）， and the levels of the two in the observation group were significantly lower in the observation group than in the control group （P<0.05）. After treatment， IL-10 level of the observation group was higher than that before treatment and in the control group （P<0.05）. ConclusionThe modified Shenling Baizhusan can relieve the gastrointestinal dysfunction and PEW in CAPD patients with the syndrome of spleen deficiency， blood stasis， and dampness.

The relationship between TyG, CRP/Alb, 25(OH)D and the prognosis of patients with continous ambulatory peritoneal dialysis / 中国医师杂志

Objective:To investigate the relationship between triglyceride glucos (TyG), C-reaction protein/albumin (CRP/Alb), 25-hydroxy vitamin D[25(OH)D] and the prognosis of patients with continous ambulatory peritoneal dialysis (CAPD).Methods:A total of 220 CAPD patients in the Affiliated Hospital of Jining Medical University from January 2017 to March 2020 were prospectively selected and divided into death group and survival group according to the 6-month prognosis. The peritoneal urea clearance index (Kt/V urea), TyG, CRP/Alb, 25(OH)D were compared between the two groups. Logistic regression was used to analyze the prognostic factors of CAPD patients. The predictive value of TyG, CRP/Alb and 25(OH)D on the prognosis of CAPD patients was analyzed by receiver operating characteristic (ROC) curve. Results:After 3 months and 6 months of dialysis, the peritoneal Kt/V urea in the death group [(1.21±0.18)ml/(s·1.73 m 2), (1.02±0.14)ml/(s·1.73 m 2)] was significantly lower than that in the survival group [(1.57±0.40)ml/(s·1.73 m 2), (1.49±0.42)ml/(s·1.73 m 2)] (all P<0.05). After 3 months and 6 months of dialysis, the TyG [(8.79±0.86), (9.24±1.03)] and CRP/Alb [(4.98±0.94)×10 -4, (5.14±1.39)×10 -4] in the death group were higher than those in the survival group [(8.03±0.60), (7.26±0.93), (3.57±1.19)×10 -4, (3.07±0.88)×10 -4], while the 25(OH)D [(19.14±2.29)ng/ml, (17.79±3.17)ng/ml] was lower than that of survival group [(22.67±3.03)ng/ml, (24.31±2.51)ng/ml] (all P<0.05). TyG and CRP/Alb at 3 months and 6 months of dialysis were negatively correlated with Kt/V urea, while the 25(OH)D was positively correlated with Kt/V urea (all P<0.05). Logistic regression analysis showed that Kt/Vurea, TyG, CRP/Alb and 25(OH)D were associated with prognosis in the two groups after 3 and 6 months of dialysis (all P<0.05). The AUC of TyG, CRP/Alb and 25(OH)D at 6 months of dialysis combined to predict the prognosis of CAPD patients was the highest, which was 0.911. Conclusions:TyG, CRP/Alb and 25(OH)D are associated with all-cause mortality in CAPD patients. High TyG and CRP/Alb and low 25(OH)D suggest a higher risk of all-cause mortality. Combined detection of all indicators can effectively predict the prognosis of CAPD, which is convenient for early clinical intervention.

Internet of things follow-up improves blood pressure management in patients with continuous ambulatory peritoneal dialysis / 中华肾脏病杂志

Objective:To explore the difference of blood pressure compliance rate in patients with continuous ambulatory peritoneal dialysis (CAPD) in the internet of things (IoT) follow-up and conventional care.Methods:CAPD patients from 3 peritoneal dialysis centers from May 2019 to October 2019 were included in this retrospective cohort study. They were divided into IoT group and conventional care group according to the way of follow-up. The difference in blood pressure compliance rate during 1 year of follow-up between the two groups was observed. The primary outcome was defined as the proportion of patients with blood pressure compliance rate≥85%.Results:A total of 75 patients were included in this study, in during 32 patients in IoT group and 43 patients in conventional care group. The comparison of baseline data between the two groups showed that the dialysis age of patients in IoT group was shorter ( P<0.01). After a median of 9(9, 12) months follow-up, the median blood pressure compliance rate was 85.2% (65.2%, 95.1%), and 25 patients (65.6%) in IoT group had met the target of blood pressure compliance rate≥85%, which was significantly higher than that in the conventional care group (17 cases, 39.5%) ( χ2=4.996, P=0.025). The cumulative probability of the target of blood pressure compliance rate≥85% was 97%, 90%, 90% and 52%, respectively in IoT group, while 95%, 86%, 55% and 34%, respectively in conventional care group after 3, 6, 9 and 12 months of follow-up, and the different between the two groups was significant (Log-rank χ2=4.774, P=0.029). Adjusted for age, sex and dialysis age, the multivariate Cox proportional risk regression model showed that serum creatinine level(for every 1 μmol/L increase, HR=1.002, 95% CI 1.000-1.003, P=0.033), follow-up mode (IoT follow-up vs conventional care, HR=0.023, 95% CI 0.003-0.210, P=0.001), follow-up times (for each additional time, HR=0.879, 95% CI 0.823-0.939, P<0.001) and the rate of weight compliance (for each increase of 1%, HR=0.964, 95% CI 0.939-0.991, P=0.008) was the independent influencing factors for the blood pressure compliance rate<85%. The results of subgroup analysis showed that patients with shorter dialysis age (<10 months) and in the centers where the nurses finished the PD follow-up work as part-time job had better blood pressure control in IoT follow-up. Conclusions:IoT follow-up is helpful to improve CAPD patients' blood pressure compliance rate. Elevated serum creatinine level at baseline is the independent risk factor associated with poor blood pressure compliance. However, IoT follow-up, more follow-up times and the elevated rate of weight compliance are the protective factors for blood pressure compliance. IoT follow-up mode is more recommended for patients with short dialysis age and for dialysis centers where most of the nurses are part-time.

Clinical Profile and Complications of Continuous Ambulatory Peritoneal Dialysis in Kashmir

Introduction: Diabetes Mellitus is a syndrome characterizedby chronic hyperglycemia and disturbances of carbohydrate,fat and protein metabolism with absolute or relative deficiencyof insulin secretion and/or insulin action. It is one of themost common non-communicable diseases in the world.Adiponectin is a protein secreted exclusively by adipocytesthat regulates glucose and lipid metabolism. It has been foundto influence the body’s response to insulin thereby modulatinginsulin action and resistance. Several studies have found thatadiponectin levels are inversely associated with the severityof diabetes mellitus. Our study, thus, aims to compare theassociation between levels of adiponectin, fasting bloodglucose, body mass index and waist-hip ratio in patients ofdiabetes mellitus.Material and Methods: This case control study was done inpatients of type 2 diabetes mellitus attending Medicine OPDand ward from October 2016 to September 2018. A total of 88people were included in the study; 44 cases and 44 controls.Results: This study shows that serum adiponectin level issignificantly decreased in type 2 diabetes mellitus patients ascompared to controls and it also shows negative correlationwith fasting blood glucose, body mass index and waist-hipratio.Conclusion: It can be concluded that serum adiponectinestimation may be a useful biomarker for the diagnosis oftype 2 diabetes mellitus and it may be a useful adjunct in thetreatment of type 2 diabetes mellitus.

Application of 16S rRNA Gene-Targeted Next-Generation Sequencing for Bacterial Pathogen Detection in Continuous Ambulatory Peritoneal Dialysis Peritonitis / 대한임상미생물학회지

BACKGROUND: 16S rRNA gene-targeted next-generation sequencing (NGS) can detect microorganisms in a comprehensive reference database. To date, NGS has been successfully applied to samples such as urine, blood, and synovial fluid. However, there is no data for continuous ambulatory peritoneal dialysis (CAPD) fluid. The purpose of this study was to evaluate the clinical usefulness of microbiome analysis of CAPD fluids for the diagnosis of CAPD peritonitis.METHODS: We included 21 patients with high suspicion of CAPD peritonitis. Routine CAPD fluid culture was performed using a pellet of 50 mL CAPD fluid onto the chocolate and blood agar for two days, and thioglycollate broth for one week. 16S rRNA gene-targeted NGS of pellets, stored at −70℃ was performed with MiSeq (Illumina, USA).RESULTS: Many colonized or pathogenic bacteria were detected from CAPD fluids using NGS and the microbiomes were composed of 1 to 29 genera with a cut-off 1.0. Compared to the culture results, NGS detected the same pathogens in 6 of 18 valid results (three samples failed with low read count). Additionally, using NGS, anaerobes such as Bacteroides spp. and Prevotella spp. were detected in six patients. In two of five samples in which no bacterial growth was detected, possible pathogens were detected by NGS.CONCLUSION: To our knowledge, this is the first report about the application of 16S rRNA gene-targeted NGS for diagnosis of CAPD peritonitis. Etiology of culture-negative CAPD peritonitis can be better defined in NGS. Furthermore, it also helped the detection of anaerobic bacteria.

An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

Combating protein energy wasting in end stage kidney disease: role of exogenous proteolytic enzyme as an adjuvant to dietary protein

Background: Despite interventions, the prevalence of protein energy wasting in patients on dialysis continues to be unacceptably high. The objective of the study is to evaluate the efficacy of exogenous proteolytic enzyme Aminace 70000 (Hemoglobin Tyrosine Unit), as an adjuvant to dietary protein in improving the nutritional status.Methods: This is a retrospective, real world, single centre, observational study, aimed at assessing the changes in key nutritional indices, over 6 months in patients with chronic kidney disease (CKD) initiated on continuous ambulatory peritoneal dialysis (CAPD). The intervention included addition of egg protein and use of an exogenous proteolytic enzyme. Three cohorts were identified. Cohort 1, had access to a nephrologist and CAPD counsellor; Cohort 2, in addition had access to a dietician who emphasized the need for increase in dietary protein in form of 4-6 eggs a day; and cohort 3, were in addition given an exogenous proteolytic enzyme with the major protein meal.Results: The absolute fall in serum albumin at 6 months for the cohort 1, 2 and 3 is 0.48, 0.29 and 0.09 gm/dl respectively. Not only was the fall in serum albumin significantly less with the use of exogenous proteolytic enzyme, a higher proportion of patients were able to maintain or improve their serum albumin. The fall in midarm circumference was maximum in cohort 1 (2.08 cm) and least in cohort 3 (0.45 cm). This positive trend however, did not achieve statistical significance.Conclusions: Use of exogenous proteolytic enzyme, when combined with egg protein, improves key nutritional indices in patients of CKD on CAPD.

Peritoneal Dialysis-associated Peritonitis Caused by Chryseobacterium indologenes / 대한내과학회지

Chryseobacterium indologenes (C. indologenes) is a nonmotile, gram-negative bacillus that is widely distributed in nature. Generally considered nonpathogenic, C. indologenes rarely infects humans and is not normally present in the human microflora. C. indologenes infections have been observed in cases of peritoneal dialysis (PD)-associated peritonitis, although the incidence of these infections is low. Although C. indologenes is generally susceptible to trimethoprim-sulfamethoxazole, levofloxacin, ciprofloxacin, piperacillin-tazobactam, and cefepime, no guidelines have been established for the treatment of PD-associated peritonitis. Here we report the first case of PD-associated peritonitis in Korea with C. indologenes identified as the sole etiologic agent. The patient recovered after intraperitoneal antibiotic treatment without the need for Tenckhoff catheter removal.

The Cost Of Dialysis In Malaysia: Haemodialysis And Continuous Ambulatory Peritoneal Dialysis

@#In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.

Effect of peritoneal dialysis in the treatment of children with burns complicated with acute renal failure / 中国基层医药

Objective To observe the clinical efficacy of peritoneal dialysis in the treatment of acute renal failure in children with burns ,and to summarize the experience of treatment .Methods The clinical data of 9 children with burns complicated with acute renal failure who received peritoneal dialysis were retrospectively analyzed . Results On the basis of rehydration and anti -infective therapy , 9 patients underwent continuous bed peritoneal dialysis(CAPD) treatment.The average duration of peritoneal dialysis was 11 days.The average hospital stay was 33 days.The levels of blood urea nitrogen and creatinine were (17.69 ±6.01)mmol/L,(412.21 ±188.74)μmol/L at 5 days after peritoneal dialysis,and the levels of blood urea nitrogen and creatinine were (35.24 ±8.35)mmol/L, (801.23 ±298.15)μmol/L before the peritoneal dialysis,the differences were statistically significant (t =5.12, 3.31,all P<0.01).The levels of blood urea nitrogen and creatinine were (9.76 ±3.37) mmol/L,(168.48 ± 112.25)μmol/L at 10 days after peritoneal dialysis,there were significant improvements compared with 5 days after peritoneal dialysis(t=3.45,3.33,all P<0.01).The symptoms of uremia disappeared or improved obviously ,and the complications of peritoneal dialysis were not obvious .Conclusion Pediatric burns with acute renal failure with dialysis indications preferred peritoneal dialysis treatment ,in the course of treatment should take into account the ade-quacy of dialysis and children with the development of individualized programs .

Campylobacter fetus Peritonitis in a Patient with Continuous Ambulatory Peritoneal Dialysis: A First Case Report in Korea / 대한임상미생물학회지

Campylobacter fetus may cause infections such as septicemia, peritonitis, meningitis, endocarditis, septic arthritis, and cellulitis, increasing the risk of spontaneous abortion but decreasing the likelihood of gastroenteritis. We identified C. fetus from continuous ambulatory peritoneal dialysis (CAPD) fluid using 16S rRNA gene sequencing. It is significant that this is the first case report in Korea of CAPD peritonitis caused by C. fetus, which is known to be rare.

Aspectos clínicos y microbiológicos de la peritonitis asociada a diálisis peritoneal en pacientes adultos con insuficiencia renal crónica en el Servicio de Urgencias / Clinical and microbiological aspects of peritonitis associated with peritoneal dialysis in adult patients with chronic renal failure in the Emergency Department

Resumen Introducción: La peritonitis es la complicación más importante y frecuente de la diálisis peritoneal (DP), las infecciones bacterianas son las responsables en la mayoría de los casos, con sintomatología característica. Objetivo: Determinar los patógenos más frecuentes en peritonitis asociado con la DP en pacientes con insuficiencia renal crónica (IRC). Metodología: Estudio retrospectivo, descriptivo, transversal y observacional, de pacientes con peritonitis en DP con IRC del servicio de urgencias, entre julio de 2012 y junio de 2013. Se evaluaron de los expedientes datos sociodemográficos, de diagnóstico, clínicos y microbiológicos y celulares de líquido de diálisis. Resultados: De 73 expedientes revisados 52% correspondían a pacientes del género masculino, la causa primaria de la IRC fue la diabetes mellitus tipo 2 (67%). Síntomas presentados: dolor abdominal (86%), vómitos (42%) y náuseas (34%), con anemia, azoemia, hiperglicemia hipoalbuminemia e hiponatremia. Los cultivos microbiológicos positivos fueron 59%; y los patógenos identificados fueron Candida tropicalis (9,6%), Staphylococcus epidermidis (8,2%), y Enterococcus faecalis y Staphylococcus haemolyticus (6,8% cada uno), asociados con elevación de leucocitos, azoemia y celularidad alta en el líquido peritoneal (p < 0,05). Conclusiones: El principal microorganismo determinado fue de origen fúngico asociado a leucocitos, azoemia y celularidad alta.

Background: Peritonitis is the most important and frequent complication of peritoneal dialysis (PD). Bacterial infections are responsible in most cases, with characteristic symptoms. Aim: To determine the most frequent pathogens in peritonitis associated with PD in patients with chronic renal failure (CRF). Methodos: Retrospective, descriptive, cross-sectional and observational study of patients with peritonitis in PD with CRF of the emergency department, between July 2012 and June 2013. Sociodemographic, diagnostic, clinical and microbiological and cellular data were evaluated from the patient's fluid. Dialysis. Results: From 73 reviewed records, 52% were male. The primary cause of CRF was diabetes mellitus type 2 (67%). Symptoms presented: abdominal pain (86%), vomiting (42%) and nausea (34%), with anemia, azotemia, hyperglycemia, hypoalbuminemia and hyponatremia. The positive microbiological cultures were 59%; and the pathogens identified were Candida tropicalis (9.6%), Staphylococcus epidermidis (8.2%), Enterococcus faecalis and Staphylococcus haemolyticus (6.8% each one), associated with elevated leukocytes, azotemia and high cellularity in peritoneal fluid (p <0.05). Conclusions: The main microorganism determined was of fungal origin associated with leukocytes, azotemia and high cellularity.

Clinical characteristics and the factors relevant to peritoneal transport function in patients with continuous ambulatory peritoneal dialysis / 中南大学学报(医学版)

Objective:To observe the clinical characteristics with different peritoneal transport type in patients with continuous ambulatory peritoneal dialysis (CAPD),and to investigate the factors associated with peritoneal transport function.Methods:The clinical data of 158 CAPD patients were analyzed retrospectively.According to peritoneal equilibration test,a method for evaluation of the peritoneal transport function,the patients were divided into 2 groups:a high average and high peritoneal transport group (Group A,n=84) and a low average and low peritoneal transport group (Group B,n=74).T-he demographics,clinical biochemical indexes and the incidence of cardiovascular complications were compared between the 2 groups.Logistic regression analysis was used to find the factors relevant to peritoneal transport function.Results:The level of serum albumin (ALB) in the Group B was significantly higher than that in the Group A (P＜0.05).The 4 h dialysate/plasma creatinine (D/Pcr),high-sensitivity C-reactive protein (hs-CRP),body mass index (BMI),and the rates of cardiovascular complications in the Group A were significantly higher than those in the Group B (P＜0.05).Correlation analysis showed that the D/Pcr was positively correlated with the BMI,serum hs-CRP and cardiovascular complications (r=0.179,0.373 and 0.426,respectively,P＜0.05),while it was negatively correlated with ALB (r=-0.393,P＜0.01).Logistic regression analysis showed that the high BMI (OR=1.178,P＜0.05),cardiovascular complications (OR=5.035,P＜0.01),and the low serum ALB (OR=0.852,P＜0.01)were the risk factors for high peritoneal transport.Conclusion:The serum ALB level,BMI and the cardiovascular complications are associated with high peritoneal transport,which are useful markers for predicting the peritoneal transport function before peritoneal dialysis.

Survival analysis in automated peritoneal dialysis patients / 中华肾脏病杂志

Objectives To compare the clinical characteristics, long - term survival and associated risk factors of automated peritoneal dialysis (APD) patients and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods As a retrospectively study, adult patients started peritoneal dialysis in Peking Union Medical College Hospital (PUMCH) from September 1st, 2002 to September 30th, 2016 were enrolled. Baseline information and dialysis associated parameters were collected. The primary outcome was death and the secondary outcome was technical failure. The risk factors of death were analyzed in APD patients by Cox's regression model. Homochromous gender and age matched CAPD patients were analyzed as control. Results The baseline condition of 69 APD patients were similar to those of 138 CAPD patients. The survival rates of APD patients at 1-year、3-year and 5-year were 95.4%, 88.0% and 73.0% respectively, which were superior to CAPD patients. No significant difference in technical survival was found between APD and CAPD patients. Single-factor Cox's regression analysis showed that all-cause mortality of CAPD patients was 2.2 times higher than that of APD patients (95% CI 1.221-3.837). In the multi-factor Cox regression analysis model, adjusted by age, complications (including cardiovascular disease and diabetes), nPCR and serum creatinine, dialysis modality was not an independent risk factor of dialysis patients. Age (HR=1.077, 95%CI 1.016-1.142, P=0.013), diabetes (HR=3.608, 95%CI 1.117-11.660, P=0.032) and serum albumin (HR=0.890, 95%CI 0.808-0.982, P=0.020) were independently associated with all-cause death of APD patients. Conclusions Dialysis modality was not an independent risk factor for the all-cause mortality of peritoneal dialysis patients. Age, diabetic nephropathy and hypoalbuminemia were independently associated with the death of APD patients.

The inflammatory state and protein-energy wasting in the maintenance peritoneal dialysis population / 重庆医学

Objective To investigate micro-inflammatory state and protein-energy wasting (PEW) states in maintenance peritoneal dialysis(MPD) patients,then analysis of the correlation between them.Methods Ninty-six cases of MPD patients in this Hospital were selected from March 2012 to September 2015.The status of nutrition were assessed by Quantitative Subjective and global Assessment(SGA),malnutrition-inflammation score(MIS) and albumin(Alb),micro-inflammatory state was assessed by enzyme-linked immunoassay(ELISA) method serum hypersensitive c-reactive protein (hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6).At the same time,various serological markers like serum Alb,serum total protein(TP),serum prealbumin(PA),hemoglobin(Hb),transferrin(TF),serum creatinine(Scr),urea nitrogen(BUN),cholesterol(Teh) were measured.Results The incidence of PEW in MPD patients was 36.50％,among which 62.86 ％ of them were over 65 years old,57.10％ were over 2 years of dialysis time and 40.00％ with diabetic nephropathy.MPD patients with hs-CRP＞5 mg/L accounted for 58.33％,of which over 65 year old accounted for 42.86％,MPD age longer than 2 years accounted for 60.71％,32.14％ of them with diabetic nephropathy.The proportion of diabetic nephropathy,average age,dialysis duration time,hs-CRP,TNF-α and IL-6 in PEW group were higher than non-PEW group(P＜0.05);BM,TP,Alb,PA,Hb,TCh,MAC and MAMC were lower ban non-PEW group(P＜0.05).Compared with the hs-CRP≤5 mg/L group,average age,the time of dialysis duration,TNF-α,IL-6 were higher and TP,Alb,PA,TF,Hb,the proportion of Kt/V≥1.72 were lower in the hs-CRP＞5 mg/L group.After the correction of age,sex,dialysis ages,it was found that the level of hs-CRP in MPD patients was negatively correlated with the level of Alb,PA,TF,Tch,Scr,TG;The level of IL-6 was negatively correlated with the levels of Alb,PA,TF,Tch,TG.The level of TNF-α in MPD patients showed different degrees of negative correlation with the leves of Alb,PA,TF,TG,Tch(all P＜0.05).Multivariate analysis showed that elderly,the time of dialysis duration,the microinflammatory state,and hypoalbuminemia were the independent risk factors of PEW.Conclusion PEW and micro-inflammatory state are very common in PHD patients.Patients with longer duration of dialysis,elderly or associated with diabetic nephropathy are more likely to suffer PEW and micro-inflammatory.Elderly,the time of dialysis duration,microinflammatory state,hypoalbuminemia are the independent risk factors of PEW.

Protective effect and its mechanism of Shenkang injection on peritoneal mesothelial cells in CAPD mice / 天津医药

Objective To study the protective effect of Shenkang injection on peritoneal mesothelial cells (PMCs) of continuous ambulatory peritoneal dialysis (CAPD) mice, and explore the possible mechanism. Methods Forty ICR mice were randomly divided into blank control (A) group, peritoneal dialysis (B) group, low dose of Shenkang (C) group ( 2.5%dialysate+5 mL/kg Shenkang injection), medium (D) group (2.5% dialysate+10 mL/kg Shenkang injection) and high (E) group (2.5% dialysate+ 20 mL/kg Shenkang injection). Mice were observed for 4 weeks. Fasting blood glucose, total cholesterol, triglyceride and C-reactive protein (CRP) were detected by biochemical assay. Tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) levels of serum and dialysate were detected by ELISA. Pathological changes of peritoneal tissue were observed by HE staining. Expression and mRNA transcription levels of these four cytokines in the peritoneal tissue were detected by immunohistochemical staining and real-time PCR respectively. Results There were no significant differences in body weight, fasting blood glucose, total cholesterol and triglyceride between 5 groups of mice (P>0.05). Compared with group B, there was no significant difference in CRP level between group C and group E, but which was significantly decreased in group D (P<0.05). The serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were decreased in group C and group D. The serum and dialysate levels of TNF-αand TGF-β1 were significantly increased in group E (P<0.05), but there was no significant difference between VEGF and CTGF in group E. Compared with group E, except for CTGF in dialysate of group C, the serum and dialysate levels of TNF-α, TGF-β1, VEGF and CTGF were significant decreased in group C and group D (P<0.05). Damaged PMCs were found in group B, which were improved in various degrees in group C, group D and group E. Compared with group B, the protein expression and mRNA relative transcription levels of TNF-α, TGF-β1, VEGF and CTGF tended to decrease gradually in group C, group D and group E (P<0.05). Conclusion A certain concentration of Shenkang injection can protect PMCs by inhibiting the expression of TNF-α, TGF-β1, VEGF and CTGF in CAPD mice, so as to control the occurrence and development of peritoneal fibrosis.

Campylobacter jejuni: un agente infrecuente de peritonitis en un niño con diálisis peritoneal / Campylobacter jejuni: A rare agent in a child with peritoneal dialysis-related peritonitis

La peritonitis es un problema grave en los niños que reciben diálisis peritoneal. La bacteria Campylobacter jejuni es una causa infrecuente de peritonitis. Un niño de 10 años de edad con insuficiencia renal terminal causada por síndrome urémico hemolítico atípico ingresó a nuestro hospital con dolor abdominal y fiebre. El líquido de la diálisis peritoneal era turbio; en el examen microscópico se observaron leucocitos abundantes. Se inició tratamiento con cefepime intraperitoneal. En el cultivo del líquido peritoneal se aisló Campylobacter jejuni, por lo que se agregó claritromicina oral al tratamiento. Al finalizar el tratamiento, el resultado del cultivo del líquido peritoneal era negativo. Hasta donde sabemos, no se había informado previamente peritonitis por C. jejuni en niños. Conclusión. Si bien la peritonitis por C. jejuni es rara en los niños, debe considerarse como factor etiológico de la peritonitis.

Peritonitis is a serious problem in children receiving peritoneal dialysis. Campylobacter jejuni is an unusual cause of peritonitis. A 10-year-old boy who had end stage renal failure due to atypical hemolytic uremic syndrome was admitted to our hospital with abdominal pain and fever. Peritoneal dialysis fluid was cloudy and microscopic examination showed abundant leukocytes. Intraperitoneal cefepime treatment was started. Campylobacter jejuni was isolated from peritoneal dialysis fluid culture and oral clarithromycin was added to the treatment. At the end of therapy, peritoneal fluid culture was negative. To our knowledge, C. jejuni peritonitis was not reported in children previously. Conclusion : Although C. jejuni peritonitis is rarely encountered in children, it should be considered as an etiologic factor for peritonitis.

Escolha do método dialítico - variáveis clínicas e psicossociais relacionadas ao tratamento / Choice of dialysis modality-clinical and psychosocial variables related to treatment

Resumo Introdução: Entre as modalidades dialíticas, é nítida a prevalência da hemodiálise (HD). Objetivos: Verificar quem escolhe modalidade dialítica, e quais variáveis refletem a percepção dos pacientes e equipe de saúde sobre o tratamento. Métodos: O estudo foi realizado em três clínicas de HD e uma de diálise peritoneal (DP). Participaram 220 pacientes, 69,5% em HD e 30,5% em DP. Incluídos pacientes voluntários em tratamento de 90 dias a 2 anos. Dos 54 profissionais de saúde, 18,5% eram médicos, 20,4% enfermeiros e 61,1% técnicos de enfermagem. Foram aplicados dois questionários: um aos profissionais e outro aos pacientes. Resultados: A maioria dos pacientes teve sua modalidade dialítica escolhida pelos médicos: 76,3%. A maioria recusa uma mudança de tratamento tanto na HD (83%) quanto na DP (92,5%). Os pacientes em DP associaram a sua modalidade a maior segurança no tratamento (p = 0,041), bem-estar (p = 0,002), manutenção de uma vida normal (p = 0,002), liberdade (p < 0,001), ânimo (p = 0,021). HD percebe a DP como proporcionando maior liberdade (p = 0,003), autonomia (p < 0,001) e ânimo (p = 0,019). Na avaliação da equipe médica e de enfermagem das variáveis clínicas e psicossociais, os profissionais indicaram em maior frequência os fatores referentes à qualidade de vida (p = 0,007), bem-estar psicossocial (p = 0,007) e bem-estar clínico (p = 0,004) quando associaram a terapia com a DP. Conclusões: A escolha da modalidade dialítica foi decisão exclusivamente dos médicos em 76,3% dos casos. A DP foi considerada pelos profissionais como melhor terapia dialítica no que diz respeito à qualidade de vida, bem-estar clínico e psicossocial.

Abstract Introduction: Among the dialysis modalities, there is a prevalence of hemodialysis (HD). Objectives: To verify who chooses the dialysis modality and which variables reflect the perception of patients and health care team about treatment. Methods: The study was conducted at three clinics of HD and peritoneal dialysis (PD). Two hundred and twenty patients participated in the study, of whom 69.5% were on HD and 30.5% on PD. Included voluntary patients on treatment from 90 days to 2 years, with. Of the 54 health workers, 18.5% were doctors, 20.4% nurses and 61.1% nurse technicians: Two questionnaires were applied: one for professionals and one for patients. Results: Most patients had their modality of dialysis chosen by doctors: 76.3%. Most patients rejected a change of treatment in both HD (83%) and PD (92.5%). There was a significant association by PD patients of their modality with greater safety (p = 0.041), well-being (p = 0.002), near normal life (p = 0.002), freedom (p < 0.001) and high-spirits (p = 0.021). HD patients perceive PD as allowing more freedom (p = 0.003), autonomy (p = 0.001) and high spirits (p = 0.019). In assessing the medical and nursing staff for clinical and psychosocial variables, professionals indicated a greater frequency for variables related to quality of life (p = 0.007), psychosocial well-being (p = 0.007) and clinical well-being (p = 0.004) when associated with PD therapy. Conclusions: The choice of dialysis modality was a decision solely of doctors in 76.3% of cases. PD was considered by the health care team as the best modality therapy with regard to quality of life, clinical and psychosocial well-being.

The influence of dialysis treatment on insulin resistance in patients with end-stage renal disease / 中国医师进修杂志

Objective To compare the effect of two different dialysis modalities, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on insulin resistance in patients with adult end-stage renal disease (ESRD), and to identify the possible predictive factors for insulin resistance. Methods Fifteen non-diabetic patients with ESRD (ESRD group) were selected. Eight patients were treated with HD (HD group), and 7 patients were treated with CAPD (CAPD group). The insulin inhibition was examined by hyper insulin-euglycemic glucose clamp technique before and after dialysis treatment, and the glucose disposal rate (GDR) was used as an index of insulin sensitivity during the clamp technique. Meanwhile, 8 healthy controls were selected as control group. The biochemical parameters which might be associated with insulin resistance were determined by multiple linear regression. Results The GDR in control group was (9.93 ± 1.33) mg/(kg · min), in ESRD group was (6.44 ± 1.76) mg/(kg·min), and there was statistical difference (P<0.05). The GDR in HD group after treatment was increased from (6.53 ± 1.84) mg/(kg · min) to (9.74 ± 2.88) mg/(kg · min), and there was statistical difference (P<0.01). The GDR in CAPD group after treatment was increased from (6.35 ± 1.65) mg/(kg·min) to (8.18 ± 1.76) mg/(kg·min), and there was statistical difference (P<0.05). Multiple linear regression result showed that the levels of urea nitrogen, hematocrit and bicarbonate were significant predictive factors in insulin resistance (P<0.05). Conclusions CAPD and HD therapy can improve insulin resistance in adult patients with ESRD.