Comparison of Blood Pressure Control and Left Ventricular Hypertrophy in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD)

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.

Comparison of the BACTEC Blood Culture and Conventional Culture Methods for Isolation of Microorganisms Causing Peritonitis in CAPD Patients / 대한내과학회지

BACKGROUND/AIMS: Peritonitis is the most frequent complication of continuous ambulatory peritoneal dialysis (CAPD). Prompt recognition and treatment of peritonitis is important. The purpose of this study was to compare the effectiveness of isolation of the microorganisms causing CAPD peritonitis by the BACTEC blood culture and conventional methods. METHODS: We retrospectively reviewed 38 episodes of peritonitis in 34 CAPD patients between September 2007 and February 2010. Two methods of processing dialysate from patients on CAPD were used. Blood culture was performed using two 10-mL effluents, which were inoculated into a pair of BACTEC culture bottles. The conventional method was performed using 50 mL of centrifuged dialysate. The sedimented dialysate was inoculated onto blood agar and MacConkey agar plates or into thioglycollate broth. To evaluate effectiveness, we compared the rate of positive culture results and the time to identify the causative organism of the two culture methods. RESULTS: Use of the BACTEC bottle method resulted in more positive culture results than did conventional culture (86.8 vs. 57.9% p = 0.003). The time taken to identify the causative organism from culture-positive peritonitis was more rapid using the blood culture compared with the conventional culture method (90 vs. 109 hr, p = 0.03). CONCLUSIONS: Blood culture using the BACTEC bottle is more effective than the conventional culture technique for detection of causative microorganisms in CAPD peritonitis.

The Effect of an Anti-adhesion Agent in Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion Operation

PURPOSE: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of performing renal replacement therapy in patients with chronic renal failure. A significant complication of CAPD is malfunction of the catheter because of catheter adhesion that leads to catheter malposition. So we evaluated the effect of an anti-adhesive agent called Guardix-Sol(R). METHODS: We prospectively evaluated the clinical results of 78 patients who had received CAPD catheter insertion from Sep. 2007 to May 2009. A test group of 34 patients used the anti-adhesion agent and a control group of 44 patients did not use it. All the procedures were standardized and performed by a single surgeon. RESULTS: The patients consisted of 49 males and 29 females. The common reasons for CAPD insertion were diabetic nephropathy (47 patients) and hypertension (20 patients). Fifteen patients needed reposition operations during their postoperative course, which were done under spinal anesthesia. Out of 15 patients, 3 were from the test group (Guardix-Sol(R) group) and 12 from the control group (P=0.0526). All the repositioned patients had a malpositioned catheter because the greater omentum had adhered to the catheter, except for one patient in each group (P=0.0315). CONCLUSION: Using an anti-adhesive agent for CAPD insertion is an effective method to reduce the incidence of greater omental adhesion. So the rate of reoperation cases for catheter repositioning is decreased.

A Case of Encapsulating Peritoneal Sclerosis, Presenting as Hemoperitoneum, Successfully Treated by Enterolysis / 대한신장학회지

Encapsulating peritoneal sclerosis (EPS) is an uncommon but fatal complication of peritoneal dialysis (PD). Recently, there were some reports of advanced EPS cases that were successfully treated by enterolysis although an intestinal perforation or leakage from intestinal anastomosis were associated with a high mortality. We experienced a case of EPS in a 53-year-old man on PD for 3.5 years without a previous history of episode of peritonitis who presented with hemoperitoneum during treatment of peritonitis. EPS was diagnosed radiologically according to typical CT findings; The series of CT scans revealed how to develop in sequence from a very subtle findings to full-blown findings of EPS. Enterolysis was performed because the patient did not respond to conservative management such as cessation of PD with transfer to hemodialysis, nutritional support and steroid therapy. In spite of intestinal perforation during surgery, he was successfully treated with enterolysis. Therefore, we report this case with review of the literature.

A Case of Encapsulating Peritoneal Sclerosis Significantly Improved after Enterolysis / 대한신장학회지

Encapsulating peritoneal sclerosis (EPS) is a rare but fatal complication of continuous ambulatory peritoneal dialysis (CAPD). There are some reports on the effect of immunosuppressant therapy including steroid, but the results have not always been promising. Recently, owing to the advance of surgical techniques, there are some reports of the EPS cases significantly improved after successful surgery. A 30-year old man developed EPS after 9 years of peritoneal dialysis, and switched to hemodialysis. In spite of repetitive conservative management and immunosuppressant therapy, there was no improvement. His body weight decreased from 50 kg to 40 kg (BMI 14.2 kg/m2) due to severe malnutrition, so we decided to perform surgery. Total intestinal enterolysis was done successfully without concomitant enterectomy, and his general condition improved dramatically. Four months after surgery, the serum albumin concentration increased from 3.1 g/dL to 4.3 g/dL, cholesterol from 92 mg/dL to 208 mg/dL, and hemoglobin from 9.2 g/dL to 12.5 g/dL. His body weight increased to 61 kg (BMI 21.6 kg/m2), and there was not any fluid collection or bowel obstruction seen on the abdominal CT scan. We experienced a case of EPS which was significantly improved after enterolysis. We report this case with review of the literature.

A case of encapsulating peritoneal sclerosis presenting with a fulminant clinical course associated with small intestinal perforation / 대한내과학회지

Encapsulating peritoneal sclerosis (EPS) is a fatal complication of long-term continuous ambulatory peritoneal dialysis. A 55-year old male presented with abdominal pain and a turbid dialysate. He had been maintained on CAPD for 52 months without signs of ultrafiltration failure and had two previous episodes of peritonitis. We removed the peritoneal catheter because of refractoriness to intraperitoneal antibiotic therapy. Immediately after the removal of the peritoneal catheter, he presented with a palpable abdominal mass. An abdominal CT showed loculated fluid collection, enhancement/thickening of peritoneum and tethering of the small bowel. We started total parenteral nutrition, and corticosteroid and tamoxifen therapy. He complained of persistent abdominal pain, nausea and vomiting, despite the therapy. Unexpectedly, om the 10th day after the therapy he died of septic shock as a result of a small intestinal perforation. We report a case of EPS presenting with a fulminant clinical course associated with small intestinal perforation.

Pyridostigmine for Treatment of Acute Colonic Pseudo-obstruction(Ogilvie's syndrome) in a Older Patient on CAPD

In acute colonic pseudo-obstruction(Ogilvie's syndrome, 1948), there is no distal obstruction but colonic obstruction symptom and distended colon is shown radiologicaly and clinically. The etiology of this syndrome are complex of any medical and surgical problem. Elderly patients who are undergoing CAPD have multiple medical problems. But among them only one case which was diagnosed with this syndrome was reported in Korea. Neostigmine is unstable medicine due to muscarinic effects if neostigmine(anticholinesterase inhibitor) has side effects to the CAPD patients with multiple medical problems, it can be fatal. We use pyridostigmine, which has less muscarinic effect, and has similiar potency compared to neostigmine to acute colonic pseudo-obstruction, and thus achieved radiological improvement.

Comparative study of secondary hyperparthyroidism according to the mode of dialysis in patients with end-stage renal disease / 대한내과학회지

BACKGROUND: It has been well known that parathyroid hormone (PTH) plays an important role as a uremic toxin in patients with end-stage renal disease, and develops many abnormalities in musculo-skeletal, nervous, cardiovascular and immune systems, which contributes mortalities and morbidities of the patients. Recently, many researches have reported various clinical significances of PTH. Especially, there is some suggestion that parathyroid hormone level could be used as a new marker of survival in uremic patients. The purpose of this study was to assess the prevalence of secondary hyperparathyroidism according to the modality and duration of dialysis in patients with ESRD and to determine the factors that attribute to increasing iPTH levels. METHODS: From January 1996 to June 2001, 328 dialysis patients who have received maintenance hemodialysis or peritoneal dialysis more than 6 months in Severance Hospital were included in this study. We studied retrospectively by reviewing their medical records and defined hyperparathyroidism, if iPTH level was increased more than three times of upper normal limit. RESULTS: The number of patients with iPTH level greater than 195 pg/mL was 170(49.8%): HD 76 (53.9%), CAPD 94 (50.2%). The average level of iPTH was increased with dialysis duration in both groups, and also, significantly more increased in hemodialysis group than CAPD more than 40months after the beginning of dialysis. The iPTH level was negatively correlated with age and creatinine clearance by simple and multiple regression analysis in both dialysis groups. Alkaline phosphatase and serum phosphorus levels had positive correlation with the level of iPTH in both CAPD and HD patients. Cox regression analysis showed an increment of development of secondary hyperparathyroidism with duration of dialysis. In patients on HD, the prevalence of secondary hyperparathyroidism was much higher than those on CAPD with statistical significance in patients on dialysis more than 40 months. CONCLUSION: In this study, iPTH level was correlated with age, serum phosphorus level and residual renal function at the initiation of dialysis in both groups. And also, in patients on HD, the average level of iPTH and the prevalence of secondary hyperparathyroidism were much higher than those on CAPD with statistical significance. So, we suggest that early dialysis and intensive attention to serum phosphorus level would be required in patients with ESRD for preventing the secondary hyperparathyroidism and more careful monitoring for serum calcium, phosphorus and parathyroid hormone with adequate treatments would be needed especially in hemodialysis patients.

Effect of Peritoneal Dialysis Duration on the Outcome of Peritonitis in CAPD Patients / 대한신장학회잡지

BACKGROUND: The clinical manifestations of peritonitis in long-term PD patients may be more severe due to structural and functional alterations of the peritoneum caused by repeated exposure to the bioincompatible dialysate. However, the study in which outcome of peritonitis was compared to the duration of PD has been reported rarely. This study was performed to evaluate the effect of PD duration on the outcome of peritonitis. METHODS: Medical records of patients cared for in Kyungpook University Hospital between June 1998 and May 2001 were reviewed retrospectively. Patients were divided into three groups by PD duration: group 1, or =37 months. RESULTS: There were 303 episodes (156 patients) of peritonitis during the study periods: 77 episodes in group 1, 115 episodes in group 2 and 111 episodes in group 3. There was no difference in gram- positive, gram-negative or fungal rate of peritonitis among three groups. In group 3, 16.2% of the patients transferred to hemodialysis, while 3.9% and 7.0% of patients in group 1 and 2 transferred to hemodialysis (p<0.05). CONCLUSION: Patients maintained on PD for over three years are associated with higher rate of technique failure than patients maintained on PD for less than three years. PD duration may be considered as a factor for predicting prognosis of peritonitis. Peritonitis in patients on long-term PD needs special attention.

Causative organisms and patterns of antibiotics sensitivity of CAPD peritonitis in different dialysis centers / 대한내과학회지

BACKGROUND: The International Society for Peritoneal Dialysis (ISPD) changed their recommendations for empiric therapy of peritonitis to a first generation cephalosporin to substitute vancomycin and a ceftazidime or an aminoglycoside to cover Gram negative organisms. These guidelines have been recently challenged based on microbiologic evidence and practical considerations. We believe that the management of CAPD peritonitis should be adapted to the specific circumstances affecting the patient, geographic location, local epidemiology of causative bacteria and availability of specific antibiotics. METHODS: To evaluate causative microorganisms and patterns of antibiotics sensitivity of CAPD peritonitis in different dialysis centers, we performed retrospective analysis in three dialysis centers located at different geographic area : Kyungpook University Hospital (Center A), Samsung Seoul Hospital (Center B), Ilsan Hospital (Center C). Among a total of 642 patients on CAPD from January 2001 to December 2001, 113 patients who experienced peritonitis (157 episodes of peritonitis) were included. For microbiologic culture, dialysate effluent was plated in blood agar, thioglycollate broth and McConkey medium. The pattern of antibiotic sensitivity was assessed using broth dilution and disc diffusion method. RESULTS: The sex ratio and proportion of diabetic patients were not different among each center, but the age of center C was higher than that in center A (A: 56.2 13.6, C: 64.6 14.1, p<0.05). Distribution of the causative microorganisms was not different among each center but the pattern of antibiotic sensitivity was different. The incidence of methicillin-resistant staphylococcus species and aztreonam-resistant Gram negative organisms was significantly different among each center. Regimen of 2000 ISPD empiric treatment protocol was ineffective in about 23% of all peritonitis episodes. A treatment with cefazolin instead of vancomycin was associated with resistance in 32.1% of Gram positive organisms and with mobactam instead of ceftazidime was associated with resistance in 23.1% of Gram negative organisms. CONCLUSION: Individual centers should continue to monitor the epidemiology of CAPD peritonitis and the epidemiology of the causative organisms and their sensitivity patterns in order to adapt general guidelines into a center-tailored empirical treatment protocols.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

Peritoneal Equilibration Tests on Continuous Ambulatory Peritoneal Dialysis patients / 대한내과학회지

OBJECTIVES: The peritoneal equilibration test(PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. This study focuses on the evaluation of characteristics of peri toneal solute transport rates and physical and serological factors affecting peritoneal transport rate performed in our continuous ambulatory peritoneal dialysis(CAPD) patients due to guide adequate peri toneal dialysis form. METHODS: We analyzed 95 PET results which had been tested on the 28th day of CAPD and physical and serological values, such as age, sex, diabetes mellitus, height, weight, body surface area, arterial blood pressure, blood urea nitrogen, creatinine, glucose, cholesterol, triglyceride, total protein, albumin, hematocrit, hemoglo bin, sodium, potassium, phosphate which had been ob tained on the day of PET. RESULTS: 1) According to transport rate, high transport rate group was 9 cases(9.5%), high average transport group 26 cases(27.4%), low average transport rate group 32 cases(33.6%), and low transport rate group 28 cases (29.5%) respectivly. 2) The average of 4hour D/PCr was 0.60, 4hour D/Do glucose was 0.46, and drain volume was 2480ml. Thus the average of peritoneal solute transport rate of total patients was low average transport rate. 3) Factors affecting peritoneal solute transport rate were age, body surface area, plasma albumin, serum creatinine and triglyceride level. CONCLUSION: These findings suggest that high dose peritoneal dialysis form should be used in our CAPD patients because most of them have low average peritoneal transport rate, and age, body surface area, plasma albumin, serum creatinine, and triglyceride level should be consid ered when select the adequate peritoneal dialysis form.

A Comparative Study of Three Connector Systems in Continuous Ambulatory Peritoneal Dialysis(CAPD) Related Peritonitis / 대한내과학회지

OBJECTIVES: The purpose of the present study was to compare the general condition of peritonitis through a study of three connector systems : The Straight transfer set with Spike-and-Pork system(SPS), The Straight transfer set with Luer-Lock system(SLS), and The Y-set with Two Bag system(YS). METHODS: We reviewed our experience with 134 patients from 1988.1 to 1995.12. According to various kinds of connector system, we divided cases into 3 groups : The SPS(1988. 1-1991. 3) was used on 55 patients(mean age 47+/-2, M:F=30:25); The SLS(1991.4-1993.8) on 45 patients(mean age 55+/-1, M:F=30:15); and The YS(1993.9-1995.12) on 34 patients(mean age 49+/-5, M:F=15:19). RESULTS: 1) Total CAPD duration was 1.22 patient year in SPS, 1.08 in SLS, and 0.96 in YS. The incidence of peritonitis is 1.71 episodes per patient year in SPS, 1.03 in SLS, and 0.61 in YS. 2) Among the causative organisms of peritonitis, coagulase negative Staphylococcus was most common in the three groups(SPS:10.4%, SLS:10%, YS:20%). In SPS and SLS, S. aureus(7.7%, 8%), Pseudomonas(6.5%, 8%), E. coli(5.2%, 6%) were present in decreasing order. In YS, Pseudomonas (15%), S. aureus(15%), E. coli(10%) were present in decreasing order. There were no growth of organisms in 55.9% of SPS, 38% of SLS, and 30% of YS. 3) The probability of experiencing the first peritonitis at 1, 3, 6, and 12 months was 21.4%, 21.4%, 21.4%, and 23.9% respectively in SPS, 3.4%, 34.5%, 34.5%, and 10.3% respectively in SLS, and 0%, 28.5%, 35.7%, and 28.5% respectively in YS. 4) In the response to the treatment of peritonitis, 59.7% of the peritonitis episodes in SPS, 72% in SLS, and 85% in YS were cured with antibiotics. In 37.7% of the peritonitis episodes in SPS, 24% in SLS, and 10% in YS, the catheter was removed due to fungal, tubercolous, recurrent, or peritonitis not responding to antibiotics. 2 patients in SPS, 2 patients in SLS, and 1 patient in YS died due to peritonitis. 5) The catheter survival rate at 3, 6, 12 months was 72%, 63.6%, and 40% respectively in SPS, 89%, 78.3%, and 46.7% respectively in SLS, and 94%, 85.3%, and 76.6% respectively in YS. CONCLUSION: Our study suggests that there is a relationship between the development of connector system and a decrease of peritonitis in CAPD.

Effcts of Hemodialysis and Contiuous Ambulatory Peritoneal Dialysis on Thyroid Function in Chronic Renal Failure / 대한신장학회잡지

The changes of thyroid hormones are expected in patients with chronic renal failure(CRF) because the kidney plays an important role in metabolism and excretion of thyroid hormones. In spite of many studies about this issue, there have not been full consensus about the nature and mechanism of thyroid hormone changes. We undertook the present study to reveal the dialysis effects on these hormones. We measured basal levels of serum total T3 (T3), total T4(T4), free T4(FT4), reverse T3(rT3) and TSH, and then calculated the ratio of T3/T4, rT3/T3 and rT3/T4. The following groups were identifed : Group I-10 cases of normal controls, Group II-18 cases of pre-dialysis or treated conservatively, Group III-20 cases treated by maintenance hemodialysis(HD), Group IV-18 cases treated by continuous ambulatory peritoneal dialysis(CAPD). Patients from group II, III and IV revealed significantly decreased levels of T3 and T4, and increased ratio of rT3/T4 in comparison to the control group(P36months), the mean concentrations of free T4 levels revealed signifcantly decreased in comparison to the short-term dialysis group(P<0.05). Thyroid dysfunction are observed in CRF patients with partial recovery after dialysis therapy. Especially, CAPD achieves significantly improved thyroid dysfunction compared to HD, but further study would be necessary.

Efficacy and Safety of the Modification of the Y-TEC(R) Procedure in Peritoneal Catheter Placement: Clinical Results in 65 Patients / 대한신장학회잡지

The Y-TEC(R) system is an equipment for the peritoneoscopic placement of peritoneal dialysis catheter. The advantage of this method is the direct visualization of peritoneal cavity by using a small diameter minitrocar and dilatable guide. But this method has some limitations because of the expensive equipment and the difficulty in being expert at peritoneoscopy. We placed the CAPD catheter by using a minitrocar without peritoneoscopy(so called Modified Y- tec(R) system) in 44 patients who had no history of major abdominal surgery(MY-group), the classic Y- tec(R) system in 8 patients(Y-group), and surgical method in 13 patients with history of major abdominal surgery(S-group) and compared the effecacy and safety of three methods. In conclusion, the short and long term results of blind minitrocar placements were comparable to, or better than the surgical and other percutaneous methods of catheter implantation when they were used in the patients without history of major abdominal surgery.

Nine Kinds of Tumor Markers in Patients on Continuous Ambulatory Peritoneal Dialysis / 대한신장학회잡지

Tumor markers have been clinically used to monitor the progression of various tumors or to assess their response to therapy. We studied the effects of continuous ambulatory peritoneal dialysis(CAPD) on the serum levels of nine tumor markers; carcinoembryonic antigen(CEA), squamous cell carcinoma- related antigen(SCC), CYFRA 21-1, CA(carbohydrate antigen) 125, CA 19-9, -fetoprotein(AFP), prostate specific antigen(PSA), human chorionic gonadotropin (hCG) and CA 72-4.Serum tumor markers were measured in 68 persons without chronic renal failure (CRF) as controls, and 46 stable CAPD patients who did not present any evidences of neoplasia. The results were as followings: 1) Serum AFP, PSA, hCG and CA 72-4 levels were almost within normal limits in the peritoneal dialysis similar to normal control groups; positive values were 2.2%, 3.8%, 8.3% and 4.0%, respectively. 2) Serum tumor markers, which were raised in the peritoneal dialysis compared to normal controls, include; CEA (5.29+/-3.6 vs. 1.42+/-1.0, P<0.001); SCC (3.90+/-5.57 vs. 0.9+/-1.1, P<0.01); CYFRA 21-1 (5.45+/-3.2 vs. 1.80+/-1.5, P<0.001); CA 125 (31.22+/-40.8 vs. 17.91+/-11.7, P<0.001); CA 19-9 (24.25+/-18.3 vs. 14.41+/-12.1, P<0.01). Raised CEA, SCC, CYFRA 21-1, CA 19-9 and CA 125 levels were detected 50%, 75%, 88.6%, 21.6% and 20.0% of peritoneal dialysis patients. In conclusion, serum levels of CEA, SCC, CYFRA 21-1, CA 19-9, CA 125 cannot be used as prognostic indicators for patients with malignancy while undergoing peritoneal dialysis treatment, but the other tumor markers such as AFP, PSA, hCG and CA 72-4 can be used as reliable tumor markers for patients of peritoneal dialysis similar to normal healthy people.

Studies on Lymphocyte Subpopulations and Cell-mediated lmmunity in Patients with Chronic Renal Failure

Several parameters of cell-mediated immunity thirty-eight patients with end stage chronic renal failure were measured including total lymphyocytes, B-and T-lymphocytes, T-cell subsets and the mitogenic reponse to PHA and Con A at three different times; before dialysis, 3 months and 12 months after dialysis treatment. There were no significant differences in the absolute numbers of peripheral leukocytes between each patient and the control group. But the absolute numbers of lymphocytes of each patient group were significantly reduced compared to the control group (p< 0.01). The proportion of peripheral blood active T cells and helper T cells was significantly reduced both in the predialysis uremic and dialysis populations compared to the control group, although the helper/suppressor(OKT4/OKT8) ratio was not different between each patient and the control group except for a lower ratio in the hemodialysis 12 month follow-up group (HD 12M). With respect m the PHA and Con A stimulation tests, the stimulation indices of the predialysis and hemodialysis groups were significantly lower than those of the control group. However, patients on continuous ambulatory peritoneal dialysis (CAPD) exhibited a normal mitogenic response and a lower suppressor cell removal index compared to the patients on hemodialysis, suggesting an improved cell-mediated immunity in the patients undergoing CAPD.