Outcomes of Chronic Peritoneal Dialysis by Various Modalities in Korean Children: A Single Center Study

PURPOSE: A single center cross sectional retrospective study was performed to compare the outcomes of different peritoneal dialysis(PD) modalities in Korean children. METHODS: Among children dialyzed with PD between the year 2004 and 2007, 35 children had reliable data on PD adequacy after 3 to 15 months of dialysis. Subjects were grouped by their modalities; 17, 13 and 5 children were on continuous ambulatory PD(CAPD), continuous cyclic PD(CCPD) and nightly intermittent PD(NIPD), respectively. Body weight and height, number of patients taking anti-hypertensives and laboratory data including biochemical and hemoglobin levels were compared. Dialysis adequacy including weekly Kt/Vurea, creatinine clearance (Ccr) and daily water removal were also compared. Patients were sub-grouped by their peritoneal permeability characteristics. RESULTS: The percentage of patients taking anti-hypertensives, monthly change in Z-scores of body weight and height and laboratory data did not differ among the groups. Patients on CAPD and CCPD showed similar dialysis adequacies. Weekly dialytic Ccr was significantly lower in the NIPD group compared to the others. But total Ccr was not different when residual renal function was added. Weekly dialytic Ccr by CAPD was significantly higher than that of CCPD in low and low-average transporters. CONCLUSION: We propose that modality can be selected flexibly according to the patients' preferences. And peritoneal permeability characteristics provide valuable information for adjusting PD prescriptions in ultrafiltration failure or in inadequate dialysis. Further study of other clinical performance measures should be performed to clarify the comparable outcomes in different PD modalities.

A Case of Small Bowel Perforation Associated with Sclerosing Encapsulating Peritonitis in Patient with Intermittent Peritoneal Dialysis (IPD) / 대한신장학회잡지

Sclerosing ecapsulating peritonitis (SEP) first described by Gandhi and Humyn at 1980 is generally recognized, but uncommon complication of continous ambulatory peritoneal dialysis (CAPD) and the prognosis is very poor. A 62-year old female was admitted to our hospital with chief complaint of abdominal pain, nausea, vomiting. On physical examination, abdominal pain was not detected. Abdominal CT demonstrated paralytic ileus and adhesion in proximal ileum. She underwent adhesilolysis of ileum and repair of perforated ileum. We experienced one case of SEP presenting small bowel perforation and peritonitis in patient with IPD. We report this case with review of the literature.

Dos estrategias educativas en el manejo de pacientes con diálisis peritoneal intermitente / Two educational strategies in patients with intermittent peritoneal dialysis

En este trabajo se comparan los efectos de dos estrategias educativas tendentes a incrementar la competencia clínica de la enfermera ante pacientes con diálisis peritoneal intermitente Se realizó un diseño cuasi experimental con dos grupos de estudio. En uno se utilizó una estrategia habitual de tipo expositivo (EHE) y en el otro una estratega promotora de la participación (EPP) o experimental. A todos los participantes se les efectuaron mediciones basares y finales con un instrumento construido exprofeso. Las mediciones básales permitieron apreciar la similitud de ambos grupos en relación con los tres indicadores con que se midió la competencia clínica En cada grupo hubo un incremento significativo: EHE de 34.0 a 42.8 (p-:0.05) y EPP de 31.8 a 39.8 (p-:0.01), sin diferencias entre ambos después de las intervenciones educativas La efectividad de las estrategias resultó semejante. Se hacen diversas consideraciones acerca de los obstáculos que enfrenta una estrategia educativa promotora de la participación de los alumnos.

The effect of two educational strategies that tend to increase the clinical competence of the nurse who treats patients with intermittent peritoneal dialysis are compared in this work. A quasi-experimental study was performed in two groups. In one group the usual expository type strategy was utilized (ETS). In the other group an experimental strategy that promotes participation (SPP) was used. Basal and end measurements were taken to all participants using an instrument especially designed for that purpose. Basal measurements allowed us to observe the similarity of both groups with respect to the three indicators used to measure clinical competency. There were significant increments in both groups: ETS from 34.0 to 42.8 (p< 0.05) and SPP from 31.8 to 39.8 (p< 0.01), with no difference between both groups after the educational interventions. The effectiveness of both strategies was similar. Several considerations are made concerning the difficulties confronted by an educational strategy that seeks to promote student participation.