Habilidad de cuidado del cuidador principal del adulto mayor con diálisis peritoneal / Caregiver skills of the main caregiver of the older adult with peritoneal dialysis

Introducción: la enfermedad renal crónica tiene consecuencias graves para los adultos mayores. La diálisis peritoneal continua ambulatoria es una alternativa de tratamiento, pero afecta la calidad de vida del paciente, la familia y el cuidador primario, por lo que se requiere un cuidador con habilidades que ofrezca apoyo en algunas actividades elementales y, además, apoye emocional y espiritualmente al paciente. Objetivo: identificar el nivel de la habilidad del cuidador primario del adulto mayor con diálisis peritoneal. Metodología: estudio descriptivo en 80 cuidadores familiares de adultos mayores con diálisis peritoneal continua ambulatoria. Se utilizó el instrumento Habilidad de cuidado del cuidador familiar, que consta de 55 reactivos y se divide en tres dimensiones: relación, 27 reactivos; comprensión, 18 reactivos; y modificación de la vida, 10 reactivos. El instrumento incluye variables sociodemográficas, de parentesco y tiempo dedicado al cuidado. Se elaboró una base de datos y éstos se analizaron mediante estadística descriptiva. Resultados: la habilidad de cuidado fue alta en 65%; la dimensión de relación resultó alta en 38.8% y media en 61.3%, con una comprensión alta en 86.2% y modificación de la vida alta en 68.8%. Los cuidadoras fueron mujeres en 85%; 46.3% cuidó > 37 meses; 50% cuidó > 24 h, y padres y esposa(o) apoyaron en 91.3%. Conclusión: estos hallazgos muestran que las habilidades de los cuidadores primarios fueron en general buenas, con la notoria participación del personal de enfermería en la capacitación y el apoyo recibido.

Introduction: Chronic kidney disease has severe consequences for older adults, and continuous ambulatory peritoneal dialysis is an alternative treatment, but it affects the quality of life of patient, family, and primary caregiver. It requires a caregiver with caregiving skills to provide support in some elemental activities, as well as emotional and spiritual support to the patient. Objective: To identify the level of caregiving skills of the primary caregiver of the older adult on peritoneal dialysis. Methodology: Descriptive study in 80 family caregivers of older adults with continuous ambulatory peritoneal dialysis. It was used the Caregiving skill of the family caregiver instrument, which consists of 55 items, divided into three dimensions: relationship, 27 items; understanding, 18 items; and life modification, 10 items. The instrument includes sociodemographic, relationship and time spent variables. A database was created and it was used descriptive statistics analysis. Results: Caregiving skills were high in 65%; relationship dimension high in 38.8%, and medium in 61.3%; understanding high in 86.2%; life modification high in 68.8%. 85% were female caregivers; 46.3% spent > 37 months providing care, 50% provided care > 24 hours; parents and wife/husband supported in 91.3%. Conclusion: Our findings show that caregiving skills of pri- mary caregivers were generally good with the significant involvement of the nursing staff in the training and support received.

Manifestaciones dematológicas en pacientes con insuficiencia renal crónica, en diálisis perinatal automatizada intermitente / Dermatological Manifestations in Patients with Chronic Renal Failure in Intermittent Automated Peritoneal Dialysis

La enfermedad renal crónica es la vía final común de distintas patologías que afectan al parénquima renal. La prevalencia e incidencia de esta enfermedad se ha incrementado en las últimas décadas de forma exponencial, que la convierte en un grave problema de salud pública a nivel mundial, de acuerdo a su estadio requiere terapia de sustitución renal tipo diálisis peritoneal. La piel y sus anexos son afectados cuando existe un deterioro crónico de la función renal, algunas de las cuales influyen notoriamente en la calidad de vida de estos pacientes. Objetivo: identificar las manifestaciones en piel de los pacientes con enfermedad renal crónica, en diálisis peritoneal. Material y Métodos: estudio no experimental, transversal, descriptivo. Previo consentimiento informado, se evaluó a todos los 87 pacientes en diálisis peritoneal automatizada intermitente, de la sala de Nefrología del Hospital Escuela Universitario, de julio a diciembre del 2017. Se aplicó instrumento obteniendo datos generales, condición metabólica actual, tiempo en diálisis peritoneal y se realizó examen físico en búsqueda de manifestaciones dermatológicas por un dermatólogo, el día que asistieron a su sesión programada de diálisis. Se utilizó el programa estadístico Epi-Info versión 7.2. Resultados: todos los pacientes estudiados tenían al menos 2 manifestaciones dermatológicas, las de mayor frecuencia fueron: xerosis 72(82.8%), palidez 80(81.4%), alteraciones ungüeales 64(73.4%), prurito 56(64.4%), alteraciones pigmentarias 47(54%) y alteraciones en pelo 46(52.9%). Conclusión: la xerosis fuela manifestación más frecuente; no se encontró relación entre xerosis y prurito, ni entre prurito y niveles de azoados, calcio o fosforo. La principal manifestación en uñas fue onicopaquia y en pelo dermatitis seborreica.La incidencia de manifestaciones dermatológicas en pacientes con enfermedad renal crónica fue mayor a la de otros estudios, es importante identificar estos signos y síntomas para realizar diagnósticos tempranos y tratamientos oportunos...(AU)

Peritoneal Dialysis

SUMMARY Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).

RESUMO A diálise peritoneal (DP) é uma terapia renal substitutiva baseada na infusão de uma solução estéril na cavidade peritoneal através de um cateter, proporcionando a remoção de solutos e água usando a membrana peritoneal como superfície de troca. Essa solução, em contato com os capilares do peritônio, permite o transporte difuso de solutos e a perda de água por ultrafiltração osmótica, uma vez que é hiperosmolar ao plasma devido à adição de agentes osmóticos (normalmente, a glicose). A infusão e drenagem da solução dentro da cavidade peritoneal pode ser realizada de duas maneiras: manualmente (DP ambulatorial contínua), em que o paciente, geralmente, passa por quatro trocas de solução durante o dia, ou por DP mecânica (automatizada), em que a diálise é realizada com o auxílio de uma máquina de diálise que permite que as trocas sejam feitas durante a noite, enquanto o paciente está dormindo. A prescrição e o acompanhamento da DP envolvem a caracterização do tipo de transporte peritoneal e a avaliação da dose de diálise oferecida (depuração do soluto), bem como o diagnóstico e tratamento de possíveis complicações relacionadas ao método (infecciosas e não infecciosas).

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.

Síntomas gastrointestinales en pacientes en Programa de diálisis peritoneal continua ambulatoria en Hospital Nacional Rosales, durante los meses de Febrero a Marzo 2019 / Gastrointestinal symptoms in patients in continuous ambulatory peritoneal dialysis program at Hospital Nacional Rosales, during the months of February to March 2019

Los síntomas gastrointestinales son comunes en pacientes con enfermedad renal crónica terminal (ERCT) y puede llegar a ser de un 77 a 79%, los síntomas prevalentes más comunes son estreñimiento, indigestión, dolor abdominal y pirosis. La escala de evaluación de síntomas gastrointestinales (GSRS) y el cuestionario de la calidad que vida de reflujo y dispepsia (QOLRAD), han sido desarrolladas para evaluar pacientes con dispepsia, las características psicométricas en los diferentes lenguajes son buenas con confiabilidad y validación aceptable. Materiales y Métodos: se realizó un estudio descriptivo, de tipo prospectivo de corte transversal en 64 pacientes que asisten a diálisis peritoneal continua ambulatoria (DPCA) del Hospital Nacional Rosales, se obtuvieron características clínicas de los pacientes como edad, sexo, comorbilidades asociadas, tiempo en diálisis peritoneal y de DPCA, y se evaluaron los cuestionarios GSRS y QOLRAD. Resultados: La frecuencia de síntomas gastrointestinales (GSRS >1) es de un 90.6%, la indigestión es el síntoma más frecuente con 79.7%, seguido de reflujo con un 64.7%, El QOLRAD mostró que el impacto sobre la calidad de vida es leve, donde se encontró la mayor prevalencia de síntomas fue vitalidad (36%) y en problemas con comida y bebida (29.8%). Discusión: La frecuencia de síntomas gastrointestinales medida por la escala de GSRS en pacientes en DPCA es alta, en comparación con la literatura internacional. La indigestión y reflujo son los síntomas predominantes en estos pacientes, en la escala QOLRAD hay afectación en la calidad de vida la cual es leve.

Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study

Efficacy of triple diuretic treatment in continuous ambulatory peritoneal dialysis patients: A randomized controlled trial

BACKGROUND: The efficacy of combined diuretic treatment in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known. METHODS: In a single-center, double-blinded, randomized controlled trial, we randomly assigned 51 adult CAPD patients to receive furosemide 1,000 mg/day, hydrochlorothiazide 100 mg/day, and spironolactone 50 mg/day (triple diuretics [TD] group) or furosemide 1,000 mg/day plus placebo (single diuretic [SD] group) for 6 months. The primary outcome was the difference in daily urine output at the 3rd and 6th month of the study compared to baseline (ΔUO) between the SD and TD group. Secondary outcomes were urinary sodium (UNa) and potassium (UK) excretion and overhydration (OH) measured by bioimpedance at 3 and 6 months compared to baseline (ΔUNa, ΔUK, and ΔOH, respectively) and daily glucose exposure (g/day). RESULTS: Forty-three of 51 patients completed the 6-month trial. The ΔUO at 3 and 6 months was significantly higher in the TD group compared to the SD group (386.32 ± 733.92 mL/day vs. −136.25 ± 629.08 mL/day, P < 0.001, at 3 months; 311.58 ± 640.31 mL/day vs. 120.00 ± 624.07 mL/day, P < 0.001, at 6 months) but there was no significant difference in ΔUNa and ΔUK excretion. Hydration status was significantly better in the TD group (ΔOH 1.84 ± 2.27 L vs. 0.44 ± 1.62 L, P = 0.03, at 3 months; 1.49 ± 2.82 L vs. −0.48 ± 2.61 L, P = 0.02, at 6 months). There was no serious adverse event in this study. CONCLUSION: For end-stage renal disease patients on CAPD, the combination of furosemide, hydrochlorothiazide, and spironolactone results in higher urine output and better volume control compared to furosemide alone.

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.

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.

Peritoneal dialysis-related eosinophilic peritonitis: a case report and literature review / 北京大学学报(医学版)

Peritoneal dialysis (PD)-related peritonitis is recognized as a common complication of peritoneal dialysis. Eosinophilic peritonitis is a rare type of non-infection PD-related peritonitis. Eosinophilic peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients was first reported in 1967. The cause of eosinophilic peritonitis is obscure, however it may be related to some etiologies: (1) hypersensitivity to PD materials, including catheter or dialysate; (2) bacteria, fungal or mycobacterium tuberculosis infection. Clinical investigations include asymptomatic cloudy PD effluent, fever, abdominal pain and eosinophil count elevate in PD effluent. Eosinophilic peritonitis is usually mild and self-limited. With the development of PD, more eosinophilic peritonitis cases and researches were reported. Here, we report a patient on CAPD with eosinophilic peritonitis. A 71-year-old female patient developed end-stage renal disease for 4 years and underwent CAPD (2 000 mL of 1.5% dialysis solution with four exchanges daily) for 5 months. With a history of unclean food, she was hospitalized for complaints of diarrhea, fever and cloudy peritoneal effluent for 10 days. Dialysis effluent showed an elevated white blood cell (WBC) count of 1 980 cell/mm3, with 60% polymorphonuclear cells. She was diagnosed as PD-related peritonitis, and therapy was initiated with intraperitoneal ceftazidime 1 g once a day and vancomycin 500 mg every other day. She was admitted to the hospital as the symptoms were not relieved. Her peripheral blood cell count showed a total WBC count of 6 940 cells/mm3, 36.8% eosinophil. Her PD effluent analysis showed turbidity, total WBC count of 1 480 cells/mm3, and 83% polymorphonuclear cells. Her dialysate bacteria culture, fungus culture, polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR), acid-fast stain were all negative. On admission day 4, the treatments were changed to levofloxacin 200 mg once a day and vancomycin 500 mg every other day. After two weeks of antibiotics treatment, patient's symptoms were not completely improved and her dialysis effluent remained cloudy. Her blood eosinophil count elevated to 36.8%，eosinophil proportion in PD effluent>90% and PD effluent pathological findings showed eosinophil>90%. Eosinophilic peritonitis was diagnosed and a decision was made to give loratadine daily dose of 10 mg orally. The possible reasons might be the patient's allergy to some components of PD solution or connection systems in the beginning of PD, and this bacterial peritonitis episode, as well as the application of vancomycin, might lead to the fact that eosinophilic peritonitis acutely developed. For there was no improvement in clinical symptoms, loratadine was stopped, and the patient was discharged 18 days later, and received follow-up closely. Two months later, eosinophil count in blood and PD fluid decreased to normal range with no symptom. This case reminds us that in any PD-related peritonitis patient with prolonged symptoms after appropriate antibiotic therapy, and typical clinical symptoms, the diagnosis of eosinophilic peritonitis should be considered. For the count and percentage of eosinophils are not routinely reported in most laboratories, doctors need to contact the department of laboratory and the department of pathology, to confirm the cell count and proportion of eosinophils in dialysis effluent, so as to make the definite diagnosis, which can not only avoid antibiotics overuse, but also avoid antibiotics-induced eosinophilic peritonitis (such as vancomycin).

Peritoneal-pleural leak improved by switching from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis

No abstract available.

Calidad de vida relacionada con la salud en pacientes con diálisis peritoneal continua ambulatoria. Eje cafetero colombiano 2015 / Quality of life related to health in patients with continuous ambulatory peritoneal dialysis. Colombian coffee axis, 2015 / Qualidade de vida relacionada à saúde em pacientes contínuos peritoneal ambulatorial Com diálise. Eixo de café colombiano, 2015

ResumenIntroducción. El objetivo de esta investigación fue evaluar la calidad de vida relacionada con la salud (CVRS) en pacientes con diálisis peritoneal continua ambulatoria (DPCA), en tres unidades renales del eje cafetero de Colombia, en 2015.Método. La metodología de este trabajo está sustentada en un diseño descriptivo transversal. Participaron voluntariamente 185 personas del Programa de DPCA. Se aplicó encuesta y cuestionario SF-36, [Alfa de Cronbach >0,7] y análisis binominal y multinominal. En escalas de 0 a 100 puntos de peor a mejor CVRS, se calculó medias por dimensión. Se utilizó el software SPSS-v21.Resultados. Población con alta vulnerabilidad socioeconómica. Comorbilidad con hipertensión y diabetes.Percepción de mejor CVRS en dolor corporal (Me=87,2) y función social, (Me=76,8). Peor CVRS en Rol físico (Me=52,1) y Rol emocional (Me= 57,3). Sin diferencias por género, la CVRS empeora con la edad.Conclusión.El cuidado de pacientes con DPCA requiere más investigación por enfermería. Intervenciones y evaluaciones de seguimiento en autocuidado domiciliario y apoyo social en roles físico y emocional. Se deben controlar eventos precursores de ERC.

AbstractIntroduction.The objective of this research was to evaluate the quality of life related to health (HRQOL) in patients with Continuous Ambulatory Peritoneal Dialysis (CAPD), in three renal units of the Colombian coffee industry, in 2015.Method.The methodology of this work is based on a descriptive cross - sectional design. 185 volunteers from the DPCA Program participated voluntarily. A SF-36 questionnaire, [Cronbach's alpha> 0.7] and binominal and multinominal analysis were applied. In scales of 0 to 100 points from worse to better HRQoL, we calculated means by dimension. SPSS-v21 software was used.Results.Population with high socioeconomic vulnerability. Comorbidity with hypertension and diabetes.Perception of best HRQOL in Body pain (Me = 87.2) and Social function, (Me = 76.8). HRQL in Physical role (Me = 52.1) and Emotional role (Me = 57.3). Without gender differences, HRQL worsens with age.Conclusion.Caring for patients with CAPD requires more research per nursing. Interventions and follow-up evaluations in home self-care and social support in physical and emotional roles. ERC precursor events should be controlled.

ResumoIntrodução. A grande quantidade de pacientes atendidos nas consultas externas hospitalárias e conhecer a importância de suas opiniões sobre o atendimento recebido neste serviço motiva o desenvolvimento do presente estudo, o qual busca conhecer a opinião de um grupo de usuários sobre as consultas externas de três hospitais públicos da cidade de Madrid e identificar fatores que influem na satisfação global destas pessoas.Método. Realizou-se um estudo descritivo transversal no qual se entrevistaram a 150 usuários de consultas externas mediante um questionário auto-administrado, previamente validado que constava de 12 ítens, englobados em duas dimensões com uma escala tipo Likert de 1 a 10 em função ao grau de satisfação, dos quais se obteve resultados sociodemográficos e de tipo descritivo. Por outra parte, se realizou uma análise bivariante na que se detectaram diferenças significativas em función do sexo, do nível acadêmico, da nacionalidade e da idade.Resultados. Na análise descritiva do questionário merece atenção que a qualidade administrativa é valorada abaixo de 5 pontos, enquanto que para a clínica, a valoração é de 6 pontos aproximadamente, da que resulta uma valoração do questionário total um pouco superior a 5. O tempo de espera em consultas foi o ítem que obteve a valoração média mais baixa de todo o questionário, com algo mais de 3,5 sobre 10, enquanto que a mais alta foi a obtida para o ítem referido ao atendimento por parte do pessoal de enfermagem, com uma nota de quase 7.Conclusão.Pode-se afirmar que na amostra estudada somente existem dois fatores que se relacionam com o incremento da satisfação dos usuários nas consultas externas: sexo masculino e haver cursado estudos universitários.

Sobrecarga de hierro y mecánica cardíaca anormal en pacientes con enfermedad renal crónica en diálisis peritoneal continua ambulatoria. Instituto Salvadoreño del Seguro Social año 2017 / Iron overload and abnormal heart mechanics in patients with chronic kidney disease in continuous ambulatory peritoneal dialysis. "Instituto Salvadoreño del Seguro Social" year 2017

En los pacientes con enfermedad renal crónica (ERC) los niveles de ferritina sérica han aumentado dramáticamente en los últimos años, se ha planteado la preocupación que la hiperferritinemia refleje excesivas reservas de hierro, con daño miocárdico secundario, muy bien establecido en pacientes con siderosis primarias. Sin embargo, las consecuencias en pacientes con ERC siguen siendo inciertas. El presente estudio persiguió identificar la asociación de la sobrecarga de hierro con índices anormales de mecánica cardíaca en pacientes con ERC en diálisis peritoneal continua ambulatoria (DPCA). Diseño y métodos: analítico, de casos y controles, doble ciego. Se incluyeron 52 pacientes en DPCA, de 18 a 60 años, se excluyeron pacientes con cardiopatía previamente conocida, hospitalización, desnutrición, enfermedades inflamatorias crónicas. Se categorizó como casos, aquellos con niveles séricos de ferritina 2000 ng/ml (n=26), y el resto, como controles (n=26). Se realizó ecocardiografía convencional y con speckle tracking, se midió deformación longitudinal global, deformación circunferencial global y twist. Las diferencias entre los grupos se calcularon usando prueba t de Student o chi cuadrado. Resultados: La edad media fue 41.2 años, 79% fueron hombres. El valor de ferritina de los casos fue 2816 ± 567.5ng/dl, de los controles fue 445 ± 328 ng/ml. Todos los participantes fueron encontrados con algún grado de hipertrofia ventricular izquierda y dilatación auricular izquierda, independientemente del valor de ferritina sérica. Un 11.5% presentó disfunción sistólica al menos moderada y el 5.8% presentó una severa disfunción sistólica, sin diferencias entre los grupos. No existieron diferencias entre los grupos en el valor de deformación longitudinal global: -15% ±4.5 vrs -16% ±4 (p 0.19), en la deformación circunferencial global:-14% ±4.2 vrs -14% ±4.9 (p 0.68) y en el twist: 12% ±6.7 vrs 12% ±4.6 (p 0.94). Conclusiones: En pacientes con ERC en DPCA no existe asociación significativa entre la mecánica cardíaca anormal determinada por speckle tracking y los niveles séricos de ferritina

Numerical expression of volume status using the bioimpedance ratio in continuous ambulatory peritoneal dialysis patients: A pilot study

BACKGROUND: Volume overload results in higher mortality rates in patients on continuous ambulatory peritoneal dialysis (CAPD). The ratio of bioimpedance (RBI) might be a helpful parameter in adjusting dry body weight in CAPD patients. This study examined whether it is possible to distinguish between non-hypervolemic status and hypervolemic status in CAPD patients by using only RBI. METHODS: RBI was calculated as follows: RBI = impedance at 50 kHz/impedance at 500 kHz. Based on the experts’ judgements, a total of 64 CAPD patients were divided into two groups, a non-hypervolemic group and a hypervolemic group. The RBI was measured from right wrist to right ankle (rw-raRBI) by bioimpedance spectroscopy (BCM®, Fresenius Medical Care) before and after the peritosol was emptied. Other RBIs were measured from the right side of the anterior superior iliac spine to the ipsilateral ankle (rasis-raRBI) to control for the electro-physiological effects of peritoneal dialysate. RESULTS: The mean rw-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients in the presence (1.141 ± 0.022 vs. 1.121 ± 0.021, P < 0.001) of a peritosol. Likewise, the mean rasis-raRBI of non-hypervolemic patients was higher than that of hypervolemic patients (presence of peritosol: 1.136 ± 0.026 vs. 1.109 ± 0.022, P < 0.001; absence of peritosol: 1.131 ± 0.022 vs. 1.107 ± 0.022, P < 0.001). CONCLUSION: The volume status of CAPD patients was able to be simply expressed by RBI. Therefore, this study suggests that when patients cannot be analyzed using BCM, RBI could be an alternative.

Relationship between trajectories of serum albumin levels and technique failure according to diabetic status in peritoneal dialysis patients: A joint modeling approach

BACKGROUND: In peritoneal dialysis, technique failure is an important metric to be considered. This study was performed in order to identify the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure on end-stage renal disease patients according to diabetic status. Furthermore, this study was performed to reveal predictors of serum albumin and technique failure simultaneously. METHODS: This retrospective cohort study included 300 (189 non-diabetic and 111 diabetic) end-stage renal disease patients on continuous ambulatory peritoneal dialysis treated in Al-Zahra Hospital, Isfahan, Iran, from May 2005 to March 2015. Bayesian joint modeling was carried out in order to determine the relationship between trajectories of serum albumin levels and peritoneal dialysis technique failure in the patients according to diabetic status. Death from all causes was considered as a competing risk. RESULTS: Using joint modeling approach, a relationship between trajectories of serum albumin with hazard of transfer to hemodialysis was estimated as −0.720 (95% confidence interval [CI], −0.971 to −0.472) for diabetic and −0.784 (95% CI, −0.963 to −0.587) for non-diabetic patients. From our findings it was showed that predictors of low serum albumin over time were time on peritoneal dialysis for diabetic patients and increase in age and time on peritoneal dialysis, history of previous hemodialysis, and lower body mass index in non-diabetic patients. CONCLUSION: The results of current study showed that controlling serum albumin over time in non-diabetic and diabetic patients undergoing continuous ambulatory peritoneal dialysis treatment can decrease risk of adverse outcomes during the peritoneal dialysis period.

Clinical analysis for patients with continuous ambulatory peritoneal dialysis associated peritonitis / 中南大学学报(医学版)

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.

Tratamento com diálise peritoneal: a prática do autocuidado no contexto familiar / Peritoneal dialysis treatment: self-care practice in the family context / Tratamiento con diálisis peritoneal: la práctica del autocuidado en el contexto familiar

Os objetivos do estudo foram identificar as dificuldades enfrentadas pelos clientes ao realizar a diálise peritoneal ambulatorial contínua (DPAC) no domicílio e analisar as soluções por eles adotadas para lidar com elas. Recorte de dissertação aprovada em 2010, sendo um estudo descritivo, qualitativo, que utilizou o método da Pesquisa Convergente-Assistencial, cujo cenário foi um hospital estadual do Rio de Janeiro. Realizaram-se três grupos de encontros com nove sujeitos. A técnica da entrevista semiestruturada originou temas que resultaram na categoria convivência com o tratamento - pontos dificulta dores na realização da DPAC no domicílio. Os participantes afirmaram que dificuldades do tratamento podem ser superadas mediante adaptação individual com auxílio da equipe de enfermagem, de redes de apoio e de familiares. Demonstrou-se a necessidade de que o modelo pedagógico utilizado para o processo educativo dos clientes seja repensado, intermediando os saberes científicos com os saberes populares.

The study objectives were to identify the difficulties faced by clients in performing continuous ambulatory peritoneal dialysis (CAPD) at home, and to analyze the solutions they encountered. Drawn from a dissertation approved in 2010, article reports a descriptive, qualitative study using the Convergent-Care Research method. With a state hospital in Rio de Janeiro as scenario, three groups of meetings were held with nine subjects. The semi-structured interview technique yielded themes that resulted in the category coexisting with the treatment – difficult points in carrying out CAPD at home. The participants noted that difficulties in the treatment can be overcome by individual adaptation with the help of nursing staff, support networks and family. It was demonstrated that the teaching model used for client education needs to be rethought soas to mediate between scientific knowledge and popular knowledge.

El objetivo del estudio consistió en identificar las dificultades enfrentadas por los clientes al realizar diálisis peritoneal continua ambulatoria (DPCA) en casa y analizar las soluciones adoptadas para hacerles frente. Parte de disertación aprobada en 2010, consistiendo en un estudio descriptivo y cualitativo que utiliza el método de Investigación Convergente Asistencial. En el escenario, un hospital del estado de Río de Janeiro, tuvieron lugar tres grupos de encuentros con nueve individuos. La técnica de entrevista semiestructurada originó temas resultaron en la categoría Convivencia con el tratamiento - puntos que dificultan la realización de la DPCA en casa. Los participantes señalar on que las dificultades del tratamiento se pueden superar mediante la adaptación individual con ayuda del personal de enfermería, de redes de apoyo y de la familia. Se ha demostrado la necesidad de que el modelo pedagógico utilizado para el proceso educacional de los clientes se a repensado, intermediando el conocimiento científico con los saberes populares.