Clinical Outcome and Risk Factors of Treatment Failure of Peritoneal Dialysis Associated Peritonitis Caused by Klebsiella Pneumoniae:A Multicenter Study / 中国医学科学院学报

Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli.Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae. Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli.The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP (P=0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP (OR=1.082,95%CI=1.011-1.158,P=0.023).Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.

Evaluation of the relationship between cardiac calcification and cardiovascular disease using the echocardiographic calcium score in patients undergoing peritoneal dialysis: a cross-sectional study

INTRODUCTION@#An echocardiographic calcium score (ECS) predicts cardiovascular disease (CVD) in the general population. Its utility in peritoneal dialysis (PD) patients is unknown.@*METHODS@#This cross-sectional study assessed 125 patients on PD. The ECS (range 0-8) was compared between subjects with CVD and those without.@*RESULTS@#Among the subjects, 54 had CVD and 71 did not. Subjects with CVD were older (69 years vs. 56 years, P < 0.001) and had a higher prevalence of diabetes mellitus (DM) (81.5% vs. 45.1%, P < 0.001). They had lower diastolic blood pressure (72 mmHg vs. 81 mmHg, P < 0.001), lower phosphate (1.6 mmol/L vs. 1.9 mmol/L, P = 0.002), albumin (30 g/L vs. 32 g/L, P = 0.001), parathyroid hormone (34.4 pmol/L vs. 55.8 pmol/L, P = 0.002), total cholesterol (4.5 vs. 4.9, P = 0.047), LDL cholesterol (2.4 mmol/L vs. 2.8 mmol/L, P = 0.019) and HDL cholesterol (0.8 mmol/L vs. 1.1 mmol/L, P = 0.002). The ECS was found to be higher in subjects with CVD than in those without (2 vs. 1, P = 0.001). On multivariate analysis, only DM and age were independently associated with CVD.@*CONCLUSION@#The ECS was significantly higher in PD patients with CVD than in those without, reflecting a higher vascular calcification burden in the former. It is a potentially useful tool to quantify vascular calcification in PD patients.

Etiological diagnostic value of metagenomic next-generation sequencing in peritoneal dialysis-related peritonitis / 中华肝脏病杂志

Objective: To explore the etiological diagnostic value of metagenomic next-generation sequencing (mNGS) in peritoneal dialysis (PD)-related peritonitis. Methods: The study was a retrospective cohort study. The clinical data of patients with PD-related peritonitis who were treated and underwent microbial cultivation and mNGS test at the same time from June 2020 to July 2021 in the Affiliated Drum Tower Hospital, Medical School of Nanjing University were analyzed. The positive rate, detection time and consistency between mNGS test and traditional microbial culture were compared. Results: A total of 18 patients with age of (50.4±15.4) years old and median dialysis time of 34.0 (12.4, 62.0) months were enrolled in the study, including 11 males and 7 females. Pathogenic microorganisms were isolated in 17 patients by mNGS test, with a positive rate of 17/18, which was higher than 13/18 of microbial culture, but the difference was not statistically significant (P=0.219). Both mNGS test and microbial culture isolated positive pathogenic bacteria in 12 patients, and mNGS test isolated the same types of pathogenic bacteria as microbial cultivation did in 11 patients. In five patients with negative microbial culture, mNGS test also isolated pathogenic microorganisms, including 3 cases of Staphylococcus epidermidis, 1 case of Mycobacterium tuberculosis and 1 case of Ureaplasma urealyticum. In 1 patient, microbial culture isolated pathogenic bacteria (Escherichia coli) whereas mNGS test did not. The detection time of mNGS was 25.0 (24.0, 27.0) h, which was significantly shorter than 89.0 (72.8, 122.0) h of microbial culture (Z=3.726, P<0.001). Conclusions: mNGS test can improve the detection rate of pathogenic microorganisms in PD-related peritonitis and greatly shorten the detection time, and has good consistency with microbial culture. mNGS may provide a new approach for pathogen identification of PD-related peritonitis, especially refractory peritonitis.

Clinical Characteristics and Treatment Outcome of Pseudomonas Peritoneal Dialysis-associated Peritonitis / 中国医学科学院学报

Objective To explore the clinical characteristics and treatment of Pseudomonas peritoneal dialysis-associated peritonitis(PsP). Methods The data of patients receiving peritoneal dialysis in four tertiary hospitals in Jilin province from 2015 to 2019 were retrospectively analyzed.According to the etiological classification,the patients with peritoneal dialysis-associated peritonitis(PDAP)were classified into PsP group and non-PsP group.The incidence of PsP was calculated,and the clinical characteristics and treatment outcomes of the two groups were compared.Kaplan-Meier method was used to draw the survival curve,and Cox regression was performed to analyze the risk factors affecting the technical failure of PsP.The treatment options of Pseudomonas aeruginosa-caused PDAP and the drug sensitivity of PsP were summarized. Results A total of 1530 peritoneal dialysis patients with complete data were included in this study,among which 439 patients had 664 times of PDAP.The incidence of PsP was 0.007 episodes/patient-year.PsP group had higher proportion of refractory peritonitis(41.38% vs.19.69%,P=0.005),lower cure rate(55.17% vs.80.79%, P=0.001),and higher extubation rate(24.14% vs.7.09%,P=0.003)than non-PsP group.The technical survival rate of PsP group was lower than that of non-PsP group(P<0.001).Multivariate Cox regression analysis showed that Pseudomonas aeruginosa was an independent risk factor for technical failure in patients with PsP(HR=9.020,95%CI=1.141-71.279,P=0.037).Pseudomonas was highly sensitive to amikacin,meropenem,and piperacillin-tazobactam while highly resistant to compound sulfamethoxazole,cefazolin,and ampicillin. Conclusion The treatment outcome of PsP is worse than that of non-PsP,and Pseudomonas aeruginosa is an independent risk factor for technical failure of PsP.

Development and validation of a prediction model for treatment failure in peritoneal dialysis-associated peritonitis patients: a multicenter study / 南方医科大学学报

OBJECTIVE@#To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP).@*METHODS@#We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram.@*RESULTS@#A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets.@*CONCLUSION@#The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.

Pseudoquiste peritoneal: una complicación inusual en paciente con diálisis peritoneal / Peritoneal pseudocysts: an unusual complication in a patient with peritoneal dialysis

Resumen Introducción: La terapia de sustitución renal con diálisis peritoneal es una modalidad segura para la enfermedad renal crónica terminal. Los resultados son comparables con pacientes en hemodiálisis por lo que lo hace una modalidad costo efectiva, especialmente en países en vía de desarrollo. Algunas complicaciones que se pueden presentar debido a diálisis peritoneal son: peritonitis, fuga, hernias, falla de filtración y disfunción del catéter. Una de las complicaciones infrecuentes de la diálisis peritoneal es la formación de un pseudoquiste peritoneal. Caso Clínico: Presentamos un caso de un paciente en terapia de sustitución renal con diálisis peritoneal, el cual presenta un pseudoquiste peritoneal como complicación de diálisis peritoneal.

Introduction: Renal replacement therapy with peritoneal dialysis is now a well-established, mature treatment modality for End-Stage Renal Disease. Patient outcomes with peritoneal dialysis are comparable than those with hemodialysis so does a more cost-effectiveness modality, especially in developing countries. Some complications of peritoneal dialysis are peritonitis, leaks, hernias, ultrafiltration failure, and catheter dislocation. One of the rare complications of peritoneal dialysis is peritoneal pseudocyst formation. Clinical Case: We report one such case of a patient with a history of renal replacement therapy managed on long-term peritoneal dialysis, which presents as a complication a peritoneal pseudocyst.

Peritonitis por fusarium en paciente en diálisis peritoneal domiciliaria / Fusarium peritonitis in a patient on home peritoneal dialysis

Introducción: La peritonitis fúngica es una complicación infrecuente pero grave para un paciente en diálisis peritoneal domiciliaria. Objetivo: Describir un caso de peritonitis fúngica en un paciente en diálisis peritoneal continua ambulatoria (DPCA). Métodos: Se presenta un paciente masculino de 53 años de edad, con antecedentes de hipertensión arterial, 9 años en diálisis peritoneal continua ambulatoria, con una desnutrición proteico energética moderada. Durante su tratamiento presentó varios episodios de peritonitis bacterianas, infecciones del orificio de salida y una recolocación de catéter peritoneal con cuff extruido. Se trabajó con sus antecedentes, cuadro clínico, agente etiológico y tratamiento. El diagnóstico se estableció por la presencia de líquido peritoneal turbio, conteo celular con más de 100 leucocitos/ul y cultivo con la presencia del hongo filamentoso. Resultados: En diciembre de 2017 se le diagnostica una peritonitis por fusarium, sin leucocitosis ni anemia, sí presentaba una hipoalbuminemia, se cultiva además pared de la habitación donde el paciente se realizaba los intercambios y se encuentra hongo filamentoso. En principio se comienza tratamiento con vancomicina y ceftacidima, posteriormente se cambia la ceftazidima por amikacina y finalmente, al tener resultado de cultivo y se muestra el patógeno, se inicia tratamiento con itraconazol, lamentablemente el paciente fallece a los 20 días. Conclusiones: Con esta investigación se analizan aspectos clínicos y microbiológicos de la peritonitis por fusarium, los cuales son poco conocidos en diálisis peritoneal domiciliaria(AU)

Introduction: Fungal peritonitis is an infrequent but serious complication for a patient on home peritoneal dialysis. Objective: To describe a case of fungal peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). Methods: A 53-year-old male patient is reported, with a history of arterial hypertension, 9 years on continuous outpatient peritoneal dialysis, moderate protein-energy malnutrition. During his treatment, he had several episodes of bacterial peritonitis, exit-site infections, and repositioning of a peritoneal catheter with an extruded cuff. We worked with his antecedents, clinical status, etiological agent and treatment. The diagnosis was established by the presence of cloudy peritoneal fluid, cell count higher than 100 leukocytes / ul, and culture with the presence of the filamentous fungus. Results: In December 2017, he was diagnosed with fusarium peritonitis, with no leukocytosis or anemia, he did present hypoalbuminemia. A culture was performed on the wall of the room where the patient had his exchanges and filamentous fungus was found. Initially, treatment started with vancomycin and ceftazidime, followed by amikacin. Finally, after having a culture showed the pathogen, treatment with itraconazole started. Unfortunately the patient died 20 days later. Conclusions: This research analyzes clinical and microbiological aspects of fusarium peritonitis, which are poorly understood in home peritoneal dialysis(AU)

Esclerosis peritoneal encapsulante en paciente en diálisis peritoneal domiciliaria / Encapsulating peritoneal sclerosis in a patient on home peritoneal dialysis

La esclerosis peritoneal encapsulante es una complicación poco común, pero muy grave, de la diálisis peritoneal. Esta complicación está asociada con altas tasas de morbilidad y mortalidad. El diagnóstico clínico requiere la presencia de obstrucción intestinal o función gastrointestinal alterada con signos patológicos y radiológicos de encapsulamiento intestinal. El diagnóstico patognomónico es solo con la realización de una biopsia peritoneal. El mecanismo patogénico exacto de esta entidad sigue siendo desconocido, aunque se asocia firmemente con el tiempo de duración del paciente en el tratamiento con diálisis peritoneal. Se presenta un caso clínico de esclerosis peritoneal encapsulante y se analizan las manifestaciones clínicas, diagnóstico, tratamiento, pronóstico y prevención(AU)

Encapsulating peritoneal sclerosis is a rare but very serious complication of peritoneal dialysis. This complication is associated with high morbidity and mortality rates. Clinical diagnosis is based on the presence of intestinal obstruction or altered gastrointestinal function with pathological and radiological signs of intestinal encapsulation. The pathognomonic diagnosis is achieved only by performing peritoneal biopsy. The exact pathogenic mechanism of this entity remains unknown, although it is strongly associated with the duration of the patient with peritoneal dialysis. We report a clinical case of encapsulating peritoneal sclerosis and the clinical manifestations, diagnosis, treatment, prognosis and prevention are analyzed(AU)

Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis: a multicenter study / 南方医科大学学报

OBJECTIVE@#To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis.@*METHODS@#The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events.@*RESULTS@#A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (@*CONCLUSIONS@#Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.

A case of encapsulated peritoneal sclerosis after peritoneal dialysis-related peritonitis / 中南大学学报(医学版)

Encapsulating peritoneal sclerosis (EPS) is a rare but severe complication of peritoneal dialysis. A total of 50% of the patients died within 12 months after being diagnosed. There are no obvious clinical symptoms in the early stage of EPS, which is easy to be missed. And there are few case reports of EPS in early stage. On December 22, 2018, a 70-year-old male patient undergoing peritoneal dialysis for 17 months, who was diagnosed as EPS, was admitted to the Department of Nephrology, the Third Xiangya Hospital, Central South University. The patient's peritoneal dialysis catheter was obstructed after peritonitis. The peritoneal dialysis fluid couldn't be drain in and out of the abdominal cavity. Therefore, the laparoscopy was performed to repair the catheter. The operation in progress showed that the peritoneum was slightly thickened and the ileocecal intestinal tube was closely adhered to the parietal peritoneum where the catheter was wrapped, indicating the early stage of EPS. Peritoneal relaxation was performed. The patient's catheter was normal after adhesiolysis. He underwent hemodialysis, nutritional supporting as well as peritoneal dialysis transition, etc. The peritonitis was controlled after 10 days and the peritoneal dialysis was resumed. After discharge from hospital, the patient took moxifloxacin for 2 more weeks. We followed up the patient for 6 months. The automated peritoneal dialysis is maintained, and everything remains normal. Clinicians need to improve understanding of EPS. Early diagnosis and laparoscopic adhesiolysis is helpful to continue peritoneal dialysis treatment.

Peritonitis esclerosante primaria y secundaria: estudio comparativo / Primary and secondary sclerosing peritonitis: comparative study

Resumen Introducción: Existen dos tipos de peritonitis esclerosante (PE): primaria o idiopática y secundaria, generalmente a diálisis peritoneal (DP), y con menor frecuencia a otras patologías abdominales o sistémicas. Su mortalidad es alta. Objetivo: Comparar las características clínicas, estudios diagnósticos y tratamiento de pacientes con Peritonitis Esclerosante Primaria y Secundaria, definir si existen diferencias y determinar los principales elementos clínicos e imagenológicos que permitan hacer un diagnóstico precoz y mejorar los resultados terapéuticos. Material y Métodos: Se analizan 18 casos de PE diagnosticados en nuestro hospital, entre los años 2001-2014. Incluye una serie retrospectiva de 15 casos de PE secundaria (13 por diálisis peritoneal y 2 por cirrosis hepática). Se compara con un estudio prospectivo que incluye 3 pacientes con PE primaria. Resultados: Las principales diferencias se evidencian en la presentación clínica: PE primaria: se presenta con cuadro de obstrucción intestinal y baja de peso de distinta magnitud. PE secundaria: predominan el dolor abdominal, peritonitis recurrente y la falla de ultrafiltración. La tomografía computada de abdomen es útil, sobre todo cuando hay obstrucción intestinal. Ha hecho posible el diagnóstico preoperatorio. Conclusiones: Se requiere un alto índice de sospecha para el diagnóstico precoz de PE, sobre todo para la forma primaria. Debe sospecharse en todo paciente con dolor abdominal, vómitos recurrentes y baja de peso de cualquier magnitud; y en aquellos en diálisis peritoneal durante 5 años o más, que presenten dolor abdominal y/o peritonitis recurrente y/o falla de ultrafiltración.

Introduction: There are two types of sclerosing peritonitis (SP): primary or idiopathic and secondary, generally to peritoneal dialysis, and less frequently, to other abdominal or systemic pathologies. Mortality related to this is high. Objective: To compare the clinical feature, diagnostic studies and treatment of patients with Primary and Secondary Sclerosing Peritonitis, to define whether there are any differences and to establish the main clinical and imaging elements allowing for an early diagnosis and improving the therapeutic results. Material and Methods: An analysis of 18 SP cases diagnosed at our hospital between 2001-2014 was carried out. This includes a retrospective series of 15 cases of secondary SP (13 to peritoneal dialysis and 2 to liver cirrhosis). This is compared against a prospective study that includes 3 patients with primary SP. Results: The main differences became evident in the clinical presentation: Primary SP: occurs in an intestinal obstruction and a loss of weight scenario of varying degrees. Secondary SP: abdominal pain and recurrent peritonitis as well as ultrafiltration failure prevail. CT of the abdomen has proven to be useful, in particular in those cases where there is intestinal obstruction. It has made preoperative diagnostic possible. Conclusions: A high degree of suspicion is required for an SP early diagnosis, especially for the primary form. All patients presenting abdominal pain, recurrent vomiting and any degree of weight loss and those with five or more years of peritoneal dialysis presenting abdominal pain and/or recurrent peritonitis and/or ultrafiltration failure should raise a diagnosis suspicion.

Quiloperitoneo en diálisis peritoneal: reporte de caso y revisión sistemática de la literatura / Chyloperitoneum in peritoneal dialysis: a case report and review of literature

El quiloperitoneo es una condición infrecuente que se asocia a diálisis peritoneal; en la mayoría de los casos se puede confundir con peritonitis bacteriana, aunque puede ser la consecuencia de esta infección. Se reporta el desarrollo espontáneo de quiloperitoneo en un paciente de 54 años con enfermedad renal crónica secundaria a nefropatía diabética, en diálisis peritoneal manual desde hacía 5 años. El tratamiento consistió en suspensión temporal de la diálisis peritoneal, reposo intestinal, suministro de una dieta con alto contenido de ácidos grasos de cadena media e infusión de octreotide, con lo cual a los 10 días el paciente mostró mejoría, y se reinició la diálisis peritoneal. Una búsqueda sistemática de la literatura encontró 16 casos publicados (11 mujeres), con edades desde neonato hasta 88 años.

Chyloperitoneum is a rare condition associated with peritoneal dialysis. In most cases it is misdiagnosed as bacterial peritonitis, but it can also be a consequence of this infection. We present the spontaneous development of chyloperitoneum in a 54 year old patient with chronic kidney disease secondary to diabetic nephropathy, in manual peritoneal dialysis for 5 years. The treatment consisted of temporary suspension of peritoneal dialysis, bowel rest, supply of a diet with a high content of medium chain fatty acids and infusion of octreotide. After 10 days the patient showed improvement, and peritoneal dialysis was restarted. A systematic search of the literature found 16 published cases (11 women), ranging in age from newborn to 88 years.

The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients

SUMMARY BACKGROUND One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). METHOD The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. FINDINGS Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). CONCLUSION The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.

RESUMO INTRODUÇÃO O estado nutricional é um dos principais determinantes da qualidade de vida de pacientes com doença renal crônica (DRC) e a prevenção da desnutrição aumenta o tempo e a qualidade de vida nessa população. O objetivo do presente estudo foi determinar a prevalência de desnutrição, a qualidade de vida e a inter-relação entre esses fatores em pacientes com DRC em terapia dialítica. MÉTODOS Incluímos 60 pacientes com DRC estágio 5 sob terapia dialítica (50 pacientes em hemodiálise [HD] e 10 em diálise peritoneal [DP]). Os pacientes foram analisados com relação aos seus dados sociodemográficos, índice de massa corporal (IMC), circunferência abdominal, dobra cutânea triciptal, pressão arterial sistólica e diastólica pré-diálise, Kt/V e índice de remoção de ureia, parâmetros laboratoriais, miniavaliação nutricional (MNA) e questionário EuroQol-5 Dimensions (EQ-5D). RESULTADOS Do total de pacientes, havia 27 homens (45%) e 33 mulheres (55%), 83,3% em HD e 16,7% em DP. O MNA médio foi 10,4 ± 2,8 nos pacientes em HD e 10,5 ± 2,9 naqueles em DP, não havendo diferença significativa entre os grupos. O EQ-5D médio foi 0,60 ± 0,29 nos pacientes em HD e 0,68 ± 0,33 naqueles em DP, não havendo diferença estatisticamente significativa entre os grupos. A qualidade de vida foi pior nos pacientes desnutridos (p=0,001). CONCLUSÃO O diagnóstico e o tratamento precoce da desnutrição são necessários para melhorar a qualidade de vida dessa população.

Infecciones asociadas a diálisis peritoneal en el paciente pediátrico: diagnóstico y tratamiento / Peritoneal dialysis-related infections in pediatric patients: diagnosis and treatment review

Resumen Las infecciones asociadas a diálisis peritoneal (DP), corresponden a la principal complicación de los pacientes pediátricos en esta terapia de reemplazo renal, disminuyendo la sobrevida de la membrana peritoneal y empeorando el pronóstico del paciente. El reconocimiento precoz y un tratamiento oportuno de éstas son fundamentales para preservar esta modalidad dialítica. Se presenta una revisión actualizada de la literatura científica, con el fin de entregar recomendaciones reproducibles en los distintos centros pediátricos que realizan diálisis peritoneal crónica en niños.

Peritoneal dialysis-related infections are the main complication in pediatric patients undergoing this renal replacement therapy, associating a high rate of morbidity, generating also a decreasing survival of the peritoneal membrane and worsening the patient outcome. We describe the recommended diagnostic and therapeutic modalities to treat dialysis-related in children.

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.

Encapsulating peritoneal sclerosis: case report / Esclerose peritoneal encapsulada: relato de caso

Abstract Patients with chronic kidney disease (CDK) can develop several diseases caused by the renal replacement therapy. Here we report a rare complication of peritoneal dialysis, the encapsulating peritoneal sclerosis (EPS) in which the peritoneal tissue is gradually replaced by fibrous tissue. The patient in question, after late loss of renal graft and conversion to peritoneal dialysis, evolved with multiple hospitalizations for spontaneous bacterial infections, in recent admission, he was diagnosed with sub-occlusive abdomen secondary to the EPS. Five days after, presented with intestinal obstruction requiring surgical approach by laparotomy, being performed with right colectomy, enterectomy, enteroraphy and ileostomy with drainage. The patient progressed well and follows on prednisone and tamoxifen-associated with intermittent hemodialysis.

Resumo No contexto da insuficiência renal crônica (IRC), os pacientes estão sujeitos a diversas patologias advindas da própria terapêutica de substituição renal. Relatamos aqui uma complicação rara da diálise peritoneal, a peritonite esclerosante encapsulante (PEE), na qual o tecido peritoneal é progressivamente substituído por tecido fibroso. O paciente em questão, após perda tardia de enxerto renal e conversão para terapêutica dialítica peritoneal evoluiu com múltiplas internações por infecções bacterianas espontâneas, em último internamento, foi diagnosticado com abdome sub-oclusivo secundário à PEE. Após 5 dias apresentou quadro de abdome obstrutivo com necessidade de abordagem cirúrgica por laparotomia exploradora, sendo realizado colectomia direita, enterectomia, enterorrafia e ileostomia com drenagem. O paciente evolui bem e segue em tratamento com prednisona e tamoxifeno associado à hemodiálise intermitente.

Diagnóstico y seguimiento de 12 casos de peritonitis esclerosante asociada a diálisis peritoneal crónica en Chile: Experience in 12 patients on peritoneal dialysis / Encapsulating peritoneal sclerosis

Background: Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis (PD) with a low prevalence but high mortality. It is characterized by peritoneal inflammation and fibrosis with subsequent development of intestinal encapsulation. It is associated with a long lapse on PD, frequent episodes of peritonitis, high glucose solution use, and high peritoneal transport status. Aim: To report the clinical features of patients on PD, who developed EPS. Material and Methods: Review of medical records of 12 patients aged 43 ± 10 years (eight women) who developed EPS. Results: The mean time spent on PD was 98 months. The main clinical manifestations were abdominal pain in 82% and ultrafiltration failure in 63%. In 92%, there was a history of peritonitis and 75% had high peritoneal transport at the time of diagnosis. The main findings in computed tomography were peritoneal calcification and thickening. There was a biopsy compatible with the diagnosis in 10 cases. Treatment consisted in withdrawal from PD, removal of PD catheter and the use of corticoids and tamoxifen. After withdrawal from PD 50% of patients became asymptomatic. The rest had intermittent abdominal pain and altered bowel movements. Two patients died (17%). Conclusions: EPS is a serious complication of PD, which should be suspected in any patient with compatible clinical symptoms, long time on PD, multiple episodes of peritonitis and high peritoneal transport profile.

Demencia en enfermos renales crónicos mayores de 55 años en Guatemala: prevalencia y factores asociados / Dementia in patients with chronic kidney disease older than 55 years in Guatemala: prevalence and associated factors

La demencia es un desorden que se caracteriza por un deterioro progresivo que limita la funcionalidad del individuo. Se han postulado varios factores de riesgo independientes para su desarrollo, entre ellos la enfermedad renal crónica. Se realizó un estudio transversal en 328 participantes mayores de 55 años, para determinar la prevalencia de demencia y los factores asociados en pacientes con enfermedad renal crónica. La función cognitiva de los participantes fue evaluada con la prueba cognitiva Montreal y el cuestionario de actividad funcional de Pfeffer. Se obtuvieron datos acerca de comorbilidades, valores de hemoglobina, creatinina sérica, índice de masa corporal y presión arterial. Se realizó un análisis descriptivo de la muestra, estimación de la de prevalencia de demencia y determinación de la asociación de factores de riesgo con el desarrollo de demencia por medio de regresión logística. El 16.6% de los sujetos fueron clasificados con demencia, IC 95% [12.82, 21.11] y 47.0% con deterioro cognitivo leve, IC 95% [41.54, 52.51]. Se encontró asociación positiva entre demencia y edad (OR 1.10, IC 95% [1.05, 1.15], p < .001), diabetes (OR 3.25, IC 95% [1.62, 6.50], p = .001), y antecedente de trauma craneoencefálico (OR 3.28, IC 95% [1.18, 9.09], p = .022). La asociación fue negativa con hemoglobina (OR 0.71, IC 95% [0.58, 0.88], p = .002) y tabaquismo (OR 0.31, IC 95% [0.13, 0.78], p = .012).

Dementia is a disorder characterized by progressive cognitive impairment, which limits the functionality of the affected individuals. Several independent risk factors have been postulated for its development, including chronic kidney disease. A cross-sectional design was performed in 328 subjects over 55 years old to determine the prevalence of dementia and associated risk factors in patients with chronic kidney disease. Two tests were administered to evaluate cognitive function: Montreal Cognitive Assessment and Pfeffer Functional Activities Questionnaire. Data of comorbidities, hemoglobin, serum creatinine, body mass index and blood pressure was collected. A descriptive analysis of the sample was performed, prevalence of dementia was estimated and associated factors were analyzed with a logistic regression model. 16.6% of subjects were classified as demented, whereas 47.0% had mild cognitive impairment. Significant association was found between: dementia and age (OR 1.10 CI 95% [1.05,1.15], p< .001), hemoglobin (OR .71 [.58, .88], p=.002, diabetes (OR 3.25 [1.62,6.50], p=.001), smoking (OR .31 [.13,.78], p=.012) and traumatic brain injury (OR 3.28 [1.18, 9.09], p=.022).

Diez años del Registro Uruguayo de Peritonitis en Diálisis Peritoneal / Ten years of the Uruguayan Registry of Peritonitis in Peritoneal Dialysis

La peritonitis es una complicación grave de la diálisis peritoneal (DP), por lo que interesa conocer la incidencia y sensibilidad antibiótica de los gérmenes causantes. En Uruguay, desde el 1° de enero de 2004, se realiza un registro nacional de las peritonitis en DP, gérmenes, sensibilidad y evolución. Método: se analizaron los registros desde el 1° de enero de 2004 al 31 de diciembre de 2013. El registro fue aprobado por comités de ética institucionales. Resultados: en el período se registraron 850 peritonitis, con una incidencia que descendió de 0,49/paciente-año (2004-2005) a 0,37/paciente-año (2013). La incidencia de Staphylococcus aureus y Staphylococcus coagulasa negativo (SCoN) fue menor en 2009-2013 vs 2004-2005 (0,2 vs 0,12 peritonitis/paciente-año, test Poisson p<0,05). En 2009-2013: 14/54 S. aureus y 26/71 SCoN fueron meticilinorresistente, similar al período previo. El 98% de los gérmenes gramnegativos fueron sensibles a amikacina. En 145/467 (31%) episodios no se identificó germen. Se logró cura primaria en 71% de las peritonitis por grampositivos y en 45% por gramnegativos (chi2 p<0,05). En 2013 se observó mayor incidencia de peritonitis en los centros en los que no se controló el estado de portador nasal. Comentarios y conclusiones: se justifica implementar el control de portador de Staphylococcus aureus. La incidencia de peritonitis por S. aureus y SCoN meticilinorresistentes, la incidencia sostenida de gérmenes gramnegativos (con peor evolución), y el elevado porcentaje de cultivos sin desarrollo justifica mantener el protocolo antibiótico empírico inicial con vancomicina y amikacina. El descenso de la incidencia de S. aureus + SCoN podría ser atribuido a una mejor educación de los pacientes en DP.

Abstract Peritonitis is a severe complication of peritoneal dialysis (PD), so it is important to learn about the incidence and antibiotic sensitivity of the germs that cause it. In Uruguay, since January 1, 2004, a national record is kept for peritonitis in PD, germs, sensitivity and evolution. Method: the records from January 1, 2004 through December 31, 2013 were analyzed. The registry was approved by institutional ethical committes. Results: during the above mentioned period, 850 cases of peritonitis were recorded, and incidence dropped from 0.49/patient-year (2004-2005) to 0.37/patient-year (2013). Incidence of Staphylococcus aureus and coagulase-negative staphylococci (SCoN) was lower in 2009-2013 vs 2004-2005 (0.2 vs 0.12 peritonitis/patient-year, test Poisson p<0.05). In 2009-2013: 14/54 S. aureus and 26/71 SCoN were methicillin-resistant, similar to the previous period. 98% of Gram-negative were sensitive to amikacin. No germ was identified in 145/467 (31%) of episodes. Primary cure was achieved in 71% of peritonitis for Gram-positive and 45% for Gram-negative bacteria (chi2 p<0.05). In 2013 a greater incidence of peritonitis was observed in those centers where the nasal carriage was not controlled. Comments and conclusions: controlling Staphylococcus aureus nasal carriages is worth doing. The incidence of peritonitis by methicillin-resistant S. aureus y SCoN, the sustained incidence of Gram-negative germs (with a worse evolution), and the high percentage of cultures with no development justify keeping the initial empirical antibiotic protocol with vancomycin and amikacin. Reduction in the incidence of S. aureus + SCoN could be explained by a greater education in PD patients.

Resumo A peritonite é uma complicação grave da diálise peritoneal (DP), sendo, portanto, importante conhecer a incidência e a sensibilidade antibiótica dos gérmens causadores. No Uruguai, desde 1 de janeiro de 2004, realiza-se um registro nacional das peritonites em DP, com dados sobre gérmens, sensibilidade e evolução. Método: foram analisados os registros do período 1 de janeiro de 2004 - 31 de dezembro de 2013. O registro foi aprovado pelos comitês de ética das instituições envolvidas. Resultados: foram registradas 850 peritonites no período estudado; a incidência diminuiu de 0,49/paciente-ano no período 2004-2005 a 0,37/paciente-ano em 2013. A incidência de Staphylococcus aureus e Staphylococcus coagulase negativo (SCoN) foi menor no período 2009-2013 comparada com 2004-2005 (0,2 vs 0,12 peritonite/paciente-ano, teste de Poisson p<0,05). No período 2009-2013: 14/54 S. aureus e 26/71 SCoN foram resistentes à meticilina, similar ao período prévio. 98% dos gérmens gramnegativos eram sensíveis a amicacina. Não se pode identificar o gérmen em 145/467 (31%) episódios. Em 71% das peritonites por grampositivos e em 5% por gramnegativos (chi2 p<0,05) foi possível obter cura primária. Em 2013 foi observada uma maior incidência de peritonite nos centros em que não se realizava controle de portador nasal. Comentários e conclusões: justifica-se a realização de controle de portador de Staphylococcus aureus. A incidência de peritonite por S. aureus e SCoN resistentes à meticilina, a incidência constante de gérmens gramnegativos (com pior evolução), e a alta porcentagem de cultivos sem crescimento justificam manter o protocolo antibiótico empírico inicial com vancomicina e amicacina. A redução da incidência de S. aureus + SCoN poderia ser atribuída a melhor educação dos pacientes em DP.