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1.
Rev. cuba. med ; 59(4): e1346, oct.-dic. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144509

ABSTRACT

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)


Subject(s)
Humans , Male , Middle Aged , Peritonitis/mortality , Peritoneal Dialysis/adverse effects , Fusariosis/mortality
2.
Rev. cuba. med ; 59(1): e174, ene.-mar. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139043

ABSTRACT

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)


Subject(s)
Humans , Male , Adult , Peritoneal Dialysis/adverse effects , Renal Insufficiency, Chronic/diagnosis , Peritoneal Fibrosis/complications , Peritoneal Fibrosis/pathology
3.
Article in Chinese | WPRIM | ID: wpr-880805

ABSTRACT

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.


Subject(s)
Humans , Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Retrospective Studies , Treatment Outcome
4.
Article in English | WPRIM | ID: wpr-880613

ABSTRACT

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.


Subject(s)
Aged , Early Diagnosis , Humans , Male , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/pathology , Peritoneum , Peritonitis/pathology , Sclerosis/pathology
5.
Rev. cir. (Impr.) ; 71(5): 412-424, oct. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058295

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peritonitis/diagnosis , Peritonitis/therapy , Peritoneal Dialysis/adverse effects , Peritonitis/pathology , Sclerosis , Tomography, X-Ray Computed
6.
Rev. nefrol. diál. traspl ; 39(2): 115-119, jun. 2019. tabl.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352751

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Chylous Ascites/diagnosis , Chylous Ascites/diet therapy , Chylous Ascites/drug therapy , Peritoneal Dialysis/adverse effects , Renal Dialysis , Rare Diseases
7.
In. CASMU. Investigación clínica: desarrollo e innovación, 2019. Montevideo, Ideas Uruguay, 2019. p.263-271.
Monography in English | LILACS, BNUY, UY-BNMED | ID: biblio-1359701
8.
Rev. Assoc. Med. Bras. (1992) ; 64(9): 845-852, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-976865

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Aged , Quality of Life , Renal Dialysis/adverse effects , Peritoneal Dialysis/adverse effects , Malnutrition/etiology , Malnutrition/epidemiology , Renal Insufficiency, Chronic/complications , Socioeconomic Factors , Time Factors , Turkey/epidemiology , Nutrition Assessment , Anthropometry , Nutritional Status , Prevalence , Cross-Sectional Studies , Risk Factors , Middle Aged
9.
Rev. chil. infectol ; 35(2): 123-132, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959421

ABSTRACT

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.


Subject(s)
Humans , Child, Preschool , Child , Surgical Wound Infection/diagnosis , Surgical Wound Infection/drug therapy , Peritoneal Dialysis/adverse effects , Catheter-Related Infections/diagnosis , Catheter-Related Infections/drug therapy , Anti-Infective Agents/therapeutic use , Surgical Wound Infection/classification , Surgical Wound Infection/etiology , Severity of Illness Index , Risk Factors , Catheter-Related Infections/etiology , Anti-Infective Agents/classification
10.
Rev. chil. infectol ; 35(3): 225-232, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959435

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Peritonitis/microbiology , Peritoneal Dialysis/adverse effects , Kidney Failure, Chronic/therapy , Time Factors , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Emergency Service, Hospital
11.
J. bras. nefrol ; 39(4): 470-472, Oct.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-893810

ABSTRACT

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.


Subject(s)
Humans , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/etiology
12.
Rev. méd. Chile ; 145(1): 41-48, ene. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-845502

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Peritonitis/diagnosis , Peritonitis/etiology , Peritoneal Dialysis/adverse effects , Peritoneal Fibrosis/etiology , Peritonitis/pathology , Peritonitis/therapy , Chile , Retrospective Studies , Risk Factors , Peritoneal Fibrosis/pathology , Peritoneal Fibrosis/therapy , Kidney Failure, Chronic
13.
Cienc. tecnol. salud ; 4(2): 194-202, 2017. ^c27 cmilus
Article in Spanish | LILACS | ID: biblio-964637

ABSTRACT

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).


Subject(s)
Middle Aged , Prevalence , Risk Factors , Dementia , Renal Insufficiency, Chronic , Peritoneal Dialysis/adverse effects , Dialysis , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/blood
14.
Rev. méd. Urug ; 32(3): 166-177, set. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-796339

ABSTRACT

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.


Subject(s)
Humans , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Peritonitis/etiology , Uruguay/epidemiology
15.
Rev. chil. infectol ; 33(2): 222-225, abr. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-784871

ABSTRACT

Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.


La peritonitis fúngica es una complicación mayor de la diálisis peritoneal, con una alta mortalidad asociada y la mayoría de los sobrevivientes presentan una alta tasa de abandono de diálisis peritoneal como terapia de reemplazo renal. Se presenta un caso de peritonitis fúngica por un agente infrecuente. Mujer de 83 años, diabética con múltiples episodios de peritonitis bacteriana asociada a fallas técnicas en la ejecución de diálisis peritoneal automatizada, ingresa por cuadro clínico de dolor abdominal y líquido peritoneal turbio. Se confirmó la presencia de Rhodotorula mucilaginosa en líquido peritoneal mediante MALDI-TOF. Fue tratada con retiro del catéter y posaconazol oral por 14 días, presentando una evolución favorable.


Subject(s)
Humans , Female , Aged, 80 and over , Peritonitis/microbiology , Rhodotorula/isolation & purification , Peritoneal Dialysis/adverse effects , Familial Mediterranean Fever/therapy , Time Factors , Triazoles/therapeutic use , Peritoneal Dialysis/methods , Catheter-Related Infections/microbiology , Catheter-Related Infections/therapy , Antifungal Agents/therapeutic use
16.
J. bras. nefrol ; 38(1): 76-81, jan.-mar. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-777493

ABSTRACT

Resumo Introdução: A anemia é uma complicação frequente em pacientes em diálise e poucos estudos avaliaram sua ocorrência em pacientes submetidos à diálise peritoneal (DP). Objetivo: Este estudo teve como objetivo investigar a prevalência e fatores associados à presença de anemia em pacientes submetidos à DP de um único centro onde havia acesso irrestrito a agentes estimulantes da eritropoiese (AEE) e a suplementação de ferro intravenoso. Métodos: Estudo transversal que analisou variáveis demográficas, clínicas e laboratoriais de 120 pacientes. Anemia foi definida como hemoglobina (Hb) < 11g/dl. Resultados: Os pacientes estavam em DP por 17 meses, sendo 86% automatizada. A idade média foi de 58 ± 16,5 anos, 52% dos pacientes eram do sexo feminino e 29% diabéticos. Anemia esteve presente em 34 pacientes (28%). Quando comparados com pacientes sem anemia, aqueles com anemia recebiam maior dose de ferro (p = 0,02) e apresentavam menores triglicérides (p = 0,01). A Hb se correlacionou negativamente com as doses de ferro (r = -0,20;p = 0,03) e AEE (r = -0,23; p = 0,01), e positivamente com albumina (r = 0,38; p = 0,01), triglicérides (r = 0,24; p = 0,01) e índice de saturação da transferrina (r = 0,20; p = 0,03). Na análise múltipla, a concentração de albumina (coefβ = 0,84; 95% IC = 0,381,31;p < 0,001) e a dose de AEE (coefβ = -0,06; 95% IC = 0,00-0,00; p = 0,02) foram associadas de forma independente com a Hb. Conclusões: No presente estudo, anemia foi observada em aproximadamente 30% dos pacientes em programa de diálise peritoneal, com uso irrestrito de AEE e suplementação intravenosa de ferro. A saturação de transferrina e o estado nutricional, avaliado pela albumina, foram os fatores independentes associados à concentração de hemoglobina nesta população.


Abstract Introduction: Anemia is a common complication in dialysis patients, scare studies have evaluated anemia in patients undergoing peritoneal dialysis (PD). Objective: This study aimed to investigate the prevalence of anemia and its associated factors in patients undergoing PD in a single center where patients have free access to agents stimulating erythropoiesis (ESA) and intravenous iron supplementation. Methods: Cross-sectional study analyzing the demographic, clinical and laboratory variables of 120 patients. Anemia was defined as hemoglobin (Hb) < 11 g/dl. Results: Patients were on PD for 17 months, and the majority of them (86%) received automated PD. The mean age was 58 ± 16.5 years, and 52% were female and 29% were diabetes. Anemia was present in 34 (28%) patients. When compared with those without anemia, patients with anemia received a higher dose of iron (p = 0.02) and had a lower concentration of triglycerides (p = 0.01). Hb levels correlated negatively with iron (r = -0.20;p = 0.03) and ESA (r = -0.23; p = 0.01) doses and positively with albumin (r = 0.38; p = 0.01), triglycerides (r = 0.24; p = 0.01) and transferrin saturation (r = 0.20; p = 0.03). In multiple analyses, only the albumin concentration (beta = 0.84; 95% IC = 0.38-1.31;p < 0.001) and ESA dose (beta = -0.06; 95% IC = 0.00-0.00; p = 0.02) were independently associated with Hb levels. Conclusions: Almost 30% of PD patients had anemia, even with free access to erythropoietin and intravenous iron. The transferrin saturation and nutritional status assessed by albumin, were the factors associated with the occurrence of anemia in this population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Peritoneal Dialysis/adverse effects , Anemia/epidemiology , Kidney Failure, Chronic/therapy , Hemoglobins/analysis , Prevalence , Cross-Sectional Studies , Erythropoietin/therapeutic use , Hematinics/therapeutic use
17.
Braz. j. med. biol. res ; 49(3): e4733, Mar. 2016. tab
Article in English | LILACS | ID: lil-771939

ABSTRACT

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Arteriovenous Fistula/complications , Hypertension, Pulmonary/etiology , Peritoneal Dialysis/adverse effects , C-Reactive Protein/analysis , China/epidemiology , Hypertension, Pulmonary/epidemiology , Incidence , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Natriuretic Peptide, Brain/blood , Phosphorus/blood , Prospective Studies , Risk Factors
18.
Article in English | WPRIM | ID: wpr-220496

ABSTRACT

BACKGROUND/AIMS: This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. METHODS: A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. RESULTS: The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. CONCLUSIONS: In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD.


Subject(s)
Adult , Aged , Body Mass Index , Humans , Kidney Failure, Chronic/diagnosis , Male , Middle Aged , Nutritional Status , Peritoneal Dialysis/adverse effects , Prospective Studies , Renal Dialysis/adverse effects , Republic of Korea , Risk Factors , Time Factors , Treatment Outcome
20.
Rev. latinoam. enferm. (Online) ; 23(5): 902-909, Sept.-Oct. 2015. tab
Article in English | LILACS, BDENF | ID: lil-763284

ABSTRACT

Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home.Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance.Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015).Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment.


Objetivo: analisar as complicações relacionadas à peritonite e infecção de orifício de saída do cateter, em pacientes em diálise peritoneal no domicílio.Método: estudo quantitativo e transversal, realizado com 90 pacientes em diálise peritoneal no domicílio, em um município do Nordeste brasileiro. Para coleta de dados utilizaram-se dois roteiros estruturados e consulta aos prontuários de saúde. Foram utilizadas análises descritivas e testes de comparação entre grupos independentes, considerando o nível de significância estatística de p<0,05.Resultados: comparando-se a frequência de peritonite e o tempo de tratamento, constatou-se que pacientes com mais de dois anos de diálise peritoneal apresentaram maior chance de ter peritonite (X²=6,39; p=0,01). O número de episódios de infecção de orifício de saída do cateter peritoneal mostrou associação com o tempo de tratamento (U=224,000; p=0,015).Conclusão: a peritonite e infecção de orifício de saída do cateter estão associadas ao tempo de tratamento.


Objetivo: analizar las complicaciones relacionadas con la peritonitis e infección del orificio de salida del catéter, en pacientes en diálisis peritoneal en casa.Método: estudio cuantitativo y transversal, realizado con 90 pacientes en diálisis peritoneal, en casa en una ciudad en el Nordeste de Brasil. Para la recogida de datos se utilizaron dos guiones estructurados y consulta de los registros médicos. Se utilizaron análisis descriptivos y pruebas de comparación entre grupos independientes, teniendo en cuenta el nivel de significación estadística de p<0,05.Resultados: al comparar la frecuencia de peritonitis y el tiempo de tratamiento, se encontró que los pacientes con más de dos años de diálisis peritoneal eran más propensos a tener peritonitis (X²=6,39; p=0,01). El número de episodios de infección del orificio de salida del catéter peritoneal mostró asociación con el tiempo de tratamiento (U=224.000; p=0,015).Conclusión: la peritonitis e la infección de orificio de salida del catéter se asocian con el tiempo de tratamiento.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Peritonitis/microbiology , Peritonitis/epidemiology , Peritoneal Dialysis/adverse effects , Catheter-Related Infections/etiology , Catheter-Related Infections/epidemiology , Cross-Sectional Studies , Retrospective Studies , Hemodialysis, Home/adverse effects
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