Peritoneal-Retroperitoneal-Scrotal Leakage as a Complication of Peritoneal Dialysis / 대한내과학회지

We report a case of retroperitoneal and scrotal dialysate leakage resulting from peritoneal-retroperitoneal communication in a patient on peritoneal dialysis (PD). The ultrafiltration volume was reduced and the scrotum became enlarged in a patient who had been undergoing PD for 4 years. Retroperitoneal and scrotal leakage of dialysate was confirmed by computed tomography (CT) performed 1 hour after the intraperitoneal infusion of contrast-containing dialysate. The PD was halted and the patient was transferred to hemodialysis (HD). One month after the transfer to HD, the PD was resumed and there were no signs of extraperitoneal leakage.

Clinical Usefulness of Automated Peritoneal Dialysis (APD) in End Stage Renal Disease Patients / 대한신장학회잡지

BACKGROUND: In many countries, APD is growing dialysis modality in ESRD patients, however, it is still unfamiliar in Korea. To evaluate the clinical usefulness of APD, we retrospectively analyzed the clinical and biochemical characteristics of APD patients in Yonsei University Medical Center (YUMC). METHODS: The incidence of CAPD (continuous ambulatory peritoneal dialysis) and APD in Korea was evaluated by PD solution companies (Baxter, FMC, Gambro, Boryung) in Korea. Clinical and biochemical data were collected from 96 subjects who have been maintained on APD at least more than 1 month from January 1996 to Jan. 2004 in YUMC. Peritoneal equilibration test (PET) was done within 3 months after initiation of CAPD and APD, respectively. Kt/V urea was also evaluated. We compared the factors of APD maintenance between early termination group and maintenance group. The maintenance group was defined as those patients who could be treated more than 6 month by APD. RESULTS: The mean age of the patients was 51.6+/-14.6 years with sex ratio (M: F) 45: 51, and mean duration of dialysis was 25.3+/-28.2 months. The causes of conversion from CAPD to APD were inadequate dialysis, ultrafiltration failure, and patient preference, etc. As urea kinetics was analyzed during CAPD or APD, there was no difference in total Kt/Vurea, but significant difference in renal Kt/ Vurea and dialysis Kt/Vurea between CAPD and APD. Incidence of PD peritonitis was significantly lower in APD group compared to CAPD group. There was no difference in the incidence of exit site infection. APD was stopped from kidney transplantation, death, peritonitis, and patient refuse. Only 11 cases were not solved the problems even after the conversion to APD. In maintenance group, duration of dialysis was shorter than the early termination group and serum albumin was significantly higher at 6 month after APD. CONCLUSION: APD has been rapidly expanding the territory in Korean ESRD patients. In CAPD patients with inadequate dialysis dose and ultrafiltration failure, APD is good alternatives for the maintenance to peritoneal dialysis modality.

Practical application of modified peritoneal equilibrium test in peritoneal dialysis patients / 中华肾脏病杂志

Objectives To investigate the practical application of modified peritoneal equilibration test (modified PET) employing 4.25% glucose exchange in peritoneal dialysis patients and to assess the reference values and clinical significance of the test. Methods Modified PETs were performed in 97 patients without peritonitis for at least 4 weeks. Mass transfer area coefficient (MTAC) was calculated according to the Garred model. Creatinine D/P concentration ratio at 4 hr (4 h D/Pcr), sodium D/P concentration ratio at 1 hr (1 h D/PNa+) and net ultrafiltration (nUF) were also assessed. Ultrafiltration 0.05). 4 h D/Pcr and MTACcr of modified PET were significantly correlated with 4h D/Pcr of standard PET (P

Risk Factors and Clinical Features of Ultrafiltration Failure in CAPD Patients; Case-control Study / 대한신장학회잡지

PURPOSE: Ultrafiltration (UF) failure is one of the most important causes of CAPD withdrawal accounting for up to 20% of CAPD catheter removal. Factors contributing to UF failure are; severe and multiple peritonitis, continuous exposure to nonphysiologic dialysis solution, and use of beta-blockers. We evaluated clinical features of patients with UF failure and assessed the risk factors for UF failure in CAPD patients. METHODS: CAPD data of our institution from Jan 1990 to Dec 2000 were analyzed and a subgroup of 191 patients whose CAPD catheters were removed were collected. Nineteen patients, whose CAPD catheters were removed due to UF failure, were selected from the subgroup as the case group. Seventy-six hospital controls without ultrafiltration failure matched for age, sex, and time of CAPD initiation who were currently maintained on CAPD were selected as the control group. Peritoneal equilibration test (PET) was done within 3 months of initiation of CAPD and at the diagnosis of UF failure, respectively. Peritoneal glucose load was estimated for the first two years. Incidence of peritonitis, accumulated days of peritoneal inflammation (APID), causative organisms of peritonitis, and history of beta-blocker use were evaluated. Peritoneal function was determined by daily net ultrafiltration and mass transfer area coefficient (MTAC) for creatinine. Serum albumin, normalized protein catabolic rate (nPCR) and Kt/Vurea were also evaluated. RESULTS: There was no difference between cases and controls in etiology of ESRD, peritonitis incidence, APID and causative organisms of peritonitis. The case group included more high transporters at the time of the diagnosis of UF failure. The patients with UF failure showed lower nPCR and higher CRP than controls. Serum albumin level was similar at start of CAPD, but decreased faster in UF failure group. Use of beta-blockers and decline in RRF were not different between the two groups. UF fail ure group had higher MTAC for creatinine and more peritoneal glucose load compared to control group. By logistic regression analysis, peritoneal glucose load and increment in glucose load were independent factors associated with UF failure. CONCLUSION: Peritoneal glucose load and increment of glucose load were found to be important risk factors for UF failure in our study. Therefore, various efforts to reduce peritoneal glucose load in CAPD patients are needed for prevention of UF failure.

Peritoneal Expression of Vascular Endothelial Growth Factor in Rat with Peritonitis / 대한신장학회잡지

BACKGROUND: Ultrafiltration failure resulting from increased peritoneal vascular permeability during peritonitis is a major problem in CAPD patients. However, the mechanism of increased peritoneal permeability during peritonitis has not been clearly determined. We studied changes in the peritoneal permeability and the expression of vascular endothelial growth factor(VEGF), which is known to increase vascular permeability, in the peritoneal tissues of rats with peritonitis. METHODS: After implanting peritoneal dialysis catheter to 20 Sprague-Dawley rats and performing peritoneal equilibration test(PET), rats were divided into control group(n=7) and peritonitis group(n=13). One ml of saline or Staphylococcus aureus(1X10(9) colony forming unit/mL) was injected intraperitoneally to control or peritonitis group for five days, and PET was repeated. Peritoneal transport rates of glucose and total protein were measured, and macrophages infiltration and VEGF expression in peritoneal tissues were examined by immunohistochemical stain. RESULTS: Peritoneal transport rates of glucose and total protein were significantly increased in peritonitis group compared with control group, suggesting that peritonitis increased peritoneal transport rates of both low and high molecular weight solutes. The peritoneal tissues of peritonitis rats showed profuse infiltration of macrophages in the submesothelial space, submesothelial widening and denudation of mesothelial cells. While VEGF was slightly expressed in peritoneal mesothelial cells in control rats, it was intensively stained not only in the peritoneal mesothelial cells but also in the infiltrated macrophages in the submesothelial space in peritonitis rats. CONCLUSION: Peritonitis increases peritoneal vascular permeability and VEGF expression in peritoneal mesothelial cells and infiltrated macrophages in the submesothelial space. These data suggest that VEGF may play a role in the increased peritoneal permeability during peritonitis.

Nandrolone Decanoate-Induced Transient Ultrafiltration Failure in End Stage Renal Disease Patients Undergoing Dialysis / 대한신장학회잡지

Nandrolone decanoate(ND), one of the anabolic steroids, has been used by athletes to build muscle mass and enhance weight-lifting performance and has also shown to be useful in malnourished ESRD patients. However, ND has several adverse effects including edema. After we experienced a case of severe edema and transient ultrafiltration failure(TUF) requiring more frequent number of dialysis during ND treatment, we prospectively studied the incidence and clinical characteristics of TUF during ND treatment. Among 30 ND-treated patients, 7 patients developed TUF. All TUF+ patients were female and had sigificantly higher number of patients with congestive heart failure, more use of minoxidil and moderate to severe malnutrition than TUF- patients. There were no significant differences in age, duration of dialysis, and number of diabetics between TUF+ and TUF- group. In ND-treated male patients, the number of patients with CHF and moderate to severe malnutrition and with use of minoxidil were significantly lower than TUF+ ones. Body weight and serum albumin concentrations were significantly increased 2-3 months after ND treatment in TUF+ patients. But there were no differences in body weight and serum albumin in TUF-patients. In TUF+ patients, frequency of HD increased from 3 times to 4 to 6 times a week. CAPD patients with TUF+ had more frequently used 4.25% dialysate and number of exchanges were increased. In most TUF+ patients, severe edema and TUF were disappeared about 2 weeks after treatment. Most TUF+ patients returned to previous schedle of dialysis. In conclusion, ND seems to induce TUF in ESRD patients who had risk for volume regulation such as CHF, hypoalbuminemia, or the use of minoxidil.