Preparing patients for peritoneal dialysis.

When told of their need for dialysis, patients often cannot accept it and are fearful toward dialysis. Pre-dialysis counseling programs help patients to face dialysis, to make the right choice of dialysis modality, and to prepare themselves for life on dialysis. Clear explanations of peritoneal dialysis (PD) help patients choosing PD. Patients should be referred to pre-dialysis programs at least 4 - 6 months before commencement of dialysis or when their glomerular filtration rate is around 15 mL/min/1.73 m(2). The pre-dialysis program is best conducted by experienced staff such as renal nurses and multidisciplinary staff including nephrologists, dietitians, physiotherapists, psychologists, social workers, or even dialysis patient representatives depending on availability. The program should be designed according to the culture, settings, staff availability, and patient load in individual hospitals. Pre-dialysis home visits may be needed in some cases to assess suitability and prepare the home for PD.

Cefazolin plus netilmicin versus cefazolin plus ceftazidime for treating CAPD peritonitis: effect on residual renal function.

UNLABELLED: BACKGROUND. The International Society for Peritoneal Dialysis (ISPD) treatment guidelines for continuous ambulatory peritoneal dialysis (CAPD) peritonitis 2000 recommended the use of cefazolin plus ceftazidime as the initial empirical therapy in patients with residual renal function (RRF). However, this treatment regimen has not been compared with the conventional regimen of cefazolin plus netilmicin in prospective, randomized controlled trials. METHODS: Stable CAPD patients who developed clinical evidence of peritonitis were randomized to receive intraperitoneal (i.p.) cefazolin plus netilmicin or cefazolin plus ceftazidime once daily in the long dwell for 14 days. For patients with RRF (>1 mL/minute) before entry into the study (N= 50), RRF and 24-hour urine volume were measured at days 1, 14, and 42 after commencement of i.p. antibiotic treatment. RESULTS: One hundred and two patients were recruited into the study. The primary cure rates of i.p. cefazolin plus netilmicin and cefazolin plus ceftazidime were 66.7% and 64.7%, respectively. The overall cure rate for the 2 treatment regimens was 82.3% for both. Seven patients (14%) from each treatment group required removal of the dialysis catheters due to treatment failure. Relapse of peritonitis occurred in 2 patients (4%) in both treatment groups. Thirty-six patients with RRF at baseline achieved primary cure of their peritonitis by the assigned antibiotics. In this subgroup of patients, their RRF and daily urine volume showed significant reduction at day 14 and returned to near baseline values at day 42. The degree of reduction in RRF and urine volume did not differ significantly between the patients treated with cefazolin plus netilmicin and cefazolin plus ceftazidime. CONCLUSION: Intraperitoneal cefazolin plus netilmicin and cefazolin plus ceftazidime have similar efficacy as empirical treatment for CAPD peritonitis. In CAPD patients with RRF, significant but reversible reduction in RRF and 24-hour urine volume could occur after an episode of peritonitis, despite successful treatment by i.p. antibiotics. The effect of i.p. cefazolin plus netilmicin, or i.p. cefazolin plus ceftazidime on RRF in CAPD patients with peritonitis does not appear to be different. Our findings do not support the routine use of cefazolin and ceftazidime as the empirical treatment for CAPD peritonitis.

Seroprevalence of Helicobacter pylori in Chinese patients on continuous ambulatory peritoneal dialysis.

BACKGROUNDS AND AIMS: There is relatively little data on the seroprevalence of Helicobacter pylori in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). This study aims at establishing the seroprevalence of and the factors associated with H. pylori infection in Chinese CAPD patients. METHODS: All CAPD patients from a single dialysis centre were invited to participate in the study. Diagnosis of H. pylori infection was made serologically by the pylori DTect ELISA method. Dyspeptic symptoms were assessed by the Hong Kong Index of Dyspepsia (HKID) Questionnaire. Demographic, clinical and laboratory parameters were correlated with the H. pylori serology results. RESULTS: One hundred and thirty-six Chinese CAPD patients were included in the study. The mean age of the patients was 61.8 +/- 12.5 years with a male to female ratio of 1:1.4. The mean duration of CAPD was 54 +/- 42 months. Thirty-five patients (26%) have positive serology against H. pylori. Nineteen patients had a HKID score of >16. There was no association between H. pylori seropositivity and dyspeptic symptoms (P = 0.62). Patients who were seropositive for H. pylori were significantly older (64.9 +/- 9.5 years vs 60.7 +/- 13.2 years, P < 0.05) and had lower KT/V-values than patients who were seronegative for H. pylori (1.88 +/- 0.3 vs 2.03 +/- 0.3, P < 0.05). Patients with positive or negative H. pylori serological status did not differ in terms of demographic parameters (e.g. sex, duration of CAPD), clinical factors (e.g. bodyweight, body mass index, hepatitis status, use of H(2) antagonists or proton pump inhibitors) and laboratory data (e.g. haemoglobin, serum urea, creatinine, albumin and parathyroid hormone levels). CONCLUSIONS: The seroprevalence of H. pylori infection among Chinese CAPD patients is 26%. Helicobacter pylori seropositivity is not associated with dyspepsia. Older age and lower KT/V-values appear to be associated with the development of H. pylori seropositivity in our dialysis population.

Screening by trained nurses for peripheral vascular disease in continuous ambulatory peritoneal dialysis patients with and without diabetes.

OBJECTIVE: We studied the effectiveness of a screening program for peripheral vascular disease (PVD) carried out by trained renal nurses in patients with and without diabetes on continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: We recruited 30 stable diabetic and 30 stable non diabetic CAPD patients into this cross-sectional study. Trained renal nurses measured the patients' ankle-to-brachial systolic pressure index (ABI) using a Doppler ultrasound machine and their foot vibration perception (VPT) using a biothesiometer, and administered a questionnaire on foot symptoms. An ABI < 1.0 was regarded as abnormal and suggestive of the presence of PVD. An ABI < 0.7 or > 1.3 was regarded as severely abnormal. Findings for VPT were classified as normal or abnormal. Patients were then followed for 1 year for any overt development of clinical PVD, leg complications, and other vascular complications and for clinical outcome. RESULTS: The mean age of the patients was 63 +/- 9 years, and the ratio of men to women was 1:1.3. An abnormal ABI was seen in 22 patients (37%). The questionnaire detected clinical PVD symptoms in 3 patients. Abnormal ABI and VPT findings were more frequent in diabetic patients. After 12 months of follow-up, patients with an abnormal ABI (and particularly those with a severely abnormal ABI) were more likely to develop leg complications and any type of cardiovascular disease than were patients with a normal ABI. Foot vibration perception had no predictive value on subsequent development of leg complications. When risk factors including age, ABI, and VPT were analyzed by logistic regression, only ABI was a significant independent predictor of subsequent lower-limb vascular complications [odds ratio (OR): 21.0; 95% confidence interval (CI): 2.35 to 187.0; p = 0.00064]. The OR for moderately abnormal ABI was 13.0 (95% CI: 1.015 to 166.3); for severely abnormal ABI, it was 27.4 (95% CI: 2.35 to 187.0, p = 0.0045). CONCLUSIONS: Measurement of ABI by Doppler ultrasound is a useful and effective screening test for PVD in CAPD patients. In this study, VPT was not shown to be predicative of future leg complications, indicating that peripheral neuropathy plays a less important role in the development of such complications. Our results proved that trained renal nurses can play an active role in detecting foot problems in renal patients by ABI measurement.