Fungal peritonitis among the peritoneal dialysis patients of four Turkish centres.

This study evaluates the clinical findings and treatment of continuous ambulatory peritoneal dialysis (CAPD) patients with fungal peritonitis in Istanbul from 2000 to 2010. The clinical records of 15 patients with fungal peritonitis among the total 795 patients were reviewed for the clinical and laboratory data. The mean duration of dialysis from the initiation of treatment until the development of fungal peritonitis was 41.14 months. Fungal peritonitis was the primary episode of infection in eight patients. In five other patients previous intensive antibiotherapy was documented. The isolated mircoboes were Candida albicans in six, non-C. albicans in eight and Aspergillus fumigatus in one patient. Tenckoff catheters were removed in all cases and antifungal treatment was given for a minimum of three weeks. Two patients died in the hospital due to the fungal infection whereas others were transferred to haemodialysis. This study highlights the importance of removing the catheter and initiating antifungal therapy as soon as possible in cases of fungal peritonitis because it is responsible for high morbidity and mortality.

Assessing and training patients on peritoneal dialysis in their own homes can influence better practice.

Peritoneal dialysis (PD) offers the opportunity of a better quality of life for patients as long as they are able to perform dialysis according to the set procedures. Our aim in this study was to assess the change in PD patients' knowledge about their treatment and practice through repeated home visits. This study was based on the findings of a previous study. Fifteen patients participated and received two visits post training. During the visits, a questionnaire was completed, and the answers were analysed. Data were analysed by percentage statistics and assessed for differences between the two visits. The correct number of answers given during the first visit was 25.5 +/- 3.2/31 and was 27.8 +/- 4.0/31.8 at the second visit. The mean infection section and medication scores had increased from the original study findings. The personal hygiene section was the least correctly answered section. Consecutive home visits revealed that as the time on PD increased, knowledge and practice regarding infections and medication increased. Personal hygiene scores did not improve. This study confirmed the importance of home visits in detecting the weakest point of PD practice.

Can using a questionnaire for assessment of home visits to peritoneal dialysis patients make a difference to the treatment outcome?

Training provided by dialysis nurses to the patients is of great importance in peritoneal dialysis (PD). This study aimed to examine how PD patients continue with the training and practice taught in this unit and correlate these data with the incidence of peritonitis. Home visits were paid to 32 patients. A form including questions about 'knowledge and skill' and dialysis environment was filled in for each patient. Answers were graded out of 100 points and were reported as average, percentage and minimum-maximum values. The mean 'knowledge and skill' criterion scoring was 79.8 +/-14.0, and the mean score for the dialysis environment was 87.7 +/-10.9. There was a significant correlation between the 'knowledge and skill' and environmental scores. Meaningful correlations were detected between the 'knowledge and skill' score as well as the environmental score with the rate of peritonitis. Training is of vital importance in PD practice, but results show that the dialysis environment is as important as the patient's knowledge or skill in exchanges.

Relation of demographic, clinic and biochemical parameters to peritonitis in peritoneal dialysis.

The relation of various demographic, clinical and biochemical parameters of peritoneal dialysis patients with peritonitis and other infections was evaluated. The age, gender, peritoneal dialysis (PD) period, educational status, peritonitis, exit site score, serum albumin, C-reactive protein (CRP), and triglyceride levels at the beginning and the last visit were recorded. Mean age of 32 patients was 45.1 years; PD period was 13.1 months. Albumin level was inversely proportional to the frequency of peritonitis. Patients with peritonitis had albumin levels that were lower at the last visit, and were independent of the CRP values at the start of PD and during follow-up. Significant correlation was detected between females and exit site scores. There was significant correlation between educational status and peritonitis. Albumin level at first visit was a factor that reduced the likelihood of peritonitis, and low levels obtained during follow-up constituted a risk for peritonitis. It was also shown that peritonitis risk tended to decrease inversely with education level.