No increased risk for peritonitis by insulin injected into peritoneal dialysis solution bag through Coloplast.

OBJECTIVE: This study assessed the incidence of peritonitis that occurred when insulin was injected intraperitoneally with an insulin pen (Novo Pen) through an elastic plastic plate (Coloplast) attached to the dialysis solution bag. DESIGN: A retrospective, exploratory descriptive study was used. SETTING AND SAMPLES: Seventeen patients (7 women and 10 men) with insulin-dependent diabetes mellitus (IDDM) and end-stage renal disease (ESRD), who were treated with continuous ambulatory peritoneal disease (CAPD), were studied. METHODS: All patients injected insulin intraperitoneally. The IDDM patients on CAPD were divided into Group I (n = 6, total of 143 treatment months), who injected insulin with syringes and needles via the injection site on the bags, and Group II (n = 11, total of 163 treatment months), who injected insulin with an insulin pen through a nonsterile Coloplast plate added to the dialysis solution bag by the patient. Seventeen other patients (without diabetes mellitus) on CAPD, who did not use injections, served as comparison groups and were matched by age and sex with the treatment groups: Comparison Group I (n = 6, total of 51 treatment months) and Comparison Group II (n = 11, total of 217 treatment months). RESULTS: Seven episodes of peritonitis occurred in Group I versus two episodes in Group II, corresponding to one episode of peritonitis for every 20 treatment months versus one episode every 81 months for Group II (p = 0.06). There were no significant differences between Group I and the matched Comparison Group I (1 episode/25 months) nor between Group II and the Comparison Group II (1 episode/31 months). CONCLUSION: A Coloplast device enables CAPD patients to administer insulin into the dialysis solution bag without increasing the risk for peritonitis.

Blood glucose and cholesterol control improved by continuous ambulatory peritoneal dialysis in patients with end-stage renal disease and diabetes mellitus.

This longitudinal study was performed to evaluate the change of total cholesterol, triglycerides, and glucose control in patients with insulin-dependent diabetes mellitus (IDDM) and end-stage renal disease (ESRD) during predialysis (PreD), on continuous ambulatory peritoneal dialysis (CAPD) and after kidney graft. A total of 20 consecutive patients (7 women, 13 men, mean age 42 years) with IDDM and ESRD were studied retrospectively in 1991 during PreD and during CAPD. Twelve were also investigated after obtaining a kidney graft. Insulin was administered intraperitoneally (CAPD period) and subcutaneously (PreD and transplant). The mean values of weight, serum albumin, glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides were calculated during each period. Patients were age- and sex-matched with a group of healthy controls (Group 1) and with a group of patients with IDDM without nephropathy (Group 2). T-test statistics were used. During CAPD, there were significant decreases in HbA1c (mean 8.1 mmol/L vs 12.1, p = 0.003) and cholesterol (mean 6.1 mmol/L vs 7.1, p = 0.025) compared to PreD. No differences were found between PreD and CAPD stages with regard to weight, serum albumin, or triglycerides. After transplantation an improvement was found in serum albumin compared to PreD and CAPD (mean value 40 g/L vs 34 and 35, p < 0.03), and HbA1c compared to PreD (9.6 mmol/L vs 12.1, p = 0.014), if the pancreas transplanted were included. Patients compared to Group 1 or 2 showed no differences in total cholesterol or triglycerides. HbA1c was higher in patients during PreD than in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrafiltration failure and dialysate glucose in CAPD.

This study was performed to evaluate the use of the glucose concentration versus glucose absorption in the dialysate to estimate ultrafiltration efficacy. In 26 patients (16 men, 10 women) on continuous ambulatory peritoneal dialysis, a total of 128 dwells were investigated. Each dwell lasted 5 hours, using 2 L of peritoneal dialysis fluid containing 140 mmol/L glucose. After the dwell, the removed peritoneal dialysis fluid was weighted. The concentrations of creatinine and glucose and the total amount of glucose were analyzed. The mean concentration of dialysate glucose for the whole group after a 5-hour dwell was 38.9 +/- 8.9 (SD) mmol/L. The ultrafiltration volume was inversely correlated to the glucose absorbed (r = -0.59, p = 0.002), but was not significantly correlated to the glucose concentration in the dialysate (r = 0.40, p = 0.057). The ultrafiltration volume was not related to the creatinine concentration in the dialysate or the body weight. The average dialysate glucose did not change during a one-year observation time. Patients with diabetes mellitus had significantly lower glucose absorption than nondiabetics (p = 0.045), and patients with low ultrafiltration efficacy had significantly greater glucose absorption than those with normal and high ultrafiltration (p = 0.038). There was no difference between those who had those who had not suffered from peritonitis. The results indicate that the glucose absorption from the dialysis fluid is the best parameter to calculate the peritoneal ultrafiltration efficacy and not the glucose concentration currently used.

CAPD bag changing with integrated disconnect system gives lower incidence of peritonitis than with UV-box system.

UNLABELLED: The use of a UV-box disconnect system reduces the incidence of peritonitis as compared with manual exchanges. An integrated disconnect system (IDS) also gives good results. See Figure 1. From 1988-1991, we prospectively compared two groups of patients using either a UV-box disconnect system (Baxter, n = 18, mean age 64, range 28-75 yrs) or an IDS (Baxter, n = 25, mean age 53, range 30-78). The Tenckhoff catheter had been inserted by the same technique in all patients, and the training program and nursing care were also identical. Since many younger patients preferred IDS and refused randomization, age was significantly lower in the IDS group. All peritonitis episodes (PER) were registered. Excluded from calculations of PER were episodes most probably not due to failure in connective device: PER after incidental penetration of the dialysis bags, deep penetrating tunnel infections and in the direct course of abdominal surgery. RESULTS: There were significantly fewer months with PER (one month = 1 PER; Chi-2 = 6.45, p < 0.05) in patients using the IDS (3 PER/269 months) compared with those using the UV-box system (15 PER/355 months). The IDS was requested mainly by younger patients, while some older patients found it to be too complicated. CONCLUSION: The integrated disconnect system is especially acceptable by younger patients, and patients using the IDS show a low incidence of peritonitis.

Reduced risk for peritonitis in CAPD with the use of a UV connector box.

A common route for peritoneal infection is the bag transfer connecting site. To investigate possible reduction of such transfer infections with the use of a bag transfer set (UV-XD, Travenol, Baxter, Minneapolis), this study sampled patients using a transfer set with or without UV light sterilization. Calculations excluded peritonitis due to penetrating tunnel infection or defective peritoneal dialysis bag (4 episodes in 2 patients). The study included 51 patients with a median age of 62 years (range 25-81). Five were switched from manual connection (Travenol, Type II) to UV-XD, and each suffered from at least 2 peritonitis episodes during 9-24.5 months prior to the change to UV-XD. In this patient group, the incidence of peritonitis fell significantly from 1 peritonitis/4 to 1/21 months. The bag transfer set was used without UV light in 35 patients for a total of 178 months, producing an incidence of 1 episode/7.7 treatment months. These patients had significantly more peritonitis than 35 patients who used the UV light for a total of 416 months (1 episode/21 months). In 19 patients who used both techniques, there was less risk for peritonitis when UV light was used (p = 0.001). We conclude that the UV-XD device is simple to handle and may reduce the incidence of peritonitis, especially if the box is used in tandem with UV light sterilization.