Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: silver ring prophylaxis at the catheter exit study.

Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the silver ring in preventing catheter-related infections in PD patients. Thus, prevention of infection-related method failure in PD still has to rely on conventional antibiotic treatment strategies and less so on alternative methods.

Protein requirements in maintenance hemodialysis.

Protein requirements in maintenance hemodialysis patients are still unclear. Based on nitrogen balance studies and different analyses of protein and amino acid metabolism, the recommendations until recently were 1 g/kg of body weight, primarily of high biological value protein. According to the results of controlled long-term studies the 1 g recommendation now seems too low. The paper reports on the results of a controlled study undertaken to define protein requirements. The effect of supplementation with a special protein mixture is studied on the basis of 1 g of protein per kilogram of body weight intake and about 20 hr standard dialysis per week. The results suggest that 1.2 g of protein per kilogram of body weight primarily of high biological value protein and 35 kcal/kg of body weight should be prescribed for dialysis patients. In case of complications (bleeding, infection, and other stress situations) additional supplements are necessary.

[Vocational rehabilitation in chronic renal insufficiency: the phase of compensated retention (author's transl)]. / Die berufliche Rehabilitation bei chronischer Niereninsuffizienz: Das Stadium der kompensierten Retention

The article reports on the vocational rehabilitation of 141 patients with chronic renal insufficiency in the compensated retention phase (creatine 1,3-7,9 mg%). It points out in how far rehabilitation is dependent on the disease, type of work performed and degree of severity of the renal insuffiency. It also stresses the necessity of an early detection and prompt initiation of vocational rehabilitation.

[Perimembranous glomerulonephritis after treatment with D-penicillamine. Report on 31 cases (author's transl)]. / Perimembranöse Glomerulonephritis nach Penicillamintherapie. Bericht über 31 Fälle

This report includes 31 patients who developed a perimembranous glomerulonephritis generally 7 months after the onset of the treatment of various illnesses with D-Penicillamine. In all cases the patients had a proteinuria, associated with a hematuria in 12 cases. After the treatment was stopped 8 patients rapidly developed a nephrotic syndrome, while its onset was more gradual in 12 other patients. 5 patients initially with a nephrotic syndrome had no proteinuria at the time of a second biopsy made up to 12 months later. In these 5 cases the typical changes of perimembranous glomerulonephritis observed on electron microscopy were much reduced in the second biopsy.