Lower malfunction rate with self-locating catheters.

OBJECTIVE: We analyzed malfunction rates (obstruction, omental wrapping, displacement) and catheter survival for self-locating catheters as compared with other Tenckhoff catheter designs. PATIENTS AND METHODS: We conducted our survey at two centers, prospectively studying all self-locating catheters implanted from May 1997 to October 2000 and used for peritoneal dialysis (PD). Tenckhoff catheters of other designs used previously in our units were used as the control group. We analyzed removal causes and catheter survival. RESULTS: We studied 173 catheters (105 self-locating catheters, 53 straight catheters, and 15 coiled catheters) implanted in 139 patients (43% of them women) with a mean age of 53 +/- 14 years. The analysis of catheter removal showed that 3 of 105 self-locating catheters, 3 of 15 coiled catheters, and 17 of 53 straight catheters were removed owing to malfunction (chi2: p = 0.0000). Kaplan-Meier curves showed that the bulk of removals for malfunction occurred within the first 3 months after PD start. The group of self-locating catheters showed better survival (log-rank: p = 0.0009). Other causes for catheter removal included peritonitis (n = 22), exit-site infection alone (n = 4), and end of PD treatment (n = 66). No significant differences were seen in the annual peritonitis rate (straight-tip: 0.955 +/- 2.315 episodes annually; coiled-tip: 0.651 +/- 0.864 episodes annually; self-locating: 0.720 +/- 1.417 episodes annually; t-test: p > 0.400). No gut or bladder perforations were observed. CONCLUSION: In our survey, self-locating catheters were associated with better survival and fewer removals for malfunction than were Tenckhoff catheters of other designs.

Prevention of intraocular pressure elevations during hemodialysis.

Intraocular pressure (IOP) may rise during hemodialysis sessions in predisposed patients because of a rapid drop in osmolality at the blood compartment. A patient with diabetes had painful ocular episodes during hemodialysis that were associated with an IOP increase. We modified the dialysis parameters to prevent a rapid decrease in osmolality by creating conductivity and ultrafiltration profiles and adding a colloid solution at the beginning of the procedure. After instituting these changes, the patient became asymptomatic and did not have variations in IOP during the dialysis sessions.

Evaluation of complications due to percutaneous renal biopsy in allografts and native kidneys with color-coded Doppler sonography.

We studied 142 consecutive percutaneous renal biopsies (puncturing on 73 allografts and 69 native kidneys) which were performed under continuous ultrasonic guidance, on 133 adult patients. The patients were monitored, at least, during the next 24 hours. We compared the complication rate for biopsies recording clinical and biochemical data and, the day after the biopsy, the kidney was examined with a color-coded Doppler sonography (CCDS): in real-time survey of the kidney and with spectral wave form analysis. The diagnosis of arteriovenous (AV) fistula was achieved detecting increased color saturation toward white, high peak systolic flow velocity and low resistive index in the supplying artery. Three procedures were excluded of the analyses because of incomplete data recorded, although none of them showed any remarkable complication. There was a 94.3% rate of successful biopsies. The mean +/- SEM number of glomeruli under light microscopic examination was 8.5 +/- 0.6. Complications occurred 64 times in relation to 55 patients with a higher incidence in allografts (61%) than in native kidneys (31%). Renal transplant patients showed higher serum creatinine values (5.8 +/- 0.8 vs. 3.2 +/- 0.4; p > 0.0001) and lower hematocrit (31.3 +/- 1.1 vs. 34.4 +/- 0.9; p = 0.025) than the native-kidney patients at the time of biopsy. De novo hematuria occurred in 30% of the procedures. In transplant patients, the gross hematuria incidence (9.9%) more than doubled that showed by native-kidney patients. The incidence of serious complications (hematoma, hemoperitoneum and AV fistula) was 16.5% and these were more frequent in transplant than in native kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)