Does previous abdominal operation affect peritoneal dialysis complications and outcomes?

OBJECTIVE: Peritoneal dialysis (PD) "First Policy" for end stage renal disease (ESRD) patients who are under universal healthcare coverage scheme, was implemented in Thailand since January 2008. Now there are about 10,000 PD patients all over the country and most of them are in low to medium socio-economic status. In the past, previous abdominal operation was considered as a contra-indication to PD. The purpose of the present study is to compare the complications and outcomes between patients with and without previous abdominal operation. MATERIAL AND METHOD: The present study was a retrospective review of all new PD cases for complications and outcome of the first PD catheter implantation. The method of catheter implantation is mini-laparotomy under local anesthesia by one surgeon. The bleeding, exit site/wound infection, catheter malposition/obstruction, and catheter/technique/patient survival rate were compared between two groups. RESULTS: In 730 ESRD patients who underwent catheter implantation, there were 106 patients with history of previous abdominal operation (14.5%). There were no significant differences between patients "with previous abdominal operation" and "without previous abdominal operation", for bleeding, exit site/wound infection, catheter malposition/obstruction, and catheter/technique/patient survival. CONCLUSION: History of previous abdominal operation in ESRD patients is not a contra-indication to PD. The complications are low and the outcomes are excellent regardless of previous abdominal operation. Dedicated catheter implantation team might be the key of success.

Exfoliated mesothelial cell and CA-125 in automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) patients.

OBJECTIVE: Automated peritoneal dialysis (APD) becomes the first option for peritoneal dialysis, nowadays overtaking continuous ambulatory peritoneal dialysis (CAPD) in many countries. The comparison of peritoneal membrane alteration in CAPD and APD is inconclusive. The authors therefore compared the peritoneal membrane changes in patients undergoing CAPD and APD. MATERIAL AND METHOD: In naive end stage renal disease patients, the choice of PD modes (CAPD or APD) was dependent on the patient's decision. Thirty-six CAPD and 25APD patients with a total of 287 patient-months were compared. The peritoneal mass parameter, exfoliated mesothelial cell (MTC) and dialysate CA-125, as well as modified peritoneal equilibrium test (mPET) with 4.25% dextrose solution was simultaneously evaluated at 1 and 6 month follow-up. RESULTS: Although the peritoneal function (as measured by D/P creatinine, D/D0 glucose, sodium dipping, and dialysate protein loss), adequacy, serum albumin, nutritional status, and residual renal function showed no significant differences between groups at 1 and 6 months, CA-125 but not MTC was higher in APD compared with CAPD at the first month of PD beginning. Due to the single time-point measurement limitation, the authors compared the peritoneal mass parameter differences between 1 and 6 month. During 6-month follow-up, CA-125 decreased 30 +/- 5% vs. 7 +/- 5% and MTC decreased 5 +/- 12% vs. 40 +/- 11% in APD and CAPD, respectively. The higher CA-125 reduction in APD and greater changes of MTC in CAPD suggested that there was less viable mesothelial cell in APD compared with CAPD. CONCLUSION: The authors observed that both APD and CAPD damaged peritoneum. However, there might be higher peritoneal injury in APD patients. The proper randomization study in longer follow-up period is mandatory to confirm this observation.