Peritonitis fúngica en diálisis peritoneal continua ambulatoria: descripción de 10 casos / No disponible

Antecedentes: La peritonitis fúngica es una complicación infrecuente pero grave en pacientes en diálisis peritoneal continua ambulatoria (DPCA). Métodos: Durante un período de 10 años (1999-2008), de un total de 175 pacientes con insuficiencia renal crónica en tratamiento con DPCA, estudiamos retrospectivamente 10 casos de peritonitis fúngica, analizando los factores predisponentes, aspectos clínicos, agentes etiológicos y tratamiento. El diagnóstico se estableció por la presencia de efluente peritoneal turbio con recuento superior a 100 leucocitos/µl y aislamiento de hongos en el cultivo microbiológico. Resultados: La peritonitis fúngica representó un 3,6% del total de peritonitis. Nueve pacientes tenían historia de peritonitis bacteriana previa y todos habían recibido antibioterapia. Otros hallazgos destacables fueron: edad superior a70 años (50%) y diabetes mellitus (40%). El examen microscópico del líquido peritoneal fue de utilidad para sospechar la infección en 6 pacientes (60%). Los agentes responsables de peritonitis fueron: Candida parapsilosis (4), C. albicans(2), C. tropicalis(1), C. glabrata (1), C. famata (1) y Fusarium oxysporum(1). Los antifúngicos utilizados en el tratamiento fueron: fluconazol intraperitoneal y oral, vorizonazol intravenoso y oral y anfotericina B intravenosa. A consecuencia de la infección fúngica, 8 pacientes fueron transferidos a hemodiálisis. Un paciente murió antes de ser diagnosticado y otros tres durante el episodio de peritonitis. Conclusiones: Los pacientes con episodios de peritonitis bacteriana previos y tratamiento antibiótico presentaron un mayor riesgo de desarrollar peritonitis fúngica. C. parapsilosis fue el patógeno más frecuente. El tratamiento antifúngico junto con la retirada del catéter peritoneal fue eficaz en el 60% de los pacientes (AU)

Background: Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis(CAPD). Methods: During a ten-year period (1999-2008), from a total of 175 patients with chronic renal failure undergoing CAPD, we retrospectively studied 10 cases of fungal peritonitis analyzing the predisposing factors, clinical aspects, etiological agents and treatment. Diagnosis was based on elevated CAPD effluent count(>100/µl) and isolation of fungi on culture. Results: Fungalperitonitis represented 3.6% of all peritonitis episodes. Nine patients had a history of previous bacterial peritonitis and all of them were under antibiotic therapy. Other common findings were: age higher than 70 years old (50%) and diabetes mellitus(40%). Direct microscopic examination of the peritoneal fluid was useful for the suspicion of fungal infection in six patients(60%). The responsible agents for peritonitis were: Candidaparapsilosis (4), C. albicans (2), C. tropicalis (1), C. glabrata (1), C.famata (1) and Fusarium oxysporum (1). Intraperitoneal and oralfluconazole, intravenous and oral voriconazole and intravenousamphotericin B were the antifungal agents used in the treatment. As a result of fungal infection, eight patients were transferred to hemodialysis. One patient died before the diagnosis and three other during the episode of peritonitis. Conclusions: Patients with previous bacterial peritonitis and antibiotic treatment were at greater risk of developing fungal peritonitis. C. parapsilosis was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in60% of patients (AU)

[Fungal peritonitis in ambulatory continuous peritoneal dialysis: description of 10 cases]. / Peritonitis fúngica en diálisis peritoneal continua ambulatoria: descripción de 10 casos.

BACKGROUND: Fungal peritonitis is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS: During a ten-year period (1999-2008), from a total of 175 patients with chronic renal failure undergoing CAPD, we retrospectively studied 10 cases of fungal peritonitis analyzing the predisposing factors, clinical aspects, etiological agents and treatment. Diagnosis was based on elevated CAPD effluent count (>100/microl) and isolation of fungi on culture. RESULTS: Fungal peritonitis represented 3.6% of all peritonitis episodes. Nine patients had a history of previous bacterial peritonitis and all of them were under antibiotic therapy. Other common findings were: age higher than 70 years old (50%) and diabetes mellitus (40%). Direct microscopic examination of the peritoneal fluid was useful for the suspicion of fungal infection in six patients (60%). The responsible agents for peritonitis were: Candida parapsilosis (4), Candida albicans (2), Candida tropicales (1), Candida glabrata (1), Candida famata (1) and Fusarium oxysporum (1). Intraperitoneal and oral fluconazole, intravenous and oral voriconazole and intravenous amphotericin B were the antifungal agents used in the treatment. As a result of fungal infection, eight patients were transferred to hemodialysis. One patient died before the diagnosis and three other during the episode of peritonitis. CONCLUSIONS: Patients with previous bacterial peritonitis and antibiotic treatment were at greater risk of developing fungal peritonitis. Candida parapsilosis was the most common pathogen. For the successful management of fungal peritonitis besides the antifungal therapy, peritoneal catheter removal was necessary in 60% of patients.

Informe del registro de pacientes con insuficiencia renal crónica en tratamiento con diálisis peritoneal de Andalucía: período 1999-2004 / Report of the andalusian registry of patients with end stage renal disease in treatment with peritoneal dialysis: period 1999-2004

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Experiencia clínica con icodrextrina. Estudio multicéntrico / Clinical experience and peritoneal clearance with icodextrin. Multicenter study

El propósito de este estudio ha sido analizar la experiencia clínica con icodextrina en nuestra comunidad, especialmente la incidencia de efectos secundarios y la repercusión en el peso y lípidos plasmáticos a medio plazo al disminuir la carga de glucosa. La muestra estaba formada por 51 pacientes; edad57 ± 18 años (18-86), 30 mujeres y 21 hombres; tiempo icodextrina 10,3 ± 7meses (0-41); 21 en DPCA y 30 con cicladora. Además de los datos clínicosen relación con los efectos secundarios, se observó la evolución de diversos parámetros bioquímicos en el período basal (antes de icodextrina) y a los 6, 12 y18 meses. En 12 pacientes se estudiaron la ultrafiltración y aclaramientos decreatinina y urea en el dializado de 24 horas y tras un intercambio de icodextrina trina. Resultados: Todos los efectos secundarios observados fueron dermatológicos, presentándose en 4 de los 51 pacientes (7,8%); dos de ellos sufrieron (..) (AU)

The aim of this study was to analyse our experience with icodextrin in Andalusia, Spain. The study includes 51 patients (30 women and 21 men) on peritoneal dialysis (21 on CAPD and 30 on Automated Peritoneal Dialysis) treated withicodextrin for 10.3 ± 7 months (0-41 months). Their mean age was 57 ± 18 years(18-86 years). We have recorded the appearance of side effects, and the evolution of several biochemical parameters at baseline and after 6, 12 ans 18 months from initiation of icodextrin. We also studied drainage fluid from 12 patients after an icodextrin exchange. Results: There were side effects (all cutaneous) in 4 out of 51 patients (7,8%).Two of the affected suffered from cutaneous hypersensitivity reactions, and icodextrin had to be suspended; the other two had exfoliative dermatitis affecting hands and feet that disappeared without have to withdraws icodextrin. Biochemical parameters: Serum sodium levels decreased from baseline to six months (138 ± 6 mEq/l vs 136 ± 3 mEq/l; p = 0.006), and then persisted at the same levels throughout the rest of the study period. There was a slight but (..) (AU)

Experiencia clínica con icodrextrina. Estudio multicéntrico / Clinical experience and peritoneal clearance with icodextrin. Multicenter study

El propósito de este estudio ha sido analizar la experiencia clínica con icodextrina en nuestra comunidad, especialmente la incidencia de efectos secundarios y la repercusión en el peso y lípidos plasmáticos a medio plazo al disminuir la carga de glucosa. La muestra estaba formada por 51 pacientes; edad57 ± 18 años (18-86), 30 mujeres y 21 hombres; tiempo icodextrina 10,3 ± 7meses (0-41); 21 en DPCA y 30 con cicladora. Además de los datos clínicos en relación con los efectos secundarios, se observó la evolución de diversos parámetros bioquímicos en el período basal (antes de icodextrina) y a los 6, 12 y18 meses. En 12 pacientes se estudiaron la ultrafiltración y aclaramientos de (..) (AU)

The aim of this study was to analyse our experience with icodextrin in Andalusia, Spain. The study includes 51 patients (30 women and 21 men) on peritoneal dialysis (21 on CAPD and 30 on Automated Peritoneal Dialysis) treated with icodextrin for 10.3 ± 7 months (0-41 months). Their mean age was 57 ± 18 years(18-86 years). We have recorded the appearance of side effects, and the evolu(18-86 years). We have recorded the appearance of side effects, and the evolution of several biochemical parameters at baseline and after 6, 12 ans 18 months from initiation of icodextrin. We also studied drainage fluid from 12 patients after an icodextrin exchange. Results: There were side effects (all cutaneous) in 4 out of 51 patients (7,8%).Two of the affected suffered from cutaneous hypersensitivity reactions, and icodextrin had to be suspended; the other two had exfoliative dermatitis affecting hands and feet that disappeared without have to withdraws icodextrin. Biochemical parameters: Serum sodium levels decreased from baseline to six months (138 ± 6 mEq/l vs 136 ± 3 mEq/l; p = 0.006), and then persisted at the same levels throughout the rest of the study period. There was a slight but (..) (AU)

[Clinical experience with icodextrin. Multicenter study]. / Experiencia clínica con icodextrina. Estudio multicéntrico.

UNLABELLED: The aim of this study was to analyse our experience with icodextrin in Andalusia, Spain. The study includes 51 patients (30 women and 21 men) on peritoneal dialysis (21 on CAPD and 30 on Automated Peritoneal Dialysis) treated with icodextrin for 10.3 +/- 7 months (0-41 months). Their mean age was 57 +/- 18 years (18-86 years). We have recorded the appearance of side effects, and the evolution of several biochemical parameters at baseline and after 6, 12 ans 18 months from initiation of icodextrin. We also studied drainage fluid from 12 patients after an icodextrin exchange. RESULTS: There were side effects (all cutaneous) in 4 out of 51 patients (7.8%). Two of the affected suffered from cutaneous hypersensitivity reactions, and icodextrin had to be suspended; the other two had exfoliative dermatitis affecting hands and feet that disappeared without have to withdraws icodextrin. Biochemical parameters: Serum sodium levels decreased from baseline to six months (138 +/- 6 mEq/l vs 136 +/- 3 mEq/l; p = 0.006), and then persisted at the same levels throughout the rest of the study period. There was a slight but significant decreased of serum HDL-cholesterol at six months vs baseline (55 +/- 26 mg/dl vs 51 +/- 20 mg/dl, p = 0.04), and a further decrease at twelve months vs six months (42 +/- 15 mg/dl vs 51 +/- 13 mg/dl, p = 0.054). There were no significant variations of glucose, osmolality, cholesterol, LDL-cholesterol (tendency to increase), triglycerides, beta 2 m and weight (tendency to increase; p = 0.08). In relation with the icodextrin exchange: average ultrafiltration 296 +/- 119 ml (ranging from 104 to 480 ml), creatinine clearance 1.9 +/- 0.5 litres (20.5% of daily creatinine clearance), urea clearance 2.08 +/- 0.5 litres (18.7% of daily urea clearance), total protein losses 3.2 +/- 0.9 g, albumin losses 1.4 +/- 0.5 g; urea and creatinine clearances were negatively correlated with ratios D/P4 of urea and creatinine of PET and positively correlated with ratio G4/G0. In conclusion, side effects are scarce with the use of icodextrin. As described in other studies, there is a trend to a slight decrease in serum sodium. The long-term use of icodextrin does not-prevent weight gain or deterioration of patients on peritoneal dialysis, despite the diminution of glucose load.

Uso de modalidades de tratamiento de la insuficiencia renal crónica en Andalucía: II. Diferencias locales y temporales / Use of different therapeutic modalities for chronic renal failure in Andalusia: II. Local and temporal differences

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Comparison of survival in continuous ambulatory peritoneal dialysis and hospital haemodialysis: a multicentric study.

We compared the survival of 842 patients on centre haemodialysis to 272 patients on continuous ambulatory peritoneal dialysis (CAPD). All patients selected had begun treatment between 1 January 1984 and 30 June 1988 and were from six centres which participate in a regional renal patients registry. Patients on CAPD were older and had a greater proportion of diabetes and other associated diseases. Age, diabetes, and cardiovascular diseases were associated with a shorter survival on treatment in all the patients studied. Without adjustment for risk factors, patient 3-year survival was higher in centre haemodialysis than in CAPD, 80% versus 64% respectively. However, no significant differences could be shown in the survival rates of the two treatment modalities after accounting for the heterogeneity of the patients in the two groups, either by stratification or by multivariate analysis (Cox). Age was the main predictive factor for CAPD patient survival, while the influence of diabetes and cardiovascular diseases was less clear. Technique survival was much better in centre haemodialysis (94% versus 56% in CAPD, 3-year survival). Older age and diabetes mellitus were associated with a greater risk of switching from centre haemodialysis to CAPD and a trend to retain those patients on CAPD.