Pub Date : 2017-08-01DOI: 10.15582/IJPD/2017/120291
U. Narain, Arvind Gupta
Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immuno compromised patients, such as peritoneal dialysis recipients. A retrospective study of 455 peritoneal dialysis patients was made to determine the incidence and understand the demographic features of patients that lead to the development of Tuberculous meningitis on the basis of CSF for cell count, routine, ADA estimation, ZN Stain, culture&PCR. Between Jan 2000 and March 2017 4.39% patients of the total patients studied had Tuberculous meningitis. CSF smear was positive for AFB in 22.2% patients, CSF culture isolated AFB in 52.8% patients, PCR was found positive in 36.1% cases, and 4.39% patients were found to be having CSF ADA above cut off value. Pearson correlation indicates that lymphocyte counts and protein levels both increase as ADA increases, however sugar decreases as ADA, lymphocyte counts and protein increase in Tuberculous meningitis patients which is also proven by regression analysis. Outcome analysis revealed 30% mortality rate in diagnosed Tuberculous meningitis cases while maximum loss of life (36.36%) was seen in diabetic patients. It is concluded that the incidence of Tuberculous meningitis in peritoneal dialysis recipients was 4.39% and mortality rate was 30%. The rapid diagnosis of Tubercular meningitis is fundamental to clinical outcome. The present study clearly states that ADA is a rapid and fairly specific method for the diagnosis of Tuberculous meningitis. The early diagnosis and treatment help in achieving an improved outcome for PD patients. However, other techniques like AFB smear, PCR for M.tuberculosis and rapid culture would be required for confirmation of the diagnosis.
{"title":"Tuberculous Meningitis in PD Patients","authors":"U. Narain, Arvind Gupta","doi":"10.15582/IJPD/2017/120291","DOIUrl":"https://doi.org/10.15582/IJPD/2017/120291","url":null,"abstract":"Tuberculous meningitis is a very rare, but serious extrapulmonary complication of mycobacterial infections in immuno compromised patients, such as peritoneal dialysis recipients. A retrospective study of 455 peritoneal dialysis patients was made to determine the incidence and understand the demographic features of patients that lead to the development of Tuberculous meningitis on the basis of CSF for cell count, routine, ADA estimation, ZN Stain, culture&PCR. Between Jan 2000 and March 2017 4.39% patients of the total patients studied had Tuberculous meningitis. CSF smear was positive for AFB in 22.2% patients, CSF culture isolated AFB in 52.8% patients, PCR was found positive in 36.1% cases, and 4.39% patients were found to be having CSF ADA above cut off value. Pearson correlation indicates that lymphocyte counts and protein levels both increase as ADA increases, however sugar decreases as ADA, lymphocyte counts and protein increase in Tuberculous meningitis patients which is also proven by regression analysis. Outcome analysis revealed 30% mortality rate in diagnosed Tuberculous meningitis cases while maximum loss of life (36.36%) was seen in diabetic patients. It is concluded that the incidence of Tuberculous meningitis in peritoneal dialysis recipients was 4.39% and mortality rate was 30%. The rapid diagnosis of Tubercular meningitis is fundamental to clinical outcome. The present study clearly states that ADA is a rapid and fairly specific method for the diagnosis of Tuberculous meningitis. The early diagnosis and treatment help in achieving an improved outcome for PD patients. However, other techniques like AFB smear, PCR for M.tuberculosis and rapid culture would be required for confirmation of the diagnosis.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127815676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.15582/IJPD/2017/120303
Rajitha Abeysekara, A. Wazil, L. Gunarathne, Sewmini Dickowita, C. Rathnayake, N. Karunasena, M. Fernando, N. Nanayakkara
Used effluent dialysate bags are thrown away which adds burden to the environment. Here CAPD patient from Srilanka describes the use of used dialysate bag for growing vegetables and flower. There by earning him part of his livelihood.
{"title":"A Novel Use for Used CAPD Bags","authors":"Rajitha Abeysekara, A. Wazil, L. Gunarathne, Sewmini Dickowita, C. Rathnayake, N. Karunasena, M. Fernando, N. Nanayakkara","doi":"10.15582/IJPD/2017/120303","DOIUrl":"https://doi.org/10.15582/IJPD/2017/120303","url":null,"abstract":"Used effluent dialysate bags are thrown away which adds burden to the environment. Here CAPD patient from Srilanka describes the use of used dialysate bag for growing vegetables and flower. There by earning him part of his livelihood.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121574764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.15582/IJPD/2017/120288
P. Anupama, A. Rohit, M. Mathew, D. George, G. Abraham
Tuberculous peritonitis is largely an undetected entity in developing countries among patients on CAPD. GeneXpert is a newer tool used in the diagnosis of Mycobacterial tuberculous peritonitis. This paper presents a report on the application of GeneXpert as a rapid and useful diagnostic tool in the diagnosis of Mycobacterial tuberculous peritonitis. After initiation of antituberculous therapy, the use of GeneXpert for the response to treatment is discussed. We used GeneXpert as a rapid diagnostic tool in four patients for the diagnosis or exclusion of MTB peritonitis. One diabetic male patient tested positive for GeneXpert; in other three patients, GeneXpert test was negative. After initiation of antituberculous therapy in the patient with positive GeneXpert, the dialysis effluent became clear within 3 days and repeat GeneXpert tested after 10 days was reported negative. A second patient had smear positive with refractory peritonitis due to co infection with Coagulase negative staphylococcus and budding yeast. In the other two suspected patients, GeneXpert, AFB smear, and Mycobacterial culture were negative. GeneXpert contributes to rapid diagnosis of Mycobacterium tuberculous complex and also in the identification of rifampicin resistance in two hours, whereas conventional tuberculosis culture takes 3-8weeks to show a positive result. However, Mycobacterial culture remains the gold standard for the diagnosis of mycobacterial tuberculous peritonitis as GeneXpert has not been widely applied for diagnosis of peritonitis in chronic peritoneal dialysis patients.
{"title":"GeneXpert Technique a New Diagnostic Modality for Diagnosis of Tuberculous Peritonitis in Patients on CAPD with a Review of Literature","authors":"P. Anupama, A. Rohit, M. Mathew, D. George, G. Abraham","doi":"10.15582/IJPD/2017/120288","DOIUrl":"https://doi.org/10.15582/IJPD/2017/120288","url":null,"abstract":"Tuberculous peritonitis is largely an undetected entity in developing countries among patients on CAPD. GeneXpert is a newer tool used in the diagnosis of Mycobacterial tuberculous peritonitis. This paper presents a report on the application of GeneXpert as a rapid and useful diagnostic tool in the diagnosis of Mycobacterial tuberculous peritonitis. After initiation of antituberculous therapy, the use of GeneXpert for the response to treatment is discussed. We used GeneXpert as a rapid diagnostic tool in four patients for the diagnosis or exclusion of MTB peritonitis. One diabetic male patient tested positive for GeneXpert; in other three patients, GeneXpert test was negative. After initiation of antituberculous therapy in the patient with positive GeneXpert, the dialysis effluent became clear within 3 days and repeat GeneXpert tested after 10 days was reported negative. A second patient had smear positive with refractory peritonitis due to co infection with Coagulase negative staphylococcus and budding yeast. In the other two suspected patients, GeneXpert, AFB smear, and Mycobacterial culture were negative. GeneXpert contributes to rapid diagnosis of Mycobacterium tuberculous complex and also in the identification of rifampicin resistance in two hours, whereas conventional tuberculosis culture takes 3-8weeks to show a positive result. However, Mycobacterial culture remains the gold standard for the diagnosis of mycobacterial tuberculous peritonitis as GeneXpert has not been widely applied for diagnosis of peritonitis in chronic peritoneal dialysis patients.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121350168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.15582/IJPD/2017/120290
S. Changsirikulchai, Suwanee Sriprach, N. Sripaiboonkij, J. Janma, P. Chuengsaman, D. Sirivongs
The peritonitis (PN) is one important clinical outcome which should be monitored by peritoneal dialysis units. To report the types of pathogens isolated from patients with peritoneal dialysis who had peritonitis. We have developed a web-based program named the Database of Peritoneal dialysis in the EXcel (DPEX). It is a program for peritoneal dialysis units to use for monitoring clinical outcomes of patients with peritoneal dialysis (PD) for continuous quality improvement. We have analyzed the data of PD patients with peritonitis during November, 2007 to September, 2015.The causative organisms were classified by cultures. The 2 month outcomes of PN consisted of the continuation of PD, technique failure or mortality rates were evaluated. The technique failure was defined as catheter removal and/or a shift to permanent hemodialysis. There were 1,300 (51.9%) males and 1,207 (48.1%)females .The mean (SD) age when PD was initiated was 54.1 (15.2) [95%CI 53.5-54.7] years. Patients with diabetes numbered 1,367 (54.5%). Patients were categorized with education levels as illiterate, primary school, secondary school, university and unknown were 728 (29%), 1,288 (51.4%), 354 (14.1%), 63 (2.5%), and 74 (3%), respectively. Universal health coverage scheme covered 2,341 (93.4%) of the cases. The numbers of gram positive, gram negative, culture negative, fungal, mycobacterial and polymicrobial PN were 1,332 (31.8%), 1,179 (28.1%), 1,498 (35.7%), 141 (3.4%), 25 (0.6%), and 15 (0.4%), respectively. The most common gram positive pathogens were Staphylococcus spp (coagulase negative and coagulase positive, not including S.aureus) 339 (25.5%) followed by Streptococcal spp. 288 (21.6%). Also, Staphylococcus aureusspp was identified in216 (16.2%). The most common gram negative pathogens were E.coli429 (36.4%) followed by Klebsiella spp. 196 (16.6%), and P.aeruginosa 142 (12.0%). The patients who continued PD, had technique failure and mortality at2,079 (82.9%), 233 (9.3%) and 178 (7.1%), respectively. There were 17 (0.7%) cases that could not be evaluated as they were transferred to other PD centers. The numbers of culture negative PN were high. Most patients who contracted PN were able to continue with PD.
{"title":"The Report of Causative Organisms in Peritonitis from the Database of Peritoneal Dialysis in Thailand Excelprogram","authors":"S. Changsirikulchai, Suwanee Sriprach, N. Sripaiboonkij, J. Janma, P. Chuengsaman, D. Sirivongs","doi":"10.15582/IJPD/2017/120290","DOIUrl":"https://doi.org/10.15582/IJPD/2017/120290","url":null,"abstract":"The peritonitis (PN) is one important clinical outcome which should be monitored by peritoneal dialysis units. To report the types of pathogens isolated from patients with peritoneal dialysis who had peritonitis. We have developed a web-based program named the Database of Peritoneal dialysis in the EXcel (DPEX). It is a program for peritoneal dialysis units to use for monitoring clinical outcomes of patients with peritoneal dialysis (PD) for continuous quality improvement. We have analyzed the data of PD patients with peritonitis during November, 2007 to September, 2015.The causative organisms were classified by cultures. The 2 month outcomes of PN consisted of the continuation of PD, technique failure or mortality rates were evaluated. The technique failure was defined as catheter removal and/or a shift to permanent hemodialysis. There were 1,300 (51.9%) males and 1,207 (48.1%)females .The mean (SD) age when PD was initiated was 54.1 (15.2) [95%CI 53.5-54.7] years. Patients with diabetes numbered 1,367 (54.5%). Patients were categorized with education levels as illiterate, primary school, secondary school, university and unknown were 728 (29%), 1,288 (51.4%), 354 (14.1%), 63 (2.5%), and 74 (3%), respectively. Universal health coverage scheme covered 2,341 (93.4%) of the cases. The numbers of gram positive, gram negative, culture negative, fungal, mycobacterial and polymicrobial PN were 1,332 (31.8%), 1,179 (28.1%), 1,498 (35.7%), 141 (3.4%), 25 (0.6%), and 15 (0.4%), respectively. The most common gram positive pathogens were Staphylococcus spp (coagulase negative and coagulase positive, not including S.aureus) 339 (25.5%) followed by Streptococcal spp. 288 (21.6%). Also, Staphylococcus aureusspp was identified in216 (16.2%). The most common gram negative pathogens were E.coli429 (36.4%) followed by Klebsiella spp. 196 (16.6%), and P.aeruginosa 142 (12.0%). The patients who continued PD, had technique failure and mortality at2,079 (82.9%), 233 (9.3%) and 178 (7.1%), respectively. There were 17 (0.7%) cases that could not be evaluated as they were transferred to other PD centers. The numbers of culture negative PN were high. Most patients who contracted PN were able to continue with PD.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117054494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-08-01DOI: 10.15582/IJPD/2017/120292
C. Sreedhara, L. Umesh, N. Raghavendra, V. Leelavathi, Shivaprasad
Background : Chronic ambulatory peritoneal dialysis (CAPD) is a form of renal replacement therapy in patients with end-stage renal failure in India, other than hemodialysis. Because of its cost and technical demand was mostly used in urban area in India. The objective of this paper is to report the experience with CAPD as a modality of renal replacement therapy from a tertiary care hospital in south India with low socioeconomic group of population. Methods.: We report a prospective study in a large south indian tertiary hospital. This study involved the patients who were initiated on CAPD between april 2011 and january 2016 and who survived and/or had more than 6 months follow up on this treatment with last follow up till July 30, 2016 Infection rates as well as factors that may influence them were studied. Results.: Forty five patients were enrolled. There were 24 males and 21 females. The mean age was 46±10 (range 5-70) years and mean duration on dialysis at the end of the trial period was 23 months. Shift to haemodialysis occurred in 13.3% of patients ( n=6). One patient had exit-site infection, six patients had peritonitis and 4 lead to removal of catheter. Other 2 cases catheter removal done for migration and in that one underwent reinsertion.16 patients died in the study. The main cause of death was cardiovascular complications. Peritonitis rate is 1 in 32 patient months, which is better than the guidelines. Conclusion.: Chronic ambulatory peritoneal dialysis (CAPD) is a safe and viable mode of renal replacement in low socioeconomic group of population. The peritonitis rate and aetiology are similar to the developed world. It can use as procedure for ESRD patients dwelling in low socioeconomic group of population in developing countries such as India.
{"title":"Continuous Ambulatory Peritoneal Dialysis Programme:Experience of State Run Tertiary Care Centre","authors":"C. Sreedhara, L. Umesh, N. Raghavendra, V. Leelavathi, Shivaprasad","doi":"10.15582/IJPD/2017/120292","DOIUrl":"https://doi.org/10.15582/IJPD/2017/120292","url":null,"abstract":"Background : Chronic ambulatory peritoneal dialysis (CAPD) is a form of renal replacement therapy in patients with end-stage renal failure in India, other than hemodialysis. Because of its cost and technical demand was mostly used in urban area in India. The objective of this paper is to report the experience with CAPD as a modality of renal replacement therapy from a tertiary care hospital in south India with low socioeconomic group of population. Methods.: We report a prospective study in a large south indian tertiary hospital. This study involved the patients who were initiated on CAPD between april 2011 and january 2016 and who survived and/or had more than 6 months follow up on this treatment with last follow up till July 30, 2016 Infection rates as well as factors that may influence them were studied. Results.: Forty five patients were enrolled. There were 24 males and 21 females. The mean age was 46±10 (range 5-70) years and mean duration on dialysis at the end of the trial period was 23 months. Shift to haemodialysis occurred in 13.3% of patients ( n=6). One patient had exit-site infection, six patients had peritonitis and 4 lead to removal of catheter. Other 2 cases catheter removal done for migration and in that one underwent reinsertion.16 patients died in the study. The main cause of death was cardiovascular complications. Peritonitis rate is 1 in 32 patient months, which is better than the guidelines. Conclusion.: Chronic ambulatory peritoneal dialysis (CAPD) is a safe and viable mode of renal replacement in low socioeconomic group of population. The peritonitis rate and aetiology are similar to the developed world. It can use as procedure for ESRD patients dwelling in low socioeconomic group of population in developing countries such as India.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127362185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.15582/IJPD/2016/104063
U. Narain, Arvind Gupta
The aim of this study is to analyze the usefulness of serum Procalcitonin levels as both diagnostic and prognostic marker for aerobic and anaerobic bacteremia and to assess the correlation between serum Procalcitonin and time to positivity. Retrospectively analyzed 410 Peritoneal Dialysis patients with suspected blood stream infections who had concurrent serum Procalcitonin data and blood culture results. The study illustrates that Procalcitonin assay is a reliable and promising biomarker to discriminate aerobic and anaerobic bacteremia from non-bacterial blood stream infections. Serum Procalcitonin levels may also predict the severity and prognosis of blood stream infections but renal function should also be taken into account.
{"title":"Bacteremia in PD Patients:Role of PCT","authors":"U. Narain, Arvind Gupta","doi":"10.15582/IJPD/2016/104063","DOIUrl":"https://doi.org/10.15582/IJPD/2016/104063","url":null,"abstract":"The aim of this study is to analyze the usefulness of serum Procalcitonin levels as both diagnostic and prognostic marker for aerobic and anaerobic bacteremia and to assess the correlation between serum Procalcitonin and time to positivity. Retrospectively analyzed 410 Peritoneal Dialysis patients with suspected blood stream infections who had concurrent serum Procalcitonin data and blood culture results. The study illustrates that Procalcitonin assay is a reliable and promising biomarker to discriminate aerobic and anaerobic bacteremia from non-bacterial blood stream infections. Serum Procalcitonin levels may also predict the severity and prognosis of blood stream infections but renal function should also be taken into account.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124904006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.15582/IJPD/2016/V31I0/104066
A. Yuvaraj, G. Abraham, L. Revathy, P. Nagarajan, A. Mullasari
We report an 83 year old patient with LVF and left intrarenal bleed with stage V CKD who was managed initially with supine low volume peritoneal dialysis and subsequently on CAPD.
{"title":"An Elderly Patient with Massive Intrarenal Haemorrhage and ESRD:Successful Management with CAPD","authors":"A. Yuvaraj, G. Abraham, L. Revathy, P. Nagarajan, A. Mullasari","doi":"10.15582/IJPD/2016/V31I0/104066","DOIUrl":"https://doi.org/10.15582/IJPD/2016/V31I0/104066","url":null,"abstract":"We report an 83 year old patient with LVF and left intrarenal bleed with stage V CKD who was managed initially with supine low volume peritoneal dialysis and subsequently on CAPD.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126033345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.15582/ijpd/2016/104064
N. Rao, S. Subhramanyam, A. Karopadi, K. A. Sinoj, K. Nayak
Severe hyponatremia and renal failure requiring renal replacement therapy pose a therapeutic challenge. Hemodialysis to correct volume overload, azotemia, and abnormal electrolyte levels will result in rapid correction of serum sodium concentration and place the patient at risk for osmotic demyelination syndrome. We present a patient with acute kidney injury and severe hypotonic hyponatremia (serum sodium<115 mEq/L) who was treated successfully with Automated Peritoneal Dialysis(APD).Previous experiences of using continuous venovenous hemofiltration successfully have been documented,,where sodium correction rate is regulated by intricate single pool sodium kinetic modelling, but there are no reports of peritoneal dialysis in these situations. In our case, bedside Tenchoff catheter placement and cycler PD used. We found that APD can be a cost effective safe, accurate and easy alternate treatment in combined hyponatremia and renal failure requiring dialysis.
{"title":"Treating Severe Hyponatremia and Renal Failure with Automated Peritoneal Dialysis","authors":"N. Rao, S. Subhramanyam, A. Karopadi, K. A. Sinoj, K. Nayak","doi":"10.15582/ijpd/2016/104064","DOIUrl":"https://doi.org/10.15582/ijpd/2016/104064","url":null,"abstract":"Severe hyponatremia and renal failure requiring renal replacement therapy pose a therapeutic challenge. Hemodialysis to correct volume overload, azotemia, and abnormal electrolyte levels will result in rapid correction of serum sodium concentration and place the patient at risk for osmotic demyelination syndrome. We present a patient with acute kidney injury and severe hypotonic hyponatremia (serum sodium<115 mEq/L) who was treated successfully with Automated Peritoneal Dialysis(APD).Previous experiences of using continuous venovenous hemofiltration successfully have been documented,,where sodium correction rate is regulated by intricate single pool sodium kinetic modelling, but there are no reports of peritoneal dialysis in these situations. In our case, bedside Tenchoff catheter placement and cycler PD used. We found that APD can be a cost effective safe, accurate and easy alternate treatment in combined hyponatremia and renal failure requiring dialysis.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121517109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.15582/IJPD/2016/104062
M. Aruna, P. N. Reddy, S. P. Devi, V. Chandra, Anil Kumar, B. Lakshmi, M. Reddy, R. Ram, V. Kumar
We present a study of the patients of CHF with chronic kidney disease who were on peritoneal dialysis for the indication that the patients had become resistant to diuretics with worsening renal function and electrolyte abnormalities. The patients of CHF with chronic kidney disease were initiated on peritoneal dialysis (PD) for the indication of diuretic resistance. Patients with congestive heart failure with New York Heart Association class III and IV and chronic kidney disease stage 4 or above were placed on peritoneal dialysis. All patients were followed for at least one year. . On echocardiography two parameters were particularly estimated, the ejection fraction and stroke volume index. Out of seven patients, five underwent, percutaneous peritoneal dialysis catheter placement by the team of nephrologists. These five patients were considered unfit for general anaesthesia. The other two underwent catheter placement by a surgeon by laparoscopy under general anaesthesia. Our patients displayed, after initiation of PD, an improvement in the ejection fraction and stroke volume index with preserved residual renal function. The mean numbers of days of hospitalization were reduced after initiation of PD. In our study all patients stopped loop diuretics. The three averments of utility of peritoneal dialysis in patients of refractory congestive heart failure were, fewer hospital days of admission, improvement in heart function and preservation of renal function and peritonitis was similar to that of patients who underwent PD for ESRD. Our patients proved that these averments were correct.
{"title":"Peritoneal Dialysis in Refractory End-Stage Congestive Heart Failure","authors":"M. Aruna, P. N. Reddy, S. P. Devi, V. Chandra, Anil Kumar, B. Lakshmi, M. Reddy, R. Ram, V. Kumar","doi":"10.15582/IJPD/2016/104062","DOIUrl":"https://doi.org/10.15582/IJPD/2016/104062","url":null,"abstract":"We present a study of the patients of CHF with chronic kidney disease who were on peritoneal dialysis for the indication that the patients had become resistant to diuretics with worsening renal function and electrolyte abnormalities. The patients of CHF with chronic kidney disease were initiated on peritoneal dialysis (PD) for the indication of diuretic resistance. Patients with congestive heart failure with New York Heart Association class III and IV and chronic kidney disease stage 4 or above were placed on peritoneal dialysis. All patients were followed for at least one year. . On echocardiography two parameters were particularly estimated, the ejection fraction and stroke volume index. Out of seven patients, five underwent, percutaneous peritoneal dialysis catheter placement by the team of nephrologists. These five patients were considered unfit for general anaesthesia. The other two underwent catheter placement by a surgeon by laparoscopy under general anaesthesia. Our patients displayed, after initiation of PD, an improvement in the ejection fraction and stroke volume index with preserved residual renal function. The mean numbers of days of hospitalization were reduced after initiation of PD. In our study all patients stopped loop diuretics. The three averments of utility of peritoneal dialysis in patients of refractory congestive heart failure were, fewer hospital days of admission, improvement in heart function and preservation of renal function and peritonitis was similar to that of patients who underwent PD for ESRD. Our patients proved that these averments were correct.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129323749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.15582/IJPD/2016/104059
R. Parthasarathy, U. Khalid, S. Philip, M. Mathew, P. Rudreshwar, Athulya Mary Joy
AKI in the setting of major vascular catastrophies are a challenge in view of its multifactorial nature and hemodynamic instability. PD is an option of Renal replacement therapy which can be used successfully in such settings with minimal complications and in a cost effective manner. We hereby present two case scenarios of Aortic aneurysmal rupture and dissection with AKI which were managed with peritoneal dialysis with a review of literature.
{"title":"Peritoneal Dialysis as a Safe and Effective Renal Replacement Therapy for Patients with Major Vascular Catastrophies","authors":"R. Parthasarathy, U. Khalid, S. Philip, M. Mathew, P. Rudreshwar, Athulya Mary Joy","doi":"10.15582/IJPD/2016/104059","DOIUrl":"https://doi.org/10.15582/IJPD/2016/104059","url":null,"abstract":"AKI in the setting of major vascular catastrophies are a challenge in view of its multifactorial nature and hemodynamic instability. PD is an option of Renal replacement therapy which can be used successfully in such settings with minimal complications and in a cost effective manner. We hereby present two case scenarios of Aortic aneurysmal rupture and dissection with AKI which were managed with peritoneal dialysis with a review of literature.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124424249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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