Pub Date : 2013-01-02DOI: 10.15582/IJPD/2013/50657
R. Ram, G. Swarnalatha, C. S. Rao, G. Naidu, K. V. Dakshinamurty
{"title":"Exit Site Infection Due to Non Tuberculous Mycobacterium","authors":"R. Ram, G. Swarnalatha, C. S. Rao, G. Naidu, K. V. Dakshinamurty","doi":"10.15582/IJPD/2013/50657","DOIUrl":"https://doi.org/10.15582/IJPD/2013/50657","url":null,"abstract":"","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"208 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122652755","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 : 2013-01-02DOI: 10.15582/IJPD/2013/50652
Ram Ramalingam, P. Arunasalam, K. S. Kumar
It is commonly believed that CAPD patients are more malnourished than their counter parts on haemodialysis. We did a Cross sectional observational study to compare the nutritional status of patients who were age, sex and dialysis vintage matched on Hemodialysis and on CAPD in our hospital. Ninety one patients were evaluated for nutritional status (HD=49, CAPD=42). The mean hemoglobin levels were higher for CAPD vs HD (10.5 vs 8.02 g%) (p<0.0005). There was no difference in Serum albumin levels (CAPD vs HD =3.35 vs 3.43 g% ) (P=NS). There was no difference in means of Mid Arm Circumference, Triceps Skin Fold Thickness , Abdominal Skin Fold Circumference and MidArm Muscle Circumference in the two cohorts. The mean Infra scapular skin fold thickness (ISSF) was significantly higher in patients on CAPD vs HD (p< 0.05 ). In our age,sex and dialysis vintage matched cohorts ofRD and CAPD, we have not found worse nutritional status in CAPD.
人们普遍认为CAPD患者比血液透析患者更营养不良。我们对我院年龄、性别和透析年龄相匹配的血液透析和CAPD患者的营养状况进行了横断面观察性研究。对91例患者进行营养状况评估(HD=49, CAPD=42)。CAPD患者的平均血红蛋白水平高于HD患者(10.5% vs 8.02 g%) (p<0.0005)。两组血清白蛋白水平无差异(CAPD vs HD =3.35 vs 3.43 g%) (P=NS)。在两个队列中，臂中围度、三头肌皮肤褶皱厚度、腹部皮肤褶皱围度和臂中肌围度的平均值没有差异。CAPD患者的平均肩胛下皮褶厚度(ISSF)明显高于HD患者(p< 0.05)。在我们的年龄，性别和透析年龄匹配的rd和CAPD队列中，我们没有发现CAPD的营养状况更差。
{"title":"Comparative Study on Malnutrition In CAPD Vs Hemodialysis Patients From a Single Center","authors":"Ram Ramalingam, P. Arunasalam, K. S. Kumar","doi":"10.15582/IJPD/2013/50652","DOIUrl":"https://doi.org/10.15582/IJPD/2013/50652","url":null,"abstract":"It is commonly believed that CAPD patients are more malnourished than their counter parts on haemodialysis. We did a Cross sectional observational study to compare the nutritional status of patients who were age, sex and dialysis vintage matched on Hemodialysis and on CAPD in our hospital. Ninety one patients were evaluated for nutritional status (HD=49, CAPD=42). The mean hemoglobin levels were higher for CAPD vs HD (10.5 vs 8.02 g%) (p<0.0005). There was no difference in Serum albumin levels (CAPD vs HD =3.35 vs 3.43 g% ) (P=NS). There was no difference in means of Mid Arm Circumference, Triceps Skin Fold Thickness , Abdominal Skin Fold Circumference and MidArm Muscle Circumference in the two cohorts. The mean Infra scapular skin fold thickness (ISSF) was significantly higher in patients on CAPD vs HD (p< 0.05 ). In our age,sex and dialysis vintage matched cohorts ofRD and CAPD, we have not found worse nutritional status in CAPD.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"230 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133383155","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 : 2013-01-02DOI: 10.15582/IJPD/2013/50654
D. Krishnaprasadh, Yuvaram N. V. Reddy, A. Rohit, A. Verma, M. Mathew, Lakshmi Revathi, A. Yuvaraj, S. Nair, G. Abraham
Peritunitis is a well-known cause of mortality in perituneal dialysis (PD) patients. This retrospective analysis was first ever done in India, on a total of 127 patients, to disclose the clinical spectrum and risk profile of peritonitis-related mortality. A total of I 00 episodes of peritonitis occurred in 67 people who entered our cbronic perituneal dialysis (CPD) programme from Februsry 2005- March 2013. They were on peritoneal dialysis for 370 I patient-months. Twenty three patients (M8, F IS) died during an episode ofperitonitis(18.1l %). They have been on CPD forameanof29.25±21.98 (range 3 to 132) months, 77 of them were diabetic, 83 hypertensive. Fifty seven percent of those who died were hypertensive (P=0.045). Twenty nine patients had catheter removal for peritonitis which was done between 7-10 days. Co-morbidities present in the 23 patients who had peritonitis related were: diabetes mellitus (IS), hypertension (13), cardiovascular disease (5), Myasthenia Gravis (I). Culture negative peritonitis occurred in 39 episodes. The most common organism isolated were E.coli 7, Mycobacterium tuberculosis 5, Candida species 5. Advanced age, diabetes mellitus and hypertension, left ventricular dysfunction are factors which predisposed to mortality in our patients with peritonitis.
腹膜炎是腹膜透析(PD)患者死亡的一个众所周知的原因。这项回顾性分析首次在印度进行，共对127名患者进行了分析，以揭示腹膜炎相关死亡率的临床谱和风险概况。从2005年2月至2013年3月，67名患者接受慢性腹膜透析(CPD)治疗，共发生1000次腹膜炎。他们接受了370个月的腹膜透析。23例(M8, F IS)死于腹膜炎发作(18.11%)。持续CPD时间为29.25±21.98(3 ~ 132)个月，其中糖尿病77例，高血压83例。57%的患者死于高血压(P=0.045)。29例患者因腹膜炎取管，取管时间为7 ~ 10天。23例腹膜炎相关患者的合并症有:糖尿病(IS)、高血压(13)、心血管疾病(5)、重症肌无力(1)，培养阴性腹膜炎39例。最常见的细菌是大肠杆菌7种，结核分枝杆菌5种，念珠菌5种。高龄、糖尿病、高血压、左心室功能障碍是导致腹膜炎患者死亡的主要因素。
{"title":"Peritonitis Related Death - A Retrospective Study Analysing Causative Factors In Chronic Peritoneal Dialysis","authors":"D. Krishnaprasadh, Yuvaram N. V. Reddy, A. Rohit, A. Verma, M. Mathew, Lakshmi Revathi, A. Yuvaraj, S. Nair, G. Abraham","doi":"10.15582/IJPD/2013/50654","DOIUrl":"https://doi.org/10.15582/IJPD/2013/50654","url":null,"abstract":"Peritunitis is a well-known cause of mortality in perituneal dialysis (PD) patients. This retrospective analysis was first ever done in India, on a total of 127 patients, to disclose the clinical spectrum and risk profile of peritonitis-related mortality. A total of I 00 episodes of peritonitis occurred in 67 people who entered our cbronic perituneal dialysis (CPD) programme from Februsry 2005- March 2013. They were on peritoneal dialysis for 370 I patient-months. Twenty three patients (M8, F IS) died during an episode ofperitonitis(18.1l %). They have been on CPD forameanof29.25±21.98 (range 3 to 132) months, 77 of them were diabetic, 83 hypertensive. Fifty seven percent of those who died were hypertensive (P=0.045). Twenty nine patients had catheter removal for peritonitis which was done between 7-10 days. Co-morbidities present in the 23 patients who had peritonitis related were: diabetes mellitus (IS), hypertension (13), cardiovascular disease (5), Myasthenia Gravis (I). Culture negative peritonitis occurred in 39 episodes. The most common organism isolated were E.coli 7, Mycobacterium tuberculosis 5, Candida species 5. Advanced age, diabetes mellitus and hypertension, left ventricular dysfunction are factors which predisposed to mortality in our patients with peritonitis.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133364224","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 : 2012-04-12DOI: 10.15582/IJPD/2012/51270
P. Mohan, L. Revathy, G. George, T. Thandavan, M. Mathew, A. Rohit, G. Abraham
There is a dearth of data regarding the performance and survival of long term PD patients. We retrospectively analysed three patients who were on CAPD for nearly ten years from our centre. Oithese three studied, two were women, and a man with age 49, 43 and 56 years respectively. All 3 were non vegetarians doing 2L X 4 exchanges of dianeal and were anuric for overt years. Mean ultrafiltration volume was 1300mL, 1200mL and 1500mL. Their last Ktili was 2, 1.96 and 2. The primary renal disease was diabetic nephropathy in the male and hypertensive nephropathy in the two female. One lady had a clotted allograft in 2005 which was removed. Male diabetic patient died after ten years following a fungal peritonitis which necessitated catheter removal.
{"title":"Three Patients on Capd for ten Years - Once a Life Time Scheme","authors":"P. Mohan, L. Revathy, G. George, T. Thandavan, M. Mathew, A. Rohit, G. Abraham","doi":"10.15582/IJPD/2012/51270","DOIUrl":"https://doi.org/10.15582/IJPD/2012/51270","url":null,"abstract":"There is a dearth of data regarding the performance and survival of long term PD patients. We retrospectively analysed three patients who were on CAPD for nearly ten years from our centre. Oithese three studied, two were women, and a man with age 49, 43 and 56 years respectively. All 3 were non vegetarians doing 2L X 4 exchanges of dianeal and were anuric for overt years. Mean ultrafiltration volume was 1300mL, 1200mL and 1500mL. Their last Ktili was 2, 1.96 and 2. The primary renal disease was diabetic nephropathy in the male and hypertensive nephropathy in the two female. One lady had a clotted allograft in 2005 which was removed. Male diabetic patient died after ten years following a fungal peritonitis which necessitated catheter removal.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124942599","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 : 2012-04-12DOI: 10.15582/ijpd/2012/51259
G. Taduri, Yugandhar B. S. Reddy, K. V. Dakshinamuty
The natural history of HCV viral infection in different renal replacement modalities is unpredictable and liver dysfunction is rapid compared to normal persons. Retrospective analysis of HCV infected patients on different renal replacement therapies (heamodialysis, CAPD, kidney transplantation) was done in a university hospital. liver enzymes(SGOT and SGPT) are lower and HCV related fulminant hepatitis is less in the CAPD group compared to other two groups (Ilemodialysis, Renal Transplant). With these advantages CAPD may be considered as better modality to prevent the spread and also for maintaining the stable liver function in select population with HCV infection.
{"title":"Liver Function in Esrd Patients with Hepatitis C Virus Infection on Different Renal Replacement Therapies: Advantage for CAPD","authors":"G. Taduri, Yugandhar B. S. Reddy, K. V. Dakshinamuty","doi":"10.15582/ijpd/2012/51259","DOIUrl":"https://doi.org/10.15582/ijpd/2012/51259","url":null,"abstract":"The natural history of HCV viral infection in different renal replacement modalities is unpredictable and liver dysfunction is rapid compared to normal persons. Retrospective analysis of HCV infected patients on different renal replacement therapies (heamodialysis, CAPD, kidney transplantation) was done in a university hospital. liver enzymes(SGOT and SGPT) are lower and HCV related fulminant hepatitis is less in the CAPD group compared to other two groups (Ilemodialysis, Renal Transplant). With these advantages CAPD may be considered as better modality to prevent the spread and also for maintaining the stable liver function in select population with HCV infection.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115623341","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 : 2012-01-02DOI: 10.15582/IJPD/2012/50432
S. Sundar, K. Venkataramanan, H. Verma, H. Mahapatra, J. Rajesh, S. Sathi
A successful PD program is dependent on the proper placement of the permanent PD catheters, knowledge of the placement techniques and complications. Study outcomes of 81 Coiled CAPD consecutive Tenckhoff catheter insertions by our nephrologists using the open dissection surgical technique were reported.The major cause of catheter technique failure was infectious complications secondary to peritonitis 9.8 %. Peri operative complications 3.7% bleeding, no bowel injury were observed. Mechanical Complications like 1.23% drainage failure, 2.4% catheter migration,2.4% fluid leak were observed. Infective complications like 1.23% wound site, 1.23% exit site, no tunnel, and no peritonitis were observed immediate post operative. But 27 episodes of peritonitis with periods of 17.4 t 1.6months peritonitis were observed. Catheter survival rates at 6 months, 1 and 2 years were 94.3 %( 66/71), 90.7 %( 59/65) and 82 D/0( 41/50) respectively. Catheter insertion by trained nephrologists is dramatically increases penetration for Peritoneal dialysis. We reported an encouraging outcome for coiled Tenckhoff catheters inserted by experienced nephrologists in an open surgical manner, with less peri-operative, mechanical, bleeding complications with 100% technical success of placement comparable to trained surgeon and a good catheter survival rate.
{"title":"Coiled Tenchoff Catheter Insertion For CAPD Using Open Dissection Technique By Nephrologists-A Single Center Experience","authors":"S. Sundar, K. Venkataramanan, H. Verma, H. Mahapatra, J. Rajesh, S. Sathi","doi":"10.15582/IJPD/2012/50432","DOIUrl":"https://doi.org/10.15582/IJPD/2012/50432","url":null,"abstract":"A successful PD program is dependent on the proper placement of the permanent PD catheters, knowledge of the placement techniques and complications. Study outcomes of 81 Coiled CAPD consecutive Tenckhoff catheter insertions by our nephrologists using the open dissection surgical technique were reported.The major cause of catheter technique failure was infectious complications secondary to peritonitis 9.8 %. Peri operative complications 3.7% bleeding, no bowel injury were observed. Mechanical Complications like 1.23% drainage failure, 2.4% catheter migration,2.4% fluid leak were observed. Infective complications like 1.23% wound site, 1.23% exit site, no tunnel, and no peritonitis were observed immediate post operative. But 27 episodes of peritonitis with periods of 17.4 t 1.6months peritonitis were observed. Catheter survival rates at 6 months, 1 and 2 years were 94.3 %( 66/71), 90.7 %( 59/65) and 82 D/0( 41/50) respectively. Catheter insertion by trained nephrologists is dramatically increases penetration for Peritoneal dialysis. We reported an encouraging outcome for coiled Tenckhoff catheters inserted by experienced nephrologists in an open surgical manner, with less peri-operative, mechanical, bleeding complications with 100% technical success of placement comparable to trained surgeon and a good catheter survival rate.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"15 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133043377","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 : 2012-01-02DOI: 10.15582/IJPD/2012/50430
G. Abraham, A. Bhalla, M. Mathew
Continuous Ambulatory Peritoneal Dialysis (CAPD) involves transfer of dialysate into and out of peritoneal cavity several times a day with the help of a permanent catheter and connection system. Connection and disconnections during the exchange lead to entry of various organisms into peritoneal cavity and therefore intraluminal infections account for approxintately one-third to one-half of all episodes of peritonitis. It is essential that innovations in technology of peritoneal dialysis delivery system should aim at protecting critical areas of the connectors from accidental contamination and incorporating effective bacterial flushing techniques. Thus the design of the connectors and )(junction is extremely critical in influencing efficiency of any delivery system. V junction plays a critical role in fluid flow path, especially in terms of convective bacterial removal. Central junction of symmetric V set can induce nonlinear turbulent flow and obstruct the flushing process leading to fibrin blockage. Hence, a variation of Y system, known as asymmetric Y set, was developed with an idea to reduce contamination and rate of peritonitis. Asymmetric Y set essentially has straight transparent line to drain the bag combined with short distance between the Y set and patient line. Various single center and small multicentric studies using twin bag with asymmetric V and advanced connectors have shown significant improvement in peritonitis rates. Further, it is essential to assess these innovations by large well-designed RCTs for their usefulness, cost advantage and impact on quality of life.
{"title":"Y Connectors In CAPD Patients: Do Subtle Important Modifications Have Potential Role In Reducing Contamination And Rate Of Infective Peritonitis?","authors":"G. Abraham, A. Bhalla, M. Mathew","doi":"10.15582/IJPD/2012/50430","DOIUrl":"https://doi.org/10.15582/IJPD/2012/50430","url":null,"abstract":"Continuous Ambulatory Peritoneal Dialysis (CAPD) involves transfer of dialysate into and out of peritoneal cavity several times a day with the help of a permanent catheter and connection system. Connection and disconnections during the exchange lead to entry of various organisms into peritoneal cavity and therefore intraluminal infections account for approxintately one-third to one-half of all episodes of peritonitis. It is essential that innovations in technology of peritoneal dialysis delivery system should aim at protecting critical areas of the connectors from accidental contamination and incorporating effective bacterial flushing techniques. Thus the design of the connectors and )(junction is extremely critical in influencing efficiency of any delivery system. V junction plays a critical role in fluid flow path, especially in terms of convective bacterial removal. Central junction of symmetric V set can induce nonlinear turbulent flow and obstruct the flushing process leading to fibrin blockage. Hence, a variation of Y system, known as asymmetric Y set, was developed with an idea to reduce contamination and rate of peritonitis. Asymmetric Y set essentially has straight transparent line to drain the bag combined with short distance between the Y set and patient line. Various single center and small multicentric studies using twin bag with asymmetric V and advanced connectors have shown significant improvement in peritonitis rates. Further, it is essential to assess these innovations by large well-designed RCTs for their usefulness, cost advantage and impact on quality of life.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125102164","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}
M. Prabhu, K. Sanman, R. Shetty, G. Prabhu, B. S. Pai
Introduction Limitations in finance and education is thought to translate into poor technique , understanding and thereby into higher incidence of peritonitis and ultimately poor patient and technique survival. This notion sometimes leads to such patients being denied Continuous Ambulatory Peritoneal Dialysis (CAPD). Methods: In 2013, 20 patients were initiated on CAPD under a Public Private Partnership (PPP) model project in Karnataka province, India. By regulation, they were required to belong to Below Poverty Line (BPL ) category which is a measure of extreme poverty. BPL is the equivalent of earning less than a dollar per day. They were followed up for peritonitis, technique and patient survival besides overall performance. Results: 20 patients were included ( Male: 60%, Mean age 56.7 years, Diabetic Nephropathy 48%). Peritonitis rate was 1 in 33.8 patient –months, with 3 episodes of Fungal Peritonitis (FP) including one of Candida Hemolunii. All FP led to termination of CAPD. Coagulase-Negative Staphylococcus (CoNS) was the most common pathogen isolated , accounting for 60% of the episodes. Technique survival was 15% and patient survival was 20% at 5 years. Cardiovascular disease, sepsis, and malignancy accounted for majority of the deaths. Conclusions: Patients with background of extreme poverty had peritonitis rates comparable to good centres, however patient survival at 5 years was lower. Educational or economic considerations did not seem to be an impediment to successful CAPD.
{"title":"Peritonitis profile in a cohort of extreme poverty patients on continuous ambulatory peritoneal dialysis-5 year experience from a South Indian public private partnership model PD programme","authors":"M. Prabhu, K. Sanman, R. Shetty, G. Prabhu, B. S. Pai","doi":"10.4103/IOPD.IOPD_3_20","DOIUrl":"https://doi.org/10.4103/IOPD.IOPD_3_20","url":null,"abstract":"Introduction Limitations in finance and education is thought to translate into poor technique , understanding and thereby into higher incidence of peritonitis and ultimately poor patient and technique survival. This notion sometimes leads to such patients being denied Continuous Ambulatory Peritoneal Dialysis (CAPD). Methods: In 2013, 20 patients were initiated on CAPD under a Public Private Partnership (PPP) model project in Karnataka province, India. By regulation, they were required to belong to Below Poverty Line (BPL ) category which is a measure of extreme poverty. BPL is the equivalent of earning less than a dollar per day. They were followed up for peritonitis, technique and patient survival besides overall performance. Results: 20 patients were included ( Male: 60%, Mean age 56.7 years, Diabetic Nephropathy 48%). Peritonitis rate was 1 in 33.8 patient –months, with 3 episodes of Fungal Peritonitis (FP) including one of Candida Hemolunii. All FP led to termination of CAPD. Coagulase-Negative Staphylococcus (CoNS) was the most common pathogen isolated , accounting for 60% of the episodes. Technique survival was 15% and patient survival was 20% at 5 years. Cardiovascular disease, sepsis, and malignancy accounted for majority of the deaths. Conclusions: Patients with background of extreme poverty had peritonitis rates comparable to good centres, however patient survival at 5 years was lower. Educational or economic considerations did not seem to be an impediment to successful CAPD.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"134 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124158272","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}
Valacyclovir (Prodrug) an antiviral agent is not well cleared by peritoneal dialysis and can cause neuropsychiatric manifestations in patient with renal failure on peritoneal dialysis and having Herpes Zoster infection being treated with this drug. Methodology followed for the collection of data and literature review was by using a medline search using the terms Acyclovir, nervous system effects, Valacyclovir, neurotoxicity and peritoneal dialysis. The representative case discussed is about an elderly gentleman with chronic renal failure on CCPD presenting with hallucinations, altered sensorium and restlessness following treatment with Valacyclovir 1000 mg three times per oral daily who was admitted and evaluated. It is of vital importance to consider the differential diagnosis of Herpes zoster encephalitis in the differential diagnosis of these patients as it is difficult to rule it out. The mechanism of this drug induced neurotoxicity is thought to be probably, the accumulation of serum carboxymethoxymethyl guanidine (CMMG), a toxic metabolite of valacyclovir.As peritoneal dialysis is not very effective in removal of this drug, it is thought to be beneficial to change to Hemodialysis for short duration so as to clear the drug from the system as shown in the case and in the discussion. Safe doses in peritoneal dialysis are not clearly delineated. Extreme precaution must be exercised while prescribing these group of anti-viral drugs in patients with CKD and especially those on peritoneal dialysis. If such a patient does manifest neuropsychiatric symptoms it is necessary to immediately stop the drug concerned. Methods to increase the excretion of the drug must be employed immediately or to remove it by intensification of PD or ideally to aggressively remove it by means of hemodialysis. Moreover there is a paucity of similar reports in the literature.
{"title":"Valacyclovir toxicity in peritoneal dialysis","authors":"P. Kumar","doi":"10.4103/IOPD.IOPD_4_20","DOIUrl":"https://doi.org/10.4103/IOPD.IOPD_4_20","url":null,"abstract":"Valacyclovir (Prodrug) an antiviral agent is not well cleared by peritoneal dialysis and can cause neuropsychiatric manifestations in patient with renal failure on peritoneal dialysis and having Herpes Zoster infection being treated with this drug. Methodology followed for the collection of data and literature review was by using a medline search using the terms Acyclovir, nervous system effects, Valacyclovir, neurotoxicity and peritoneal dialysis. The representative case discussed is about an elderly gentleman with chronic renal failure on CCPD presenting with hallucinations, altered sensorium and restlessness following treatment with Valacyclovir 1000 mg three times per oral daily who was admitted and evaluated. It is of vital importance to consider the differential diagnosis of Herpes zoster encephalitis in the differential diagnosis of these patients as it is difficult to rule it out. The mechanism of this drug induced neurotoxicity is thought to be probably, the accumulation of serum carboxymethoxymethyl guanidine (CMMG), a toxic metabolite of valacyclovir.As peritoneal dialysis is not very effective in removal of this drug, it is thought to be beneficial to change to Hemodialysis for short duration so as to clear the drug from the system as shown in the case and in the discussion. Safe doses in peritoneal dialysis are not clearly delineated. Extreme precaution must be exercised while prescribing these group of anti-viral drugs in patients with CKD and especially those on peritoneal dialysis. If such a patient does manifest neuropsychiatric symptoms it is necessary to immediately stop the drug concerned. Methods to increase the excretion of the drug must be employed immediately or to remove it by intensification of PD or ideally to aggressively remove it by means of hemodialysis. Moreover there is a paucity of similar reports in the literature.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132801403","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}
A. Lone, Tariq A Bhat, K. Sofi, I. Wani, M. Wani, M. A. Bhat
Background Many elderly hypertensive patients are on cardio/reno protective medications (ACEIs, ARBs, β blockers & K sparing diuretics), which may precipitate or worsen hyperkalemia in them. Given its potential life threatening nature, identifying such patients is imperative. Rarely emergency temporary cardiac pacing may be required to thwart cardiac arrest while K is being lowered by extracorporeal removal. In many resource-constrained settings HD to lower K quickly is not always available. Materials and Methods We describe the profile of 26 patients over a three year period who besides medications & dialysis needed temporary cardiac pacing because of severe hyperkalemia. Results: The mean age of these 26 patients (17 males, 9 females) was 64+/-11 years. 12 (46%) had diabetes mellitus. On admission, the mean serum K was 6.7 ± 1.4 mmol/L, mean serum creatinine was 2.8 ± 1.6 mg/dL, mean arterial pH was 7.1 ± 0.5 and the mean plasma bicarbonate was 12 ± 4 mmol/L. The main causes for acute kidney injury (AKI) and hyperkalemia were dehydration (n = 14) and worsening heart failure (n = 7) with concomitant use of ACEIs, ARBs, β blockers, K sparing diuretics either alone or in combination. 22 patients received PD, two HD, while two received both. Six patients were admitted to the ICU, two of whom died. The duration of hospitalization ranged from 1-12 with a mean of 7 days. The patients in the drug induced hyperkalemia group who required pacing were elderly, had been on a combination of K elevating medications, were more likely to have DM and had a longer hospital stay compared to those who had hyperkalemia but did not require cardiac pacing. Conclusion: A combination of ACEIs, ARBs, β blockers & K sparing diuretics should be used with caution in patients who are elderly, have renal insufficiency, DM or heart failure or are at risk for dehydration. In places with limited availability of emergency HD, PD is an effective alternative for lowering serum K.
{"title":"Life threatening hyperkalemia necessitating temporary cardiac pacing and dialysis in elderly patients","authors":"A. Lone, Tariq A Bhat, K. Sofi, I. Wani, M. Wani, M. A. Bhat","doi":"10.4103/IOPD.IOPD_6_19","DOIUrl":"https://doi.org/10.4103/IOPD.IOPD_6_19","url":null,"abstract":"Background Many elderly hypertensive patients are on cardio/reno protective medications (ACEIs, ARBs, β blockers & K sparing diuretics), which may precipitate or worsen hyperkalemia in them. Given its potential life threatening nature, identifying such patients is imperative. Rarely emergency temporary cardiac pacing may be required to thwart cardiac arrest while K is being lowered by extracorporeal removal. In many resource-constrained settings HD to lower K quickly is not always available. Materials and Methods We describe the profile of 26 patients over a three year period who besides medications & dialysis needed temporary cardiac pacing because of severe hyperkalemia. Results: The mean age of these 26 patients (17 males, 9 females) was 64+/-11 years. 12 (46%) had diabetes mellitus. On admission, the mean serum K was 6.7 ± 1.4 mmol/L, mean serum creatinine was 2.8 ± 1.6 mg/dL, mean arterial pH was 7.1 ± 0.5 and the mean plasma bicarbonate was 12 ± 4 mmol/L. The main causes for acute kidney injury (AKI) and hyperkalemia were dehydration (n = 14) and worsening heart failure (n = 7) with concomitant use of ACEIs, ARBs, β blockers, K sparing diuretics either alone or in combination. 22 patients received PD, two HD, while two received both. Six patients were admitted to the ICU, two of whom died. The duration of hospitalization ranged from 1-12 with a mean of 7 days. The patients in the drug induced hyperkalemia group who required pacing were elderly, had been on a combination of K elevating medications, were more likely to have DM and had a longer hospital stay compared to those who had hyperkalemia but did not require cardiac pacing. Conclusion: A combination of ACEIs, ARBs, β blockers & K sparing diuretics should be used with caution in patients who are elderly, have renal insufficiency, DM or heart failure or are at risk for dehydration. In places with limited availability of emergency HD, PD is an effective alternative for lowering serum K.","PeriodicalId":442296,"journal":{"name":"Indian Journal of Peritoneal dialysis","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129571684","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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