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Beth Piraino

Publications and source records attributed to Beth Piraino.

29 records · Page 2Linked to original sources
PubMedDate not supplied

Staphylococcus aureus prophylaxis and trends in gram-negative infections in peritoneal dialysis patients.

OBJECTIVE: To examine gram-negative exit-site infection and peritonitis rates before and after the implementation of Staphylococcus aureus prophylaxis in peritoneal dialysis (PD) patients. DESIGN: Prospective data collection with periodic implementation of protocols to decrease infection rates in two PD programs. PATIENTS: 663 incident patients on PD. INTERVENTIONS: Implementation of S. aureus prophylaxis, beginning in 1990. MAIN OUTCOME MEASURES: Rates of S. aureus, gram-negative, and Pseudomonas aeruginosa exit-site infections and peritonitis. RESULTS: Staphylococcus aureus exit-site infection and peritonitis rates fluctuated without significant trends during the first decade (without prophylaxis), then began to decline during the 1990s subsequent to implementation of prophylaxis, reaching levels of 0.02/year at risk and zero in the year 2000. Gram-negative infections fell toward the end of the 1980s, due probably to the implementation of better connectology. However, there have been no significant changes for the past 6 years. There was little change in P. aeruginosa infections over the entire time period. Pseudomonas aeruginosa is now the most common cause of catheter infection and catheter-related peritonitis. CONCLUSIONS: Prophylaxis against S. aureus is highly effective in reducing the rate of S. aureus infections but has no effect on gram-negative infections. Pseudomonas aeruginosa is now the most serious cause of catheter-related peritonitis.

Adult↗
PubMedDate not supplied

Comparison of the Charlson Comorbidity Index and the Davies score as a predictor of outcomes in PD patients.

BACKGROUND: Comorbidity is a strong predictor and confounds many studies of outcomes. Previous studies have shown that the Charlson Comorbidity Index (CCI) and the Davies score predict mortality in peritoneal dialysis (PD) patients. However, there are few data on the comparison of comorbidity scores. OBJECTIVE: To compare the CCI (combines comorbidity and age) and Davies score (comorbidity score without age) to see if one score was superior to the other in predicting outcomes. DESIGN: Prospective database study. SETTING: Seven dialysis centers in Western Pennsylvania. PARTICIPANTS: 415 incident PD patients, starting PD from 1/1/90 to 2/1/00. MEASUREMENTS: The CCI and Davies score calculated at the start of PD; serum albumin levels and demographics at the start of PD; total hospitalizations and mortality, collected prospectively. RESULTS: The correlation between CCI and Davies was 0.80, p < 0.0001. The CCI was inversely correlated with serum albumin (-0.31, p < 0.0001). Davies was significantly correlated with age (0.32, p < 0.0001) and inversely correlated with albumin (-0.27, p < 0.0001). The CCI alone was a stronger predictor than Davies alone (score by best subsets regression 49.6 vs 42.0, p = 0.0058). The CCI and Davies with age appeared to be equivalent models of survival (49.61 vs 49.64). The best predictive models were CCI and initial albumin, or Davies, age, and initial albumin. Both CCI and Davies were predictors of hospitalization rates, but the model with the Davies score was better (Akaike information criterion 799.2 vs 850.2). The best predictive model was Davies, albumin, age, and race. CONCLUSIONS: Both comorbidity scores were significant predictors of outcomes, with CCI the stronger predictor for mortality, but the Davies was a stronger predictor of hospitalizations. One or both should be done at the start of dialysis to predict outcome.

Female↗
PubMedDate not supplied

Methods to determine drain volume for peritoneal dialysis clearances.

OBJECTIVE: To compare the accuracy and convenience of 3 methods for measuring drain volume for peritoneal dialysis (PD) clearance studies. DESIGN: Prospective comparison of both automated PD (APD) and continuous ambulatory PD (CAPD) clearance study methods. SETTING: Adults > or = 18 years old at 2 dialysis clinics. PATIENTS: 28 PD patients with 43 clearance studies, 15 on CAPD and 28 on APD. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Drain volume was determined by 3 methods for each study: (1) graduate-measured volume using a 2-L graduated cylinder; (2) weighed volume, with and without bag weight, using a digital floor scale or spring scale; (3) cycler-measured volume using the initial drain and ultrafiltration indicated by the cycler, plus the prescribed inflow volume without the last fill. RESULTS: There was no statistically significant difference in volumes using the 3 methods studied (all p > 0.89 for APD, all p > 0.97 for CAPD). Effluent volume was more accurate with the weight of the bag subtracted. CONCLUSION: The most convenient and a precise method for APD is to determine the effluent drain volume using the prescription and total ultrafiltration and initial drain, as measured by the cycler. For CAPD, using the weight of drained bags is accurate but the weight of the empty bag must be subtracted. These approaches have the least risk of exposing staff to body fluids.

Adult↗
PubMedDate not supplied

The effect of depressive symptoms on survival in peritoneal dialysis patients.

OBJECTIVE: There is little information on the relationship between depressive symptoms and survival in peritoneal dialysis (PD) patients. We examined whether a single measurement of depressive symptoms using a simple self-administered tool predicts survival. DESIGN: Screening test of depressive symptoms as a predictor of outcome. SETTING: Three dialysis centers in Southwestern Pennsylvania. PARTICIPANTS: 66 adult PD subjects were screened in 1997-1998 for depression using the Zung scale. MAIN OUTCOME MEASURES: Baseline data collection included assessments of comorbidity, residual renal function, total Kt/V, nPNA, previous renal transplant, and serum albumin. Outcomes were collected prospectively after completion of the depression survey to 12/01. Cox regression analysis of patient survival was performed using all cofactors with p < 0.05 on univariate analysis. RESULTS: One third of patients had depressive symptoms. Compared to nondepressed patients, depressive symptom patients were older (62.5 vs 52.5 years, p = 0.012), had borderline lower serum albumin levels (3.47 vs 3.70 g/dL, p = 0.058), and were more disabled (Karnofsky score 70 vs 90, p< 0.001), but had similar Kt/V, residual renal function, and previous time on PD at the point of the testing. Using multivariate analysis and controlling for comorbidity (using a measurement that includes diabetes mellitus and age) and serum albumin, the survival of patients with depressive symptoms was significantly reduced compared to nondepressed patients. CONCLUSION: A single measurement of depressive symptoms using a simple self-administered test was an independent predictor of death in a cohort of PD patients, which extends observations in hemodialysis patients. Screening for depressive symptoms should be routine for dialysis patients, and those depressed should have thorough assessment and treatment. Whether treating depression will have an impact on survival is unclear and needs to be studied.

Adult↗
PubMedDate not supplied

Bleeding complications associated with peritoneal dialysis catheter insertion.

OBJECTIVE: To identify the incidence of bleeding complications associated with peritoneal dialysis catheter insertion. DESIGN: Retrospective review at a tertiary-care center of all double-cuffed Tenckhoff catheters placed surgically from 1 January 1992 to 1 October 2003 to identify the incidence of major bleeding complications occurring with catheter insertion. Major bleeding episodes were defined as > or = 3% decline in hematocrit, or the need for surgical intervention or blood transfusion within 2 weeks of insertion. RESULTS: 292 catheters had been inserted in 263 patients. Six patients satisfied the criteria for a major bleeding event, for a major bleeding complication rate of 2%. Bleeding was associated with perioperative anticoagulation in 3 patients, uremia and thrombocytopenia in 1 patient, aspirin use and thrombocytopenia in 1 patient, and 1 patient experienced intraoperative bleeding. Coagulation parameters were not obtained prior to the procedure in 2 of the 6 patients. CONCLUSION: The rate of serious bleeding complications related to catheter insertion is low and usually associated with anticoagulation. Holding anticoagulation therapy for a minimum of 24 hours during the postoperative period should eliminate much of the risk. Coagulation parameters should also be obtained and corrected preoperatively.

Catheterization↗
PubMedDate not supplied

Prevalence and correction of 25(OH) vitamin D deficiency in peritoneal dialysis patients.

BACKGROUND: Peritoneal dialysis (PD) patients are at risk for 25(OH) vitamin D deficiency due to effluent loss in addition to traditional risk factors. OBJECTIVES: To measure 25(OH) vitamin D deficiency in prevalent PD patients, to evaluate a replacement dose, and to determine the effects of correction. METHODS: 25(OH) vitamin D levels were drawn on prevalent PD patients. Patients deficientin 25(OH) vitamin D were given ergocalciferol, 50000 IU orally once per week for 4 weeks. Patients scored muscle weakness, bone pain, and fatigue on a scale of 0 (none) to 5 (severe). Serum calcium, phosphate, parathyroid hormone (PTH), and 25(OH) vitamin D, and 1,25(OH)2 vitamin D levels were obtained before and after treatment. RESULTS: 25(OH) vitamin D levels were measured in 29 PD patients. Deficiency (<15 ng/mL) was found in 28/29 (97%); 25/29 (86%) had undetectable levels (<7 ng/mL). One course of ergocalciferol corrected the deficiency in all but 1 patient, who required a second course. Scores for muscle weakness and bone pain fell from pre- to posttreatment (p < 0.001). 1,25(OH)2 vitamin D levels rose post ergocalciferol (from 20 to 26 pg/mL, n = 20, p = 0.09). Serum calcium, phosphate, and PTH levels did not change with ergocalciferol. CONCLUSIONS: Most PD patients had marked 25(OH) vitamin D deficiency, which was readily and safely corrected with one course of 50000 IU ergocalciferol, having no effect on serum calcium, phosphorus, or PTH, but complaints of muscle weakness and bone pain decreased. A prospective, placebo-controlled double-blinded study is needed to determine whether replacement of 25(PH) vitamin D is beneficial in PD patients.

Administration, Oral↗
PubMedDate not supplied

The choice study.

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Humans↗