Biomedical subjects

Nancy Gorban-Brennan

Publications and source records attributed to Nancy Gorban-Brennan.

8 recordsLinked to original sources

PubMed2005

Course of C-reactive protein during continuous peritoneal dialysis-associated peritonitis.

OBJECTIVE: C-reactive protein (CRP) levels increase during peritonitis. Little is known about the extent and duration of CRP elevation. PATIENTS AND METHODS: Patients on continuous peritoneal dialysis (CPD) therapy had a baseline CRP value at the start of the study. CRP values were determined at 48 h, 2 weeks and 4 weeks after an episode of peritonitis developed in the 13 months after the study started. RESULTS: The demographic values and comorbid diseases of the patients developing and not developing peritonitis were not significantly different. Patients who developed peritonitis had a mean +/- SD CRP value of 15.0 +/- 11.1 mg/L compared with 15.7 +/- 9.9 mg/L in patients without peritonitis. The CRP value rose to 118.35 +/- 96.86 mg/L at 48 h, and decreased to 34.5 +/- 43.6 mg/L at 2 weeks and to 30.1 +/- 39.7 mg/L at 4 weeks after the onset of peritonitis. All types of peritonitis were associated with a significant increase in CRP at 48 h. Nine patients had CRP elevations above baseline at 4 weeks; seven patients had active medical issues. CONCLUSION: CRP values become significantly elevated during peritonitis. Most patients have a decrease in the CRP values toward baseline values at 4 weeks following the onset of peritonitis while 20% of patients had continued elevations. The significance of the elevations is unclear. Given the associations of CRP with cardiovascular mortality in both uremic and non-uremic patients and the association of peritonitis with mortality, the role of this inflammatory marker deserves further evaluation.

Adult↗

PubMed2005

Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.

Peritoneal catheter removal may be clinically indicated in the management of peritonitis. The data on the course of patients undergoing peritoneal catheter reinsertion after removal for peritonitis are limited. The present study was designed to examine what happens to patients on chronic peritoneal dialysis (CPD) after peritoneal catheter removal for peritonitis. We retrospectively reviewed the charts of patients who developed peritonitis between January 1, 1990, and September 1, 2002. We identified 1146 episodes of peritonitis; in 189 of the episodes (16%), the peritoneal catheter was removed. Catheters were reinserted in 88 of those patients (47%). Reasons for peritoneal catheter removal among the 88 patients who underwent peritoneal catheter reinsertion included unit protocol (51%), poor response to antibiotics (46%), and exit-site or tunnel infection (3%). Reasons for peritoneal catheter removal among the 101 patients in whom the peritoneal catheter was not reinserted included unit protocol (62%), poor response to antibiotics (20%), and extensive history of peritonitis (18%). After reinsertion, the new peritoneal catheter remained in place for a mean of 15.4 +/- 15.4 months (range: 1-75 months). In 37 of the 88 patients with reinserted peritoneal catheters (42%), the catheters remained in place for longer than 1 year. The remaining 6 patients underwent transplantation or were transferred to another facility. Of the remaining 51 patients whose new peritoneal catheters lastedfor less than I year, 13 (25.5%) died, and 32 (63%) were transferred permanently to hemodialysis. Of the 101 patients who did not have a peritoneal catheter reinserted, 23 (23%) died within the 2-week period following the onset of peritonitis. The rest were transferred to hemodialysis. The reasons noted for not reinserting the peritoneal catheter included frequent episodes of peritonitis, patient unwillingness to retry CPD therapy, psychosocial reasons, bowel perforation, or transfer to an institution unable to perform CPD therapy. We conclude that, among patients who medically require peritoneal catheter removal because of peritonitis, few will successfully return to long-term CPD therapy. Of the patients who required peritoneal catheter removal in our study, 23% died within the first 2 weeks after the onset of peritonitis, before catheter reinsertion could be considered. Only 47% of the patients underwent a successful catheter reinsertion; and, of those, only 34% remained on CPD therapy I year later Thus, only 20% of patients undergoing PD catheter removal remain on CPD therapy 1 year after catheter removal.

Anti-Bacterial Agents↗

PubMed2004

Compliance with the dialysis regimen in chronic peritoneal dialysis patients: utility of the pro card and impact of patient education.

Noncompliance (NC) with the dialysis prescription has been described as a common problem in dialysis patients. In previous studies, NC in peritoneal dialysis (PD) patients has been assessed by obtaining patient or family histories, using questionnaires, and making home visits. With the use of the HomeChoice Pro Chip Card (PCC: Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), the dialysis staff can monitor the total volume of dialysate used, the frequency of exchanges, and the duration of dialysis in patients maintained on automated peritoneal dialysis (APD). Last year, we reported that the PCC was an effective tool for assessing compliance and noted that more than half of patients had a compliance rate (CR) < 95%. In the present study, we examined the impact of patient education on compliance with the prescribed dialysis regimen. We evaluated our APD patients for CR with their dialysis prescription. The PCC was used to record the duration of dialysis and the actual volume of fluid used. From October 2002 to September 2003, all patients maintained at home for 3 consecutive months on APD in the New Haven continuous ambulatory peritoneal dialysis unit were educated concerning the importance of compliance with their dialysis regimen. They were also educated about the function of the PCC and were informed that the dialysis facility would be monitoring their compliance with the prescribed regimen. Compliance rates were calculated by dividing the delivered dialysis volume by the prescribed dialysis volume and multiplying by 100. We obtained data on 42 APD patients. Of the 42 patients, 35 (83%) had a CR > or = 95%, 3 (7%) had a CR between 90% and 94.9%, and 4 (10%) had a CR < 90%. Those CRs are much better than the ones we had previously reported, before the institution of the patient education program. The PCC can be used to assess compliance in APD patients. Patient education results in an improvement in patient compliance. Further study is required to determine factors that affect CR in APD patients.

Female↗

PubMed2003

Depression and its association with peritonitis in long-term peritoneal dialysis patients.

BACKGROUND: Depression is the most common psychological disorder among patients with end-stage renal disease and has been associated with mortality in patients maintained on hemodialysis therapy. Peritonitis is the leading cause of technique failure among long-term peritoneal dialysis (PD) patients. This prospective study is designed to examine the relationship between depression and peritonitis. METHODS: All patients on long-term PD therapy in our unit between January 1, 1997, and January 31, 2002, completed a Beck Depression Inventory (BDI) assessment at 6-month intervals. BDI scores were analyzed 2 ways. First, patients were placed into either group I (BDI score < 10) or group II (BDI score > or = 11) and were reclassified based on subsequent scores. Second, multivariable analysis was performed looking at initial BDI score as a risk factor for peritonitis, adjusting for age older than 65 years, diabetes, coronary artery disease, and race. RESULTS: One hundred sixty-two patients were enrolled, and 281 individual BDI assessments were completed. There was a significantly greater incidence of diabetes and coronary artery disease in group II. Rates for overall and gram-positive peritonitis were significantly greater in group II patients compared with group I patients. Using Cox regression, only BDI score of 11 or greater was associated with the development of peritonitis (hazard ratio, 2.7; 95% confidence interval, 1.2 to 6.0). CONCLUSION: There is an association between BDI score of 11 or greater and the development of peritonitis. Whether treatment of depression can impact on the rate of peritonitis remains to be examined.

Aged↗

PubMed2002

Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis.

The causes of peritonitis in patients with end-stage renal disease maintained on long-term peritoneal dialysis (PD) are unclear. One possible explanation for peritonitis, particularly in patients with multiple episodes of infection, is the release of planktonic bacteria from biofilm on the walls of catheters. Bacteria form biofilm on the walls of catheters within 48 hours of their placement. If this explanation were correct, one would expect there to be reappearance of organisms causing infection in patients with multiple episodes of peritonitis. The charts of all patients starting long-term PD at New Haven CAPD from January 1, 1990, through July 31, 2000, were reviewed. Patients were included in the study if they had experienced more than one episode of culture-positive peritonitis and complete data were available concerning cultured organisms and antibiotic sensitivity patterns. Episodes of infection, organisms, and sensitivities and catheter changes were reviewed. Of 630 patients, 198 were identified as meeting these criteria. There were 114 men; 104 patients were white. Of 198 patients, 157 (80%) had at least one repeat infection with the same organism. In 124 (79%) patients, more than 50% of the peritonitis episodes were caused by the same organism. Of 90 patients who had more than four episodes of infection in their history, 59 (65%) had at least half or more of their episodes caused by the same organism. Sequential analyses for independence revealed that for Staphylococcus epidermidis and for Staphylococcus aureus, there was a significantly increased likelihood for these organisms to follow themselves as causative organisms of peritonitis. When the data were analyzed using the Spearman correlation test, the results indicated that the likelihood of repeat infections occurring was significantly greater than by chance alone. Of 67 patients with catheter changes and subsequent peritonitis, only 10 (15%) developed repeat infections with the same organism after the catheter change. Eight of these were due to yeast. These data support the hypothesis that bacterial biofilm on the walls of peritoneal catheters may be associated with peritonitis in patients maintained on long-term PD and may contribute to at least some of these episodes of infection.

Adult↗

PubMed2002

Racial differences and peritonitis in an urban peritoneal dialysis center.

Racial differences have been reported among various groups with end-stage renal disease maintained on dialysis. In particular, patient survival on dialysis has been reported to be better in African-American patients than in Caucasian patients. Peritonitis rates and dropout from chronic peritoneal dialysis (CPD) have been reported to be higher in African-American patients. We decided to review our experience with peritonitis rates in African-American and Caucasian patients. From 1994 to 2000, 403 patients were maintained on CPD in the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit. Peritonitis rates were 1 episode in 14 patient-months in Caucasian patients and 1 episode in 13.6 patient-months in African-American patients. Mean ages at the start of dialysis were 52.4 +/- 16.2 years in the Caucasian patients and 62.6 +/- 14.9 years in the African-American patients. African-American patients were older. African-American and Caucasian patients had similar peritonitis rates. Time of first episode of peritonitis was not different in the two groups.

Adult↗

PubMedDate not supplied

APD in the elderly.

Few elderly patients with end-stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients >or=65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectiveness of automated peritoneal dialysis (APD) in the elderly, we compared several outcome measures in cohorts of different ages maintained on APD. The outcome measures we examined included mortality and technique failure rates, peritonitis rates, outcomes of peritonitis, and quality of life measures. We found that while patients >or=65 years of age have a higher mortality rate than younger patients, technique failure rates, overall peritonitis rates, and most quality of life measures are not different than for younger patients. However, patients >or=65 years of age have higher gram-negative peritonitis rates and lower scores on the physical component score of the SF-36 than younger patients. The present study suggests that APD is a reasonable treatment modality for elderly patients with ESRD and that elderly patients with progressive renal failure should be considered as candidates for APD.

Aged↗

PubMedDate not supplied

Continuous peritoneal dialysis-associated peritonitis: a review and current concepts.

The percentage of end-stage renal disease (ESRD) patients in the United States maintained on continuous peritoneal dialysis (CPD) therapy is decreasing. Complications from CPD therapy, including peritonitis, may be the reason for the decline. Improvements in CPD technology and a better understanding of the risk factors that predispose patients to the development of peritonitis have been responsible for a decline in the rate of peritonitis. Yet peritonitis remains a significant cause of patient morbidity and mortality and the overall outcome of peritonitis is not acceptable. Factors that have limited our ability to lessen the impact of peritonitis include a lack of data on dosing antibiotics in patients on continuous cycling peritoneal dialysis (CCPD) therapy, a lack of knowledge concerning the biology of bacterial biofilm, and the development of resistance to the current prophylactic antibiotic protocols. Further studies are needed concerning the optimal management of the peritoneal catheter and whether it is feasible to resume CPD therapy after catheter removal.

Anti-Bacterial Agents↗