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PubMedDate not supplied

Laparoscopic placement of peritoneal dialysis catheter (same day dialysis).

BACKGROUND AND OBJECTIVE: Peritoneal dialysis (PD) remains the generally accepted method for management of renal failure in chronic and acute renal failure. Despite the rapidly increasing use of continuous ambulatory peritoneal dialysis (CAPD) since its introduction, controversy persists as to the efficacy and exact role of the modality in the treatment of end stage renal failure. The aim of this paper is to present the experience with laparoscopic placement of a peritoneal dialysis catheter and starting the peritoneal dialysis on the same day. METHODS: The laparoscopic placement of a peritoneal dialysis catheter was performed on 11 patients (10 males and 1 female) with an average age of 35 years, over a 12-month period. The procedure was done using two 5 mm abdominal trocars. The precise position of the catheter on the pelvis was ensured laparoscopically. One to two liters exchange dialysis was used for every patient, and no leakage was recorded. RESULTS: The patients tolerated the procedure well. The peritoneal dialysis was started immediately. Patients were discharged after an overnight stay, and PD was carried out routinely. CONCLUSION: The results of laparoscopic placement of a peritoneal dialysis catheter show the following advantages: minimal incision; less surgical trauma; the procedure hastens the early start of peritoneal dialysis and has no complications.

Adult↗
PubMedDate not supplied

[Evolution of the aluminum concentration in the final dialysis solution: Multicenter study in Spanish dialysis centers].

Aluminium contaminated dialysate is the most dangerous source of aluminium for dialysis patients. The aim of this study was to assess the aluminium content in the dialysis fluid in all the Spanish dialysis centres in 1999 and to compare the results with those obtained in previous studies. For this purpose, all the 275 Spanish centres were invited to participate, we measured the concentration of aluminium in the dialysis fluids in all of them. Aluminium was measured by atomic absorption spectrometry. Since 1988 our laboratory has participated in a external quality assessment scheme for aluminium measurement (University of Surrey) having a good performance (fig. 1). The aluminium concentration in the dialysis fluids were compared with the results obtained in other 2 cross sectional studies performed in 1990 and 1994 following the same methodology. The participating centres were 242 out of 275 (88%). The percentage of centres with a concentration of aluminium in the dialysis fluid lower than 2 micrograms/l has increased throughout the period of study (45% in 1990, 69.8% in 1994 and 81.8% in 1999, fig. 2). One important finding of the new study was the increment in the percentage of centres having undetectable aluminium (< 1 microgram/L) (22.9% in 1990, 41.2% in 1994 and 66.9% in 1999, fig. 3). The safety threshold of 1 microgram/L should be the goal for all the dialysis centres. By contrast, the percentage of centres with aluminium concentration greater than 10 micrograms/L (the old safety threshold to avoid aluminium exposure established by the European Union in 1986) did not show a relevant decrease from 1994 to 1999 (from 5.1% to 4.1% respectively). Taking into account the aluminium content, the quality of the dialysis fluid has improved during the last 10 years, although there is still a non negligible percentage of centres (4.1%) with high aluminium concentration in the dialysis fluid (> 10 micrograms/L).

Aluminum↗
PubMed2003

[Effect of peritonitis frequency on the effectiveness of peritoneal dialysis and effect of peritoneal dialysis effectiveness on the frequency of peritonitis].

UNLABELLED: Peritonitis is the most serious complication of peritoneal dialysis treatment for ESRD. There is no unanimous attitude yet concerning the influence of PD adequacy on the frequency of peritonitis. PATIENTS: The paper reports on a study of interrelation of peritonitis frequency and PD adequacy in 61 patients (27 women, 34 men) during a 5-year period. The group included 88% of all PD patients (61 of totally 69). RESULTS AND DISCUSSION: The patients experienced a total of 71 peritonitis episodes over a total of 1615 months of PD treatment. There was one peritonitis episode per 23 months of treatment on an average. When a patient who experienced 11 peritonitis episodes was excluded, the average frequency of peritonitis turned to one in 26 months. Peritonitis frequency and PD adequacy showed a significant negative correlation (r = 0.25, p < 0.05). PD adequacy expressed as total weekly Kt/V did not differ between the patients with and those without a history of peritonitis (Kt/V+ = 1.87 +/- 0.21, Kt/V- = 1.88 +/- 0.24; t = 0.17, p > 0.05). The frequency of peritonitis in men was twofold that in women, i.e. one peritonitis in every 17.24 +/- 11.67 months of treatment in men, and one peritonitis in every 37.81 +/- 13.11 months in women. The difference was statistically significant (t = 6.39, p < 0.01). However, PD adequacy did not differ between men and women (Kt/V = 1.84 +/- 0.21: 1.92 +/- 0.23, t = 1.40, p > 0.05). Patients with more adequate dialysis (n = 51) (Kt/V = 1.70) had one peritonitis in every 23.16 +/- 20.07 months on an average, and those with less adequate dialysis one peritonitis in 21.82 +/- 18.12 months of treatment. The difference was not statistically significant (t = 0.21, p > 0.05). The patients in whom PD was the first method of ESRD treatment (n = 55) experienced one peritonitis in every 24.04 +/- 12.51 months of treatment on an average, and those in whom PD was the second method of ESRD treatment (n = 6) had one peritonitis in 15.68 +/- 13.54 months of treatment. The difference was not significant (t = 1.45, p > 0.05). The difference in dialysis adequacy between these two groups was not significant either, even though the patients with PD as the first method had more adequate dialysis (1.88 +/- 0.22: 1.83 +/- 0.27; t = 0.44, p > 0.05). CONCLUSION: Peritonitis frequency and PD adequacy are significantly negatively correlated. The patients with higher peritonitis frequency had less adequate dialysis, while the patients with less adequate dialysis had peritonitis more frequently. However, the patients with a history of peritonitis had not significantly less adequate dialysis, nor the patients with less adequate dialysis had a significantly higher frequency of peritonitis.

Adult↗
PubMed1993

Influence of dialysis membranes on the development of dialysis associated osteoarthropathy.

The influence of the dialysis membrane and the patients' ages on the development of dialysis osteoarthropathy was studied in 25 patients who had been on hemodialysis for more than 10 years. The patients were dialyzed with cuprophane membranes, and then treated with polyacrylonitrile AN 69. Radiolucent bone cysts (at least 5 mm in diameter in the wrists and at least 10 mm in the shoulders or hips) were evaluated by X-ray and confirmed by CT scan. The patients with bone cysts (N = 9) had been exposed significantly more to cuprophane dialysis and significantly less to AN 69 dialysis than the patients without bone cysts (N = 16). There was no significant difference in the total duration of dialysis between the two groups. The average age was significantly greater in patients with bone cysts than in patients without bone cysts. The severity of the cystic bone lesions correlated positively with the patient's age and the duration of dialysis using cuprophane membranes, and negatively with the duration of dialysis using AN 69. These findings suggest that the development of dialysis osteoarthropathy may be related to both age and the use of cuprophane membranes. Hemodialysis using AN 69 may prevent, or at least postpone the development of dialysis amyloidosis.

Adult↗
PubMed2006

Meta-analysis: the dialysis mode and immunological response to hepatitis B virus vaccine in dialysis population.

BACKGROUND: Patients on maintenance dialysis typically show a suboptimal immune response to hepatitis B virus vaccine compared with the non-uraemic population. Some authors have claimed that dialysis mode has an impact on the immune response to hepatitis B virus vaccine but consistent information is lacking on this issue. AIM: To evaluate the relationship between dialysis mode and immune response to hepatitis B vaccine in dialysis population by performing a systematic review with a meta-analysis of clinical trials. METHOD: We used the random effects model of DerSimonian and Laird; sources of heterogeneity in effect estimates were explored by performing sensitivity analyses. RESULTS: The relative risk of failure to respond to hepatitis B vaccine among patients who underwent maintenance haemodialysis vs. peritoneal dialysis was the end point of interest. We identified 14 clinical trials involving 1211 unique patients on maintenance dialysis. Pooling of study results did not show a significant decreased risk of response to hepatitis B vaccine among haemodialysis patients (overall risk ratio: 1.0, 95% confidence intervals: 0.92-1.1). The P-value was 0.13 for our test of study heterogeneity. CONCLUSION: There is no significant link between dialysis mode and seroresponse to hepatitis B virus vaccine in dialysis population.

Antibodies, Viral↗
PubMedDate not supplied

Recovery of renal function and the discontinuation of dialysis in patients treated with continuous peritoneal dialysis.

OBJECTIVE: Previous studies have shown that patients with end-stage renal disease (ESRD) treated with continuous peritoneal dialysis (CPD) have better preservation of endogenous renal function than patients treated with hemodialysis (HD). We wondered if this better preservation of endogenous renal function seen with CPD patients translates into the improved likelihood of recovery of endogenous renal function in those patients with potentially reversible causes of renal failure. METHODS: To evaluate this question, we reviewed the records of all 1200 patients that completed CPD training at a large, freestanding peritoneal dialysis center in New Haven, Connecticut, between 1979 and 1999, and the records of all patients completing CPD training in New England between 1993 and 1998. In New Haven, about half the new patients with ESRD were started on CPD compared to only 15% in New England. We then compared the chances of recovery of renal function in these two cohorts of CPD patients to the chances of recovery of renal function in two groups of HD patients. The first group consisted of all patients that started on HD in New England between 1993 and 1998. The second group consisted of all patients that started HD in our HD unit in New Haven, Connecticut, between 1993 and 1999. The data on the New England patients were provided by the ESRD Network of New England. All patients entered into the present study had to have been on dialysis for a minimum of 3 months, as in the United States Renal Data System database, and had to have recovered sufficient renal function to be able to be maintained off dialysis for a minimum of 30 days. RESULTS: 29 of 1,200 CPD patients (2.4%) trained in New Haven recovered sufficient renal function to permit the discontinuation of dialysis for a minimum of 30 days. In comparison, only 305 of 19,032 patients (1.6%) managed with HD in New England (p < 0.05 compared to New Haven CPD patients) and 3 of 430 patients (0.7%) in our HD center (p < 0.05 compared to New Haven CPD patients) recovered sufficient glomerular filtration rate (GFR) to allow the discontinuation of dialysis for at least 30 days. If only those CPD patients that initiated dialysis between 1993 and 1999 in New Haven were analyzed, 15 of 369 (4.1%) recovered sufficient GFR to allow discontinuation of dialysis for at least 30 days (p < 0.025 compared to both groups of HD patients). Of the 2,924 patients completing CPD training in New England, 60 (2.1%) recovered renal function; this percentage is not significantly different from the percent of HD patients in New England recovering renal function. CONCLUSION: Although the present study is a retrospective study and the actual criteria for selection of CPD and HD therapy are not controlled for, the data raise the question of whether there may be a therapeutic advantage to treating newly diagnosed ESRD patients, that have a potentially reversible cause of renal failure, with CPD.

Adult↗
PubMed1987

Controlled study of renal osteodystrophy in patients undergoing dialysis. Improved response to continuous ambulatory peritoneal dialysis compared with hemodialysis.

To assess the effect of different dialysis modalities on renal osteodystrophy, a controlled study was performed in six patients undergoing continuous ambulatory peritoneal dialysis and six hemodialysis-treated patients. All patients were enrolled at the initiation of dialysis, and age, sex, cause of renal failure, prior treatment of renal osteodystrophy, and baseline serum and bone histologic variables were similar in the two groups. After initial blood samples and bone biopsy specimens (with double-tetracycline labels) were obtained, renal osteodystrophy in both groups received comparable treatment with aluminum hydroxide to maintain serum phosphorus levels between 3.5 and 5.5 mg/dl, and with calcium carbonate and calcitriol to maintain total serum calcium levels between 10 and 11 mg/dl. Blood and bone samples were obtained again after nine months. All patients were asymptomatic at the beginning and end of the study. Phosphorus values were well controlled, and total calcium increased similarly in both groups. Although ionized calcium levels increased in both groups, the final level was higher in hemodialysis-treated patients than in patients undergoing continuous ambulatory peritoneal dialysis (2.82 +/- 0.07 meq/liter and 2.5 +/- 0.05 meq/liter, respectively; p = 0.005). Amino-terminal parathyroid hormone levels normalized in both groups, and histologic improvement of osteitis fibrosa occurred in a similar proportion of patients in both groups; however, quantitative improvement was greater in the hemodialysis-treated patients. Osteomalacia, assessed qualitatively and by dynamic histomorphometric measurements, was ameliorated to a much greater degree in patients undergoing continuous ambulatory peritoneal dialysis compared with hemodialysis-treated patients. Bone aluminum staining was absent in all biopsy specimens. Overall, bone histologic findings improved to a greater degree in patients undergoing continuous ambulatory peritoneal dialysis. When patients undergoing continuous ambulatory peritoneal dialysis or hemodialysis and receiving similar treatment for renal osteodystrophy were compared, patients treated with continuous ambulatory peritoneal dialysis appeared to have a greater improvement in their metabolic bone disease.

Aluminum Hydroxide↗
PubMed2002

Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access.

BACKGROUND: Care of patients with end-stage renal disease (ESRD) is important and resource intense. To enable ESRD programs to develop strategies for more cost-efficient care, an accurate estimate of the cost of caring for patients with ESRD is needed. METHODS: The objective of our study is to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and contrast differences in resources required for various dialysis modalities. One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospectively for 1 year. Detailed information on baseline patient characteristics, including comorbidity, was collected. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. We also estimated separately the cost of maintaining the dialysis access. RESULTS: Overall annual cost of care for in-center, satellite, and home/self-care hemodialysis and peritoneal dialysis were US $51,252 (95% confidence interval [CI], 47,680 to 54,824), $42,057 (95% CI, 39,523 to 44,592), $29,961 (95% CI, 21,252 to 38,670), and $26,959 (95% CI, 23,500 to 30,416), respectively (P < 0.001). After adjustment for the effect of other important predictors of cost, such as comorbidity, these differences persisted. Among patients treated with hemodialysis, the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft (P < 0.001). CONCLUSION: To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis.

Adult↗