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Clinical and Experimental Nephrology Jul 2022Peritoneal fibrosis induced by various factors during peritoneal dialysis (PD) can eventually lead to ultrafiltration failure and termination of PD treatment. The...
BACKGROUND
Peritoneal fibrosis induced by various factors during peritoneal dialysis (PD) can eventually lead to ultrafiltration failure and termination of PD treatment. The existing animal models are caused by a single stimulus, and cannot accurately simulate complex pathogenesis of peritoneal injury and fibrosis. We aim to develop an efficient and realistic mouse model of PD-associated peritoneal injury using daily intraperitoneal injection (I.P.) of human peritonitis PD effluent.
METHODS
Eight-week-old male C57BL/6 mice were classified into six groups: saline control; 2.5% PD fluid; 2.5% PD fluid + lipopolysaccharide (LPS); 4.25% PD fluid; 4.25% PD fluid + LPS; and peritonitis effluent. Mice received daily I.P. for 6 weeks, and were sacrificed to determine peritoneal structural and functional damage, inflammation, and fibrosis.
RESULTS
Mice in the peritonitis effluent group had low mortality. The submesothelial thickness in the peritonitis effluent group was significantly greater than that in the 2.5% PD fluid group. The peritonitis effluent group had increased expression of fibrosis markers (α-SMA, Collagen I, etc.), neutrophil granulocytes (MPO), and macrophages (CD68, F4/80) in the peritoneum based on immunohistochemical staining; and significantly higher expression of inflammation markers (IL-1β, IL-6, etc.) and fibrosis markers (TGF-β1, α-SMA, etc.) based on real-time qPCR. Modified peritoneal equilibration tests (PET) demonstrated that I.P. of peritonitis effluent reduced peritoneal ultrafiltration.
CONCLUSION
Our novel animal model of PD-associated peritoneal injury faithfully simulates the clinical pathophysiological process. This animal model may be useful for study of the pathogenesis of PD-associated peritoneal injury and identification of novel treatments.
Topics: Animals; Dialysis Solutions; Disease Models, Animal; Humans; Inflammation; Lipopolysaccharides; Male; Mice; Mice, Inbred C57BL; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Peritonitis
PubMed: 35353282
DOI: 10.1007/s10157-022-02208-x -
Expert Opinion on Pharmacotherapy Aug 2021Bacterial peritonitis is an infection with high mortality if not treated immediately. In the absence of an intraabdominal source of infection, bacterial peritonitis may... (Review)
Review
Bacterial peritonitis is an infection with high mortality if not treated immediately. In the absence of an intraabdominal source of infection, bacterial peritonitis may arise in patients with liver cirrhosis, in patients on peritoneal dialysis (PD) for end-stage renal disease or in patients with tuberculosis. In patients with cirrhosis, bacterial peritonitis may trigger acute on chronic liver failure with substantial mortality despite optimal treatment. In patients on PD, peritonitis may make continuation of PD impossible, necessitating the switch to hemodialysis. Recovery from peritonitis and prevention of complications depend on timely pharmacological management. Challenges are the broad microbiological spectrum with growing rates of antimicrobial resistance, the underlying chronic liver or kidney failure and high rates of relapse. The authors provide a review of predisposing conditions, diagnosis, and prevention of bacterial peritonitis with a particular focus on the pharmacological management. Diagnosis of the type of bacterial peritonitis is essential to pharmacological management. In patients with spontaneous bacterial peritonitis, broad-spectrum antibiotics should be given intravenously in conjunction with albumin. In patients on PD, antibiotic therapy should be preferably applied intraperitoneally with empirical coverage of gram-positive and gram-negative bacteria. Secondary peritonitis usually requires surgical or interventional treatment.
Topics: Anti-Bacterial Agents; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Peritoneal Dialysis; Peritonitis
PubMed: 33878993
DOI: 10.1080/14656566.2021.1915288 -
American Journal of Health-system... Jul 2023The purpose of this review is to discuss infectious disease-related adverse effects associated with long-term proton pump inhibitor (PPI) therapy in patients with... (Review)
Review
PURPOSE
The purpose of this review is to discuss infectious disease-related adverse effects associated with long-term proton pump inhibitor (PPI) therapy in patients with cirrhosis and to provide recommendations for appropriate use and choice of PPI when such therapy is indicated.
SUMMARY
Long-term PPI therapy in patients with cirrhosis increases the risk of infections, with infections in turn increasing the risk of mortality in this patient population. Expert recommendations include restricting long-term PPI use in cirrhosis to patients with appropriate gastrointestinal indications, using a PPI for the shortest possible duration and at the lowest possible dose, and avoiding PPIs with unfavorable pharmacogenetic properties.
CONCLUSION
Long-term PPI use in patients with cirrhosis has been associated with increased infections. The risk of adverse effects in observational studies, including decompensation, severe infection (especially spontaneous bacterial peritonitis), and increased mortality, appears to increase as the dose and duration of PPI increase.
Topics: Humans; Proton Pump Inhibitors; Bacterial Infections; Liver Cirrhosis; Peritonitis; Risk Factors
PubMed: 37105716
DOI: 10.1093/ajhp/zxad089 -
Peritoneal Dialysis International :... Mar 2022Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact...
BACKGROUND
Peritoneal dialysis induces the inflammatory response within the peritoneal cavity, which contributes to the progressive damage of the peritoneum. Due to close contact of the peritoneal cavity and the intestines, there is the possibility that the visceral disorders can affect the intraperitoneal inflammation during peritoneal dialysis.
OBJECTIVES
Study of the effect of acute colitis on the intraperitoneal inflammation in conditions of peritoneal dialysis and evaluation of the protective effect of hyaluronan in that scenario.
METHODS
In rats with the dextran sulphate-induced colitis, 6-h peritoneal dialysis was performed with dianeal 2.5% +/- hyaluronan 10 mg/dL. In the control group, rats without colitis were studied. Peritoneal permeability and dialysate inflammation were studied at the end of the dialysate exchange.
RESULTS
In rats with colitis, intraperitoneal inflammatory reaction was increased as compared with the control group and reflected by the following studied parameters: dialysate cell count (+26%, < 0.01), number of neutrophils (+75%, < 0.01), generation of free radicals in the leukocytes (+70%, < 0.05), dialysate level of elastase (+102%, < 0.01), tumor necrosis factor α (+48%, < 0.01) and monocyte chemoattractant protein-1 (+42%, < 0.01). Drained dialysate volume was lower (-21%, < 0.01) and peritoneal permeability increased in rats with colitis (+55%, < 0.01). In animals with the hyaluronan supplemented dialysis fluids, the intensity of the intraperitoneal inflammation was reduced.
CONCLUSIONS
Visceral inflammation during colitis induces the inflammatory reaction within the peritoneal cavity that may accelerate damage to the peritoneum. Supplementation of the dialysis fluid with hyaluronan reduces the intensity of that effect.
Topics: Animals; Colitis; Dialysis Solutions; Humans; Hyaluronic Acid; Inflammation; Peritoneal Dialysis; Peritoneum; Peritonitis; Rats; Rats, Wistar
PubMed: 33998321
DOI: 10.1177/08968608211014568 -
Renal Failure Dec 2021Peritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and...
BACKGROUND
Peritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and the first episode of peritonitis, as well as the prognosis of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
METHOD
A retrospective cohort study was conducted, analyzing data of CAPD patients from 1st January 2009, to 31st December 2017. Baseline data within 3 months after PD catheter placement was recorded. Cox multivariate regression analysis was performed to determine the risk factors for the first episode of peritonitis, technique failure and overall mortality.
RESULTS
A total of 591 patients were included in our analysis, with a mean follow-up visit of 49 months (range: 27-75months). There were 174 (29.4%) patients who had experienced at least one episode of peritonitis. Multivariate Cox regression analysis revealed that a higher peritoneal transport status (high and high-average) (HR 1.872, 95%CI 1.349-2.599, = 0.006) and hypoalbuminemia (HR 0.932,95% CI 0.896, 0.969, = 0.004) were independent risk factors for the occurrence of the first episode of peritonitis. In addition, factors including gender (male) (HR 1.409, 95%CI 1.103, 1.800, = 0.010), low serum albumin (HR 0.965, 95%CI 0.938, 0.993, = 0.015) and the place of residence (rural) (HR 1.324, 95%CI 1.037, 1.691, = 0.024) were independent predictors of technique failure. Furthermore, low serum albumin levels (HR 0.938, 95%CI 0.895, 0.984, = 0.008) and age (>65years) (HR 1.059, 95%CI 1.042, 1.076, < 0.001) were significantly associated with the risk of overall mortality of PD patients.
CONCLUSIONS
Baseline hypoalbuminemia and a higher peritoneal transport status are risk factors for the first episode of peritonitis. Factors including male gender, hypoalbuminemia, and residing in rural areas are associated with technique failure, while hypoalbuminemia and age (>65years) are predictors of the overall mortality in PD patients. Nevertheless, the peritoneal transport status does not predict technique failure or overall mortality of PD patients.
Topics: Adult; Age Factors; Female; Humans; Hypoalbuminemia; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum; Peritonitis; Prognosis; Retrospective Studies; Risk Factors; Sex Factors; Survival Analysis
PubMed: 34233593
DOI: 10.1080/0886022X.2021.1949350 -
Nephrology, Dialysis, Transplantation :... Apr 2022The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best...
BACKGROUND
The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis.
METHODS
Adult patients on PD <3 months participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) were included. Training characteristics (including duration, location, nurse affiliation, modality, training of family members, use of individual/group training and use of written/oral competency assessments) were reported at patient and facility levels. The hazard ratio (HR) for time to first peritonitis was estimated using Cox models, adjusted for selected patient and facility case-mix variables.
RESULTS
A total of 1376 PD patients from 120 facilities across seven countries were included. Training was most commonly performed at the facility (81%) by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with a reduced peritonitis risk [adjusted HR 0.31 (95% confidence interval 0.15-0.62) versus facility nurses only]. However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk.
CONCLUSIONS
There was no evidence to support that peritonitis risk was associated with when, where, how or how long PD patients are trained.
Topics: Adult; Humans; Peritoneal Dialysis; Peritonitis; Proportional Hazards Models; Prospective Studies
PubMed: 34634100
DOI: 10.1093/ndt/gfab298 -
Peritoneal Dialysis International :... May 2021Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are...
OBJECTIVES
Nontuberculous mycobacteria (NTM) infections pose a diagnostic challenge in peritoneal dialysis (PD) patients. In this study, we sought to identify findings that are suggestive of NTM infection in PD adult patients.
METHODS
All patients with NTM exit-site infection (ESI) with/without tunnel infection and peritonitis identified during the last decade in eight medical centers in Israel were included. Clinical, microbiological, and outcome data were collected and analyzed.
RESULTS
Thirty patients were identified; 16 had ESI (53%) and 14 had peritonitis (47%). Median age was 65 years (interquartile range 52-76). Abdominal pain and cloudy PD fluid were reported in all patients with peritonitis, whereas exit-site discharge and granulation tissue were common in patients with ESI. Fourteen patients (47%) had negative cultures prior NTM diagnosis, and isolation of diphtheroids or was reported in 9 of 30 patients (30%). Antimicrobial treatment prior to diagnosis was documented in 13 of 30 patients (43%). Delayed diagnosis was frequent. Treatment regimens and duration of therapy varied widely. In 26 of 30 (87%) patients, catheter was removed and 19 of 30 patients (63%) required permanent transition to hemodialysis. Two patients with peritonitis (2 of 14, 14%) and seven with ESI (7 of 16, 44%) were eligible for continuation of PD.
CONCLUSIONS
Culture negative peritonitis, isolation of diphtheroids or ., previous exposure to antibiotics, and/or a refractory infection should all prompt consideration of PD-related NTM infection and timely workup. Catheter removal is recommended aside prolonged antimicrobial therapy. In select patients with ESI, continuation of PD may be feasible.
Topics: Adult; Aged; Anti-Bacterial Agents; Humans; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Peritoneal Dialysis; Peritonitis
PubMed: 32400280
DOI: 10.1177/0896860820923461 -
Peritoneal Dialysis International :... Nov 2023To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop... (Review)
Review
To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop patient-centred pharmacotherapeutic plans. Traditional PD solutions promote osmosis using dextrose or icodextrin with a lactate buffer. Newer PD solutions have modified the osmotic vehicle and buffer. Knowledge of antimicrobial compatibility and stability with newer PD solutions will assist with determining the route of antimicrobial administration as compatible and stable solutions could be delivered directly to the peritoneum using intraperitoneal administration. This review updates the compatibility and stability of antimicrobial additives in newer PD solutions for PD-related peritonitis.
Topics: Humans; Peritoneal Dialysis; Dialysis Solutions; Peritonitis; Anti-Infective Agents; Lactic Acid; Glucose
PubMed: 37728078
DOI: 10.1177/08968608231196034 -
Journal of Gastroenterology and... Nov 2022Early readmissions of spontaneous bacterial peritonitis (SBP) are often associated with poor outcomes. We compared characteristics and outcomes for index and 30-day...
BACKGROUND AND AIM
Early readmissions of spontaneous bacterial peritonitis (SBP) are often associated with poor outcomes. We compared characteristics and outcomes for index and 30-day readmissions of SBP in the USA.
METHODS
We analyzed the Nationwide Readmissions Database for 2018 to identify all adult (≥ 18 years) 30-day readmissions of SBP in the USA. Hospitalization characteristics and outcomes for index and 30-day readmissions of SBP were compared. Independent predictors of 30-day readmissions were also identified.
RESULTS
In 2018, of the 5,797 index admissions for SBP, 30% (1726) were readmitted within 30 day. At the time of readmission, the most common admitting diagnosis was alcoholic cirrhosis of the liver with ascites (11.8%) followed by sepsis due to an unspecified organism (9.2%). SBP as an admitting diagnosis was identified for only 8.3% of these 30-day readmissions. Compared with index admissions, 30-day readmissions of SBP had a lower mean age (56.1 vs 58.6 years, P < 0.001) without a statistically significant difference for gender. Furthermore, 30-day readmissions of SBP were associated with significantly higher odds of inpatient mortality (10% vs 4.9%, OR: 2.15, 95% CI: 1.66-2.79, P < 0.001), and mean total hospital charge ($85,031 vs $56,000, mean difference: 29,032, 95% CI: 12,867-45,197, P < 0.001) compared with index admissions. The presence of chronic pulmonary disease, liver failure, inpatient dialysis, and discharge against medical advice were identified as independent predictors for increased 30-day readmissions of SBP.
CONCLUSION
The 30-day readmission rate of SBP was 30% and these readmissions were associated with higher odds of inpatient mortality compared with index admissions.
Topics: Adult; Humans; United States; Middle Aged; Patient Readmission; Risk Factors; Renal Dialysis; Retrospective Studies; Peritonitis
PubMed: 35869617
DOI: 10.1111/jgh.15965 -
Veterinary Surgery : VS Feb 2021To identify etiology, clinical findings, diagnostic results, treatment, and short- and long-term survival and to report factors associated with nonsurvival and survival...
OBJECTIVE
To identify etiology, clinical findings, diagnostic results, treatment, and short- and long-term survival and to report factors associated with nonsurvival and survival in horses with peritonitis.
STUDY DESIGN
Retrospective study.
ANIMALS
Horses (n = 72).
METHODS
Medical records at William R. Pritchard Veterinary Medical Teaching Hospital from 2007-2017 were reviewed for horses diagnosed with peritonitis. The essential inclusion criterion was a peritoneal nucleated cell count of ≥25 000 cells/μL. Gastrointestinal rupture and cases in which peritonitis occurred after abdominal surgery or castration were excluded. Information retrieved from medical records included signalment, history, clinicopathological and peritoneal fluid variables, diagnostic imaging findings, inciting cause, treatment, and short- and long-term survival. Data were analyzed by using Fisher's exact test, Wilcoxon rank sum test, and χ test (P < .05).
RESULTS
Colic was the most common presenting complaint (34/72 [48%]). A definitive diagnosis could be made in 44 (44/72 [61%]) cases. The most common cause of peritonitis was infectious agents (31/72), followed by trauma (8/72), gastrointestinal thickening (3/72), and eosinophilic peritonitis (2/72). Idiopathic peritonitis was identified in 28 (28/72 [39%]) cases. Sixty (83%) horses survived to hospital discharge. Long-term follow-up was available for 49 horses, with 43 (88%) horses alive 1 year after discharge. Significant differences between nonsurvivors and survivors were history of colic, positive peritoneal fluid culture, and several hematological/peritoneal fluid variables.
CONCLUSION
Peritoneal fluid analysis was essential for a definitive diagnosis of peritonitis, and certain variables were useful for predicting outcome.
CLINICAL SIGNIFICANCE
Results of this study provide evidence of the value of peritoneal fluid analysis for identification of peritonitis, prediction of outcome, and successful treatment.
Topics: Animals; Colic; Female; Horse Diseases; Horses; Male; Peritonitis; Prognosis; Retrospective Studies
PubMed: 33415827
DOI: 10.1111/vsu.13564