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Nederlands Tijdschrift Voor Geneeskunde Apr 2020Available treatment options for patients with end-stage kidney disease are kidney transplantation, haemodialysis, peritoneal dialysis or refraining from renal...
Available treatment options for patients with end-stage kidney disease are kidney transplantation, haemodialysis, peritoneal dialysis or refraining from renal replacement therapy (conservative treatment). Haemodialysis removes uremic toxins and fluid by passing blood via vascular access through an artificial kidney for 4 hours 3 times a week on average. Peritoneal dialysis (PD) removes uremic toxins and fluid through the peritoneum by instillation and drainage of a special fluid via a PD catheter in and out of the abdominal cavity a number of times a day. Peritoneal dialysis is performed at home, while haemodialysis is performed at a hospital or dialysis centre, but can also be performed at home. Both forms of dialysis have significant impact on patients' quality of life and each have their own specific complications. These are mainly problems with vascular access and intradialytic hypotension in the case of haemodialysis, while the occurrence of peritonitis and membrane failure are those of peritoneal dialysis.
Topics: Humans; Hypotension; Kidney Failure, Chronic; Kidneys, Artificial; Peritoneal Dialysis; Peritoneum; Peritonitis; Quality of Life; Renal Dialysis
PubMed: 32392008
DOI: No ID Found -
Le Mali Medical 2023The aim was to describe the diagnostic and therapeutic aspects of biliary peritonitis.
AIMS
The aim was to describe the diagnostic and therapeutic aspects of biliary peritonitis.
PATIENTS AND METHODS
This was a descriptive cross-sectional study with retrospective collection over a period of 10 years including patients operated on for biliary peritonitis.
RESULTS
We collected 10 cases of biliary peritonitis with an average age of 38 years with a sex ratio of 2.3. Two patients presented with an abdominal contusion following a road traffic accident. Maximum abdominal pain in the right hypochondrium was present in three patients, signs of peritoneal irritation in all patients, positive Widal and Felix serodiagnosis in eight patients. At midline laparotomy, the gallbladder was perforated in three patients, gangrenous in five, phlegmonous in one, sclero-atrophic in one. Cholecystectomy was performed in all patients. Biliary peritonitis was of traumatic origin in two patients, and typhoid in eight. Postoperatively, there were four cases of sepsis and three cases of parietal suppuration. Three patients died.
CONCLUSION
Biliary peritonitis discovered during laparotomies for peritonitis, was secondary to typhoid cholecystitis, and had a high morbidity and mortality.
Topics: Humans; Adult; Typhoid Fever; Retrospective Studies; Cross-Sectional Studies; Peritonitis; Gallbladder
PubMed: 38514946
DOI: No ID Found -
Journal of Renal Care Dec 2023Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis, especially in older adults.
OBJECTIVES
We evaluated the effectiveness of a retraining programme for reducing peritonitis and exit site infection rates in older adults on peritoneal dialysis. The cost-benefit ratio was also calculated.
DESIGN
A two-arm prospective randomised controlled trial.
PARTICIPANTS
One hundred and thirty patients aged 55 years or older were recruited. Participants were randomly assigned to the intervention or control group. While both groups received usual care, the intervention group received a retraining programme (a knowledge and practical assessment and a one-on-one retraining session) 90 days after starting home-based continuous ambulatory peritoneal dialysis therapy.
MEASUREMENTS
The outcomes included peritonitis rate, exit site infection rate and direct medical costs at 180, 270, and 360 days after starting home-based continuous ambulatory peritoneal dialysis therapy.
RESULTS
No significant differences were found in the baseline characteristics between groups. The peritonitis rates were 0.11 episodes per patient-year in the intervention group versus 0.13 in the control group. The incidence of exit site infection was 20.0% in the intervention group and 12.3% in the control group. The cost-benefit ratio of retraining was 1:9.6. None of the results were statistically significant.
CONCLUSIONS
The absence of statistical significance may be partly explained by the premature termination of the study. Large-scale multi-centre trials are warranted to examine the effectiveness of retraining. The timing and long-term effects of retraining also need to be examined.
Topics: Humans; Aged; Prospective Studies; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Cost-Benefit Analysis
PubMed: 36463502
DOI: 10.1111/jorc.12450 -
World Journal of Emergency Surgery :... Mar 2023Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intraoperative peritoneal lavage (IOPL) with saline has been widely used in surgical practice. However, the effectiveness of IOPL with saline in patients with intra-abdominal infections (IAIs) remains controversial. This study aims to systematically review randomized controlled trials (RCTs) evaluating the effectiveness of IOPL in patients with IAIs.
METHODS
The databases of PubMed, Embase, Web of Science, Cochrane library, CNKI, WanFang, and CBM databases were searched from inception to December 31, 2022. Random-effects models were used to calculate the risk ratio (RR), mean difference, and standardized mean difference. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to rate the quality of the evidence.
RESULTS
Ten RCTs with 1318 participants were included, of which eight studies on appendicitis and two studies on peritonitis. Moderate-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (0% vs. 1.1%; RR, 0.31 [95% CI, 0.02-6.39]), intra-abdominal abscess (12.3% vs. 11.8%; RR, 1.02 [95% CI, 0.70-1.48]; I = 24%), incisional surgical site infections (3.3% vs. 3.8%; RR, 0.72 [95% CI, 0.18-2.86]; I = 50%), postoperative complication (11.0% vs. 13.2%; RR, 0.74 [95% CI, 0.39-1.41]; I = 64%), reoperation (2.9% vs. 1.7%; RR,1.71 [95% CI, 0.74-3.93]; I = 0%) and readmission (5.2% vs. 6.6%; RR, 0.95 [95% CI, 0.48-1.87]; I = 7%) in patients with appendicitis when compared to non-IOPL. Low-quality evidence showed that the use of IOPL with saline was not associated with a reduced risk of mortality (22.7% vs. 23.3%; RR, 0.97 [95% CI, 0.45-2.09], I = 0%) and intra-abdominal abscess (5.1% vs. 5.0%; RR, 1.05 [95% CI, 0.16-6.98], I = 0%) in patients with peritonitis when compared to non-IOPL.
CONCLUSION
IOPL with saline use in patients with appendicitis was not associated with significantly decreased risk of mortality, intra-abdominal abscess, incisional surgical site infection, postoperative complication, reoperation, and readmission compared with non-IOPL. These findings do not support the routine use of IOPL with saline in patients with appendicitis. The benefits of IOPL for IAI caused by other types of abdominal infections need to be investigated.
Topics: Humans; Peritoneal Lavage; Abdominal Abscess; Peritonitis; Surgical Wound Infection; Appendicitis; Randomized Controlled Trials as Topic
PubMed: 36991507
DOI: 10.1186/s13017-023-00496-6 -
BMC Nephrology Mar 2024To validate an association between new inflammation and frequent peritoneal dialysis-associated peritonitis (PDAP).
OBJECTIVE
To validate an association between new inflammation and frequent peritoneal dialysis-associated peritonitis (PDAP).
MATERIALS AND METHODS
In China, retrospective clinical data were collected on 208 patients who received continuous ambulatory peritoneal dialysis (CAPD) between 2010 and 2021. The patients were divided into two groups: non-frequent PDAP (the interval between two peritonitis episodes of more than one year) and frequent PDAP (the interval between two peritonitis episodes of less than one year). Patients with their first episode of peritonitis had their age, gender, history of hypertension, diabetic disease, underlying renal disease, bacterial infection, and laboratory data collected. The outcomes of bacterial dispersion, systemic immune-inflammation index (SII), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), and risk variables associated with frequent PDAP were analyzed.
RESULTS
There are differences between the two groups in dialysis time (p = 0.006), hypertensive nephropathy (p = 0.038), staphylococcus (p = 0.035), white blood cells (p = 0.001), neutrophil (p < 0.01), lymphocyte (p < 0.01), platelet(p = 0.01), SII(p < 0.01), CRP/HDL-C (p = 0.002), CRP (p < 0.001), serum creatinine (p = 0.007), blood urea nitrogen (p = 0.05), serum magnesium (0.03), serum potassium (p = 0.007), and dialysate polymorphonuclear cells (p = 0.004). Multifactorial logistic regression analysis found that SII (p < 0.001), CRP/HDL-C (p = 0.041), and Diabetes mellitus (p = 0.027) were independent risk factors for frequent PDAP. The ROC curve analysis revealed that combining SII with CRP/HDL-C resulted in the largest AUC area (AUC = 0.814).
CONCLUSIONS
Our findings offer clinical proof of the combination of SII and CRP/HDL-C in patients with frequent PDAP.
Topics: Humans; Retrospective Studies; Renal Dialysis; Inflammation; Peritonitis; Peritoneal Dialysis; Cholesterol, HDL
PubMed: 38443857
DOI: 10.1186/s12882-024-03496-z -
Indian Journal of Pathology &... 2024Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a...
Sclerosing encapsulating peritonitis also known as cocoon abdomen is a rare chronic inflammatory condition of the peritoneum in which the bowel loops are encircled by a membrane (cocoon formation) within the peritoneal cavity leading to intestinal obstruction. It can be primary (idiopathic) or secondary (chemotherapy, beta-blockers, peritoneal dialysis, shunts, tuberculosis, systemic lupus erythematosus, etc.). The symptomatology report includes recurrent episodes of abdominal pain and vomiting. We present here a case of a 32-year-old male who presented with complaints of being unable to pass stools, vomiting (3-4 times), and abdomen pain for 4 days. This case is considered worth mentioning due to its rarity, lack of identification of secondary causes, and diminutive mention of histopathological aspect.
Topics: Male; Humans; Adult; Peritonitis; Intestinal Obstruction; Peritoneum; Vomiting
PubMed: 38358217
DOI: 10.4103/ijpm.ijpm_1228_21 -
Journal of Laparoendoscopic & Advanced... Dec 2021Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is...
Peritoneal tuberculosis (PT) is a rare form of extrapulmonary tuberculosis in children. The diagnosis is difficult because of its clinical polymorphism. Laparoscopy is the gold standard to make the diagnosis by exploring and performing peritoneal biopsies. Our aim was to show the place of laparoscopy in the diagnosis of PT, to compare the anatomopathological results of peritoneal biopsies with a macroscopic appearance to quick start antituberculosis treatment. We reported 4 patients with PT, 3 girls and 1 boy. The middle age was 9 years old. The revealing symptomatology was ascites in all cases. Radiological exploration was not contributing. Laparoscopy was performed for all patients. The exploration revealed an agglutination of the intestinal loops with the presence of whitish micronodules scattered over the entire abdominal cavity. Peritoneal biopsies were done in all cases. Histological examination confirmed the diagnosis of PT in all patients and antituberculosis treatment was introduced. There was a good clinical evolution with a follow-up of 30 months. PT is a public health problem due to its clinical and biological polymorphism. Laparoscopy with peritoneal biopsies remains the essential means for the diagnosis of this pathology in children.
Topics: Ascites; Child; Female; Humans; Laparoscopy; Male; Peritoneum; Peritonitis, Tuberculous
PubMed: 34748433
DOI: 10.1089/lap.2021.0374 -
Translational Research : the Journal of... Feb 2022Trimethylamine-N-oxide (TMAO), a gut microbiota-produced metabolite, is accumulated in chronic kidney disease (CKD) patients. It is well known to contribute to...
Trimethylamine-N-oxide (TMAO), a gut microbiota-produced metabolite, is accumulated in chronic kidney disease (CKD) patients. It is well known to contribute to CKD-related cardiovascular complications. However, the effect of TMAO on peritoneal dialysis (PD)-related peritonitis remains largely unknown. Here, we demonstrate that serum concentrations of TMAO were positively correlated with C-reactive protein levels, and the appearance rate of dialysate IL-6 and PAI-1, in PD patients. During the follow-up period of 28.3 ± 8.0 months, patients with higher TMAO levels (≥50 μM) had a higher risk of new-onset peritonitis (HR, 3.60; 95%CI, 1.18-10.99; P=0.025) after adjusting for sex, age, diabetes, PD duration, BUN, rGFR, C-reactive protein, BMI and β2-M. In CKD rat models, TMAO significantly promoted peritoneal dialysate-induced inflammatory cell infiltration, inflammatory cytokines production in the peritoneum. In vitro study revealed that TMAO directly induced primary peritoneal mesothelial cell necrosis, together with increased production of pro-inflammatory cytokines including CCL2, TNF-α, IL-6, and IL-1β. In addition, TMAO significantly increased TNF-α-induced P-selectin production in mesothelial cells, as well as high glucose-induced TNF-α and CCL2 expression in endothelial cells. In conclusion, our data demonstrate that higher levels of TMAO exacerbate peritoneal inflammation and might be a risk factor of incidence of peritonitis in PD patients.
Topics: Adult; Animals; Cell Death; Cytokines; Epithelium; Female; Gastrointestinal Microbiome; Glucose; Human Umbilical Vein Endothelial Cells; Humans; Inflammation; Inflammation Mediators; Male; Metabolome; Methylamines; Middle Aged; P-Selectin; Peritoneal Dialysis; Peritoneum; Peritonitis; Rats, Sprague-Dawley; Renal Insufficiency, Chronic; Risk Factors; Up-Regulation; Rats
PubMed: 34673277
DOI: 10.1016/j.trsl.2021.10.001 -
Nephrology, Dialysis, Transplantation :... Sep 2023The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these...
BACKGROUND
The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these alterations after kidney transplantation (KTx) is scant.
METHODS
Parietal peritoneal tissues were obtained from 81 pediatric patients with chronic kidney disease stage 5 (CKD5), 72 children on PD with low glucose degradation product (GDP) PD fluids, and from 20 children 4-8 weeks after KTx and preceding low-GDP PD. Tissues were analyzed by digital histomorphometry and quantitative immunohistochemistry.
RESULTS
While chronic PD was associated with peritoneal hypervascularization, after KTx vascularization was comparable to CKD5 level. Submesothelial CD45 counts were 40% lower compared with PD, and in multivariable analyses independently associated with microvessel density. In contrast, peritoneal mesothelial denudation, submesothelial thickness and fibrin abundance, number of activated, submesothelial fibroblasts and of mesothelial-mesenchymal transitioned cells were similar after KTx. Diffuse peritoneal podoplanin positivity was present in 40% of the transplanted patients. In subgroups matched for age, PD vintage, dialytic glucose exposure and peritonitis incidence, submesothelial hypoxia-inducible factor 1-alpha abundance and angiopoietin 1/2 ratio were lower after KTx, reflecting vessel maturation, while arteriolar and microvessel p16 and cleaved Casp3 were higher. Submesothelial mast cell count and interleukin-6 were lower, whereas transforming growth factor-beta induced pSMAD2/3 was similar as compared with children on PD.
CONCLUSIONS
Peritoneal membrane damage induced with chronic administration of low-GDP PD fluids was less severe after KTx. While peritoneal microvessel density, primarily defining PD transport and ultrafiltration capacity, was normal after KTx and peritoneal inflammation less pronounced, diffuse podoplanin positivity and profibrotic activity were prevalent.
Topics: Humans; Child; Kidney Transplantation; Renal Dialysis; Peritoneal Dialysis; Peritoneum; Dialysis Solutions; Peritonitis; Kidney Failure, Chronic; Glucose
PubMed: 36754369
DOI: 10.1093/ndt/gfad031 -
Scientific Reports Jul 2019Infection remains a major cause of morbidity, mortality and technique failure in patients with end stage kidney failure who receive peritoneal dialysis (PD). Recent...
Infection remains a major cause of morbidity, mortality and technique failure in patients with end stage kidney failure who receive peritoneal dialysis (PD). Recent research suggests that the early inflammatory response at the site of infection carries diagnostically relevant information, suggesting that organ and pathogen-specific "immune fingerprints" may guide targeted treatment decisions and allow patient stratification and risk prediction at the point of care. Here, we recorded microRNA profiles in the PD effluent of patients presenting with symptoms of acute peritonitis and show that elevated peritoneal miR-223 and reduced miR-31 levels were useful predictors of bacterial infection. Cell culture experiments indicated that miR-223 was predominantly produced by infiltrating immune cells (neutrophils, monocytes), while miR-31 was mainly derived from the local tissue (mesothelial cells, fibroblasts). miR-223 was found to be functionally stabilised in PD effluent from peritonitis patients, with a proportion likely to be incorporated into neutrophil-derived exosomes. Our study demonstrates that microRNAs are useful biomarkers of bacterial infection in PD-related peritonitis and have the potential to contribute to disease-specific immune fingerprints. Exosome-encapsulated microRNAs may have a functional role in intercellular communication between immune cells responding to the infection and the local tissue, to help clear the infection, resolve the inflammation and restore homeostasis.
Topics: Adult; Aged; Aged, 80 and over; Animals; Bacterial Infections; Cross-Sectional Studies; Escherichia coli Infections; Extracellular Vesicles; Female; Genetic Markers; Gram-Negative Bacterial Infections; Humans; Male; Mice, Inbred C57BL; MicroRNAs; Middle Aged; Neutrophils; Peritoneal Dialysis; Peritonitis; Reproducibility of Results; Young Adult
PubMed: 31300703
DOI: 10.1038/s41598-019-46585-y