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Journal of the American Society of... Dec 2013Systemic inflammation, as evidenced by elevated inflammatory cytokines, is a feature of advanced renal failure and predicts worse survival. Dialysate IL-6 concentrations...
Systemic inflammation, as evidenced by elevated inflammatory cytokines, is a feature of advanced renal failure and predicts worse survival. Dialysate IL-6 concentrations associate with variability in peritoneal small solute transport rate (PSTR), which has also been linked to patient survival. Here, we determined the link between systemic and intraperitoneal inflammation with regards to peritoneal membrane function and patient survival as part of the Global Fluid Study, a multinational, multicenter, prospective, combined incident and prevalent cohort study (n=959 patients) with up to 8 years of follow-up. Data collected included patient demographic characteristics, comorbidity, modality, dialysis prescription, and peritoneal membrane function. Dialysate and plasma cytokines were measured by electrochemiluminescence. A total of 426 survival endpoints occurred in 559 incident and 358 prevalent patients from 10 centers in Korea, Canada, and the United Kingdom. On patient entry to the study, systemic and intraperitoneal cytokine networks were dissociated, with evidence of local cytokine production within the peritoneum. After adjustment for multiple covariates, systemic inflammation was associated with age and comorbidity and independently predicted patient survival in both incident and prevalent cohorts. In contrast, intraperitoneal inflammation was the most important determinant of PSTR but did not affect survival. In prevalent patients, the relationship between local inflammation and membrane function persisted but did not account for an increased mortality associated with faster PSTR. These data suggest that systemic and local intraperitoneal inflammation reflect distinct processes and consequences in patients treated with peritoneal dialysis, so their prevention may require different therapeutic approaches; the significance of intraperitoneal inflammation requires further elucidation.
Topics: Adult; Aged; Cohort Studies; Comorbidity; Cytokines; Female; Humans; Incidence; Inflammation; Kidney Failure, Chronic; Male; Middle Aged; Multivariate Analysis; Peritoneal Dialysis; Peritoneum; Peritonitis; Predictive Value of Tests; Prevalence
PubMed: 24009237
DOI: 10.1681/ASN.2013030314 -
American Journal of Nephrology 2014Icodextrin is a peritoneal dialysis solution that is commonly used to increase ultrafiltration during the long dwell. The other major clinical benefit of icodextrin is... (Review)
Review
BACKGROUND
Icodextrin is a peritoneal dialysis solution that is commonly used to increase ultrafiltration during the long dwell. The other major clinical benefit of icodextrin is that it is glucose-sparing, which may help preserve peritoneal membrane function. Since it has a different chemical composition than dextrose, and with its increasing use, there are several clinical considerations healthcare providers must familiarize themselves with prior to prescribing icodextrin.
SUMMARY
Failure to recognize these special properties of icodextrin can lead to adverse events reaching patients. This narrative review explores the hemodynamic, metabolic, and idiopathic effects of icodextrin to facilitate the safe use of icodextrin in peritoneal dialysis.
KEY MESSAGES
Hemodynamic effects include hypotension from enhanced ultrafiltration contributing to loss of residual kidney function. Metabolic effects include the chemical structure of icodextrin interfering with biochemical assays, resulting in misleading glucose readings on non-specific glucometers. Idiopathic adverse effects include a diffuse rash and sterile peritonitis. It is also important to remember that not all antibiotic combinations have undergone stability testing in icodextrin. This narrative review will help healthcare providers to confidently prescribe icodextrin to maximize its benefit in peritoneal dialysis patients.
Topics: Blood Glucose Self-Monitoring; Dialysis Solutions; Glucans; Glucose; Hemodiafiltration; Hemodynamics; Humans; Hypotension; Icodextrin; Kidney Failure, Chronic; Peritoneal Dialysis; Peritoneum; Peritonitis
PubMed: 24925229
DOI: 10.1159/000363417 -
Internal Medicine (Tokyo, Japan) Nov 2021A 77-year-old man developed peritoneal dialysis-related peritonitis caused by Streptococcus oralis, a rare pathogen causing the disease. The infection, which was not... (Review)
Review
A 77-year-old man developed peritoneal dialysis-related peritonitis caused by Streptococcus oralis, a rare pathogen causing the disease. The infection, which was not controlled by one-week intraperitoneal administration of cefazolin and ceftazidime, was cured only after switching to two-week intravenous administration of cefazolin and ceftazidime. The patient had no major dental disease or recent history of dental intervention. This case suggests that S. oralis might cause peritoneal dialysis-related peritonitis with persistent systemic inflammation via an extra-oral infection route. The clinical course is discussed along with a review of the literature.
Topics: Aged; Anti-Bacterial Agents; Humans; Male; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Streptococcus oralis
PubMed: 34024849
DOI: 10.2169/internalmedicine.6234-20 -
Annals of Surgery Mar 1991Intraperitoneal (IP) abscesses frequently are composed of aerobes and anaerobes, and, in experimental models, a particulate adjuvant. The environmental changes effected...
Intraperitoneal (IP) abscesses frequently are composed of aerobes and anaerobes, and, in experimental models, a particulate adjuvant. The environmental changes effected by these components, either singularly or in combination, have not been well defined. The IP pO2, pH, and recoverable bacteria from the peritoneum of rats were quantified over 6 hours during simple aerobic and anaerobic infections and during mixed peritonitis with and without a sterile feces-barium sulfate adjuvant (SFA). Fourteen groups were studied, receiving intraperitoneally, at time of oxygen probe placement, 1 mL normal saline (control), Escherichia coli (EC), Bacteroides fragilis (BF), SFA alone, or a mixture of EC and BF, EC and SFA, BF and SFA, or EC, BF, and SFA. Control animals exhibited a stable IP pO2 and pH during 6 hours. In monomicrobial EC peritonitis, inocula well below the LD50 produced an increased IP pO2 and reduced arterial-peritoneal gradient (APG), with a stable IP pH. By 6 hours lethal doses of EC produced a dramatic decline in IP pO2, with no change in arterial pO2 as well as acidic IP and arterial pHs. Simple BF peritonitis caused no or minor elevations in IP and arterial pO2 with no change in pH. During mixed infections a significant decline in the IP pO2 and pH at 6 hours in those groups infected with both SFA and EC of a moderate, normally sublethal inoculation was observed, while arterial pO2 was unchanged and arterial pH was decreased only slightly. Concomitantly there was a significant increased number of aerobic bacteria in those groups with SFA as adjuvant compared to similar inocula without SFA. This study demonstrates the complex interactions of bacteria, sterile particulate adjuvant (SFA), and the host peritoneum. It suggests that the combination of SFA and aerobic bacteria alter the peritoneal environment to one permitting anaerobic growth and promoting abscess formation.
Topics: Animals; Bacteroides Infections; Bacteroides fragilis; Barium Sulfate; Colony Count, Microbial; Escherichia coli; Escherichia coli Infections; Feces; Hydrogen-Ion Concentration; Male; Oxygen; Partial Pressure; Peritoneal Cavity; Peritonitis; Rats; Rats, Inbred Strains
PubMed: 1998406
DOI: 10.1097/00000658-199103000-00013 -
Kidney International Jan 2012Long-term peritoneal dialysis induces peritoneal fibrosis with submesothelial fibrotic tissue. Although angiogenesis and inflammatory mediators are involved in...
Long-term peritoneal dialysis induces peritoneal fibrosis with submesothelial fibrotic tissue. Although angiogenesis and inflammatory mediators are involved in peritoneal fibrosis, precise molecular mechanisms are undefined. To study this, we used microarray analysis and compared gene expression profiles of the peritoneum in control and chlorhexidine gluconate (CG)-induced peritoneal fibrosis mice. One of the 43 highly upregulated genes was pleiotrophin, a midkine family member, the expression of which was also upregulated by the solution used to treat mice by peritoneal dialysis. This growth factor was found in fibroblasts and mesothelial cells within the underlying submesothelial compact zones of mice, and in human peritoneal biopsy samples and peritoneal dialysate effluent. Recombinant pleiotrophin stimulated mitogenesis and migration of mouse mesothelial cells in culture. We found that in wild-type mice, CG treatment increased peritoneal permeability (measured by equilibration), increased mRNA expression of TGF-β1, connective tissue growth factor and fibronectin, TNF-α and IL-1β expression, and resulted in infiltration of CD3-positive T cells, and caused a high number of Ki-67-positive proliferating cells. All of these parameters were decreased in peritoneal tissues of CG-treated pleiotrophin-knockout mice. Thus, an upregulation of pleiotrophin appears to play a role in fibrosis and inflammation during peritoneal injury.
Topics: Adult; Aged, 80 and over; Animals; Biopsy; CD3 Complex; Carrier Proteins; Cell Movement; Cells, Cultured; Chlorhexidine; Connective Tissue Growth Factor; Cytokines; Dialysis Solutions; Female; Fibronectins; Gene Expression; Humans; Interleukin-1beta; Ki-67 Antigen; Lymphocyte Count; Male; Mice; Middle Aged; Mitotic Index; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Peritonitis; Permeability; RNA, Messenger; T-Lymphocytes; Transforming Growth Factor beta1; Tumor Necrosis Factor-alpha; Up-Regulation
PubMed: 21881556
DOI: 10.1038/ki.2011.305 -
The American Journal of Pathology Jul 2017Peritoneal dialysis (PD) is a life-saving form of renal replacement therapy for those with end-stage kidney disease. Mesothelial cells (MCs) line the peritoneal cavity...
Peritoneal dialysis (PD) is a life-saving form of renal replacement therapy for those with end-stage kidney disease. Mesothelial cells (MCs) line the peritoneal cavity and help define peritoneal response to treatment-associated injury, a major reason for treatment failure. miRNAs are important regulators, but their roles in peritoneal fibrosis are largely unknown. In this study, miR-21 was one of the most abundant miRNAs in primary MCs, and was up-regulated by the profibrotic cytokine transforming growth factor-β1 and in PD effluent-derived MCs exhibiting mesenchymal phenotypic change. Increased miR-21 was found in peritoneal membrane biopsy specimens from PD patients compared to healthy controls (PD biocompatible, 5.86×, P = 0.0001; PD conventional, 7.09×, P < 0.0001, n = 11 per group). In PD effluent from a cohort of 230 patients, miR-21 was higher in those receiving the therapy long-term compared to new starters (n = 230, miR-21 3.26×, P = 0.001) and associated with icodextrin use (R = 0.52; 95% CI, 0.20-0.84), peritonitis count (R = 0.16; 95% CI, 0.03-0.29), and dialysate cytokines. miR-21 down-regulated programmed cell death 4 and programmed cell death 4 protein was decreased in peritoneal membrane biopsy specimens from PD patients compared to healthy controls. New miR-21 targets were identified that may be important during PD fibrogenesis. These data identify miR-21 as an important effector of fibrosis in the peritoneal membrane, and a promising biomarker in the dialysis effluent for membrane change in patients receiving PD.
Topics: Biomarkers; Cells, Cultured; Cohort Studies; Down-Regulation; Epithelial Cells; Epithelium; Gene Expression Regulation; Glucans; Glucose; Humans; Icodextrin; Kidney Failure, Chronic; MicroRNAs; Oligonucleotide Array Sequence Analysis; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Peritonitis; Treatment Failure; Up-Regulation
PubMed: 28495592
DOI: 10.1016/j.ajpath.2017.03.007 -
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 -
PloS One 2013Peritoneal calcification (PC) is a specific finding in patients undergoing peritoneal dialysis (PD), but its prevalence, risk factors, and impacts in PD patients remain...
BACKGROUND
Peritoneal calcification (PC) is a specific finding in patients undergoing peritoneal dialysis (PD), but its prevalence, risk factors, and impacts in PD patients remain unclear. The present study investigated these issues and provided information useful for the management of PC.
METHODS
The study included 183 PD patients. The severity of PC was determined using abdominal computed tomography (CT), and we summed up all scores from slices obtained from the diaphragm to the pelvic floor normalized to body surface area. We analyzed the associations between PC and demographic and clinical characteristics, and between PC and levels of biomarkers, including C-reactive protein (CRP), osteoprotegrin and fetuin-A. The determinants of PC were examined using multiple regression analysis.
RESULTS
Patients were categorized into group 1 (without PC, n = 133) and group 2 (with PC, n = 50). Group 2 patients showed different degrees of PC with a mean of 160±769 mm(2)/m(2). Group 1 patients had higher fetuin-A levels than group 2 patients (861±309 vs. 760±210 µg/mL; p = 0.021). The independent risk factors for the presence of PC included male gender, previous peritonitis, and PD adequacy (KT/V). Further analysis performed in group 2 patients showed that the dosage of vitamin D, serum levels of CRP, and dialysate calcium load were the independent determinants of PC. However, the presence of PC did not affect patients' technique survival, peritonitis incidence, or mortality in the mean follow up period of 28±12 months.
CONCLUSIONS
The presence and severity of PC were associated with inflammation, peritoneal KT/V, and mineral metabolism. The impact of PC on the outcomes of PD patients requires further study with a longer follow-up.
Topics: Calcinosis; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Peritonitis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 23977097
DOI: 10.1371/journal.pone.0071636 -
Peritoneal Dialysis International :... 2015Kocuria species are found in the environment and on human skin. These micro-organisms are generally considered to be nonpathogenic saprophytes, rarely causing infection.... (Review)
Review
Kocuria species are found in the environment and on human skin. These micro-organisms are generally considered to be nonpathogenic saprophytes, rarely causing infection. However, the peritoneum has been reported to be a site of Kocuria infection. We reviewed all cases of peritonitis in peritoneal dialysis (PD) patients caused by Kocuria species that were reported in the worldwide literature. In total, 12 episodes of Kocuria species peritonitis have been reported in 9 PD patients. The median age of the patients was 62 years (range: 8 - 78 years). In the reported episodes, 4 different Kocuria species were isolated, with K. varians being the predominant species (41.7%). The most common initial symptom was abdominal pain (83.3%), followed by turbid effluent (75%) and fever (33.3%). Intraperitoneal first-generation cephalosporins and glycopeptides were the most-used antibiotics, with first-generation cephalosporins being more often preferred as first-line therapy. The median duration of treatment was 14 days, and in 2 episodes, the Tenckhoff catheter was removed. Although Kocuria peritonitis in PD patients is rare, it should be promptly treated because relapses can occur, especially with K. varians episodes.
Topics: Actinomycetales Infections; Cephalosporins; Female; Follow-Up Studies; Humans; Incidence; Male; Micrococcaceae; Peritoneal Dialysis; Peritonitis; Rare Diseases; Risk Assessment; Treatment Outcome
PubMed: 24584591
DOI: 10.3747/pdi.2013.00138 -
Polskie Archiwum Medycyny Wewnetrznej Apr 2009Numerous studies have confirmed beneficial effects of polyglucose dialysis solution (PG-DS), an amino acid dialysis solution (AA-DS), and bicarbonate (bic) or... (Review)
Review
Numerous studies have confirmed beneficial effects of polyglucose dialysis solution (PG-DS), an amino acid dialysis solution (AA-DS), and bicarbonate (bic) or bicarbonate/lactate (bic/lac) buffered solutions on selected components of peritoneal bioavailability or clinical parameters of peritoneal dialysis (PD) patients. Few adverse effects have also been described. A question arises whether these solutions affect the PD outcome. A better controlled fluid status of PD patients associated with the use of PG-DS has been shown in a double-blind randomized controlled trial. Continuous cyclic PD patients treated with the PG-DS did not show changes in solute kinetics and peritoneal membrane markers remained unaltered. The use of PG-DS in anuric automated PD patients was associated with less impaired membrane function. A prospective, randomized, controlled study on the AA-DS in malnourished continuous ambulatory PD patients did not show significant effects of the AA-DS on patient survival, hospitalization rate, C-reactive protein levels, total urea Kt/V, ultrafiltration and drop-out rates, but nutritional status improved or was stable. Improved acid-base balance with bic-buffered solutions was shown in patients treated with automated PD or continuous PD. A registry-based study suggests better survival of patients treated with a neutral pH, low glucose degradation product solution, but there were no differences in dialysis technique survival, peritonitis-free survival, or peritonitis rates. However, reduced peritonitis rate was also reported with the use of bic/lac solutions. Current concepts of PD solutions involve efforts to use fluids which combine the advantages of PG-DS, AA-DS and bic-buffered solutions. Large-scale studies should be continued to improve biocompatibility of peritoneal solutions and to establish their effect on the clinical outcome.
Topics: Bicarbonates; Biological Availability; Dialysis Solutions; Disease-Free Survival; Glucans; Humans; Incidence; Materials Testing; Peritoneal Dialysis; Peritoneum; Peritonitis; Survival Rate
PubMed: 19413184
DOI: No ID Found