Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis最新文献

{"title":"Effluent decoy receptor 2 as a novel biomarker of peritoneal fibrosis in peritoneal dialysis patients.","authors":"Jie Yang,&nbsp;Mingyu Cai,&nbsp;Jinfang Wan,&nbsp;Liming Wang,&nbsp;Jia Luo,&nbsp;Xue Li,&nbsp;Wenjiang Gong,&nbsp;Yani He,&nbsp;Jia Chen","doi":"10.1177/08968608211067866","DOIUrl":"https://doi.org/10.1177/08968608211067866","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal fibrosis (PF) is a common complication of peritoneal dialysis (PD), but a specific and sensitive biomarker for PF is lacking. The present study aimed to determine the use of effluent decoy receptor 2 (eDcR2) as a biomarker for PF in PD patients.</p><p><strong>Methods: </strong>PD patients (<i>n</i> = 248) were recruited, and peritoneal specimens were collected at PD initiation (<i>n</i> = 30) and cessation (<i>n</i> = 33). Enzyme-linked immunoassay was used to measure eDcR2 and the eDcR2 appearance rate (eDcR2-AR) was calculated. The levels of DcR2 mRNA and protein were determined. The correlation of eDcR2 level with peritoneal function, histological parameters and DcR2 expression were analysed. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of eDcR2 for PF, which was defined as a submesothelial thickness 150 µm or more. Co-localisation of DcR2 with a mesothelial marker, fibroblast markers and fibrotic markers were determined.</p><p><strong>Results: </strong>The eDcR2-AR level correlated with PD duration, D/P Cr values, peritoneal <i>Kt/V</i> and peritoneal injury scores, especially submesothelial thickness (<i>r</i> = 0.638, <i>p</i> < 0.001). DcR2 was primarily expressed in peritoneal fibroblasts, and co-localised with α-SMA, vimentin, collagen I and fibronectin, but not with E-cadherin. Peritoneal DcR2 expression had a positive correlation with eDcR2-AR. ROC analysis indicated eDcR2 had an area under the curve of 0.907 for detection of PF (sensitivity: 78.6%, specificity: 100%) and the best cut-off value was 392.5 pg/min.</p><p><strong>Conclusion: </strong>The eDcR2-AR level is a potential biomarker for assessing PF in PD patients. Effluent DcR2 was mainly derived from peritoneal fibroblasts and DcR2-positive cells may accelerate PF, suggesting that it may be a potential therapeutic target.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"631-639"},"PeriodicalIF":2.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39932906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of metagenomic next-generation sequencing for detection of pathogens from dialysis effluent in peritoneal dialysis-associated peritonitis .","authors":"Peiyi Ye,&nbsp;Chao Xie,&nbsp;Cuixia Wu,&nbsp;Cuiyan Yu,&nbsp;Yuhe Chen,&nbsp;Zijie Liang,&nbsp;Youyuan Chen,&nbsp;Qiyan Chen,&nbsp;Yaozhong Kong","doi":"10.1177/08968608221117315","DOIUrl":"https://doi.org/10.1177/08968608221117315","url":null,"abstract":"<p><strong>Background: </strong>Metagenomic next-generation sequencing (mNGS) can improve pathogen identification in infectious diseases.</p><p><strong>Methods: </strong>A prospective parallel control study was undertaken to evaluate the clinical significance of mNGS in identifying pathogens in dialysis effluent of patients with peritoneal dialysis-associated peritonitis (peritonitis). Dialysis effluent specimens were detected both by peritoneal dialysis effluent culture and mNGS. The positive rates and coincidence rates of the two methods were compared.</p><p><strong>Results: </strong>From April 2020 to March 2021, 30 patients presenting with peritonitis were enrolled in this study. The positive pathogen detection rate of mNGS was significantly higher than that of the traditional culture method (86.67% vs. 60.00%; <i>p</i> = 0.039). Fifteen specimens were positive for both of the methods, while 11 specimens were negative for culture but positive for mNGS. Three specimens were positive for culture but negative for mNGS; all of them were <i>streptococcus mitis</i>. One specimen was negative for both methods. The culture method detected one type of pathogen in all specimens; however, two or more types of pathogens were detected in eight specimens by mNGS. In addition to common pathogens, additional pathogens detected by mNGS included <i>Coxiella burnetii</i>, human herpesvirus type 5, human herpesvirus type 6B and <i>Mortierella.</i></p><p><strong>Conclusion: </strong>The pathogen detection rate of mNGS in dialysis effluent of peritonitis patients was significantly higher than that of traditional culture. The mNGS is advantageous in diagnosing the pathogens that are difficult to be cultured. However, mNGS did not demonstrate sensitivity to <i>streptococcus mitis</i>. Results from this study show that mNGS, combined with traditional culture, has potential application for detecting pathogens in peritoneal dialysis patients with peritonitis.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"585-590"},"PeriodicalIF":2.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40647082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current costs of dialysis modalities: A comprehensive analysis within the United Kingdom.","authors":"Gareth Roberts, Jennifer Holmes, Gail Williams, James Chess, Ned Hartfiel, Joanna M Charles, Leah McLauglin, Jane Noyes, Rhiannon Tudor Edwards","doi":"10.1177/08968608211061126","DOIUrl":"10.1177/08968608211061126","url":null,"abstract":"<p><strong>Background: </strong>Previous evidence suggests home-based dialysis to be more cost-effective than unit-based or hospital-based dialysis. However, previous analyses to quantify the costs of different dialysis modalities have used varied perspectives, different methods, and required assumptions due to lack of available data. The National Institute for Health and Care Excellence reports uncertainty about the differences in costs between home-based and unit-based dialysis. This uncertainty limits the ability of policy makers to make recommendations based on cost effectiveness, which also impacts on the ability of budget holders to model the impact of any service redesign and to understand which therapies deliver better value. The aim of our study was to use a combination of top-down and bottom-up costing methods to determine the direct medical costs of different dialysis modalities in one UK nation (Wales) from the perspective of the National Health Service (NHS).</p><p><strong>Methods: </strong>Detailed hybrid top-down and bottom-up micro-costing methods were applied to estimate the direct medical costs of dialysis modalities across Wales. Micro-costing data was obtained from commissioners of the service and from interviews with renal consultants, nurses, accountants, managers and allied health professionals. Top-down costing information was obtained from the Welsh Renal Clinical Network (who commission renal services across Wales) and the Welsh Ambulance Service Trust.</p><p><strong>Results: </strong>The annual direct cost per patient for home-based modalities was £16,395 for continuous ambulatory peritoneal dialysis (CAPD), £20,295 for automated peritoneal dialysis (APD) and £23,403 for home-based haemodialysis (HHD). The annual cost per patient for unit-based modalities depended on whether or not patients required ambulance transport. Excluding transport, the cost of dialysis was £19,990 for satellite units run in partnership with independent sector providers and £23,737 for hospital units managed and staffed by the NHS. When ambulance transport was included, the respective costs were £28,931 and £32,678, respectively.</p><p><strong>Conclusion: </strong>Our study is the most comprehensive analysis of the costs of dialysis undertaken thus far in the United Kingdom and clearly demonstrate that CAPD is less costly than other dialysis modalities. When ambulance transport costs are included, other home therapies (APD and HHD) are also less costly than unit-based dialysis. This detailed analysis of the components that contribute to dialysis costs will help inform future cost-effectiveness studies, inform healthcare policy and drive service redesign.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"578-584"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39728153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TINKER-ing with neonatal acute kidney injury.","authors":"A Iyengar,&nbsp;R Shroff","doi":"10.1177/08968608221103750","DOIUrl":"https://doi.org/10.1177/08968608221103750","url":null,"abstract":"The newborn’s kidneys are immature and vulnerable to multiple perinatal insults. Acute kidney injury (AKI) occurs in 30–70% of critically ill neonates and is an important contributor to neonatal mortality and morbidity. With significant contributions made by the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database to neonatal nephrology, the past decade has witnessed a growing body of literature on the incidence, risk factors and outcomes of neonatal AKI. Neonates are particularly at risk for perinatal hypoperfusion injury; with redistribution of cardiac output secondary to a hypoxic–ischaemic insult, perfusion to the kidneys can be compromised, causing AKI. Fundamentally, making a prompt diagnosis of AKI in neonates is challenging as the baby’s results reflect the maternal creatinine in the first 72 h of birth and several perinatal insults that are unique to neonates can trigger AKI. Differences in the physiological parameters of kidney function across the spectrum of gestational age and birth weight add to the diagnostic complexity. Interestingly, there are considerable differences in the perception and practice of diagnosing and managing neonatal AKI among care providers such as neonatologists, paediatricians and paediatric nephrologists. The Acute Disease Quality Initiative highlights the need for strategies designed to improve AKI care processes for neonates. In contrast to paediatric AKI, kidney replacement therapy (KRT) is used sparingly in neonatal AKI. There is limited data on the utility of KRT in high-risk neonates. KRTs for neonates can be in the form of acute peritoneal dialysis (PD), extracorporeal therapy with or without extracorporeal membrane oxygenation or a combination of the above. Globally, PD is the most common modality offered to neonates. However, newer continuous KRT systems like the Cardio-Renal Pediatric Emergency Dialysis Machine, Newcastle infant dialysis and ultrafiltration system and the Aquadex system for ultrafiltration are routinely being used in resource-rich countries. Recently, PD has gained considerable interest in special groups of neonates (very low birth weight (VLBW) and extremely low birth weight (ELBW)). In this issue of Peritoneal Dialysis International, Sethi et al. report their findings of a multicentre prospective study of neonates with AKI from the ‘The Indian Iconic Neonatal Kidney Educational Registry – TINKER’. Across 11 Indian centres consisting of level 2 or level 3 neonatal intensive care units (NICUs), 1600 neonates &lt;28 days of life were included through a web-database system. Neonates needing congenital heart surgery within the first week of life were excluded. The objective was to study potentially modifiable risk factors that predicted the need for acute PD in neonates with AKI and correlate these with clinical outcomes. AKI was defined based on the modified Kidney Disease Improving Global Outcomes (KDIGO) criteria. Neonates with AKI were managed as per e","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"443-446"},"PeriodicalIF":2.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40688408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of pleuroperitoneal communication during long-term steroid therapy for dermatomyositis.","authors":"Masanobu Takasu,&nbsp;Hiroyuki Kadoya,&nbsp;Yu Yamanouchi,&nbsp;Yuji Nojima,&nbsp;Toshiya Yamamoto,&nbsp;Seiji Itano,&nbsp;Masao Nakata,&nbsp;Tamaki Sasaki,&nbsp;Naoki Kashihara","doi":"10.1177/08968608221088441","DOIUrl":"https://doi.org/10.1177/08968608221088441","url":null,"abstract":"Dermatomyositis is characterised by inflammation of the muscles that causes muscle weakness, and the muscles proximal to the trunk are most affected. Corticosteroids are mainly used for the treatment of dermatomyositis. We describe an extremely rare case of a patient with dermatomyositis who developed pleuroperitoneal communication (PPC) during long-term steroid therapy. A 60-year-old woman had been diagnosed with dermatomyositis approximately 20 years earlier and remission was maintained on prednisolone 5 mg/day. During the course of treatment, she had developed kidney impairment associated with antiphospholipid syndrome, and her kidney function gradually deteriorated, resulting in initiation of automated peritoneal dialysis (PD) approximately 6 months earlier. Five days before admission to our hospital, she had fallen out of bed and bruised her chest. She developed difficulty breathing and gained weight, in addition to having poor outflow during PD. A plain chest radiography revealed pleural effusion predominantly (Figure 1(a)). Ultrasonography performed after intraperitoneal injection of a contrast agent (perflubutane) showed leakage of contrast into the right thoracic cavity (Figure 1(b)). Accordingly, the patient was diagnosed with PPC. Thoracoscopy confirmed remarkable thinning of the diaphragm with tears and blebs. Intraoperative identification of fistula areas was challenging and dialysate leakage from the peritoneal cavity to the thoracic cavity was observed at several sites (Figure 1(c)). Therefore, PD was discontinued and hemodialysis was started. To date, there have been no reports of onset of PPC after initiation of PD in patients with underlying dermatomyositis. PPC develops within 30 days of initiation of PD in approximately 50% of patients. The frequency of PPC in patients on PD is approximately 1.6–10%. In general, PPC occurs unilaterally and predominantly on the right side. Causes of PPC are reported to include congenital or traumatic factors and bleb laceration. Why did our patient develop PPC? We believe that two mechanisms caused the weakening of the diaphragm in this patient. The first was the dermatomyositis. Approximately 78% of patients with idiopathic inflammatory muscle disease develop a weakened diaphragm. Dermatomyositis also causes perivascular inflammation, which results in degeneration and atrophy of muscle fibre bundles because of inflammation of the intermuscular septum. In our patient, inflammation and muscle atrophy may have been present in the striated muscles of the diaphragm. The second mechanism was the effect of long-term steroid use. The mechanism of steroid-related muscle disorders includes inhibition of proliferation of fibroblasts and synthesis of collagen fibres through insulin-like growth factor signalling. In this way, steroid use can weaken tissues. In our patient, chronic inflammation of striated muscles caused by the dermatomyositis led to degeneration and atrophy of muscle fibres in the diaphrag","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"434-436"},"PeriodicalIF":2.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated cryptococcal disease presenting as peritonitis in a patient on automated peritoneal dialysis: Could it have been prevented?","authors":"Francesca Heard,&nbsp;Jenny Allen,&nbsp;Annie Joseph","doi":"10.1177/08968608211004678","DOIUrl":"https://doi.org/10.1177/08968608211004678","url":null,"abstract":"Fungal peritonitis is an uncommon complication of peritoneal dialysis (PD). Cryptococcus neoformans is a very rare cause of fungal PD peritonitis. At our regional dialysis centre, we diagnosed a case of disseminated cryptococcal disease presenting as peritonitis in an 82-year old male receiving automated PD. The main risk factors in this patient were long-term steroid prescription for bullous pemphigoid and repeated episodes of bacterial PD peritonitis requiring multiple courses of antibiotics. A sample of PD fluid was sent to the microbiology facility for microscopy and culture. On receipt of the sample, initial Gram stain revealed yeast cells and white cell count was 19. India Ink was also positive. Small clear mucoid colonies grew after 48 h on blood and Sabouraud agar. MALDI-TOF mass spectrometry identified the organism as C. neoformans. Reference laboratory sensitivity testing confirmed full sensitivity to amphotericin, minimum inhibitory concentration (MIC 1⁄4 0.5), fluconazole (MIC 1⁄4 2) and intermediate to flucytosine (MIC 1⁄4 8). Serum cryptococcal antigen (CrAg) at the start of treatment was strongly positive at 1:800 via latex agglutination test. CrAg of cerebrospinal fluid (CSF) was also positive at 1:32. Ultimately, this patient had evidence of abdominal, central nervous system and lung involvement. This patient received 4 weeks of intravenous liposomal amphotericin B and 2 weeks of high dose fluconazole. Unfortunately, this patient showed deterioration despite aggressive dual antifungal therapy. After careful consideration, active treatment was ceased and the patient died at home with palliative care. In non-HIV patients, one of the main risk factors for cryptococcosis is immunosuppressive drugs, such as corticosteroids, as demonstrated here. In non-HIV nontransplant patients, disseminated disease is very rare. Higher mortality has been observed in this patient cohort, possibly related to late diagnosis compared to the HIV or transplant group. Disseminated cryptococcal infection presenting as peritonitis is extremely uncommon. One case series of cryptococcosis in HIV-negative patients on renal dialysis found only 2 out of 10 cryptococcal PD cases over a 16-year period involved both abdominal ascites and CSF. Antifungal prophylaxis with fluconazole has been shown to reduce the incidence of fungal peritonitis in PD patients when used with treatment for bacterial PD peritonitis. However, there is significant variation in practice across PD providers in the United Kingdom. At the time of this patient’s management, it was not standardised practice at our centre. Further studies are required in this patient subgroup to evaluate whether antifungal prophylaxis may prevent cases of fungal peritonitis in patients with a history of bacterial peritonitis. It has also not been studied in patients who are at risk of invasive fungal disease due to immunocompromise. If C. neoformans is detected, investigating for disseminated cryptococcal disease ","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"227-228"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211004678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25565266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of intraperitoneal vancomycin in peritoneal dialysis-associated peritonitis.","authors":"Wui Ming Chang,&nbsp;Elaine Cheng,&nbsp;Karen Shalansky,&nbsp;Suneet R Singh","doi":"10.1177/08968608211051579","DOIUrl":"https://doi.org/10.1177/08968608211051579","url":null,"abstract":"<p><strong>Background: </strong>Intraperitoneal (IP) vancomycin is recommended as one of the treatment options for gram-positive coverage in the management of peritoneal dialysis (PD)-associated peritonitis. There is a lack of literature supporting the optimal dose and approach to vancomycin therapeutic drug-level monitoring.</p><p><strong>Methods: </strong>A retrospective chart review was conducted using the BC Renal Agency PROMIS Database and our hospital records from 1 June 2011 to 1 July 2019. Adult patients with PD-associated peritonitis who received IP vancomycin and had at least one serum vancomycin level drawn were included. All patients received a loading dose of 30 mg/kg, which was repeated every 3-5 days depending on PD modality. Serum vancomycin levels were drawn prior to the second vancomycin dose, then at the discretion of the prescriber. The primary end point was the rate of therapeutic serum vancomycin levels ≥15 mg/L.</p><p><strong>Results: </strong>Twenty-three episodes of PD-associated peritonitis in 20 patients met the eligibility criteria. Only 15/23 serum vancomycin levels were drawn appropriately after the first dose. Sixty per cent of these levels were subtherapeutic at <15 mg/L. All subsequent serum vancomycin levels were above the therapeutic target. Most peritonitis episodes (78%) achieved resolution of infection. Residual kidney function was not significantly correlated with serum vancomycin levels (<i>p</i> = 0.19).</p><p><strong>Conclusions: </strong>An IP vancomycin regimen of 30 mg/kg every 3-5 days resulted in subtherapeutic serum vancomycin levels in most patients following the loading dose but therapeutic levels thereafter. A large percentage of vancomycin levels were drawn inappropriately due to misalignment of outpatient follow-up visits and timing of blood work.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"171-176"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39563633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phytopathogen transmitted from plant to human causing peritoneal dialysis-associated peritonitis.","authors":"Bunpring Jaroenpattrawut,&nbsp;Ussanee Poonvivatchaikarn,&nbsp;Talerngsak Kanjanabuch,&nbsp;Somchai Eiam-Ong","doi":"10.1177/08968608211048063","DOIUrl":"https://doi.org/10.1177/08968608211048063","url":null,"abstract":"<p><p>We report the first case of peritoneal dialysis (PD)-associated peritonitis due to <i>Sporothrix schenckii</i>, a thermally dimorphic black fungus transmitted from epiphytotic disease. The patient presented with PD-associated peritonitis and fungal colonisation inside the PD catheter's lumen after an exposing 'wet contamination' event with a phytopathogen 11 days prior to the onset of infection. The human pathogen and phytopathogen were confirmed the same species by nucleotide sequences of the internal transcribed spacer and large subunit regions of the ribosomal RNA gene. A 'wet contamination' should be closely monitored for an extended period, and a broader spectrum of organisms might lead to peritonitis, particularly in centres with a high prevalence of fungal infection. PD patients and their caregivers should have periodic retraining of aseptic technique and personnel hygiene. We also recommend a long course of antifungal medication in eradicating peritoneal sporotrichosis to prevent unfavourable outcomes and relapsing peritonitis from this organism.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"223-226"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39470222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyaluronan reduces colitis-induced intraperitoneal inflammation during peritoneal dialysis.","authors":"Jasiński Tomasz,&nbsp;Bręborowicz Andrzej","doi":"10.1177/08968608211014568","DOIUrl":"https://doi.org/10.1177/08968608211014568","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%, <i>p</i> < 0.01), number of neutrophils (+75%, <i>p</i> < 0.01), generation of free radicals in the leukocytes (+70%, <i>p</i> < 0.05), dialysate level of elastase (+102%, <i>p</i> < 0.01), tumor necrosis factor α (+48%, <i>p</i> < 0.01) and monocyte chemoattractant protein-1 (+42%, <i>p</i> < 0.01). Drained dialysate volume was lower (-21%, <i>p</i> < 0.01) and peritoneal permeability increased in rats with colitis (+55%, <i>p</i> < 0.01). In animals with the hyaluronan supplemented dialysis fluids, the intensity of the intraperitoneal inflammation was reduced.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"212-217"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211014568","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38908215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of peritoneal dialysis-related peritonitis on PD discontinuation and mortality: A population-based national cohort study.","authors":"Mu-Chi Chung,&nbsp;Tung-Min Yu,&nbsp;Ming-Ju Wu,&nbsp;Ya-Wen Chuang,&nbsp;Chih-Hsin Muo,&nbsp;Cheng-Hsu Chen,&nbsp;Shih-Ting Huang,&nbsp;Chi-Yuan Li,&nbsp;Jeng-Jer Shieh,&nbsp;Peir-Haur Hung,&nbsp;Chi-Jung Chung","doi":"10.1177/08968608211018949","DOIUrl":"https://doi.org/10.1177/08968608211018949","url":null,"abstract":"<p><strong>Background: </strong>The impact of peritoneal dialysis-associated peritonitis (PD peritonitis) on long-term outcomes is uncertain. This nationwide retrospective study was conducted in Taiwan to understand the incidence, risk factors and long-term outcomes of PD peritonitis.</p><p><strong>Methods: </strong>A total of 11,202 incident adult peritoneal dialysis (PD) patients from 2000 to 2010 were collected from a Longitudinal Health Insurance Database and followed up until the end of 2011. Definition of peritonitis, the primary outcome, simultaneously met the diagnosis of peritonitis (International Classification of Diseases, Ninth Revision, Clinical Modification 567) and antibiotic use. Secondary outcomes included the impact of peritonitis on PD discontinuation and survival. Cox proportional hazards models with and without time-dependent variables were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>There were 7634 peritonitis episodes in 4245 patients during the follow-up period. The overall incidence of peritonitis was 0.18 episodes per patient-year. Peritonitis-associated risk factors included older age, female gender, chronic heart failure, cerebrovascular disease, liver cirrhosis and lower monthly income. In an adjusted Cox hazard proportional regression with the time-dependent model, peritonitis patients had a higher risk of PD discontinuation (HR 2.71, 95% CI 2.52-2.92) and mortality (HR 1.68, 95% CI 1.57-1.81) compared to patients without peritonitis. The adjusted HRs for mortality increased with each prior episode: one episode, two episodes and more than two episodes (all <i>p</i> < 0.05). The adjusted HRs for PD discontinuation also increased with the frequency of peritonitis. These negative effects were greatest during the first year and persisted significantly after 5 years. In a sensitivity analysis in which peritonitis within 30 days of death or PD discontinuation was excluded, peritonitis patients still had significantly increased risk of PD discontinuation and mortality compared to patients without peritonitis.</p><p><strong>Conclusions: </strong>Although peritonitis incidence was low, our findings reveal that peritonitis carried acute and long-term sequelae of higher PD discontinuation and lower patient survival.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"194-203"},"PeriodicalIF":2.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08968608211018949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39073034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}