[Prolonged survival with weekly peritoneal dialysis in chronic uremic patients]

We show our experience in 12 patients treated during a year with weekly intermittent dialysis whit a rigid catheter for 36 hours a week. Patients were on a diet of 50 g. of proteins a day, normocaloric without sodium or fluid restriction. They received supplementation whith iron, calcium, vitamins B, C and folic acid, anabolic hormonal and, in some cases, furosemide hypotensives and antibiotics. Patients received the procedure for a mean of 8 months. The results show the following mean values: blood pressure: 143 +/- 12/99 +/- 3 mm. Hg., plasma urea 208 +/- 62 ng./dl.; creatinine 21 +/- 2 mg./dl., hematocrit 25 mm. and 8.0 g. hemoglobin. There was light increase of glucose, K, P, Mg, alkaline phosphatase. Na, CO2, proteins cholesterol, albumin and Ca keep in normal values. Nine patients passed to hemodialysis after a mean period of nine months and three of them received a kidney transplant. Three are still in peritoneal dialysis, one of them for 18 months. We compared our results with a similar group of patients who were treated with non-regular peritoneal dialysis. Our group had less cardiovascular complaints, or infections and keep more adequate body weight, and also got more survival in better conditions with less days in hospital, they received less blood transfusion. We concluded that weekly peritoneal dialysis is an alternative method of treatment in uremic patients for longer period of time even though frequently paracentesis.

Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis

To find the ideal dialysate flow rate and exchange volume for use in long-term peritoneal dialysis, 10 patients were studied over a period of 1.5 yr. Exchange volumes of 1 or 2 liters and dialysate flow rates of 1, 2, 3, 4, and 6 liters/hr were tested. Dextrose concentration remained constant at 1.5 g/100 ml. Peritoneal clearances for BUN, creatinine, and uric acid were calculated at 2, 5, 10, 15, and 20 hr during dialysis making a total of 120 clearances for each patient. All patients used a reverse osmosis automatic machine. The clearance of all three solutes tended to be higher with exchange volumes of 2 liters than they did with 1 liter; this trend was significant for BUN (P less than 0.025) and uric acid (P less than 0.025) but not for creatinine. There was a significant rise in clearance with increasing flow rates per hour for all solutes as shown in the following table. (Formula: see text), Since patients could not tolerate a flow rate of 6 liters/hr, we conclude that flow rate of 4 liters/hr with a 2-liter exchange will give maximum efficiency.

Automated peritoneal dialysis for home use

In order to provide an alternative to maintenance home dialysis for patients remotely situated or who had vascular access failure, a parallel peritoneal dialysis (PD) program was developed in March 1972. Over four years, 36 patients started PD with the intention of carrying out home treatments. Thirty of the 36 succeeded and 22 completed at least six months of home treatments, seven have so far been treated for over one year. No neuropathy developed except in diabetic patients. No patient, including four who had undergone bilateral nephrectomy, was depenedent on blood transfusions. Predialysis serum creatinine values were questionably higher (p less than 0.07) in a group of six patients who at another time had been maintained on hemodialysis (HD). In this group serum albumin was (mean +/- 1 S.D.) 3.3 +/- 4 g/100 ml on PD and 3.8 g/100 ml on HD (p less than 0.05). Sixteen of the 36 patients had bacterial peritonitis on 22 occasions; the average incidence was once every 14 months of patient exposure. An epidemic of sterile peritonitis involving 40 episodes in 16 patients was resolved after machine techniques were changed. Catheter failure occurred in 15 of the 22 patients in the long-term group, but catheter replacement was not difficult.

Chronic peritoneal dialysis

Since the introduction of the permanent peritoneal catheter, interest in chronic peritoneal dialysis is increasing. The automatic peritoneal dialysis cycler and the reverse osmosis peritoneal dialysis machine have been other development that made chronic peritoneal possible. Chronic peritoneal dialysis is indicated for the children, the elderly, those without hemodialysis access sites, those living along (for home dialysis) and the diabetics, whose retinopathy seems to progress less on peritoneal dialysis than on hemodialysis. Patients awaiting a kidney transplant can be maintained equally satisfactorily on peritoneal dialysis as on hemodialysis. Because of its simplicity almost any patient can be trained for home peritoneal dialysis, and a high incidence of rehabilitation can be achieved. A flow rate of 4 1/hr with 21 exchanges, 40 hours a week, seem to the ideal dialysis requirements. Complications of chronic peritoneal dialysis include those related to the permanent catheter such as one or two way obstruction and those related the dialysis itself. The latter can be either acute (i.e. peritonitis etc.) or chornic such as neuropathy, renal osteodystrophy, anemia etc. Integrated with hemodialysis and transplantation, peritoneal provides the nephrologists with the ability to treat his patients with the most appropriate treatment.