Current concepts. Continuous ambulatory peritoneal dialysis

Comparison of two commercial broth-culture systems for microbial detection in dialysates of patients on continuous ambulatory peritoneal dialysis

The capability of two commercial systems was studied for microbial detection in dialysis effluents from patients on continuous ambulatory peritoneal dialysis (CAPD). Two methods of processing dialysate from patients on CAPD were compared: (a) direct inoculation of 10 ml of dialysate into a single bottle broth culture system (Signal; Oxoid, U.S.A., Columbia, Maryland) and 5 ml into each of two BACTEC blood culture bottles (Johnston Laboratories, Towson, Maryland); and (b) centrifugation of 50 ml of dialysate and culture of the sediment in an Oxoid bottle. Of the 196 specimens cultured, 99 (51%) yielded growth. Recovery rates of significant isolates were 95% for the BACTEC system, 89% for the Oxoid system, and 88% for the centrifugation-Oxoid system. Recovery of eight isolates from the Oxoid system was by subculture rather than a visual "signal." The Oxoid system is a practical, cost-effective, alternative culture method for effluents from CAPD patients in laboratories not having access to the BACTEC system.

Lipids, lipoproteins and apolipoproteins A-I and B and apolipoprotein losses in continuous ambulatory peritoneal dialysis

Comparison of lipid, lipoprotein and apolipoprotein levels was made between 3 groups: continuous ambulatory peritoneal dialysis patients (n = 5); haemodialysis patients (n = 15) and normals (n = 31). Continuous ambulatory peritoneal dialysis (CAPD) patients showed significantly elevated total cholesterol, low density lipoprotein (LDL)-cholesterol and apolipoprotein B (apo B) levels compared with haemodialysis and normal groups. Both CAPD and haemodialysis (HD) showed reduced levels of high density lipoprotein (HDL)-cholesterol and apolipoprotein A-I (apo A-I). Measurement of apo A-I and apo B in dialysate during a 6 h CAPD session indicated significant losses of apo A-I to dialysate with negligible losses of apo B. Grossly elevated apo B and reduced apo A-I indicates that CAPD patients are at increased risk of coronary heart disease and that their risk is probably greater than for haemodialysis patients.

Idiopathic sclerosing encapsulating peritonitis

Sclerosing encapsulating peritonitis (SEP) was diagnosed in two men, one middle-aged woman, and a prepubertal girl, none of whom had been treated with beta-blockers, peritoneal dialysis, or peritoneal shunting. Idiopathic SEP has hitherto been reported mainly in adolescent females. It is hypothesised that in these patients, who were from two adjacent districts of Rajasthan, an aetiological factor was consumption of cereals infected with fungus that contained biologically active amines.

Peritoneal dialysis. Current technology and techniques

The use of chronic peritoneal dialysis has increased greatly in recent years. The procedure has few contraindications, and complications such as mild peritonitis respond quickly to intraperitoneal antibiotics. At present, a continuous ambulatory regimen, which can be performed by the patient anywhere, is the predominant form of peritoneal dialysis.