Treatment of infections in peritoneal dialysis

Peritoneal Vicenza "Short" Catheter Outcomes and Comparison with International Society for Peritoneal Dialysis Guidelines

INTRODUCTION

A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza "short" catheter is a modified Tenckhoff catheter with a shorter intraperitoneal segment. The aim of this study was to evaluate the incidence of catheter-related complications and catheter survival rate using the Vicenza "short" catheter, according to the goals suggested by the International Society for Peritoneal Dialysis (ISPD) guidelines. Second, we compared insertion techniques used in our center.

METHODS

This is a retrospective cohort, single-center study analyzing incident PD patients undergoing Vicenza "short" peritoneal catheter placement between January 1, 2015, and December 31, 2019. As clinical outcomes, we evaluated catheter patency at 12 months, exit-site/tunnel infection and peritonitis within 30 days of catheter insertion, visceral injury, or significant hemorrhage during the procedure, in accordance with ISPD guidelines.

RESULTS

The percentage of patency at 12 months for all catheter insertion methods was 88.91%, and the percentage for laparoscopic placement was 93.75%. The exit-site/tunnel infection and peritonitis occurring within 30 days of catheter insertion were, respectively, 0.75% and 2.2%; the visceral injury leading to intervention was 0.75%. We did not have any case of significant hemorrhage. All results were in line with ISPD guidelines.

CONCLUSION

We conclude that the Vicenza "short" catheter is a suitable device for peritoneal access. The implantation procedure is safe and easy to perform, and both nephrologists and surgeons can do it. A confident use and a proper implantation of the Vicenza "short" catheter help achieve the clinical ISPD goals for the PD access procedure in terms of catheter survival and complication rates.

A clinical review of peritoneal dialysis

OBJECTIVE

To review the principles and practice of peritoneal dialysis in veterinary medicine.

DATA SOURCES

Clinical and experimental studies and current guideline recommendations from the human literature; and original case studies, case reports, and previous reviews in the veterinary literature.

SUMMARY

Peritoneal dialysis involves the exchange of solutes and fluid between the peritoneal capillary blood and the dialysis solution across the peritoneal membrane. It requires placement of a peritoneal dialysis catheter for repeated dialysate exchange. The ideal catheter provides reliable, rapid dialysate flow rates without leaks or infections. Catheter selection and placement are reviewed along with dialysate selection, exchange prescriptions, and overall patient management. PD does not require specific or complex equipment, and it can achieve effective control of uremia and electrolyte imbalances.

CONCLUSIONS

Peritoneal dialysis is a potential life-saving measure for patients with acute renal failure. Peritoneal dialysis results in gradual decline in uremic toxins. Previously low success rates have been reported. Improved success rates have been noted in dogs with acute kidney injury (AKI) secondary to leptospirosis. Cats also have a good success rate when PD is elected in patients with a potentially reversible underlying disease. Overall, PD remains a viable intervention for patients with AKI unresponsive to medical management. In select patients a favorable outcome is attained whereby PD provides temporary support until return of effective renal function is attained.

Peritoneal cells at admission: do they have prognostic significance in peritonitis?

Peritonitis accounts for considerable morbidity and hospitalization in peritoneal dialysis (PD) patients. We investigated the factors related with time of hospital stay, especially focusing on the peritoneal cell profiles at the time of hospital admission in PD-related peritonitis. Eighty peritonitis attacks were evaluated. Data were collected at the time of hospital admission, clinical and biochemical parameters, including initial systemic and dialysate white cell counts (including percentage and differential count of neutrophils and lymphocytes) and length of hospital stay. Peritoneal leukocyte (r=+0.289, p=0.009) and neutrophil counts (r=+0.403, p<0.0001), peritoneal neutrophil percentage (r=+0.492, p<0.0001), time of hospital admission (r=+0.498, p<0.0001), and C-reactive protein (CRP) (r=+0.231, p=0.042) were positively correlated; lymphomononuclear cell percentage (r=-0.650, p<0.0001) was negatively correlated with hospitalization length. Hospital admission>or=24 hours of symptom onset was associated with higher CRP, dialysate leukocyte and neutrophil counts, longer hospitalization, and with lower dialysate lymphomononuclear cell percentage compared to admission<24 hours (p=0.04, p=0.04, p=0.005, p<0.0001, and p=0.04, respectively). In multiple linear regression, the time of hospital admission (p=0.002), initial peritoneal neutrophil count (p=0.011), and lymphomononuclear cell percentage (p<0.0001) were independently associated with hospitalization length. Hospital admission within first 24 hours of peritonitis symptoms onset is of vital importance; delayed admission is associated with higher peritoneal leukocyte and neutrophil counts, and increased length of hospital stay.