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Woodrow G, Fan SL, Reid C, Denning J, Pyrah AN. Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children. BMC Nephrol 2017; 18:333. [PMID: 29145808 PMCID: PMC5691857 DOI: 10.1186/s12882-017-0687-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 12/15/2022] Open
Abstract
These guidelines cover all aspects of the care of patients who are treated with peritoneal dialysis. This includes equipment and resources, preparation for peritoneal dialysis, and adequacy of dialysis (both in terms of removing waste products and fluid), preventing and treating infections. There is also a section on diagnosis and treatment of encapsulating peritoneal sclerosis, a rare but serious complication of peritoneal dialysis where fibrotic (scar) tissue forms around the intestine. The guidelines include recommendations for infants and children, for whom peritoneal dialysis is recommended over haemodialysis.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and A-D depending on the quality of the evidence that the recommendation is based on.
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Affiliation(s)
- Graham Woodrow
- St James's University Hospital Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Christopher Reid
- Evelina Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Jeannette Denning
- Peritoneal Dialysis Unit, St James's University Hospital Leeds Teaching Hospitals NHS Trust, London, UK
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Lee CC, Tu KH, Chen HH, Chang MY, Hung CC. Risk factors for drainage-requiring ascites after refractory peritonitis in peritoneal dialysis patients. Int Urol Nephrol 2016; 48:1721-30. [PMID: 27495322 DOI: 10.1007/s11255-016-1376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Refractory peritonitis remains a thorny issue for patients with chronic peritoneal dialysis (PD). Shortly after catheter removal, some patients develop persistent peritoneal inflammation and ascites formation, which require percutaneous drainage for symptom relief. Our study aimed at finding the risk factors for this kind of event. METHODS A total of 47 PD patients complicated with refractory peritonitis who underwent catheter removal between January 2009 and December 2011 were enrolled in this study. Data were compared between patients with and without the development of symptomatic ascites requiring drainage during hospitalization. RESULTS Among the 47 refractory peritonitis patients, 15 patients developed symptomatic ascites that needed further drainage shortly after catheter removal during hospitalization. The following factors were associated with an increased risk: longer dialysis duration, higher peritoneal Kt/V urea, and a significant rise in serum C-reactive protein (CRP) level after catheter removal. These patients had a prolonged hospital stay (62 vs 21 days, P < 0.001) and a significantly higher risk of recurrent loculated ascites during subsequent 6 months of follow-up (33.3 vs 6.2 %, P = 0.022) compared with patients who did not develop ascites requiring drainage during hospitalization. CONCLUSION A significant portion of patients with refractory PD peritonitis experienced ascites requiring drainage shortly after catheter removal, which led to a prolonged hospitalization. Whether routine drain placement at the time of catheter removal for this high-risk group would be of benefit warrants further prospective studies.
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Affiliation(s)
- Cheng-Chia Lee
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Hui Chen
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
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Petrie MC, Traynor JP, Mactier RA. Incidence and outcome of encapsulating peritoneal sclerosis. Clin Kidney J 2016; 9:624-9. [PMID: 27478609 PMCID: PMC4957727 DOI: 10.1093/ckj/sfw051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/09/2016] [Indexed: 11/24/2022] Open
Abstract
Background Studies report variation in the incidence and outcomes of encapsulating peritoneal sclerosis (EPS). This study reports the incidence and outcome of EPS cases in a national cohort of peritoneal dialysis (PD) patients. Methods The incident cohort of adult patients who started PD between 1 January 2000 and 31 December 2007 in Scotland (n = 1238) was identified from the Scottish Renal Registry. All renal units in Scotland identified potential EPS cases diagnosed from 1 January 2000 to 31 December 2014, by which point all patients had a minimum of 7 years follow-up from start of PD. Results By 31 December 2014, 35 EPS cases were diagnosed in the 1238 patient cohort: an overall incidence of 2.8%. The incidence for subgroups with longer PD duration rises exponentially: 1.1% by 1 year, 3.4% by 3 years, 8.8% at 4 years, 9.4% at 5 years and 22.2% by 7 years. Outcomes are poor with mortality of 57.1% by 1 year after diagnosis. Survival analysis demonstrates an initial above-average survival in patients who later develop EPS, which plummets to well below average after EPS diagnosis. Conclusions The incidence of EPS is reassuringly low provided PD exposure is not prolonged and this supports ongoing use of PD. However, continuing PD beyond 3 years results in an exponential rise in the risk of developing EPS and deciding whether this risk is acceptable should be made on an individual patient basis.
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Affiliation(s)
| | - Jamie P Traynor
- Glasgow Renal andTransplant Unit, Glasgow, UK; Scottish Renal Registry, Glasgow, UK
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Yang TK, Lee JJ, Lu PL, Kuo HT, Kuo MC, Chen HC. Peritoneal Dialysis-Associated Peritonitis Caused by Mycobacterium abscessus. Perit Dial Int 2016; 35:369-71. [PMID: 26015424 DOI: 10.3747/pdi.2014.00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tsung-Kun Yang
- Division of Nephrology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Division of Infectious Diseases Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Tien Kuo
- Division of Nephrology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chuan Kuo
- Division of Nephrology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Chun Chen
- Division of Nephrology Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Faculty of Renal Care College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Latus J, Habib SM, Kitterer D, Korte MR, Ulmer C, Fritz P, Davies S, Lambie M, Alscher MD, Betjes MGH, Segerer S, Braun N. Histological and clinical findings in patients with post-transplantation and classical encapsulating peritoneal sclerosis: a European multicenter study. PLoS One 2014; 9:e106511. [PMID: 25171219 PMCID: PMC4149574 DOI: 10.1371/journal.pone.0106511] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/30/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) commonly presents after peritoneal dialysis has been stopped, either post-transplantation (PT-EPS) or after switching to hemodialysis (classical EPS, cEPS). The aim of the present study was to investigate whether PT-EPS and cEPS differ in morphology and clinical course. METHODS In this European multicenter study we included fifty-six EPS patients, retrospectively paired-matched for peritoneal dialysis (PD) duration. Twenty-eight patients developed EPS after renal transplantation, whereas the other twenty-eight patients were classical EPS patients. Demographic data, PD details, and course of disease were documented. Peritoneal biopsies of all patients were investigated using histological criteria. RESULTS Eighteen patients from the Netherlands and thirty-eight patients from Germany were included. Time on PD was 78(64-95) in the PT-EPS and 72(50-89) months in the cEPS group (p>0.05). There were no significant differences between the morphological findings of cEPS and PT-EPS. Podoplanin positive cells were a prominent feature in both groups, but with a similar distribution of the podoplanin patterns. Time between cessation of PD to the clinical diagnosis of EPS was significantly shorter in the PT-EPS group as compared to cEPS (4(2-9) months versus 23(7-24) months, p<0.001). Peritonitis rate was significantly higher in cEPS. CONCLUSIONS In peritoneal biopsies PT-EPS and cEPS are not distinguishable by histomorphology and immunohistochemistry, which argues against different entities. The critical phase for PT-EPS is during the first year after transplantation and therefore earlier after PD cessation then in cEPS.
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Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sayed M. Habib
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Mario R. Korte
- Department of Internal Medicine, Division of Nephrology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Christoph Ulmer
- Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Fritz
- Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Simon Davies
- Institute for Science and Technology in Medicine, Keele University, Keele, United Kingdom
| | - Mark Lambie
- Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Michiel G. H. Betjes
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Niko Braun
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
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