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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In order to determine the long-term effects of continuous peritoneal dialysis on weight, 100 consecutive patients entering our program in 1988 were studied and followed for a maximum of 36 months. All patients underwent monthly evaluations including weight and biochemical surveys. Peritoneal equilibration tests were performed in 75 patients. A definite and significant trend was noted for weight gain during the first 17 months with a mean weight gain of 6.41 +/- 8.36 kg or 6.4% increase (p < 0.01). This was followed by a downward trend with a nadir on month 21 (p < 0.05). There were no significant differences in the change in weight for small or large patients. A positive correlation was noted between weight change and D/P creatinine at 12 and 24 months. Albumin concentrations remained stable throughout the period of observation. Serum albumin did not correlate with percent weight change nor with D/P creatinine. The frequency of peritonitis did not influence weight change in this population. The data suggest that there is marked interpatient variation, but the majority of patients on chronic peritoneal dialysis experience significant weight gain upon initiation of therapy. The trend is reversed after approximately 1.5 years of therapy raising the question of underdialysis due to loss of residual renal function or from patient selection after transfer of the healthier patients to transplantation and/or hemodialysis.
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PMID:Is weight gain inevitable in most chronic peritoneal dialysis patients? 136 18

Urea kinetic modeling was applied to 19 CAPD patients followed in our outpatient clinics. Serum beta 2-microglobulin was also measured as a marker of large molecular weight substances. Clinical conditions of patients were assessed by both doctors and patients. Patient's assessment were done by the questionnaire. Indices of urea kinetics (KT/V, PCR) and biochemical parameters were compared between well-treated and not well-treated patients judging from patient's and doctor's assessment scores. The rate of peritonitis was significantly higher in the latter group. None of the parameters were different between 2 groups except for serum albumin. There was a significant correlation between serum concentration of albumin and doctor's assessment score (gamma = 0.52). In conclusion, urea kinetic parameters is not a good indicator for adequacy of dialysis in our CAPD population. Serum albumin seems to be one of the indices for adequate dialysis. However, clinical symptoms and signs are more valuable than biochemical parameters for the assessment of adequacy of dialysis.
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PMID:[Is there any correlation between urea kinetics and the clinical outcomes in CAPD patients?]. 158 68

Factors contributing and predisposing to peritonitis were studied retrospectively in 83 children treated with continuous ambulatory (CAPD) or continuous cycling peritoneal dialysis (CCPD) from 1978 to 1988. Recurrent peritonitis was the most frequent complication and the major reason for peritoneal dialysis failure. Fifty patients had 171 episodes of peritonitis during the ten years and 33 remained peritonitis-free. The duration of dialysis was significantly shorter in the peritonitis-free group. The incidence of peritonitis was lower with CCPD than with CAPD. Leucopenia was not a predisposing factor nor was blood leucocytosis helpful in diagnosing peritonitis. Serum IgG was low in 33% of patients with episodes of peritonitis, but there was no correlation or predictive value in this finding. The C3 component of complement was relatively lower than the C4 but both components was relatively lower than the C4 but both components were usually in the normal range. Serum albumin was low in all patients, but lower in those with peritonitis episodes. Age, sex, primary disease, diapers, pyelostomies, dialysis training, and living conditions were not significantly associated risk factors. Sterile dressings gave no benefit over the shower technique. Patient noncompliance, upper respiratory tract infection, skin infections, and dental treatment were potential risk factors. However, peritonitis seemed to be distributed randomly among the patients.
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PMID:Factors predisposing and contributing to peritonitis during chronic peritoneal dialysis in children: a ten-year experience. 209 25

To evaluate the efficacy of supplemental arginine with nutritional support in the presence of sepsis, eighty-eight gastrostomized female Hartley guinea pigs were implanted with osmotic pumps effusing an Eschericia coli/Staphylococcus aureus mixture. Animals were randomized and infused for two weeks with isocaloric and isovolumetric diets containing 0%, 2%, 4%, or 6% supplemental arginine as arginine hydrochloride. Survival was 12/22 (54%) in 0%, 9/22 (41%) in 2% and 4%, and 2/22 (9%) in 6%. Analysis by chi-square test of independence was significant (p = 0.0141) with 6% survival lower than the others. Median survival was 11 days in 0%, 8 days in 2% and 6%, and 9 days in 4%. Median survival was longer in 0% than in 2% or 6% (Kruskal-Wallis ANOVA: p = 0.02). Nitrogen balance was significantly lower in 6% compared to 0% on days 2 through 10, and lower than 2% and 4% on days 6 and 9. Nitrogen balance was higher in 0% than in 2% on days 4, 6, 10, and 13. Serum albumin and C3 were lower in all experimental groups than normal controls (ANOVA: p = 0.01). Comparison of liver, spleen, adrenals, gastrocnemius, and carcass weights, cell-mediated immunity as determined by contact sensitivity to DNFB, and transferrin showed no significant differences. There was a positive dose-response effect seen amongst the experimental groups for the amino acids arginine, ornithine, and citrulline in relation to the amount of supplemental arginine. This study suggests that dietary arginine supplementation does not enhance survival in a guinea pig model of established peritonitis.
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PMID:Arginine supplementation and its effect on established peritonitis in guinea pigs. 211 35

Peritonitis, a major complication of end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), enhances peritoneal protein losses by increasing protein and energy requirements while simultaneously decreasing appetite, usually causing a negative nitrogen balance. The influence of peritonitis on the nutritional status of CAPD patients was evaluated. Fourteen end-stage renal disease patients being treated with CAPD and presenting with peritonitis were randomized to one group with and one without a nutritional supplement. Four CAPD patients without peritonitis served as controls. Anthropometric measurements, laboratory determinations, dietary protein intake, and protein catabolic rate were obtained. The control group lost an average of 9.6 gm protein per 24 hours in the peritoneal fluid vs. an average of 15.1 gm protein per 24 hours lost by patients with peritonitis (p less than .01). Serum albumin did not decrease except in two diabetic patients in whom it dropped an average of 42% and remained low. Nitrogen balance remained positive in all patients except one with diabetes who had very low daily protein intake and caloric intake. The catabolism produced by short uncomplicated peritonitis did not create a negative nitrogen balance in patients eating at least 1 gm protein per kilogram ideal body weight (IBW) and 25 kcal/kg IBW.
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PMID:Nutritional effects of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. 379 34

An eight-year retrospective study was performed to determine the incidence of peritonitis in a pediatric continuous ambulatory peritoneal dialysis (CAPD) population of 24 children, half of whom were boys and half, girls. All suffered from end stage renal disease (ESRD). When these children, aged 2 through 17 years (mean: 10.7 +/- 3.8), were examined, the incidence of peritonitis was one episode every 15.2 patient-months. Microbiologic evaluation showed that 76.4% of the 34 episodes were culture positive, with Staphylococci species (coagulase negative staphylococci 32.4%, Staphylococcus aureus 14.7%) causing most cases especially early in dialysis. Half the patients presented with a triad of symptoms (fever, abdominal pain and cloudy dialysate), with cloudy dialysate was the major presentation (88%). Peritonitis was treated with intraperitoneal administration of cefacin and/or netromycin when suspected, and 52.9% of the episodes needed hospitalization. Except for two patients who died of complications (sepsis, acute pancreatitis), all episodes of peritonitis were cured; in four episodes it was necessary to remove a catheter, and two of those cases came from fungal peritonitis. Peritonitis rates differed among disconnect systems. The manual spike had peritonitis rate of one episode per 4.6 patient-months which was higher than the O-set (one episode/22.2 patient-months), UV-XD and Y-set disconnect systems. Therefore, the major causes of peritonitis arose from contamination provoked by the technical aspect of the procedure. Nutrition status was stable in these patients. Serum albumin and total protein were adequate in all patients without relation to episode of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Peritonitis in children being treated with continuous ambulatory peritoneal dialysis. CAPD Team. 761 67

Male Fischer 344 rats were orally fed one of four diets (Osmolite HN, Alitraq, Impact, and Purina rodent chow). After 6 days, jejunal mucosal nitrogen content and thickness were normal in all groups. After 7 days, challenge with Escherichia coli intraperitoneally demonstrated no difference in survival for any dietary group. In a second study, acute protein-calorie malnutrition was induced by administering 5% dextrose orally for 10 days. Animals were refed for 7 days with one of the four diets. Serum albumin concentrations and intestinal mucosal nitrogen content and thickness returned to normal with each refeeding program. Challenge with E. coli after 7 days of refeeding, however, again demonstrated no difference in survival for any dietary group. Specialized enteral feeding products, containing additional amounts of arginine, glutamine, glutamate, RNA, and omega-3 fatty acids, are no more effective than a standard enteral feeding product or rat chow in maintaining intestinal anatomy or restoring anatomy following fasting. Furthermore, we found no survival advantage for the specialized products following E. coli peritonitis.
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PMID:Effects of enteral feeding products on survival from Escherichia coli peritonitis. 796 75

The treatment of cirrhotic patients with ascites and end-stage renal disease (ESRD) is complex. Continuous ambulatory peritoneal dialysis (CAPD), as a continuous therapy, represents an alternative to hemodialysis-associated hemodynamic intolerance. We report our experience with 5 cirrhotic patients with ascites who were treated by CAPD. Three had been transferred from hemodialysis (HD) for intolerance. The hemodynamic tolerance was excellent in all patients, and solute and water peritoneal transport were increased over the normal range in all cases. Morbidity was principally related to liver disease. Peritoneal protein losses, initially high, decreased over time. Serum albumin was within the low normal range. The incidence of peritonitis was higher than usual in these patients; episodes caused by gram-negative bacteria, streptococci and listeria, were predominant. The cause of death was not CAPD-related. In our experience, CAPD should be the treatment of choice for cirrhotic patients with ascites who require dialysis.
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PMID:CAPD for treatment of ESRD patients with ascites secondary to liver cirrhosis. 799 68

The records of 734 peritoneal dialysis (PD) patients trained at our center between January 1983 and December 1991 were reviewed, and those who had been on PD more than 5 years were selected to study the characteristics common to long-term survivors. We obtained the following results: 22 patients (3%) remained on PD for more than 5 years and 6 patients for more than 8 years (0.8%). Of these, 59.1% were males and 55% white with a mean age of 41.3 +/- 15.1 years and weight 71.1 +/- 14.7 kg. The causes of end-stage renal disease (ESRD) were: diabetes 31.8%, glomerulonephritis 36.4%, and nephrosclerosis 22.7%. The average peritonitis rate was 0.46 episodes/year and hospitalization 4.13 +/- 3.70 days/ year. After 3 years of PD all patients were essentially anuric. The mean 4-hour D/Purea = 0.94 +/- 0.01 and D/Pcreatinine = 0.68 +/- 0.03. Weekly Kpt/Vurea improved from 1.61 to 1.82, Kcreatinine from 40 to 45 L/1.73 m2, and dialysate volume from 11.6 to 14.1 L/day. The normalized catabolic protein rate (NPCR) remained stable at 0.7 g/kg/day. Serum albumin concentrations (SACs) averaged 3.5 g/dL and did not show a trend with time. Weights revealed marked variation with a mean group gain of 3.4 +/- 0.85 kg. Social support was excellent in 19 patients, and 20 were very compliant. Thirteen patients remain on PD, 4 expired, 1 received a transplant, and 4 transferred to hemodialysis. In conclusion, PD can maintain life for prolonged periods of time in the absence of renal function. Longterm survivors are typically of average size, enjoy stable and average peritoneal transport, good social support, remain compliant with therapy, and experience infrequent peritonitis. New PD modalities capable of delivering higher doses and adjustment of prescription based on residual renal function, peritoneal transport, and metabolic needs should increase the proportion of long-term survivors.
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PMID:Characteristics of long-term peritoneal dialysis patients. 936 Jun 60

Thirty-six patients on peritoneal dialysis (PD) for more than ten years in six North American centers were analyzed retrospectively. In the six centers, the percentage of patients surviving for more than ten years varied between 0.8% and 7.3%. The study group included 27 females and 9 males aged 38.6 +/- 14.2 years [mean +/- standard deviation (SD)] at the start of treatment. Of the 36 patients, 28 were Caucasian. The most common cause of end-stage renal disease (ESRD), present in 12 patients, was chronic glomerulonephritis. Only 4 patients had diabetes. At the beginning of the study, 19 patients had hypertension (the most common comorbid condition); 11 had no comorbid conditions at the start. Creatinine clearance at the start was 4.12 +/- 3.5 mL per minute, and the mean duration to anuria was 51 +/- 25 months. Mean initial body weight was 55 +/- 9 kg, and mean body surface area was 1.5 +/- 0.2 m2. Serum albumin levels showed an increase from 33.8 +/- 3.6 g/L at the start of the study to 38.2 +/- 3.9 g/L at the end. Hospitalization rate was low at 0.5 +/- 0.3 admissions per patient-year, and duration of hospitalization was 4.8 +/- 3.7 days per patient-year. Peritonitis was the most common cause of hospitalization. The mean peritonitis rate was 1 episode every 52 +/- 48 patient-months. There were 36 catheter changes in 18 patients; 16 patients had a single PD catheter throughout the period of study. Autonomous hyperparathyroidism was the most common long-term complication. At the end of the study period, 11 patients were still on PD, 9 had died, 5 had been transferred to hemodialysis (HD), 1 was alive with a functioning allograft, and 1 was lost to follow-up. We conclude that patients who survive longer than ten years on PD are most likely to be young Caucasian females, small in body size, who are non diabetic, with few comorbid conditions. These long-term survivors have few hospitalizations, and their peritonitis rate is low. In this group of patients, severe autonomous hyperparathyroidism is the most common long-term complication.
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PMID:Patients on chronic peritoneal dialysis for ten years or more in North America. 1091 58


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