Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the period 1986-1990, 119 patients were enrolled in the Italian Registry of Pediatric CPD. CAPD was largely predominant in the first 3 years, while CCPD accounted for 48% of dialysis months in the period 1989-1990. The connect-disconnect system was a Y set for all patients during the whole observation period. The incidence of peritonitis decreased from 1 episode: 10.9 patient-months in 1986 to 1:19.8 in 1988, and then passed to 1:16.2 in 1990. A comparison of the incidence of peritonitis between CAPD and CCPD, referring to the 1989-1990 period, showed no significant difference. The percentage of positive peritoneal fluid cultures changed from 48% in 1986 to 73% in 1990. Gram-positive bacteria, primarily Staphylococcus aureus and Staphylococcus epidermidis, accounted for most of the isolated organisms. Candida albicans was cultured in 3 cases both in 1986 and 1987. Exit site infection was the predominant (82%) complication, followed by leakage and catheter cuff extrusion. The hospitalization rate for peritonitis resulted persistently high (61% of episodes) and the mean duration was 12.7 days. Of the 8 patients who were switched to hemodialysis, 4 had recurrent peritonitis and 1 Candida albicans peritonitis.
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PMID:Peritonitis in children undergoing chronic peritoneal dialysis (CPD): data from the Italian Registry of Pediatric CPD. 136 37

Eleven children (7 girls and 4 boys) 2 1/2 to 17 years and 8 months of age were treated with CAPD for periods ranging from 6 to 31 months. All children were treated with commercially available dialysate solutions containing lactate. Peritoneal ultrafiltration capacity (PUFC) decreased progressively in all children without accompanying decrease in peritoneal urea and creatinine clearances. Five children developed membrane failure with negative ultrafiltration. One episode of peritonitis occurred in one of these 5 children and in 4 of them only 1.5% glucose solutions had been used. After an initial period (ranging from 14 to 31 months) of CAPD, 2 children were treated with Intermittent Ambulatory Peritoneal Dialysis (IAPD) and two others with Intermittent Cycling Peritoneal Dialysis (ICPD). In these 4 children, PUFC increased within one month from -3.75 ml/kg/day to + 5 ml/kg/day. By providing a shorter dwell time, IAPD and ICPD may allow a reduction in net inward transport of glucose, the maintenance of osmolar gradient and preservation of ultrafiltration capacity. Furthermore, periods of rest may allow some recovery from the progressive deterioration of the peritoneum resulting from long-term irrigation of the peritoneal cavity. These results indicate that IAPD and CPD may be superior to CAPD to maintain the ultrafiltration capacity of the peritoneum.
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PMID:Modification of peritoneal ultrafiltration capacity in children undergoing peritoneal dialysis. 399 71

Dialysate and blood leukocyte counts were measured during 130 episodes of peritonitis in 91 hospitalized patients on long-term peritoneal dialysis (CPD). The authors found that the blood/dialysate leukocyte count can be less than 1.0, and this is usually the case when dialysate leukocyte count exceeds 20,000/mm3. Dialysate leukocyte removal in a single 2 L drain bag can approach the leukocyte number in the entire circulating blood volume. Daily drainage can remove leukocytes in amounts exceeding the blood leukocyte pool 2 to 3 fold. The observed blood leukocyte counts throughout a range of 2,700 to 10,000 at dialysate leukocyte counts greater than 20,000 per mm3 may reflect: 1) leukocyte removal approaching maximum bone marrow output of leukocytes, and/or 2) increasing microcirculatory margination of leukocytes in those episodes of peritonitis associated with very high dialysate leukocyte counts.
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PMID:Leukocyte kinetics in patients with peritonitis on long-term peritoneal dialysis. 764 Apr 26

Catheter-related infections continue to be the most common complication of CPD, and the most frequent cause of catheter removal. Available evidence supports the superiority of double-cuff catheters and a downward-facing tunnel for preventing peritonitis in children. The Swan-neck double-cuff catheter seems best suited to achieving those objectives, while still reducing the problems of external cuff extrusion and catheter migration. Clearly further pediatric experience with that catheter is desirable. Analysis of the literature confirms that excellent catheter survival and a reduced rate of infectious complications can be achieved with a variety of catheter designs and implantation techniques. The most crucial aspect of catheter success and survival appears to be the commitment and expertise of the team involved in catheter insertion and postoperative catheter management.
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PMID:Peritoneal access in children. 1188 25

CPD-associated peritonitis is a leading cause of morbidity and mortality for ESRD patients maintained on CPD therapy. The percentage of ESRD patients maintained on CPD therapy is declining. The reasons are unclear, but may be due to concerns about CPD-associated peritonitis. The incidence of CPD-associated peritonitis has decreased largely attributed to technical advances and the identification of risk factors including exit-site infection, colonization with Staphylococcus aureus and depression. The typical spectrum of organisms causing peritonitis include gram-positive organisms (67%), gram-negative organisms (28%), fungi (2.5%) or anaerobic organisms (2.5%). Culture-negative episodes do occur: up to 20% of the episodes of peritonitis in some series are culture-negative. The treatment of CPD associated peritonitis is rather standardized with current recommendations by the International Society of Peritoneal Dialysis universally adopted. Approximately 80% of the patients developing peritonitis will respond to antimicrobial therapy and remain on CPD therapy, while 10 to 15% of the patients require catheter removal and transfer to hemodialysis. Approximately 6% of the patients expire as a result of peritonitis. The outcome is different based on organism with gram-negative and fungal episodes having a worse outcome than gram-positive episodes. The development of CPD-associated peritonitis can be linked to traditional risk factors such as exit-site infection and poor technique. Bacterial biofilm has also been suggested as a cause of peritonitis. Our current antimicrobial protocols may not permit adequate dosing to penetrate the biofilm and be a reason for recurrent or repeat episodes of peritonitis. It is important that we improve our understanding of factors responsible for the development and outcome of CPD-associated peritonitis in order for this renal replacement therapy to remain a viable option for patients with ESRD.
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PMID:Treatment and outcome of CPD-associated peritonitis. 1660 33