Although activity of iron uptake system (IUS) was thought to play an important role in staphylococcal growth in human peritoneal dialysate (HPD) solution, siderophore production, one of the well-known IUS, was not yet detected directly in HPD solution. Therefore, we tried to detect siderophore production directly in HPD solution by using a newly developed chrome azurol S (CAS) agar diffusion assay and to investigate the effect of IUS activity on bacterial growth in HPD solution. According to the susceptibility test for streptonigrin and the productivity of siderophore in the iron-deficient (ID) medium, Staphylococcus aureus ATCC 6538 strain and Staphylococcus epidermidis clinical isolate had higher IUS activity and grew better than S. aureus ATCC 25923 strain in the ID medium. These bacteria did not grow and produce siderophore in the unused chronic ambulatory peritoneal dialysis solution. However, these bacteria grew and produced siderophore in the HPD solution. Moreover, S. aureus ATCC 25923 strain with lower activity of IUS grew poorly and produced smaller amount of siderophore in HPD compared to S. aureus ATCC 6538 strain and S. epidermidis clinical isolate with higher activity of IUS like in the ID medium. To the best of our knowledge, this is the first report that sidero-phore production is directly detected in the HPD by CAS agar diffusion assay. These results indicated that activity of IUS plays an important role in bacterial growth in the HPD solution and pathogenesis of continuous ambulatory peritoneal dialysis peritonitis.
Biological Assay ; Dialysis Solutions/chemistry* ; Drug Contamination ; Human ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Siderophores/metabolism* ; Staphylococcus/metabolism*

To investigate the effect of nutritional status of continuous ambulatory peritoneal dialysis (CAPD) patients on the development of peritonitis, a cross-sectional study of the nutritional status of 79 CAPD patients and a retrospective study on the incidence of peritonitis in these patients were done. The incidences of peritonitis were compared according to the nutritional status of these patients on CAPD. Protein-caloric malnutrition assessed by a score system based on triceps skinfold thickness, mid-arm circumference, serum albumin level and relative body weight was demonstrated in 27 patients (34%) among 79 total CAPD patients. The incidence of peritonitis was significantly higher in poor nutritional status patients, with 1.09 +/- 0.86/patient-year, than that in normal nutritional status patients with 0.64 +/- 0.72/patient-year (p less than 0.05). In patients with the same nutritional status, patients using Dianeal solution had a trend of a lower incidence of peritonitis than those using Peritosol solution. In conclusion, the nutritional status and possibly the type of CAPD solution may influence CAPD peritonitis as risk factors.
Comparative Study ; Dialysis Solutions/adverse effects ; Female ; Human ; Male ; *Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/*etiology ; Support, Non-U.S. Gov't

OBJECTIVES: ACKD has been described mainly in patients treated with hemodialysis(HD), and there are only a few reports about the prevalence of ACKD in continuous ambulatory peritoneal dialysis (CAPD) patients. Therefore, we compared the prevalence of ACKD in patients receiving HD and CAPD, and evaluated the possible factors which may affect the development of ACKD. METHODS: Forty nine HD and 49 CAPD patients who had received dialysis therapy for at least 12 months were enrolled in this cross-sectional study. Patients who had a past history of polycystic kidney disease and had acquired cystic kidney disease on predialysis sonographic exam were excluded. Detection of ACKD was made by ultrasonography and ACKD was defined as 3 or more cysts in each kidney. RESULTS: The prevalence of ACKD was about 31+ACU- (30/98) and there was no significant difference between HD and CAPD patients(27+ACU- vs. 34+ACU-, p +AD4- 0.05). The prevalence of ACKD was not associated with age, sex, primary renal disease, the levels of hemoglobin, BUN, and serum creatinine. However, the duration of dialysis was significantly related to the development of ACKD (presence of ACKD, 74.4 42.4 months vs. absence of ACKD, 37.8 24.1 months, p +ADw- 0.05). CONCLUSION: The prevalence of ACKD is not different according to the mode of dialysis, and the major determinant of acquired cyst formation is duration of dialysis.
Adolescence ; Adult ; Age Distribution ; Aged ; Chi-Square Distribution ; Comparative Study ; Cross-Sectional Studies ; Female ; Human ; Kidney Failure, Chronic/therapy ; Kidney Function Tests ; Kidney, Cystic/etiology+ACo- ; Kidney, Cystic/epidemiology+ACo- ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/methods ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects+ACo- ; Prevalence ; Renal Dialysis/methods ; Renal Dialysis/adverse effects+ACo- ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Statistics, Nonparametric

It is well known that depression and sense of hopelessness worsen the quality of life in end-stage renal disease (ESRD) patients receiving dialysis. However, the characteristics of depression in continuous ambulatory peritoneal dialysis (CAPD) patients have not been analyzed in detail. We performed this study to investigate the severity of depression and the factors affecting depression in CAPD patients. With 96 CAPD patients, we evaluated each patient's depressive mood and hopelessness with CES-D (Center for Epidemiologic Studies Depression) scale and Beck Hopelessness Scale. We also evaluated the degree of stress of each patient with internal individual stress scale. Most CAPD patients experienced severe depression compared with the general population. Their depression was better explained by psychological factors, such as stress and sense of hopelessness, than by demographic or physical factors. On the basis of these findings, we suggest that the treatment of depression in CAPD patients might be possible by modulation of psychological factors.
Adult ; Aged ; Depression/*etiology ; Female ; Humans ; Kidney Failure, Chronic/psychology/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Sex Factors ; Stress, Physiological

Sclerosing encapsulating peritonitis (SEP) is a rare but serious complication in patients with continuous ambulatory peritoneal dialysis (CAPD), and is characterized by a progressive, intra-abdominal, inflammatory process resulting in the formation of sheets of new fibrous tissue, which cover, bind, and constrict the viscera, thereby compromising the motility of the bowel. No satisfactory estimate is available on the comparative incidence of dialysis related SEP and the pathogenesis of SEP still remains uncertain. Although recent therapeutic approaches have reported varying degrees of success, an efficient measure to detect, at an early stage, patients at risk for SEP would be beneficial and a standardized treatment regimen to prevent the illness is urgently needed. This study aimed to evaluate the clinical features of SEP and to identify the possible risk factors for the development of SEP in CAPD patients. We retrospectively reviewed by questionnaire SEP cases among CAPD patients from 7 university hospital dialysis centers in Korea, including Yonsei University, Ajou University, Catholic University, Inha University, Kyungpook University, Seoul National University and Soonchunhyang University, from January 1981 to December 2002. Out of a total of 4, 290 CAPD patients in these centers, 34 cases developed SEP with an overall prevalence of 0.79%. The male to female ratio was 17: 17. The median age of these patients was 44.5 years (range 19 - 66). The median duration of CAPD before SEP was 64 months (9 - 144) and 68% of patients (23/34) had been on CAPD for more than 4 years. Peritonitis (including two fungal cases) was the main cause of catheter removal in SEP (27 cases, 79%). Seventy-five percent of the cases (15/ 20) were administered beta-blocker for a mean duration of 85 months (26 - 130). Among 10 cases with available peritoneal equilibration test (PET) data, 8 showed high transporter characteristics, and the remaining 2 were high average. Eighteen cases were diagnosed by clinical and radiologic methods, and 16 were surgically diagnosed. Eleven cases were surgically treated and the others were treated conservatively with intermittent total parenteral nutrition (TPN). The overall mortality rate was 24%. SEP is a serious, life threatening complication of CAPD. Most cases had a PD duration of more than 4 years, a history of severe peritonitis, and high transporter characteristics in PET. Therefore, to reduce the incidence of SEP, careful monitoring and treatment, including early catheter removal in patients with severe peritonitis, should be considered for long-term CAPD patients with the above characteristics.
Adult ; Aged ; Female ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects/*statistics & numerical data ; Peritonitis/*epidemiology/etiology/*pathology ; Prevalence ; Sclerosis

OBJECTIVETo identify the clinical characteristics and risk factors of frequent peritoneal dialysis (PD)-related peritonitis.

METHODSA retrospective analysis was conducted in the peritonitis patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in our hospital. Frequent PD-related peritonitis was defined by two or more onsets in one year, and the patients with only one onset served as the control group. The clinical and laboratory data of the two groups were compared and the risk factors of PD-related peritonitis analyzed.

RESULTSForty-four episodes of peritonitis were recorded in the 16 patients with frequent PD-related peritonitis, as compared to 53 episodes in the 45 control patients. Compared with those in the control group, the patients with frequent peritonitis had significantly higher blood pressure (P0.05). Variables identified to be associated with an increased likelihood of frequent PD-related peritonitis included hemoglobulin<70 g/L (OR=0.135, P

CONCLUSIONCompared with the patients with only one annual occurrence of peritonitis, the patients with frequent PD-related peritonitis have severer malnutrition and water overload, which are probably correlated to the high rates of PD catheter removal and poor prognosis. Severe anemia and proteinemia are risk factors and also predictive factors of frequent PD-related peritonitis. Measures to ameliorate anemia and proteinemia and effective management of celiac endogenous infection may help prevent and control frequent PD-related peritonitis.

Adult ; Anemia ; complications ; Female ; Humans ; Hypoproteinemia ; complications ; Male ; Middle Aged ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritonitis ; etiology ; prevention & control ; Retrospective Studies ; Risk Factors

Peritoneal dialysis (PD)-related peritonitis is recognized as a common complication of peritoneal dialysis. Eosinophilic peritonitis is a rare type of non-infection PD-related peritonitis. Eosinophilic peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients was first reported in 1967. The cause of eosinophilic peritonitis is obscure, however it may be related to some etiologies: (1) hypersensitivity to PD materials, including catheter or dialysate; (2) bacteria, fungal or mycobacterium tuberculosis infection. Clinical investigations include asymptomatic cloudy PD effluent, fever, abdominal pain and eosinophil count elevate in PD effluent. Eosinophilic peritonitis is usually mild and self-limited. With the development of PD, more eosinophilic peritonitis cases and researches were reported. Here, we report a patient on CAPD with eosinophilic peritonitis. A 71-year-old female patient developed end-stage renal disease for 4 years and underwent CAPD (2 000 mL of 1.5% dialysis solution with four exchanges daily) for 5 months. With a history of unclean food, she was hospitalized for complaints of diarrhea, fever and cloudy peritoneal effluent for 10 days. Dialysis effluent showed an elevated white blood cell (WBC) count of 1 980 cell/mm³, with 60% polymorphonuclear cells. She was diagnosed as PD-related peritonitis, and therapy was initiated with intraperitoneal ceftazidime 1 g once a day and vancomycin 500 mg every other day. She was admitted to the hospital as the symptoms were not relieved. Her peripheral blood cell count showed a total WBC count of 6 940 cells/mm³, 36.8% eosinophil. Her PD effluent analysis showed turbidity, total WBC count of 1 480 cells/mm³, and 83% polymorphonuclear cells. Her dialysate bacteria culture, fungus culture, polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR), acid-fast stain were all negative. On admission day 4, the treatments were changed to levofloxacin 200 mg once a day and vancomycin 500 mg every other day. After two weeks of antibiotics treatment, patient's symptoms were not completely improved and her dialysis effluent remained cloudy. Her blood eosinophil count elevated to 36.8%，eosinophil proportion in PD effluent>90% and PD effluent pathological findings showed eosinophil>90%. Eosinophilic peritonitis was diagnosed and a decision was made to give loratadine daily dose of 10 mg orally. The possible reasons might be the patient's allergy to some components of PD solution or connection systems in the beginning of PD, and this bacterial peritonitis episode, as well as the application of vancomycin, might lead to the fact that eosinophilic peritonitis acutely developed. For there was no improvement in clinical symptoms, loratadine was stopped, and the patient was discharged 18 days later, and received follow-up closely. Two months later, eosinophil count in blood and PD fluid decreased to normal range with no symptom. This case reminds us that in any PD-related peritonitis patient with prolonged symptoms after appropriate antibiotic therapy, and typical clinical symptoms, the diagnosis of eosinophilic peritonitis should be considered. For the count and percentage of eosinophils are not routinely reported in most laboratories, doctors need to contact the department of laboratory and the department of pathology, to confirm the cell count and proportion of eosinophils in dialysis effluent, so as to make the definite diagnosis, which can not only avoid antibiotics overuse, but also avoid antibiotics-induced eosinophilic peritonitis (such as vancomycin).
Aged ; Anti-Bacterial Agents/therapeutic use* ; Eosinophilia/etiology* ; Female ; Humans ; Kidney Failure, Chronic/therapy* ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Peritoneum ; Peritonitis/etiology*

OBJECTIVES: Recent reports have suggested that patients treated by CAPD have a relatively increased risk of death compared to patients undergoing HD, although the cause of this discrepancy is poorly understood. Protein malnutrition is an important risk factor in ESRD. Also, amino acid concentrations, for which the physiological function differs from that of protein, may be an independent risk factor in ESRD. There is no doubt concerning the prevalence of low amino acid levels in both HD and CAPD patients. But the difference in plasma amino acid levels between these two groups has not been well defined. The purpose of this study is to compare plasma amino acid levels between patients with ESRD on HD and CAPD. METHODS: A cross sectional study of overnight fasting plasma amino acid concentrations was performed on 12 CAPD and 45 HD patients with ESRD, matched by age, sex and body mass index. The levels of individual plasma amino acid and TAA, EAA, NEAA and BCAA were compared for the HD and CAPD groups. In order to measure losses during HD and CAPD, amino acid and protein concentrations were measured from 10 dialysates obtained from 10 HD patients and 12 peritoneal dialysis solutions from 12 CAPD patients. RESULTS: All of the measured amino acid concentrations were found to be lower in the CAPD group compared to the HD group. Furthermore, the levels of TAA (2017.3 +/- 781.1 vs. 903.3 +/- 316.1 mumole/L), EAA(1201.8 +/- 492.6 vs. 567.6 +/- 223.2 mumole/L), NEAA(815.5 +/- 308.6 vs. 335.7 +/- 100.2 mumole/L); and BCAA (315.0 +/- 146.0 vs. 145.2 +/- 65.0 mumole/L), were all lower in the CAPD group than in the HD group. The protein loss was 2.0 +/- 0.2 g/L in the peritoneal dialysate but was not detectable in the hemodialysates. TAA loss over a one week period was about 61.8 +/- 13.0mmole for the HD group and 38.0 +/- 13.0 mmole for the CAPD group. CONCLUSIONS: Our results show that amino acid concentrations are lower in ESRD patients on CAPD than on HD. It seems likely that protein loss in the peritoneal dialysate is a contributing factor to lowered plasma amino acid concentrations in ESRD patients on CAPD than on HD. We believe that the lowered amino acid concentrations observed in CAPD patients may worsen the clinical outcome compared to HD patients.
Adult ; Amino Acids/blood* ; Amino Acids/analysis ; Comparative Study ; Dialysis Solutions/chemistry ; Female ; Human ; Kidney Failure, Chronic/therapy* ; Kidney Failure, Chronic/blood* ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Renal Dialysis*/adverse effects

Cell Line ; Dialysis Solutions ; adverse effects ; Epithelial Cells ; metabolism ; Fibrosis ; Humans ; Peritoneal Dialysis, Continuous Ambulatory ; adverse effects ; Peritoneum ; metabolism ; pathology ; RNA Interference ; RNA, Messenger ; analysis ; RNA, Small Interfering ; pharmacology ; Transforming Growth Factor beta ; antagonists & inhibitors ; genetics ; Transforming Growth Factor beta1

Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.
Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Middle Aged ; Insulin/*administration & dosage/adverse effects ; Injections, Intraperitoneal ; Humans ; Female ; Fatty Liver/diagnosis/*etiology ; Drug Monitoring ; Diabetes Mellitus, Type 2/drug therapy/physiopathology/*therapy ; *Diabetes Complications