To avoid later complication of peritoneal dialysis catheter, it is recommended to delay regular exchange of peritoneal dialysis for about 2-4weeks after insertion of catheter(break-in period). During break-in period some patients need hemodialysis(HD) or other intermittent dialysis. In such cases residual renal function(RRF) can decrease substantially compared with patients who do not need HD during break-in period since RRF is preserved better in CAPD patients than HD patients. This is prospective observational study to examine such an effect of HD during break-in period on residual renal function in CAPD patients. 20 patients who were clinically stable and had been on CAPD since March, 1999 were observed. 6 patients were treated with HD for 1month during break-in period and CAPD thereafter(group A). 14 patients were treated with CAPD without HD(group B). GFR(mean of creatinine and urea clearance of urine) and urine Kt/V urea were measured at start, and 1, 3, 6 months of renal replacement therapy. Covariables analyzed in this study were mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, the presence of diabetes mellitus, and peritonitis episode. There was no significant difference in initial RRF, mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, and the presence of diabetes mellitus between 2 groups. Initial GFR was a little smaller in group A than group B(45.0+/-10.1 L/week vs. 54.6+/-5.7L/week) which was not statistically significant. GFR after 1, 3 and 6months of dialysis(including 1month of HD in group A) were smaller in group A than B(28.6+/-5.3L/week vs. 54.4+/-5.7L/week, 32.7+/-5.2L/week vs 56.9+/-6.1L/week, 21.0+/-4.1L/week vs 53.6+/-5.4L/week at 1,3,6 months after dialysis in group A and B), which were significant. Urine Kt/V showed same pattern. The change of GFR and urine Kt/V have no correlation with serum albumin, hemoglobin, hematocrit, and change of mean arterial blood pressure and is not affected by sex, and presence of DM or peritonitis. We concluded that HD during break-in period can decrease RRF in CAPD patients, which may not recover after 6months of dialysis. Avoiding HD during break-in period with appropriate preparation can preserve RRF in CAPD patients.
Arterial Pressure ; Catheters ; Creatinine ; Diabetes Mellitus ; Dialysis ; Hematocrit ; Humans ; Observational Study ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prospective Studies ; Renal Dialysis* ; Renal Replacement Therapy ; Serum Albumin ; Urea

Hemophilia is a rare inherited bleeding disorder. The most common manifestation of hemophilia is hemorrage and it can occur at any site of the body. Chronic renal failure results from a variety of systemic disorders and its incidence is now increasing. Until now, chronic renal failure in hemophilia was rare and there was no reported case of hemodialysis or peritoneal dialysis in hemophilia patient in korea. The modality of dialysis for hemophiliac end stage renal patients is a difficult choice because hemophiliac patients always have the risk of bleeding. We have experienced one case of end stage renal disease developed in a patient with hemophilia A. He first got continuous ambulatory peritoneal dialysis for 2 years and then switched to hemodialysis because of recurrent peritoneal infection. While getting peritoneal dialysis, there was no intraperitoneal or retroperitoneal hemorrhage episode. Now he gets hemodialysis through Perm catheter. During hemodialysis, he has no bleeding complication without any factor VIII supplement.
Catheters ; Dialysis* ; Factor VIII ; Hemophilia A* ; Hemorrhage ; Humans ; Incidence ; Kidney Failure, Chronic ; Korea ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Replacement Therapy

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for the end stage renal disease. The hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. A variety of symptoms are complained. The regular chest X-ray and pleural fluid examination are needed to find out this complication with vague symptoms. Although our understanding of its mechanisms is incomplete, it is apparent that the key to successful therapy is obliteration of a transdiaphragmatic route of dialysate leakage (pleuroperitoneal communication). Several treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. We have recently managed with a patient CAPD-induced massive hydrothorax with decreased amount of effluent dialysate volumes using talc pleurodesis. This patient was successfully returned to CAPD.
Fibrin ; Humans ; Hydrothorax* ; Kidney Failure, Chronic ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Pleurodesis ; Renal Replacement Therapy ; Talc ; Tetracycline ; Thorax

Chylous ascites is extravasation of lymphatic fluid and retention in the peritoneal cavity due to traurna or obstruction of the lymphatic system. Chylous ascites is very rare complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) and is associated with trauma to the lymphatics during catheter insertion in the early stage of CAPD and repeated mild trauma to the lyrnphatics during longterm dialysis. Chylous ascites in the CAPD is suspected when the drained peritoneal fluid is milky white and confirmed by demonstration of the specific components of chyle, such as elevated triglyceride and low cholesterol than plasma and should be differentiated from pseudochyle and bacterial peritonitis. We report a case of chylous ascites in a patient undergoing CAPD at 2 months later of initiation of CAPD, which was not improved by conservative management. So CAPD catheter was removed and renal replacement therapy was changed to hemodialysis.
Ascitic Fluid ; Catheters ; Cholesterol ; Chyle ; Chylous Ascites* ; Dialysis ; Humans ; Lymphatic System ; Peritoneal Cavity ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Plasma ; Renal Dialysis ; Renal Replacement Therapy ; Triglycerides

Although CAPD has become firmly established as an effective mode of renal replacement therapy, it's technique survival rate is much inferior compared to hemodialysis. To date, few patients have been maintained on this therapy for more than 10 years. To gain insights into clinical features of patients who had maintained over 10 years on CAPD in Korea, we retrospectively compared 23 patients who survived more than 10 years on PD(Long-term survivors, LTS) and 63 patients who died(Short-term survivors, STS-died, 41 patients) or changed to hemodialysis(STS-HD, 22 patients) within 4 years of initiating PD. For all patients, age, sex, diabetic history, prior cardiac events, body weight and biochemical profiles were analyzed. 1) The LTS were younger(39.7+/-12.4 vs. 47.7+/-12.3 vs. 60.9+/-13.8 years) compared with STS-HD and STS-died. 2) The LTS had less cases of DM(4.3% vs. 31.8 % vs, 61%), and had less cases of prior cardiac events(4.3% vs. 4.5% vs, 34.1%) compared with STS-HD and STS-died. Sex ratio and body weight were comparable in three groups. 3) At the initiation of PD, the LTS had higher serum creatinine(16.7mg/dL vs. 12.4mg/dL vs, 8.4mg/dL), albumin(3.53g/dL vs. 3.27g/dL vs, 3.20g/dL) levels compared with STS-HD and STS-died. 4) During 10 year CAPD treatment, LTS showed relatively stable body weight except the increase of body weight for the first 2 years in female. BUN, creatinine, protein, albumin constantly increased for the first 4 years, and then started to decline by 4 th to 6 th years. In conclusion, young age, non-diabetic history, less prior cardiac events and good nutritional status can predict the long-term survival on peritoneal dialysis. The evaluation of nutritional status and nutritional support by 4 th to 6 th years may be important in maintaining long-term survival in CAPD patients.
Body Weight ; Creatinine ; Female ; Humans ; Korea ; Nutritional Status ; Nutritional Support ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Survivors

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorder that accounts for 8-10% of patients receiving renal replacement therapy in Unites States and Europe, and approximately 2% in Korea. ADPKD patients on renal replacement therapy constitute a particular group with typical clinical charateristics and differences from other patients on renal replcement therapy. The objective of this study was to assess clinical features, morbidity, mortality and technical survival in end stage renal disease (ESRD) patients with ADPKD and compare these between each renal replacement therapy. METHODS: We retrospectively analyzed 70 ADPKD patients who received renal replacement therapy in Yonsei university medical center (Jan. 1980-Dec. 2001). RESULTS: Among a total of 70 patients, 41 patients were male and 29 patients were female. Mean age was 45.6+/-10.7 years and average time from diagnosis of ADPKD to start of renal replacement therapy was 5.1+/-5.6 years. As the initial mode of renal replacement therapy, 25 patients started on hemodialysis, 26 patients started on CAPD and 19 patients received renal transplantation. Clinical features and laboratory findings at the initiation of renal replacement therapy had no significant differences between each renal replacement therapy. Cumulative and technical survival in ESRD patients with ADPKD receiving each renal replacement therapy had no significant differences according to Kaplan-Meier. Seven patients died within study period, including 3 hemodialysis patients, 2 CAPD patients and 2 renal transplantation patients. The most common cause of death was infection followed by bleeding and malignancy. Among patients on CAPD, 10 patients had stopped CAPD because of peritonitis, hernia, ultrafiltration failure and CAPD leakage. CONCLUSION: In summary, there were no significant differences of clinical features, cumulative and technical survival between each renal replacement therapy in ADPKD patients. The most frequent reason for cessation of CAPD was peritonitis. The most common cause of death was infection in ESRD patients with ADPKD.
Academic Medical Centers ; Cause of Death ; Diagnosis ; Europe ; Female ; Hemorrhage ; Hernia ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Korea ; Male ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Polycystic Kidney, Autosomal Dominant* ; Renal Dialysis ; Renal Replacement Therapy* ; Retrospective Studies ; Ultrafiltration

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) has become firmly established as an effective mode of renal replacement therapy. The purpose of this study was to understand the clinical courses in stable CAPD patients. METHODS: Fifty-four patients were analyzed with residual renal function (RRF), adequacy of dialysis (such as weekly Kt/V), urine volume, normalized protein catabolic rate (nPCR), serum albumin and dialysate CA125. We retrospectively compared the changes of several indices at mean 5.8 months and mean 31.3 months after initiation of CAPD. RESULTS: During CAPD, body weight was significantly increased (59.6+/-10.9 vs. 62.7+/-10.6 kg, p < 0.01: 2.9 kg/year) but RRF (2.61+/-2.78 vs. 2.02+/-2.73 mL/min, p < 0.05) were significantly decreased with time. Higher RRF group showed higher nPCR (1.07+/-0.36 vs. 0.89+/-0.15 g/kg/day, p < 0.01) and higher weekly Kt/V (2.49+/-0.66 vs. 1.97+/-0.40, p < 0.01). DM group showed lower dialysate CA125 (17.34+/-6.83 vs. 28.03+/-19.08 U/mL, p < 0.05) and lower serum albumin. From the beginning, hypoalbuminemic patients showed higher 4hr (D/P)Cr (0.68+/-0.11 vs. 0.59+/-0.12, p < 0.05). Serum albumin was negatively correlated with 4hr (D/P)Cr (r=-0.308, p=0.008). CONCLUSION: Stable CAPD patients showed weight gain and decrement of RRF with time. And better RRF group showed better clinical indices (nPCR, wKt/V). We can conclude that maintaining of RRF will be important to keep better clinical courses of CAPD patients. Further study (including effect of peritonitis) will be necessary to evaluate the clinical courses of CAPD patients.
Body Weight ; Diabetes Mellitus ; Dialysis ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Replacement Therapy ; Retrospective Studies ; Serum Albumin ; Weight Gain

Hemodialysis is a major mode of renal replacement therapy in children as well as CAPD. PermCath , a dual lumen silicone atrial catheter with a dacron cuff, has been used as vascular access for hemodialysis. Between Aug. 1, 1994 and Mar. 31, 1996, 29 children had been received PermCath catheter implantation for hemodialysis in the Department of Pediatrics, Seoul National University Children's Hospital. Their medical records were analyzed retrospectively. The mean age and weight of the patients were 9.8+/-4.6years (6months-17years) and 25.7+/-11.0kg (6.2kg-40kg), respectively. For short-term use (renal function (3), renal transplantation (3) or switch to arteriovenous fistula (1) or CAPD (3). In 16 long-term (>60days) users, mean life span of the catheter was 230.8 +/-158.6days (61-591days) and the actuarial catheter survival rate at 1 year was 44 %. The mean recirculation rate checked in 5 patients was 9.6+/-4.0%. The rate of thrombotic occlusion was 1.5/1,000 catheter days. Most of the clots except one could be lysed with local urokinase therapy. The rate of catheter associated fever was 0.6/1,000 catheter days. One catheter needed revision due to malposition and local bleeding developed during the procedure. PermCath catheterization was immediate, durable and relatively safe vascular access in childhood hemodialysis.
Arteriovenous Fistula ; Catheterization* ; Catheters* ; Child ; Fever ; Hemorrhage ; Humans ; Kidney Transplantation ; Medical Records ; Pediatrics ; Peritoneal Dialysis, Continuous Ambulatory ; Polyethylene Terephthalates ; Renal Dialysis* ; Renal Replacement Therapy ; Retrospective Studies ; Seoul ; Silicones ; Survival Rate ; Thrombosis ; Urokinase-Type Plasminogen Activator

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.
Fibrin ; Humans ; Hydrothorax ; Peritoneal Dialysis, Continuous Ambulatory* ; Pleura ; Pleurodesis* ; Recurrence ; Renal Dialysis ; Renal Replacement Therapy ; Talc* ; Tetracycline ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy

Continuous ambulatory peritoneal dialysis (CAPD) is an effective renal replacement therapy for end- stage renal disease. Hydrothorax secondary to leakage of dialysate via pleuroperitoneal communication is a rare complication of CAPD. Earlier treatments of CAPD-induced hydrothorax have included pleurodesis with tetracycline, talc, fibrin, or autologous blood and surgical treatment. These procedure have made many patients switch to hemodialysis, because of the high relapse rate of the former and the invasiveness and morbidity of the latter. The talc pleurodesis with video-assisted thoracic surgery (VATS) allows not only direct visualization of potential diaphragmatic defect but also direct application of the talc to the visceral or parietal pleura. This procedure is less invasive than thoracotomy and can perform more accurate poudrage of talc than conventional methods. We have recently managed a patient CAPD-induced massive hydrothorax using thoracoscopic talc pleurodesis. This patient was successfully returned to CAPD.
Fibrin ; Humans ; Hydrothorax ; Peritoneal Dialysis, Continuous Ambulatory* ; Pleura ; Pleurodesis* ; Recurrence ; Renal Dialysis ; Renal Replacement Therapy ; Talc* ; Tetracycline ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy