A New Approach for Treating Peritonitis in Patients Over Age 50

Researchers tried a new, 3-step “Mero-PerRest” protocol when patients over age 50 developed peritonitis due to enteric (gut) microorganisms. 1). Temporary “peritoneal rest” with the catheter in place. 2). IV meropenem. 3). Meropenum as a catheter lock. Compared to 203 bouts of peritonitis treated with usual care, 217 bouts treated with the new protocol had a higher primary cure rate (90% vs. 65.3%), better PD survival (90% vs. 64.9%), and similar patient survival.

Read the abstract » | (added 2017-02-08)

Tags: Peritoneal dialysis

Using PET Results to Screen for Encapsulating Peritoneal Sclerosis (EPS)

Identifying EPS early is vital to effectively treat this rare but devastating problem. Researchers studied whether the amount of sodium removed from the dialysate (sodium sieving) could predict EPS, in a 20-year study of 161 people. Age at PD start, duration of PD, and sodium sieving were all important predictors.

Read the abstract » | (added 2017-01-09)

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Risk Factors for Encapsulating Peritoneal Sclerosis (EPS)

In a study of 703 PD patients between 1980 and 2015 at two centers, the 44 who developed EPS were more likely to have had a history of peritonitis, which rose with the duration of time on PD. The use of biocompatible PD fluid reduced the risk.

Read the abstract » | (added 2016-09-14)

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Encapsulating Peritoneal Sclerosis (EPS) Incidence and Outcomes

A new Scottish registry study found that 2.8% of PD patients between 2000 and 2007 (n=1,238) developed EPS. The rate rose from 1.1% by year 1 to 3.4% at year 3, 8.8% at year 4, 9.4% at year 5, and 22.2% by year 7. The authors note that “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.”

Read the abstract » | (added 2016-08-09)

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Mechanisms of Peritoneal Membrane Fibrosis

Glucose in PD solution activates a cell protein in mice that typically prevents fibrosis when it is not activated. This pathway leads to inflammation, growth of new blood vessels, and fibrosis—so finding a way to switch it off could lead to new drugs to help prevent these problems.

Read the abstract » | (added 2016-06-08)

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Kt/V Urea Should NOT Be Used as an Adequacy Measure for PD

Since the National Cooperative Dialysis Study, PD adequacy attention has focused on urea clearance, rather than on the more important benefit of middle molecule clearance. In this opinion piece, Dr. Joanne Bargman asserts that the PD community “made a mistake” adopting urea kinetics to the peritoneal dialysis process,” an error that continues to this day despite the lack of evidence linking Kt/V to outcomes in PD patients.

Read the abstract » | (added 2016-05-12)

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ISPD Releases Free PD Teaching Syllabus

The Nursing Liaison Committee of the International Society for Peritoneal Dialysis (ISPD) has reviewed PD training programs from around the world. An expert group has developed a consensus document to help PD nurses train patients and care partners. The free curriculum is flexible, based on adult learning principles, and includes checklists.

Read the abstract » | (added 2016-03-10)

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Surgery for EPS May Help in the Long Term

Encapsulating peritoneal sclerosis is a rare but severe side effect of long-term PD. In a small case series, four patients who developed EPS after a kidney transplant had good results, and good kidney transplant function.

Read the abstract » | (added 2016-02-09)

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CT Scans Can Help Find Encapsulating Peritoneal Sclerosis

Finding EPS early can make treatment of this devastating problem more successful. This study had experienced radiologists look at CT scan results from 18 people with confirmed EPS and 26 matched controls with it. The radiologists were blinded to who had the disorder. Peritoneal thickening, calcification, and other findings were more common in the EPS group. Some radiologists were better than others at detecting the differences that suggested EPS.

Read the abstract » | (added 2016-01-10)

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Encapsulating Peritoneal Sclerosis Increases with Time on PD

EPS is a devastating PD complication that can be lethal. An Italian clinic looked back at 30 years worth of data and found EPS prevalence rates of 2.8% overall among 920 patients: 0.4% for <2 years of PD, 3% at 2-4 years, 4% at 4-6 years, 6% at 6-8 years, 8% at 8-10 years, 75% by 12-14 years, and 67% for those with 14+ years of PD. Steroid treatment helped reduce mortality.

Read the abstract » | (added 2015-11-11)

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