PERITONEAL DIALYSIS

Intermittent peritoneal dialysis. Review of three years' experience

A study has been made of 61 periods of peritoneal dialysis (PD), in 58 patients, Each period lasted 24–36 hours (mean 27.6 hours), using 18–40 litres (mean 27.31) of dialysis fluid per period. Due to technical faults PD was unsuccesful in 5 instances. In the remaining 56 periods of PD mean reduction of blood urea and serum potassium per period were 19.85 mmol/1 and 1.96 mEq/1 respectively. Clinical improvement was observed in 60.6% of patients. Of 11 patients with pulmonary oedema, 9 improved; and one patient with gross generalized oedema responded. Among 17 patients who died in hospital, only one death could be directly attributed to PD. Peritonitis was not encountered following PD. Dialysis for a period not exceeding 36 hours is adequate to avert life-threatening complications of renal failure in most patients. This “short-period” PD will be advantageous in developing countries with limited facilities.

Abdominal wall and inguinal hernias in continuous ambulatory peritoneal dialysis patients

This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.

Peritoneal dialysis in children. Review of 8 years' experience

During the years 1968-75, 59 periods of peritoneal dialysis were performed on 44 children aged from 2 days to 17 years. The commonest complication was peritoneal infection, which affected 68% of those under 2 years and 30% of older children. This was satisfactorily treated in all but one case which was due to Candida albicans. The use of combined intramuscular and intraperitoneal gentamicin therapy is described. 2 patients died as a result of massive intraperitoneal haemorrhage and one had a nonfatal intestinal perforation. In experienced hands peritoneal dialysis is a convenient, effective, and reasonably safe way of treating acute renal failure; it is best performed in centres capable of handling complex metabolic problems and investigating and treating the underlying renal disease.

Peritoneal infections in patients on long-term peritoneal dialysis before and after human cadaveric renal transplantation

Long-term peritoneal dialysis was carried out on 38 patients awaiting human cadaveric renal transplantation. Fifty-eight per cent of patients developed infection before transplantation and 41% of those requiring dialysis after transplantation became infected. Infection did not usually occur before the third day of dialysis and 26% of patients developed their first episode of infection in the first week. Almost 50% of patients had only a single episode of infection. The overall rate of infection per 100 patient days of dialysis was 1.23 before transplantation and 4.17 after transplantation. The commonest infecting organisms were Staph aureus and Staph albus and these organisms were frequently isolated from the skin around the dialysis catheter before the infection occurred. Gram-negative infections were more commonly seen after transplantation.Sixty-five per cent of the infections responded to a single course of antibiotic therapy administered in the dialysis fluid. After transplantation Gram-negative infections were usually associated with severe complications and were a major cause of death. Peritoneal dialysis is a convenient way of maintaining patients with chronic renal failure before human cadaveric renal transplantation, and infection, although common is not inevitable, provided precautions are taken to ensure that the dialysis procedure is carried out using aseptic techniques and prophylactic therapy is applied to the skin around the dialysis catheter.

Absorption of antibiotics during peritoneal dialysis in patients with renal failure

Cloxacillin, ampicillin, cephaloridine, kanamycin, and polymyxin B were administered singly in the dialysis fluid of patients having peritoneal dialysis for chronic renal failure. Therapeutic blood levels could be attained with all the drugs by the end of 12 hours of dialysis, using a concentration in the dialysis fluid which did not produce any local toxic symptoms. Absorption rates across the peritoneum were higher for cephaloridine, ampicillin, and cloxacillin than for kanamycin and polymyxin B. The serum half-lives after termination of dialysis were in excess of 11 hours, except that for cloxacillin which had a half life of about 2.5 hours.