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Wang AYM, Pasch A, Wong CK, Chu IMT, Tang TK, Chu J, Cheuk-Ying Fong C, Yau YY, Lo WK. Long-Term Effects of Sevelamer on Vascular Calcification, Arterial Stiffness, and Calcification Propensity in Patients Receiving Peritoneal Dialysis: The Randomized Pilot SERENE (Sevelamer on Vascular Calcification, Arterial Stiffness) Trial. Kidney Med 2021; 4:100384. [PMID: 35243302 PMCID: PMC8861951 DOI: 10.1016/j.xkme.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Rationale & Objective There is a concern regarding increased risk of vascular calcification with the use of calcium-based phosphorus binders. This study aimed to compare the effects of sevelamer used as a second-line, low-dose therapy with calcium-based phosphorus binders with those of sevelamer used as a first-line, high-dose therapy on coronary artery and heart valve calcification, aortic pulse wave velocity (PWV), and calcification propensity over 2 years in patients with hyperphosphatemia receiving peritoneal dialysis (PD). Study Design A 2-year-long prospective, multicenter, open-label, randomized pilot study. Setting & Participants Prevalent patients with hyperphosphatemia receiving PD from 2 university-affiliated hospitals in Hong Kong. Interventions The patients were randomized to receive sevelamer either as a first-line therapy at a high dose of 800 mg thrice daily (can titrate up to 1,200 mg thrice daily as required) or a second-line therapy at a low dose of 400 mg thrice daily with calcium carbonate to achieve a serum phosphorus target of ≤5.5 mg/dL. Outcomes The primary endpoints were changes in coronary artery calcium score and aortic PWV over 104 weeks. The secondary endpoints were changes in heart valve calcium scores, calcification propensity measure, and biochemical parameters of chronic kidney disease–mineral bone disease over 104 weeks. Results Among 60 prevalent patients receiving PD, with a mean age of 53 ± 10 years and with 57% men, changes in the coronary artery calcium score (median [interquartile range], 225 [79-525] vs 223 [56-1,212], respectively; P = 0.21), aortic PWV (mean ± standard error, 0.3 ± 0.1 vs 0.8 ± 0.2 m/s, respectively; P = 0.31), heart valve calcium score, maturation or transformation time, serum calcium levels, and phosphorus levels over 104 weeks were similar for the second-line, low-dose and first-line, high-dose sevelamer groups. Alkaline phosphatase and intact parathyroid hormone levels increased and low-density lipoprotein cholesterol decreased in both the groups, with no significant between-group differences. Limitations The sample size was small, and the dropout rates were relatively high. Conclusions Low-dose sevelamer used as a second-line therapy for hyperphosphatemia in combination with a calcium-based phosphorus binder had similar effects on vascular calcification, valvular calcification, and arterial stiffness compared with high-dose sevelamer used as a first-line therapy. This approach may be considered in resource-constrained countries to minimize calcium loading. Funding The study was supported by a competitive grant from SK Yee Medical Foundation. T50 assays and other biochemical assays were funded by a research grant from Sanofi Renal Corporation. Trial Registration NCT00745589.
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Chan NH, Lee SY, Cheng NHY, Wong HY, Lo WK, Lung DC. Hospital infection control best practice: Five essential elements to successfully minimize healthcare-associated COVID-19. Infect Prev Pract 2020; 3:100110. [PMID: 34316572 PMCID: PMC7837126 DOI: 10.1016/j.infpip.2020.100110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- N H Chan
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - S Y Lee
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - N H Y Cheng
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - H Y Wong
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - W K Lo
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - D C Lung
- Infection Control Team, Queen Elizabeth Hospital, Hong Kong Special Administrative Region.,Department of Pathology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
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Abstract
Penetration of peritoneal dialysis (PD) varies tremendously across the world. It ranges from about 80% in Hong Kong and Mexico to just a few percentage points in the United States, Japan, and Germany. While PD is growing in China, India, and some Eastern European and South American countries, it is declining in many European and North American countries. In terms of outcomes, the survival of PD patients is generally comparable to that of hemodialysis (HD) patients and better than that of HD patients during the first few years on dialysis. According to the U.S. Renal Data System, survival of patients on PD has been improving faster than that of patients on HD. In terms of cost, PD is usually cheaper than HD. Hence, declining PD utilization is unjustified. Work is required to identify and overcome negative factors such as physician bias, unfair medical reimbursement systems, and poor patient education.
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Affiliation(s)
- Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong SAR, PR China
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So MH, Lo WK. Giant perivascular spaces: an uncommon cause of obstructive hydrocephalus. Hong Kong Med J 2020; 25:491.e1-491.e2. [PMID: 32127504 DOI: 10.12809/hkmj197964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M H So
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - W K Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong
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Affiliation(s)
- Wai-Kei Lo
- Division of Nephrology, Department of Medicine, Queen Mary and Tung Wah Hospitals, The University of Hong Kong
| | - Tak-Mao Chan
- Division of Nephrology, Department of Medicine, Queen Mary and Tung Wah Hospitals, The University of Hong Kong
| | - Sing-Leung Lui
- Division of Nephrology, Department of Medicine, Queen Mary and Tung Wah Hospitals, The University of Hong Kong
| | - Fu-Keung Li
- Division of Nephrology, Department of Medicine, Queen Mary and Tung Wah Hospitals, The University of Hong Kong
| | - Ignatius K.-P. Cheng
- Division of Nephrology, Department of Medicine, Queen Mary and Tung Wah Hospitals, The University of Hong Kong
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Ng SY, Cheng SW, Chu WL, Lui SL, Lo WK. Screening by Trained Nurses for Peripheral Vascular Disease in Continuous Ambulatory Peritoneal Dialysis Patients with and without Diabetes. Perit Dial Int 2020. [DOI: 10.1177/089686080302302s28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We studied the effectiveness of a screening program for peripheral vascular disease (PVD) carried out by trained renal nurses in patients with and without diabetes on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods We recruited 30 stable diabetic and 30 stable non diabetic CAPD patients into this cross-sectional study. Trained renal nurses measured the patients’ ankle-to-brachial systolic pressure index (ABI) using a Doppler ultrasound machine and their foot vibration perception (VPT) using a biothesiometer, and administered a questionnaire on foot symptoms. An ABI < 1.0 was regarded as abnormal and suggestive of the presence of PVD. An ABI < 0.7 or > 1.3 was regarded as severely abnormal. Findings for VPT were classified as normal or abnormal. Patients were then followed for 1 year for any overt development of clinical PVD, leg complications, and other vascular complications and for clinical outcome. Results The mean age of the patients was 63 ± 9 years, and the ratio of men to women was 1:1.3. An abnormal ABI was seen in 22 patients (37%). The questionnaire detected clinical PVD symptoms in 3 patients. Abnormal ABI and VPT findings were more frequent in diabetic patients. After 12 months of follow-up, patients with an abnormal ABI (and particularly those with a severely abnormal ABI) were more likely to develop leg complications and any type of cardiovascular disease than were patients with a normal ABI. Foot vibration perception had no predictive value on subsequent development of leg complications. When risk factors including age, ABI, and VPT were analyzed by logistic regression, only ABI was a significant independent predictor of subsequent lower-limb vascular complications [odds ratio (OR): 21.0; 95% confidence interval (CI): 2.35 to 187.0; p = 0.00064]. The OR for moderately abnormal ABI was 13.0 (95% CI: 1.015 to 166.3); for severely abnormal ABI, it was 27.4 (95% CI: 2.35 to 187.0, p = 0.0045). Conclusions Measurement of ABI by Doppler ultrasound is a useful and effective screening test for PVD in CAPD patients. In this study, VPT was not shown to be predicative of future leg complications, indicating that peripheral neuropathy plays a less important role in the development of such complications. Our results proved that trained renal nurses can play an active role in detecting foot problems in renal patients by ABI measurement.
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Affiliation(s)
- Suk-Yi Ng
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Suk-Wai Cheng
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Wai-Ling Chu
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Sing-Leung Lui
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
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Lo WK, Cheng IKP, Lui SL, Chan TM, Li FK, Lai KN. Is Target Kt/V and Patient Survival Different between Asian and Western Continuous Ambulatory Peritoneal Dialysis (Capd) Patients? Perit Dial Int 2020. [DOI: 10.1177/089686089901902s05] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wai-Kei Lo
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
| | - Ignatius K.-P. Cheng
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
| | - Sing-Leung Lui
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
| | - Tak-Mao Chan
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
| | - Fu-Keung Li
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
| | - Kar-Neng Lai
- Division of Nephrology; Queen Mary and Tung Wah Hospitals, Department of Medicine, The University of Hong Kong
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Lo WK, Li FK, Choy CB, Cheng SW, Chu WL, Ng SY, Lo CY, Lui SL. A Retrospective Survey of Attitudes toward Acceptance of Peritoneal Dialysis in Chinese End-Stage Renal Failure Patients in Hong Kong—From a Cultural Point of View. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s56] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We undertook to study the attitudes toward dialysis of patients approaching end-stage renal failure and to analyze those attitudes from a cultural perspective. Setting The study was performed in the pre-dialysis clinic of a tertiary referral renal center. Patients All patients of Chinese ethnic origin seen in the pre-dialysis clinic from 1995 to 2000 for assessment of dialysis therapy were included. Method We performed a retrospective analysis of patient records with regard to attitudes of the patients toward dialysis, reasons for those attitudes, and factors that could lead to a subsequent change in attitude. Results We assessed 462 patients over the 6-year period. Their mean age was 65.5 ± 13.3 years, and 43.9% of the patients had diabetes. Peritoneal dialysis (PD) was offered to 74% of the patients, and hemodialysis (HD) to 3.9%. Among the patients offered PD, only 44% accepted dialysis. After counselling, 54% of the patients who originally declined PD ultimately accepted it. The major reasons for refusing PD were the ideas of “having lived long enough” and “lack of family support.” Most other reasons could be overcome by counselling. Only a minority of patients demanded hemodialysis. Conclusions Declining an offer of dialysis was common. Counselling helped patients to accept PD. Certain cultural elements that hindered acceptance of dialysis were involved in the ideas of “having lived long enough” and “lack of family support.” Those cultural elements should be tackled more specifically during counselling.
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Affiliation(s)
- Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Fu-Keung Li
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Cindy B.Y. Choy
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Wai Cheng
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Ling Chu
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Yee Ng
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Chi-Yuen Lo
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sing-Leung Lui
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
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Cheng IK, Chan CY, Cheng SW, Poon JF, Ji YL, Lo WK, Chan DT. A Randomized Prospective Study of the Cost -Effectiveness of the Conventional Spike, O-Set, and Uvxd Techniques in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089401400311] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the clinical outcome and cost-effectiveness of three techniques for continuous ambulatory peritoneal dialysis (CAPD): the conventional spike technique (C), the O-set (0), and UVXD (U, ultraviolet irradiation connection box). Design A randomized and prospective comparison of three CAPD techniques. Setting A tertiary referral and a satellite dialysis center.. Patients: One hundred patients with end-stage renal failure between 10 and 70 years of age, with good handeye coordination and not anticipated to receive a living related transplant within 6 months. Interventions Patients were randomized by referral to a table of random numbers to perform one of the three CAPD techniques. Main Outcome Measures Training time, details of peritonitis and exit-site infection (ESI) including the costs of antibiotic treatment, outpatient visits, hospital stays, technique, and patient survival were analyzed after a minimum follow-up period of one year. Results There were 38, 31, and 31 patients in groups C, 0, and U, respectively, and the total observation periods were 838,802, and 745 patient-months, respectively. The peritonitis rates for C, 0, and U were 21.5, 30.8, and 29.8 patient-months/episode, respectively. The corresponding ESI rates were 16.4,14.9, and 24 patient-months/ episode, respectively. When the time from the commencement of CAPD to the first infection was expressed using the Kaplan-Meier life table analysis, 39.5%, 67.7%, and 61.3% of patients in Groups C, 0, and U were free from peritonitis at one year (p = 0.088). The corresponding figures for ESI were 52.6%, 48.4%, and 61.3% (p = 0.35). There was no significant difference in technique survival in the three treatment groups. An analysis of the costs related to the use of antibiotics, outpatient visits, and hospital stays necessary for the treatment of peritonitis and ESI and those related to training time, additional equipment, and consumables required for the three CAPD techniques showed that, overall, the cost in 0 was the lowest, followed by U and C (U.S. $158, $170, and $179 per patient-month, respectively). Conclusion It was concluded that the O-set is a more cost-effective CAPD technique than UVXD, while both are more cost-effective than the conventional spike technique.
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Affiliation(s)
- Ignatius K.P. Cheng
- Department of Medicine, University of Hong Kong
- Renal Unit, Tung Wah Hospital, Hong Kong
- Aberdeen Renal Dialysis Centre, Hong Kong
| | | | | | | | - Yu-Lian Ji
- Department of Medicine, University of Hong Kong
| | - Wai-Kei Lo
- Department of Medicine, University of Hong Kong
- Renal Unit, Tung Wah Hospital, Hong Kong
- Aberdeen Renal Dialysis Centre, Hong Kong
| | - Daniel T.M. Chan
- Department of Medicine, University of Hong Kong
- Renal Unit, Tung Wah Hospital, Hong Kong
- Aberdeen Renal Dialysis Centre, Hong Kong
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Lo WK, Chan KT, Leung AC, Pang SW, Tse CY. Sclerosing Peritonitis Complicating Prolonged Use of Chlorhexidine in Alcohol in the Connection Procedure for Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089101100214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiologies. We have documented 14 cases of SP in 18 patients who had used chlorhexidine in alcohol (ChA) in the connection procedure for CAPD. Thirteen died. Nine of the 14 patients had been transferred to hemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer -even the 5 who were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They presented at around 5 years (30–80 months) after commencement of CAPD. Most deaths were related to intestinal obstruction. Four other patients with a comparable duration of ChA exposure were continued on CAPD with the Travenol Spike System (TSS), without further exposure to ChA. They were all asymptomatic of SP after 9–12 months. Comparing the 2 groups of asymptomatic patients, those transferred to TSS had a much better outcome after 9 months than those transferred to HD or renal transplantation (P=0.0476). We suggest that ChA is the main cause of SP in our patients and that continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD to prevent the progression of SP.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine and Department of Pathologyl, United Christian Hospital, Hong Kong
| | - Kwok Tat Chan
- Renal Unit, Department of Medicine and Department of Pathologyl, United Christian Hospital, Hong Kong
| | - Anthony C.T. Leung
- Renal Unit, Department of Medicine and Department of Pathologyl, United Christian Hospital, Hong Kong
| | - Siu-Wah Pang
- Renal Unit, Department of Medicine and Department of Pathologyl, United Christian Hospital, Hong Kong
| | - Chun-Yan Tse
- Renal Unit, Department of Medicine and Department of Pathologyl, United Christian Hospital, Hong Kong
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Lo WK, Lui SL, Li FK, Choy BY, Lam MF, Tse KC, Yip TP, Ng FS, Lam SC, Chu WL, Cheng SW. A Prospective Randomized Study on Three Different Peritoneal Dialysis Catheters. Perit Dial Int 2020. [DOI: 10.1177/089686080302302s26] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveWe compared outcomes for catheters with different configurations: conventional straight, swan-neck straight tip, and swan-neck curled tip.DesignThe study was conducted as a prospective randomized controlled trial in the continuous ambulatory peritoneal dialysis (CAPD) unit of a university center.Patients and MethodsWe randomized 93 new regular CAPD patients without prior peritoneal dialysis (PD) catheter insertion to receive a conventional straight, double-cuffed catheter (CS), a swan-neck straight catheter (SNC), or a swan-neck curled tip catheter (SNC) in 2:1:1 ratio.ResultsThe exit-site infection (ESI) rate was slightly lower with swan-neck catheters as compared with straight catheters, but the difference was not statistically significant. The peritonitis rate and overall catheter survival were similar. In Staphylococcus aureus nasal non carriers as compared with carriers, ESI-free catheter survival was significantly better with swan-neck catheters ( p = 0.0302 and p = 0.82 respectively). As compared with SC catheters, SNC catheters had a significantly higher migration rate ( p = 0.022).ConclusionsSwan-neck catheters were associated with a slightly better ESI rate, but SNC catheters are not routinely recommended because of a high migration rate. The SNS catheter is therefore recommended as the first-line catheter of choice, particularly in populations with a low rate of S. aureus nasal carriage.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Sing-Leung Lui
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Fu-Keung Li
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Bo-Ying Choy
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Man-Fai Lam
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kai-Chung Tse
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Terence P.S. Yip
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Flora S.K. Ng
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Ching Lam
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Ling Chu
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Suk-Wai Cheng
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
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Affiliation(s)
- Wai-Kei Lo
- Division of Nephrology Dalton Research Center Dialysis Clinics Inc. Columbia, Missouri, U.S.A
- Department of Internal Medicine University of Missouri-Columbia
| | - Barbara F. Prowant
- Division of Nephrology Dalton Research Center Dialysis Clinics Inc. Columbia, Missouri, U.S.A
- Department of Internal Medicine University of Missouri-Columbia
| | - Susan B. Gamboa
- Division of Nephrology Dalton Research Center Dialysis Clinics Inc. Columbia, Missouri, U.S.A
- Department of Internal Medicine University of Missouri-Columbia
| | - Harold L. Moore
- Division of Nephrology Dalton Research Center Dialysis Clinics Inc. Columbia, Missouri, U.S.A
- Department of Internal Medicine University of Missouri-Columbia
| | - Karl D. Nolph
- Division of Nephrology Dalton Research Center Dialysis Clinics Inc. Columbia, Missouri, U.S.A
- Department of Internal Medicine University of Missouri-Columbia
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Abstract
We report 3 patients on continuous ambulatory peritoneal dialysis (CAPD) who developed reversible ultrafiltration failure secondary to retroperitoneal leakage. The patients presented with pulmonary edema and fluid overload following a sudden onset of ultrafiltration failure on maintenance CAPD. There was no localized edema, suggesting peritoneal leakage in the abdominal wall or the perineum. Radiological examination showed no migration of the Tenckhoff catheter. Leakage of dialysate into the retroperitoneal space was only revealed by computed tomographic (CT) peritoneography. These patients were then treated with intermittent peritoneal dialysis twice weekly. After repeated CT peritoneography showing complete resolution of the leakage, they successfully resumed CAPD treatment 2 months later, without ultrafiltration problems. Our finding suggests that retroperitoneal leakage could be one of the uncommon, yet reversible, causes of acute ultrafiltration failure that can be diagnosed with CT peritoneography.
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Affiliation(s)
- Man-Fai Lam
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai-Kei Lo
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ferdinand S.K. Chu
- Department of Medicine, Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Fu-Keung Li
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Terence P.S. Yip
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kai-Chung Tse
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tak-Mao Chan
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kar-Neng Lai
- Nephrology Division, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C, Kawanishi H, Blake PG. Guideline on Targets for Solute and Fluid Removal in Adult Patients on Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600502] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Yip T, Tse KC, Lam MF, Tang S, Li FK, Choy BY, Lui SL, Chan TM, Lai KN, Lo WK. Risk Factors and Outcomes of Extended-Spectrum Beta-Lactamase-Producing E. Coli Peritonitis in Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080602600213] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined. Results Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coli peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12). Conclusion Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
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Affiliation(s)
- Terence Yip
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Kai-Chung Tse
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Man-Fai Lam
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Sydney Tang
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Fu-Keung Li
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Bo-Ying Choy
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Sing-Leung Lui
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Tak-Mao Chan
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Kar-Neng Lai
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
| | - Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong
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Lo WK, Mahboobani NR, Siu Y. Gastrointestinal: Phlebosclerotic colitis: A rare but increasingly recognized cause of ischemic colitis with telltale imaging features. J Gastroenterol Hepatol 2017; 32:1792. [PMID: 29024011 DOI: 10.1111/jgh.13741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- W K Lo
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
| | - N R Mahboobani
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - Ywd Siu
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong
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Cheng VCC, Wong SC, Wong IWY, Chau PH, So SYC, Wong SCY, Chen JHK, Lee WM, Tai JWM, Chau CH, Lo WK, Yuen KY. The challenge of patient empowerment in hand hygiene promotion in health care facilities in Hong Kong. Am J Infect Control 2017; 45:562-565. [PMID: 28131422 DOI: 10.1016/j.ajic.2016.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 11/17/2022]
Abstract
Patient empowerment programs in hand hygiene were implemented in 2 extended-care hospitals. Of the 223 patients approached by the infection control nurses, 167 patients (74.9%) participated in the program. A positive response from the health care workers was reported in 70 (93.3%) of 75 patients who reminded health care workers to clean hands as part of the empowerment program. A significant increase in volume of alcohol-based handrub consumption was observed during the intervention period compared with baseline.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Shuk-Ching Wong
- Infection Control Team, Tung Wah Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Ivan W Y Wong
- Infection Control Team, Grantham Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Pui-Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Y C So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Jonathan H K Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Wan-Mui Lee
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Josepha W M Tai
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Chi-Hung Chau
- Infection Control Team, Grantham Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Wai-Kei Lo
- Infection Control Team, Tung Wah Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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Li PH, Cheng VCC, Yip T, Yap DYH, Lui SL, Lo WK. Epidemiology and Clinical Characteristics of Acinetobacter Peritoneal Dialysis-Related Peritonitis in Hong Kong-With a Perspective on Multi-Drug and Carbapenem Resistance. Perit Dial Int 2016; 37:177-182. [PMID: 27680764 DOI: 10.3747/pdi.2016.00123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/09/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Acinetobacter spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on Acinetobacter peritonitis have been scarce. In view of the rising concern of carbapenem-resistant Acinetobacter (CRA) and multidrug-resistant Acinetobacter (MDRA) infections, we conducted this study on the incidence of Acinetobacter peritonitis and the impact of CRA and MDRA on its outcome. ♦ METHODS: We retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with Acinetobacter PD-related peritonitis. ♦ RESULTS: Out of 2,389 episodes of peritonitis, there were 66 episodes (3%) of Acinetobacter peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, p = 0.006) and carbapenem resistance (OR = 18.2, p = 0.049) were significantly associated with higher rates of treatment failure. ♦ CONCLUSION: Both carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of Acinetobacter isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.
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Affiliation(s)
- Philip Hei Li
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Terence Yip
- Department of Medicine, Tung Wah Hospital, Hong Kong
| | - Desmond Y H Yap
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | | | - Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong
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Chan PH, Huang D, Yip PS, Hai J, Tse HF, Chan TM, Lip GY, Lo WK, Siu CW. Ischaemic stroke in patients with atrial fibrillation with chronic kidney disease undergoing peritoneal dialysis. Europace 2015; 18:665-71. [DOI: 10.1093/europace/euv289] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 08/03/2015] [Indexed: 01/04/2023] Open
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Ho PL, Leung SMH, Chow KH, Tse CWS, Cheng VCC, Tse H, Mak SK, Lo WK. Carriage niches and molecular epidemiology of Staphylococcus lugdunensis and methicillin-resistant S. lugdunensis among patients undergoing long-term renal replacement therapy. Diagn Microbiol Infect Dis 2014; 81:141-4. [PMID: 25498337 DOI: 10.1016/j.diagmicrobio.2014.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
We collected nasal, axilla, and groin swabs from 252 adult patients from 2 nephrology centers in Hong Kong. Staphylococcus lugdunensis carriage was detected in 51.6% patients (groin, 39.3%; axilla, 19.8%; nose, 17.9%). The carriage rates of methicillin-sensitive S. lugdunensis and methicillin-resistant S. lugdunensis (MRSL) were 46.0% and 8.3%, respectively. Independent risk factors for S. lugdunensis carriage included male sex (odds ratio [OR], 4.4), hemodialysis (OR, 2.2), and aged 18-50years (OR, 2.4). The isolates belonged to 10 pulsotype clusters (n=129) and 8 singletons (n=8). All MRSL and most gentamicin- and tetracycline-resistant strains were found in a predominating sequence type 3 clone, designated HKU1, which accounted for 51.8% of all colonizing S. lugdunensis strains. The 21 MRSL isolates had SCCmec type V (n=18), type IV (n=2), and type I (n=1). The finding highlights the potential for dissemination of multidrug resistance through successful S. lugdunensis clones.
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Affiliation(s)
- Pak-Leung Ho
- Carol Yu Centre for Infection and Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China.
| | - Sammy Man-Him Leung
- Carol Yu Centre for Infection and Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Kin-Hung Chow
- Carol Yu Centre for Infection and Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | - Vincent Chi-Chung Cheng
- Carol Yu Centre for Infection and Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Herman Tse
- Carol Yu Centre for Infection and Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Siu-Ka Mak
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong, China
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Cheuk YY, Lo WK, Chan SK, Wong CW. Pancreatic Neuroendocrine Tumour Causing Chronic Diarrhoea: Radiological-Pathological Correlations. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1412150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wang AYM, Fang F, Chan J, Wen YY, Qing S, Chan IHS, Lo G, Lai KN, Lo WK, Lam CWK, Yu CM. Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial. J Am Soc Nephrol 2014; 25:175-86. [PMID: 24052631 PMCID: PMC3871774 DOI: 10.1681/asn.2013010103] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Vitamin D seems to protect against cardiovascular disease, but the reported effects of vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebo-controlled trial to determine whether oral activated vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV hypertrophy. Subjects with echocardiographic criteria of LV hypertrophy were randomly assigned to receive either oral paricalcitol (1 μg) one time daily (n=30) or matching placebo (n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volume, echocardiographic measures of systolic and diastolic function, biochemical parameters of mineral bone disease, and measures of renal function. Change in LV mass index did not differ significantly between groups (median [interquartile range], -2.59 [-6.13 to 0.32] g/m(2) with paricalcitol versus -4.85 [-9.89 to 1.10] g/m(2) with placebo). Changes in LV volume, ejection fraction, tissue Doppler-derived measures of early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However, paricalcitol treatment significantly reduced intact parathyroid hormone (P<0.001) and alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral paricalcitol (1 μg one time daily) significantly improved secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.
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Affiliation(s)
| | - Fang Fang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - John Chan
- Department of Diagnostic Radiology, Hong Kong Sanatorium Hospital, Hong Kong
| | - Yue-Yi Wen
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Shang Qing
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | | | - Gladys Lo
- Department of Diagnostic Radiology, Hong Kong Sanatorium Hospital, Hong Kong
| | - Kar-Neng Lai
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong; and
| | - Christopher Wai-Kei Lam
- Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau
| | - Cheuk-Man Yu
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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Zuo ML, Yue WS, Yip T, Ng F, Lam KF, Yiu KH, Lui SL, Tse HF, Siu CW, Lo WK. Prevalence of and Associations With Reduced Exercise Capacity in Peritoneal Dialysis Patients. Am J Kidney Dis 2013; 62:939-46. [DOI: 10.1053/j.ajkd.2013.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 05/21/2013] [Indexed: 11/11/2022]
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Cheng VCC, Tai JWM, Ng MLM, Chan JFW, Wong SCY, Li IWS, Chung HP, Lo WK, Yuen KY, Ho PL. Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong. Chin Med J (Engl) 2012; 125:3450-3457. [PMID: 23044305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci (VRE) endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intra- and inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. METHODS We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing (MLST) was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. RESULTS Between November 26 and December 17, 2011, 11 patients (1 exogenous case and 10 secondary cases) in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% (10/361). There were 8 males and 3 females with a median age of 78 years (range, 40 - 87 years). MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay (P < 0.001), a higher proportion with chronic cerebral and cardiopulmonary conditions (P = 0.001), underlying malignancies (P < 0.001), and presence of urinary catheter (P < 0.001), wound or ulcer (P < 0.001), and a greater proportion of these patients were receiving β-lactam/β-lactamase inhibitors (P = 0.009), carbapenem group (P < 0.001), fluoroquinolones (P = 0.003), or vancomycin (P = 0.001) when compared with the controls. CONCLUSION Extensive contact tracing and screening with a "search-and-confine" strategy was a successful tool for outbreak control in our healthcare region.
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Affiliation(s)
- Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Ma MKM, Yap DYH, Yip TPS, Lui SL, Lo WK. Staphylococcus aureus peritonitis in two peritoneal dialysis patients: an uncommon complication of peripheral intravenous catheter infection. Perit Dial Int 2012; 32:573-4. [PMID: 22991021 DOI: 10.3747/pdi.2011.00293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yip T, Wan W, Hui PC, Lui SL, Lo WK. Severe hyperkalemia in a peritoneal dialysis patient after consumption of salt substitute. Perit Dial Int 2012; 32:206-8. [PMID: 22383720 DOI: 10.3747/pdi.2011.00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Terence Yip
- Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, PR China.
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Affiliation(s)
- Terence Yip
- Department of Medicine Tung Wah Hospital Hong Kong
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Yip T, Tse KC, Ng F, Hung I, Lam MF, Tang S, Lui SL, Lai KN, Chan TM, Lo WK. Clinical course and outcomes of single-organism Enterococcus peritonitis in peritoneal dialysis patients. Perit Dial Int 2011; 31:522-8. [PMID: 21532006 DOI: 10.3747/pdi.2009.00260] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Enterococci are part of the normal flora of the gastrointestinal tract. They can cause enteric peritonitis, which is a serious complication of peritoneal dialysis (PD). However, the clinical course and outcome of PD-related Enterococcus peritonitis remains unclear. METHODS We reviewed all Enterococcus peritonitis episodes occurring in our dialysis unit from 1995 to 2009. RESULTS During the study period, 1421 episodes of peritonitis were recorded. Of 29 episodes (2.0%) that were attributable to single-organism Enterococcus, 12 episodes were caused by E. faecalis; 9, by E. faecium; and the remaining 8, by other Enterococcus species. The overall rate of ampicillin resistance was 41.4%. Recent use of antibiotics was associated with the development of ampicillin-resistant Enterococcus (ARE) peritonitis (hazard ratio: 12.53; p = 0.04). The primary response rate of Enterococcus peritonitis was significantly higher than that of Escherichia coli peritonitis (89.7% vs. 69.9%, p = 0.038), but the primary response rate was not significantly lower for ARE peritonitis than for ampicillin-susceptible Enterococcus (ASE) peritonitis (83.3% vs. 94.1%, p = 0.553). However, significantly more patients with ARE had received vancomycin (83.3% vs. 23.5%, p = 0.003), with a longer mean duration of vancomycin treatment (11.8 ± 6.9 days vs. 3.7 ± 6.8 days, p = 0.005). CONCLUSIONS Recent use of antibiotics was a risk factor for the development of ARE peritonitis. Outcomes in ASE and ARE peritonitis were similar, but vancomycin was required during treatment for ARE peritonitis, in turn possibly predisposing the patients to infections caused by vancomycin-resistant organisms.
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Affiliation(s)
- Terence Yip
- Dr. Lee Iu Cheung Memorial Renal Research Centre, Tung Wah Hospital, The University Department of Medicine, The University of Hong Kong, Hong Kong SAR, PR China.
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Li PKT, Cheung WL, Lui SL, Blagg C, Cass A, Hooi LS, Lee HY, Locatelli F, Wang T, Yang CW, Canaud B, Cheng YL, Choong HL, de Francisco AL, Gura V, Kaizu K, Kerr PG, Kuok UI, Leung CB, Lo WK, Misra M, Szeto CC, Tong KL, Tungsanga K, Walker R, Wong AKM, Yu AWY. Increasing home based dialysis therapies to tackle dialysis burden around the world: a position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis. Nephrology (Carlton) 2011; 16:53-6. [PMID: 21175978 DOI: 10.1111/j.1440-1797.2010.01418.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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Lee JSW, Kwok T, Chui PY, Ko FWS, Lo WK, Kam WC, Mok HLF, Lo R, Woo J. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr 2009; 29:453-8. [PMID: 19910085 DOI: 10.1016/j.clnu.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Continuous pump feeding is often used to reduce aspiration risk in older patients on tube feeding, but its effectiveness in preventing aspiration pneumonia is unproven. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients. METHODS One hundred and seventy eight elderly patients from three convalescence hospitals and one infirmary, on nasogastric tube feeding, were randomly assigned to have intermittent bolus (bolus) or continuous pump (pump) feeding for 4weeks. The primary outcome was the incidence of pneumonia. The secondary outcome was mortality. RESULTS Eighty five subjects were randomized into the pump group and 93 in the bolus group. The groups were comparable in age, nutritional and functional status, co-morbidities and history of pneumonia, except that there were more women in the pump group. Within 4weeks, 15 subjects (17.6%) in the pump group and 18 (19.4%) in the bolus group developed pneumonia. Seven subjects (8.2%) in pump group and 13 subjects (14.0%) in bolus group died. There was no significant difference in either pneumonia or death rates between the two groups. CONCLUSION Continuous pump feeding did not significantly affect the rates of pneumonia or mortality in tube-fed older hospital patients when compared with intermittent bolus feeding.
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Affiliation(s)
- J S W Lee
- Department of Medicine & Geriatrics, Shatin Hospital, Hong Kong SAR, China
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Affiliation(s)
- Wai-Kei Lo
- President International Society for Peritoneal Dialysis
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Lo WK. Peritoneal dialysis utilization and outcome: what are we facing? Perit Dial Int 2007; 27 Suppl 2:S42-7. [PMID: 17556327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Penetration of peritoneal dialysis (PD) varies tremendously across the world. It ranges from about 80% in Hong Kong and Mexico to just a few percentage points in the United States, Japan, and Germany. While PD is growing in China, India, and some Eastern European and South American countries, it is declining in many European and North American countries. In terms of outcomes, the survival of PD patients is generally comparable to that of hemodialysis (HD) patients and better than that of HD patients during the first few years on dialysis. According to the U.S. Renal Data System, survival of patients on PD has been improving faster than that of patients on HD. In terms of cost, PD is usually cheaper than HD. Hence, declining PD utilization is unjustified. Work is required to identify and overcome negative factors such as physician bias, unfair medical reimbursement systems, and poor patient education.
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Affiliation(s)
- Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong SAR, PR China.
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Wan SH, Lau H, Patil NG, Lo WK, Lui SL. Peritoneal computed tomography: a diagnostic tool for genital oedema in patients on peritoneal dialysis. Hong Kong Med J 2007; 13:82-3. [PMID: 17277399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- S H Wan
- Department of Medicine, Queen Mary Hospital and Tung Wah Hospital, University of Hong Kong, Pokfulam, Hong Kong
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Lo WK, Bargman JM, Burkart J, Krediet RT, Pollock C, Kawanishi H, Blake PG. Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int 2006; 26:520-2. [PMID: 16973505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- Wai-Kei Lo
- Department of Medicine , ting Wah Hospital, Hong Kong.
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Yip T, Tse KC, Lam MF, Tang S, Li FK, Choy BY, Lui SL, Chan TM, Lai KN, Lo WK. Risk factors and outcomes of extended-spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients. Perit Dial Int 2006; 26:191-7. [PMID: 16623424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
OBJECTIVE To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined. RESULTS Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coil peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12). CONCLUSION Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
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Affiliation(s)
- Terence Yip
- Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong.
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Abstract
Early serum parameters predicting patient outcome mainly are albumin and prealbumin. They were initially thought to represent nutritional status. With the understanding of the contribution of inflammation to malnutrition, cardiovascular disease and mortality, these negative phase inflammatory markers probably represent inflammation more than nutrition. Similarly, C-reactive protein is also found to be a strong predictor of mortality. The other strong predictor of patient outcome is residual renal function. The interlink between preservation of residual renal function and inflammation is becoming a subject of growing interest.
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Affiliation(s)
- Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong, SAR, China
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Abstract
With the recognition of the bio-incompatibility of conventional glucose based peritoneal dialysate (PDF), many new PDF has been developed and commercially available. All of them contain much less low glucose degradation product (GDP) solutions. Additional features are neutral or physiological pH, or glucose replaced by amino acid or glucose polymer icodextrin. These fluid has been shown to be more biocompatible in in-vitro and animal studies. There are short term randomized studies showing some benefit in certain clinical criteria, like increase in CA 125 in effluent PDF, better preservation of residual renal function, nutritional status, fluid and cardiovascular status, but beneficial effect on patient survival and long term peritoneal function has not been demonstrated apart from a non-randomized cohort study. To show such benefit on patient outcome, long term prospective randomized study is needed.
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Affiliation(s)
- Wai-Kei Lo
- Department of Medicine, Tung Wah Hospital, Hong Kong, SAR, China
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Lam MF, Lo WK, Tang C, Lui SL, Chan TM, Lai KN. Transport of Small Solutes in Peritonitis-free PD Patients. Int J Organ Transplant Med 2005. [DOI: 10.1016/s1561-5413(09)60198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lam MF, Leung JCK, Tam S, Tse KC, Lui SL, Lo WK, Chan TM, Lai KN. Increased Serum Leptin Levels During PD-related Peritonitis Associated with Prolonged Inflammation and Loss of Lean Body Mass. Int J Organ Transplant Med 2005. [DOI: 10.1016/s1561-5413(09)60197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lo WK, Lui SL, Chan TM, Li FK, Lam MF, Tse KC, Tang SCW, Choy CBY, Lai KN. Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis. Kidney Int 2005; 67:2032-8. [PMID: 15840054 DOI: 10.1111/j.1523-1755.2005.00305.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Residual renal clearance has been shown to be much more predictive of survival than peritoneal clearance. There has been little data to support a target level of peritoneal clearance. A retrospective study was therefore conducted to see how the peritoneal Kt/V had affected the survival of anuric patients in our center. METHODS Over a period of 10 years, there were 150 peritoneal dialysis patients with documented anuria. Their survival was analyzed according to their baseline peritoneal Kt/V at the time of documentation of anuria and at the time of their latest altered peritoneal dialysis (PD) prescription (subsequent Kt/V). RESULTS There were 90 females and 42 diabetics. The mean age and duration of dialysis were 57.7 +/- 14.7 and 44.1 +/- 31.3 months, respectively. The 2-year and 5-year survival rates were 88.7% and 66.7%, respectively. We found that patients with baseline peritoneal Kt/V below 1.67 had poorer survival after the documentation of anuria than those above [relative risk (RR) 1.985, P= 0.01], although the baseline Kt/V was not an independent risk factors in the whole group of patients. However, such effect was mainly observed in female patients. The survival was identical between those with Kt/V above or below 1.80 (P= 0.98). Among female patients, the group with baseline Kt/V 1.67 to 1.86 had the best survival, followed by those greater than 1.86 and lowest in those below 1.67 (P= 0.0016). For patients with baseline Kt/V below 1.80, those with subsequent Kt/V above 1.76 had better survival than those below (P= 0.033). CONCLUSION Our data suggested that a negative effect of peritoneal Kt/V on survival is apparent at a level below 1.67 and there exists a limit of its effect at around 1.80. We suggested a minimal Kt/V target of 1.70 and an optimal target at 1.80 in anuric patients based on survival data. Prospective randomized study is required to confirm this finding.
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Affiliation(s)
- Wai-Kei Lo
- Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong.
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Hung IFN, Cheng VCC, Lo WK, Lui SL. Paradoxical deterioration during anti-tubercular treatment in a dialysis patient on maintenance steroid therapy. Hong Kong Med J 2005; 11:210-2. [PMID: 15951588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
We report a 38-year-old Chinese woman with lupus nephritis on peritoneal dialysis and long-term maintenance steroid therapy. This patient developed paradoxical deterioration during anti-tubercular therapy for tuberculous lymphadenitis. The deterioration resolved spontaneously without change to pharmacotherapy. Paradoxical deterioration that may spontaneously resolve is a potential complication of anti-tubercular treatment in patients on long-term renal replacement therapy.
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Affiliation(s)
- I F N Hung
- Division of Nephrology, Department of Medicine, Tung Wah Hospital, Hong Kong
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46
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Li PKT, Weening JJ, Dirks J, Lui SL, Szeto CC, Tang S, Atkins RC, Mitch WE, Chow KM, D'Amico G, Freedman BI, Harris DC, Hooi LS, Jong PED, Kincaid-Smith P, Lai KN, Lee E, Li FK, Lin SY, Lo WK, Mani MK, Mathew T, Murakami M, Qian JQ, Ramirez S, Reiser T, Tomino Y, Tong MK, Tsang WK, Tungsanga K, Wang H, Wong AK, Wong KM, Yang WC, de Zeeuw D, Yu AW, Remuzzi G. A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease, Hong Kong, June 29, 2004. Kidney Int 2005:S2-7. [PMID: 15752234 DOI: 10.1111/j.1523-1755.2005.09401.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This report summarizes the discussions of the International Society of Nephrology (ISN) 2004 Consensus Workshop on Prevention of Progression of Renal Disease, which was held in Hong Kong on June 29, 2004. Three key areas were discussed during the workshop: (1) screening for chronic kidney disease; (2) evaluation and estimating progression of chronic kidney disease; and (3) measures to prevent the progression of chronic kidney disease. Fifteen consensus statements were made in these three areas, as endorsed by the participants of the workshop. The ISN can make use of and take reference to these statements in formulating its policy for tackling chronic kidney disease, a disease with significant global impact.
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Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Lui SL, Lo WK. Agrobacterium radiobacter peritonitis in a Chinese patient on CAPD. Perit Dial Int 2005; 25:95. [PMID: 15770935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Lam MF, Lo WK, Chu FSK, Li FK, Yip TPS, Tse KC, Chan TM, Lai KN. Retroperitoneal leakage as a cause of ultrafiltration failure. Perit Dial Int 2004; 24:466-70. [PMID: 15490987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
We report 3 patients on continuous ambulatory peritoneal dialysis (CAPD) who developed reversible ultrafiltration failure secondary to retroperitoneal leakage. The patients presented with pulmonary edema and fluid overload following a sudden onset of ultrafiltration failure on maintenance CAPD. There was no localized edema, suggesting peritoneal leakage in the abdominal wall or the perineum. Radiological examination showed no migration of the Tenckhoff catheter. Leakage of dialysate into the retroperitoneal space was only revealed by computed tomographic (CT) peritoneography. These patients were then treated with intermittent peritoneal dialysis twice weekly. After repeated CT peritoneography showing complete resolution of the leakage, they successfully resumed CAPD treatment 2 months later, without ultrafiltration problems. Our finding suggests that retroperitoneal leakage could be one of the uncommon, yet reversible, causes of acute ultrafiltration failure that can be diagnosed with CT peritoneography.
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Affiliation(s)
- Man-Fai Lam
- Nephrology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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Lui SL, Li FK, Choy BY, Chan TM, Lo WK, Lai KN. Long-term outcome of isoniazid prophylaxis against tuberculosis in Chinese renal transplant recipients. Transpl Infect Dis 2004; 6:55-6. [PMID: 15225230 DOI: 10.1111/j.1399-3062.2004.00050.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheung TH, Lo WK, Yu MY, Yang WT, Ho S. Extended experience in the use of laparoscopic ultrasound to detect pelvic nodal metastasis in patients with cervical carcinoma. Gynecol Oncol 2004; 92:784-8. [PMID: 14984941 DOI: 10.1016/j.ygyno.2003.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the use of laparoscopic ultrasound (USG) to detect pelvic nodal metastasis in patients with early stage cervical carcinoma. METHODS Laparoscopic USG was used to search for pelvic lymph node metastasis in stage Ia2 to IIa cervical carcinoma patients before radical hysterectomy. Suspicious lymph nodes identified by laparoscopic USG were removed laparoscopically for pathological confirmation by frozen section. If nodal metastasis was diagnosed, radical hysterectomy would be cancelled but enlarged lymph nodes were removed preferably by laparoscopic approach before closing the abdomen. These patients were treated with radiotherapy after recovering from the surgery. By comparing the laparoscopic USG and pathological findings of lymph nodes removed with or without radical hysterectomy, diagnostic accuracy of laparoscopic USG was determined. RESULTS Ninety-three patients were recruited and the final analysis included 90 patients. Laparoscopic USG found suspicious lymph nodes in 17 patients and nodal metastases were confirmed pathologically in 14 of them. Three patients with macroscopic and five patients with microscopic pelvic nodal metastases were missed by laparoscopic USG. The accuracy, sensitivity, specificity, positive and negative predictive value of laparoscopic USG in detecting pelvic lymph node metastasis were 87.8%, 63.6%, 95.6%, 82.4%, and 89%, respectively. Macroscopic metastatic nodes were successfully removed laparoscopically in 11 out of 14 patients and laparotomy was required for the other three patients. CONCLUSIONS Laparoscopic USG can be performed with no major morbidity. This technique is sensitive in detecting macroscopic but not microscopic metastatic pelvic lymph nodes. Removal of macroscopic metastatic nodes identified via laparoscopic USG via laparoscopic approach could be accomplished in majority of patients.
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Affiliation(s)
- T H Cheung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hongkong, China.
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