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Biomedical subjects

J Bernardini

Publications and source records attributed to J Bernardini.

At least 37 records · Page 2Linked to original sources
PubMed1996

A randomized trial of Staphylococcus aureus prophylaxis in peritoneal dialysis patients: mupirocin calcium ointment 2% applied to the exit site versus cyclic oral rifampin.

The objective of this study was to compare prophylaxis for Staphylococcus aureus infections in peritoneal dialysis patients using 600 mg cyclic oral rifampin for 5 days every 3 months versus mupirocin calcium ointment 2% applied daily to the exit site. The study design was a prospective randomized trial, controlling for S aureus nasal carriage. Eighty-two continuous ambulatory and continuous cyclic peritoneal dialysis patients (54% male, 71 % white, 34% insulin-dependent, mean prestudy time on peritoneal dialysis 1.2 years) were randomly assigned to cyclic rifampin (n = 41 patients) or daily exit site mupirocin prophylaxis (n = 41 patients). Mean follow-up was 1 year. S aureus catheter infection rates were 0.13/yr with mupirocin and 0.15/yr with rifampin (P = NS). Both rates were significantly lower than the center's historical rate (the period between 1983 and 1992) of 0.46/yr prior to the study (P < 0.001). S aureus peritonitis rates were 0.04/yr with mupirocin and 0.02/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.16/yr (P < 0.02). Catheter loss due to S aureus infections was 0.02/yr with mupirocin and 0/yr with rifampin (P = NS), both significantly lower than the center's historical rate of 0.12/yr (P < 0.001). There were no side effects in patients using mupirocin, but 12% were unable to continue rifampin due to side effects. We conclude that mupirocin ointment at the exit site and cyclic oral rifampin are equally effective in reducing S aureus catheter infections. In addition, rifampin or mupirocin significantly reduced S aureus peritonitis and catheter loss due to S aureus infections. Mupirocin at the exit site provides an excellent alternative prophylaxis for S aureus infections, particularly in patients who cannot tolerate oral rifampin therapy.

Administration, Cutaneous↗
PubMed1996

Peritonitis associated with exit site and tunnel infections.

We reviewed all episodes of peritonitis associated with exit site and/or tunnel infection (n = 87; rate, 0.1/yr; 13% of all peritonitis episodes) occurring from 1979 to 1995. The exit site or tunnel infection was diagnosed at the time or shortly after the patient presented with peritonitis in 66% of the episodes. In the other one third the exit site or tunnel infection was diagnosed a median of 40 days prior to the development of peritonitis. Staphylococcus aureus accounted for 52% of episodes. Pseudomonas aeruginosa was the next most common organism. In 63 (72%) of the episodes the catheter was removed to resolve the infection at a median of 8 days (range, 0 to 226 days) from the onset of peritonitis. Catheter removal after 5 days predominately for refractory peritonitis (n = 23; median time to removal, 8 days) or relapsing peritonitis (n = 11; median time to catheter removal, 103 days). Patients with relapsing peritonitis suffered two to four episodes prior to removal of the catheter. Patients with peritonitis associated with tunnel infection were more likely to lose their catheter than patients with peritonitis associated with exit site infection (86% v 58%), while Staphylococcus epidermidis infections were less likely to result in catheter loss compared with all other organisms (15% v 82%). After a protocol to reduce S aureus catheter infections was implemented in 1990, the rate of catheter-related peritonitis decreased from 0.14/yr to 0.05/yr due to a decrease in S aureus episodes. We conclude that peritonitis episodes associated with a tunnel infection infrequently resolve without catheter removal. Delayed catheter removal in such circumstances often results in refractory or relapsing peritonitis. Therefore, catheter removal should be done promptly. Antibiotic prophylaxis for S aureus can reduce catheter-related peritonitis.

Bacterial Infections↗
PubMed1996

Peritonitis influences mortality in peritoneal dialysis patients.

Mortality remains high in peritoneal dialysis (PD) patients. Known risk factors for mortality include age, diabetes, race, initial albumin level, and cardiovascular disease. Peritonitis is reported to cause death in 1 to 6% of PD patients but has not been well studied as a risk factor for mortality. This study examined 516 adults with a total of 896 yr on PD at one center to determine if peritonitis influenced mortality. Time at risk began on Day 1 of training and ended at death, transplant, or 60 days after transfer to hemodialysis or intermittent peritoneal dialysis. The overall mortality rate was 17.4/100 patient yr. Survival was lower for whites, men, diabetic patients, and older patients. Independent risk factors for mortality (by Cox proportional hazards) were race, diabetes, increased age, and increased peritonitis rate. Use of the Y-set was not associated with decreased mortality. Peritonitis was a risk factor only in whites, nondiabetic patients, and those patients over the age of 60. For every 0.5/yr increase in the peritonitis rate, the risk of death increased 10% in whites, 11% in those patients who were over the age of 60, and 4% for nondiabetic patients. Mortality rates did not decrease over time (1979 to 1995), although peritonitis rates fell significantly (P < 0.001). Rates of Gram-negative and fungal peritonitis showed no trend over time. Peritonitis contributed to 25 of 158 (15.8%) of deaths. Gram-negative/fungal peritonitis accounted for 14 deaths (9.5% of all Gram-negative/fungal episodes) whereas Staphylococcus epidermidis accounted for only 1 death (0.5% of all S. epidermidis episodes) (P < 0.001). Cardiovascular disease was more common in those patients whose deaths were unrelated to peritonitis (P < 0.01), whereas an infectious cause was more common in those patients whose deaths were peritonitis-related (P < 0.001). In this study, peritonitis was a risk factor for death in whites, nondiabetic patients, and older patients. However, the Y-set did not improve survival, perhaps because it does not decrease Gram-negative/fungal peritonitis. To have an impact on survival, efforts are needed to reduce the peritonitis that results from these more serious pathogens.

Adult↗
PubMed1996

Peritoneal dialysis catheter complications.

A functional peritoneal dialysis catheter is essential for continuous ambulatory peritoneal dialysis to be an effective form of dialysis. The most common mechanical problems that hinder adequate function include obstruction, leaks, hernias, hemoperitoneum, and pain. The reported incidence of mechanical problems varies from 12% to 73%. Symptoms, diagnostic tests, risk factors, and treatment strategies are reviewed. Surgical intervention and catheter replacement are often required to resolve mechanical problems. Avoidance of mechanical problems reduces the risk of interruptions in peritoneal dialysis therapy.

Bacterial Infections↗
PubMed1996

Pregnancy outcomes in a prospective matched control study of pregnancy and renal disease.

OBJECTIVE: Assessment and comparison of pregnancy outcomes in women with renal disease and women with high risk pregnancies due to medical illness without renal disease. DESIGN: A prospective, matched controlled study. SETTING: The High Risk Obstetrical Clinics of Magee Women's Hospital, a primary and referral center where approximately 9,500 deliveries occur per year. PATIENTS: Two groups of pregnant women, all identified in the first trimester. The study group included 43 pregnancies in 40 women with renal disease as defined by: 1) known renal disease antedating pregnancy, 2) prepregnant proteinuria > or = 150 mg/24 hours, or 3) first trimester serum creatinine > or = 0.8 mg/dl or proteinuria > or = 300 mg/24 hours. The 43 controls included women with medical problems other than renal disease that placed them at high obstetrical risk. Control women were matched to study women for parity, advanced maternal age, race, and insulin-dependent diabetes mellitus. MEASUREMENTS: For all patients, blood pressure was recorded once at approximately 10, 20, and 30 weeks gestation. For study patients, serum creatinine, 24-hour urinary protein, and creatinine clearance were obtained at least once in each trimester. Pregnancy outcomes were recorded as favorable if gestation was > or = 36 weeks and without evidence of intrauterine growth retardation. Adverse pregnancy outcomes included prematurity, intrauterine growth retardation, intrauterine fetal death, spontaneous abortion, or neonatal death. RESULTS: Forty-two percent of study and control patients were diabetic. First trimester renal function was normal (creatinine < 0.8 mg/dl) in 12 study patients, mildly impaired in 24 (creatinine 0.8-1.4 mg/dl) and moderately impaired in 5 (creatinine > or = 1.4 mg/dl). Compared with controls, first and third trimester hypertension was more prevalent in the study patients (p = 0.003, p = 0.012); overall mean blood pressure was also higher in study patients (92 +/- 11 mmHg vs 85 +/- 8 mmHg, p = 0.002). The mean gestational age was shorter in the study patients (33.4 +/- 6.9 weeks vs 37.2 +/- 4 weeks, p = 0.001). Overall pregnancy loss was more common in the study patients (14/43 vs 3/43, p = 0.003) with spontaneous abortion contributing half of those pregnancy losses (7/14). Hypertension in any trimester was associated with adverse pregnancy outcome in study but not control patients. In the subset of study patients, adverse fetal outcome was directly associated with degree of renal dysfunction and proteinuria. CONCLUSIONS: Pregnancy outcome in women with renal disease was significantly worse than in the control group and showed no improvement over retrospective reports from the 1970's and 1980's. Specifically, fetal deaths were more common in women with renal disease and were predicted by proteinuria and the degree of renal dysfunction. The uncommonly low number of spontaneous abortions in the control group may have contributed to the worse fetal outcome in the study patients compared with controls. Women with diabetes mellitus and hypertension are at particularly high risk for relatively poor pregnancy outcome. These higher risks should be discussed when counseling women with renal disease who contemplate pregnancy.

Adult↗
PubMed1995

Effect of increasing exchange volume or frequency on CAPD efficiency.

We evaluated the effect of increasing the volume of all exchanges (group A), increasing exchange frequency (group B), or increasing nocturnal exchange volume alone (group C) on dialysis urea and creatinine clearances (DUrCl and DCrCl, respectively) and on KT/V in 20 continuous ambulatory peritoneal dialysis (CAPD) patients (25 maneuvers in 20 patients). The average duration of the maneuver was 4.5 +/- 2.1 months. In group A, a significant increase occurred in DCrCl and DUrCl. Residual renal function (RRF) decreased by an average of 0.5 mL/min (not significant, NS). In group B, DUrCl increased by 19% (NS). RRF decreased significantly from 2.5 +/- 1.0 mL/min to 1.0 +/- 0.6 mL/min. In group C no changes were noted in dialysate clearances or RRF. In all groups KT/V was maintained regardless of the maneuver employed and despite the changes in dialysis clearance observed in groups A and B. This stability is probably related to the significant decline in RRF for the group as a whole during the observation period. KT/V can be maintained as RRF declines with either increases in dialysate volume or exchange frequency. However, efforts to increase KT/V to higher mandated values will probably require changes in both dialysate volume and frequency.

Creatinine↗
PubMed1994

Infecting organisms in continuous ambulatory peritoneal dialysis patients on the Y-set.

Disconnect systems for performing continuous ambulatory peritoneal dialysis (CAPD) use a flush-before-fill technique that should theoretically reduce the peritonitis caused by touch contamination. However, little information about the infecting organisms in CAPD-related infections using disconnect systems is available. We performed a retrospective matched-case controlled study to define the organisms responsible for the peritonitis and catheter infections seen in CAPD patients using the Y-set without disinfectant. One hundred nineteen patients who began CAPD on the Y-set were matched with 119 patients who began CAPD on the standard spike system. Patients were matched for age, sex, race, insulin dependence, and time on CAPD. Infection data were prospectively collected for all patients. Peritonitis, exit site, and tunnel infection rates (expressed as number of episodes per patient-year) were all significantly lower in the Y-set patients (0.56 v 0.94, 0.68 v 1.08, and 0.14 v 0.22, respectively). The lower peritonitis rate in the Y-set patients compared with that found in the standard spike system patients was due to a reduction in Staphylococcus epidermidis (0.17 v 0.26, P = 0.02), polymicrobial (0.014 v 0.06, P = 0.01), other gram-positive (0.007 v 0.09, P = 0.001), and sterile (0.10 v 0.19, P = 0.008) peritonitis. Rates of Staphylococcus aureus and gram-negative peritonitis were not different among the two groups. S epidermidis (0.12 v 0.23, P = 0.0014) and gram-negative (0.12 v 0.18, P = 0.04) exit site infection rates were also lower in the Y-set patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Assessment of renal function during pregnancy using a random urine protein to creatinine ratio and Cockcroft-Gault formula.

The current standard for assessment of renal function in pregnant women is a 24-hour urine collection to determine creatinine clearance and proteinuria. It is easier to use the random urine protein to creatinine (P:C) ratio and the Cockcroft-Gault (CG) formula to estimate protein excretion and glomerular filtration rate, but the reliability of these formulae in combination for assessing renal function in pregnant women with renal disease is unknown. We compared the results of the P:C ratio with the 24-hour urinary protein excretion and the results of the CG clearance estimate with the 24-hour urine creatinine clearance in 34 pregnant women with underlying renal disease. Comparisons were made once in each trimester and postpartum. Prepregnancy weights were used in the CG formula: (140 - age x weight [kg] x 0.85)/72 x serum creatinine (mg/dL). Twenty-six first trimester, 33 second trimester, 21 third trimester, and 15 postpartum comparisons were made for creatinine clearance and 16 first trimester, 29 second trimester, 15 third trimester, and 15 postpartum comparisons were made for protein excretion. Measured creatinine clearance for the three trimesters combined (105 +/- 40 mL/min [mean +/- SD]) correlated significantly with CG clearances (113 +/- 52 mL/min; r = 0.87). The mean P:C values (2.03 +/- 3.15) for the three trimesters combined correlated significantly with 24-hour urine protein (2.25 +/- 4.21 g; r = 0.92). Our study demonstrates excellent correlations between the CG formula using prepregnancy weights and 24-hour creatinine clearance and between the P:C and 24-hour urinary protein in this population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A comparison of clearances on tidal peritoneal dialysis and intermittent peritoneal dialysis.

OBJECTIVES: To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate. DESIGN: Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 L/exchange for a total of 30 L/treatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 L/treatment. PATIENTS: Six patients, with a mean dialysate/plasma (D/P) creatinine as determined by the peritoneal equilibration test (PET) of 0.64 +/- 0.10, were studied. Four had a low-average D/P creatinine, while 2 had a high-average D/P creatinine. MEASUREMENTS: Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test. RESULTS: The dialysate flow rates were 3.7 +/- 0.1 L/hour for IPD and 3.8 +/- 0.2 L/hour for TPD. The mean dialysate dextrose was 1.9 +/- 0.5 g/dL for both. The creatinine clearances were 9 +/- 2 versus 10 +/- 3 mL/minute, the urea nitrogen clearances 19 +/- 3 versus 20 +/- 3 mL/minute, and phosphate clearances 10 +/- 3 versus 11 +/- 3 mL/minute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9 +/- 0.9 mL/minute on IPD and 3.3 +/- 1.6 mL/minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average D/P creatinine were higher than for the 4 patients with low-average D/P creatinine. CONCLUSIONS: When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.

Blood Urea Nitrogen↗
PubMed1994

A comparison of infection rates among older and younger patients on continuous peritoneal dialysis.

OBJECTIVE: To determine if peritoneal dialysis-related infection rates are higher in older patients compared with younger patients. DESIGN: A retrospective review of prospectively collected data. Control adult patients were matched with older study patients for race, sex, insulin dependence, connection device, and time on dialysis. SETTING: A university-based peritoneal dialysis program which includes patients from a Veterans Administration Hospital outpatient dialysis program. PATIENTS: Infection rates of 103 patients 60 years of age (older patients) were compared with 103 matched control patients 18-49 years of age (younger patients). MAIN OUTCOME MEASURES: Rates of peritonitis, exit site and tunnel infection expressed as episodes/patient/year (episodes/year) and the infecting organisms for each were examined. Outcomes, including catheter removal and the cause for removal, transfer to another dialysis modality and the reason for such, death and transplantation were also assessed. RESULTS: Mean time on peritoneal dialysis was the same in each group (20 +/- 21 months in the older and 18 +/- 17 months in the younger patients). The overall peritonitis rates were the same in the two groups (0.95/year in the older and 0.89/year in the younger patients), but the older patients had a higher rate of S. epidermidis peritonitis (0.28/year vs 0.13/year, p = 0.0001). S. aureus peritonitis rates were similar (0.16/year in older and 0.17/year in younger patients). Older patients had fewer exit-site infections (0.80/year versus 1.2/year, p = 0.0001) and, specifically, lower rates of S. aureus exit-site infections (0.23/year vs 0.47/year, p = 0.0001). Tunnel infections were also less common in older patients (0.15/year vs 0.23/year, p = 0.008), but S. aureus tunnel infection rates were similar (0.05/year and 0.09/year). Catheter infection was the most common reason for catheter removal in both patient groups (35% of catheters in the older and 44% of catheters in the younger patients, p = NS). More catheters were removed form older patients because of dementia or the loss of mechanical skills required to perform peritoneal dialysis exchanges (15% vs 5%, p = 0.04). CONCLUSIONS: Older age per se is not associated with higher peritonitis rates, but the use of disconnect systems should be encouraged in older patients and their mental and physical skills monitored to avoid S. epidermidis peritonitis. The lower rates of S. aureus catheter infection in older patients requires further study.

Adolescent↗
PubMed1993

Macronutrient choice following food deprivation: effect of dietary fat dilution.

Under standard laboratory conditions rats given access to three separate macronutrient sources compose a diet yielding 31% of their total daily calories as protein, 34% as carbohydrate, and 34% as fat. This selection pattern is dramatically altered with restored access following a 48 h fast. During the first hour of refeeding, rats composed a diet that was low in protein and high in carbohydrates and fat. By the end of 24 h, no difference in selection pattern was found, though intake of all three macronutrients was higher than baseline. A separate group given access to three macronutrient sources of equal caloric density specifically increased fat intake during the period of restored access. Another group, familiarized with a concentrated fat source, was given access to a diluted fat source during refeeding. Similarly, a fourth group, familiarized with a diluted fat source during the baseline condition was given access to a concentrated fat source during refeeding. Results from these experiments suggest that prior experience with a diluted fat source promotes a significant increase in fat intake and a suppression of carbohydrate intake during initial refeeding following a 48 h fast. In a second experiment, rats that were given a choice of both fat sources preferred the concentrated source; 72% of all fat (g) and 82% of all fat calories were consumed from the concentrated fat source. These results suggest that fat intake increases following deprivation not solely due to its inherent relatively increased caloric density but also possibly due to its role in energy metabolism.

Animals↗
PubMed1993

Loss of residual renal function in patients on peritoneal dialysis.

We performed a retrospective chart review of 32 patients on peritoneal dialysis (PD) for longer than 5 months (range 5-64 months) in an attempt to identify risk factors influencing the preservation of renal function. Residual renal function (RRF) was evaluated by measurement of creatinine clearance (Ccr) from 24-hour urine collections. Risk factors examined included age and Ccr at start of PD, presence of diabetes, mean arterial pressure (MAP), diastolic blood pressure (DBP), and peritonitis rate. Multiple regression analysis was performed to determine the correlation of these factors to the rate of decline of Ccr. Loss of RRF in all patients was 0.3 mL/min/month (median 0.2, range 0.04-1.7). The contribution of RRF to total Ccr was 39% (range 12%-72.5%). Patient age, presence of diabetes, MAP, DBP, peritonitis rate, and Ccr at the start of PD had no influence on the rate of RRF loss. Nine patients in the study (28%) had been on PD longer than 2 years and still had significant renal function (mean Ccr 3.3 mL/min), which was 40% of their total weekly Ccr. These results show that PD patients can maintain RRF for extended periods and that RRF contributes substantially to their weekly Ccr. The risk factors evaluated did not influence the rate of renal function loss.

Adult↗
PubMed1993

Characteristics and outcome of peritoneal dialysate leaks and associated infections.

Much is known about leaks on continuous ambulatory peritoneal dialysis (CAPD), but little is known about peritoneal dialysis-related infection associated with leaks. All catheter infections and peritonitis associated with leaks in established CAPD/CCPD (continuous cyclic peritoneal dialysis) patients occurring between 1979 and 1 July, 1992 were reviewed. Seventy-nine leaks occurred in 66 patients involving 76 catheters. Prophylactic antibiotics were given for all leaks. Thirty-three (42%) of the leaks were associated with an infection, and 46 (58%) were not. Patient sex, age, race, insulin dependence, and renal transplant within 60 days of leak were not different among patients with infection-associated leaks and those with leaks without infection. The median time on peritoneal dialysis prior to the leak was shorter in patients without an associated infection than in those with an associated infection (1.9 vs 5.6 months, p = 0.03). More catheters were removed in the infection-associated group (17/33, 52% vs 11/43, 26%, p = 0.03). Infection preceded leaks by a median of 20 days in 22/33 and was followed by leaks in a median of 14 days in 11/33 leaks. More of the catheters with a preceding infection were removed (14/22, 64% vs 3/11, 27%, p = 0.05). Infections occurring after a leak were often polymicrobial (5/7 catheter infections and 2/4 peritonitis episodes), while those occurring before a leak were single-organism infections (21/22). Catheter infections and peritonitis followed by a leak often lead to catheter loss and probably indicate infection of the catheter's deep cuff. Infections following leaks often resolve and are likely secondary, rather than primary infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Calcium mass transfer with 10-hour dwell time using 1.25 versus 1.75 mmol/L calcium dialysate.

Dialysate containing 1.25 mmol/L calcium and 2.5 g/dL dextrose has been shown to have a negative calcium mass transfer (CMT) in a 4-hour exchange. Continuous ambulatory peritoneal dialysis (CAPD) patients usually perform three daytime exchanges that have short dwell times and one overnight exchange that dwells for 8-10 hours. Measurement of CMT with a 10-hour overnight CAPD exchange has not been done. Thirty-four CMT measurements were performed on 18 patients using 1.25 (n = 15) and 1.75 mmol/L (n = 19) calcium dialysate, both containing 2.5 g/dL dextrose, with a dwell time of 10 hours. The mean CMT values were -0.75 +/- 0.45 and 0.42 +/- 0.54 mmol/exchange for 1.25 and 1.75 mmol/L calcium dialysate, respectively (p < 0.001). The serum ionized calcium levels were similar in the two groups, 1.2 mmol/L. With multivariate analysis the CMT values had a negative correlation with drain volumes (r = -0.5, p = 0.0001) and serum-ionized calcium (r = -0.4, p = 0.002). In conclusion, the CMT of an overnight exchange using 2.5 g/dL dextrose is determined by the initial dialysate calcium, the ultrafiltration volume, and the serum-ionized calcium. An overnight dwell using 1.25 mmol/L calcium dialysate will contribute to negative calcium balance, allowing larger doses of oral calcium compounds to be prescribed.

Adult↗
PubMed1993

A randomized trial comparing 2.5 mEq/L calcium dialysate and calcitriol to 3.5 mEq/L calcium dialysate in patients on peritoneal dialysis.

Peritoneal dialysate containing 2.5 mEq/L of calcium has been used to prevent hypercalcemia when calcium-containing phosphate binders are given. However, worsening of hyperparathyroidism may result. Calcitriol used in conjunction with 2.5 mEq/L calcium dialysate is an attractive alternative, but has not been examined in a controlled trial. Eighteen patients were randomly assigned to either a control group (3.5 mEq/L calcium dialysate without calcitriol) or a study group (conversion to 2.5 mEq/L calcium dialysate with oral calcitriol, median dose 0.25 microgram/day). The initial mean serum calcium (9.9 vs 9.6 mg/dL), phosphate (5.4 vs 5.6 mg/dL), median n-terminal parathyroid hormone (PTH) levels (71 vs 55 pg/mL, normal < 25), and median 1,25 (OH)2 vitamin D levels (4 vs 5 pg/mL, normal 15-60 pg/mL) were not different in the two groups. After 8 weeks the serum calcium and phosphate were unchanged from baseline in both groups. The 9 patients who converted to 2.5 mEq/L calcium dialysate had an insignificant fall in the PTH level, not different from the control group. The median 1,25 (OH)2 vitamin D level rose from 4 to 23 pg/mL (p = 0.003) on calcitriol, but remained unchanged in the control group (5 pg/mL). The median doses of oral calcium (0.9 vs 1.1 g/day) and the frequency of serum calcium levels greater than 11 mg/dL (4/9 vs 3/9 patients, 10% vs 8% of all values) were similar in the study and control groups. Aluminum hydroxide was required intermittently for serum phosphate control in 3 patients on 2.5 mEq/L calcium dialysate and 4 on 3.5 mEq/L calcium dialysate.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1993

A comparison of peritoneal dialysis-related infections in short- and long-term peritoneal dialysis patients.

OBJECTIVE: We hypothesized that the infection rates and organisms would differ in long-term peritoneal dialysis (PD) patients versus those who died or transferred to hemodialysis during the first 4 years on PD. DESIGN: Data on PD-related infections and outcome were collected from 1979 to 1991 (prospectively since 1982). SETTING: The patients were followed at University and Veterans Administration dialysis centers. PATIENTS: All patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) for 4 years or more (n = 43) were compared to those patients who died or transferred to hemodialysis prior to 4 years on PD (n = 213). MAIN OUTCOME MEASURES: Infection rates due to various microorganisms and reasons for transfer to hemodialysis were examined. RESULTS: Peritonitis rates were 1.2/year versus 0.8/year (p < 0.001) in patients on peritoneal dialysis less than 4 years compared to those on 4 years or more, respectively, a difference due to S. epidermidis (0.32/year vs 0.20/year, p = 0.0001) and gram-negative rods other than P. aeruginosa (0.15/year versus 0.06/year, p < 0.001). Exit-site infection rates were 1.2/year versus 0.7/y (p < 0.0001) in the patients on less than 4 years compared to those on 4 years or more, respectively, a difference in part due to S. aureus (0.45/year vs 0.3/year, p < 0.001) and other gram-positive organisms (0.28/year vs 0.10/year, p < 0.001). The rates of infections that were similar in the two groups were tunnel infections (0.2/year), P. aeruginosa infections, and S. aureus peritonitis (0.18/year vs 0.14/year, p = 0.09). S. aureus was the most common cause of exist-site and tunnel infections in both groups. Forty-two percent of the patients on PD 4 years or more subsequently transferred to hemodialysis, most often due to infections, especially S. aureus. CONCLUSIONS: Although infection rates are lower in patients on peritoneal dialysis 4 years or more, S. aureus and P. aeruginosa continue to account for a high proportion of the infections. Improvement in technique survival will require prevention of these infections.

Bacterial Infections↗