Biomedical subjects
R Dressler
Publications and source records attributed to R Dressler.
Pseudomonal and candidal peritonitis as a complication of continuous ambulatory peritoneal dialysis in human immunodeficiency virus-infected patients.
PURPOSE: To our knowledge, there has been no report documenting the spectrum of peritonitis in human immunodeficiency virus (HIV)-infected persons. We therefore analyzed our records to confirm our previous observation of a higher incidence of pseudomonal and fungal peritonitis in a group of HIV antibody-positive (HIV+) patients undergoing continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: During a 22-month period, we retrospectively studied 71 patients with end-stage renal disease undergoing CAPD. Of these, seven were HIV+, five were at high risk for HIV infection but antibody-negative, and 59 were at low risk for HIV infection. Organisms isolated in episodes of peritonitis were classified microbiologically as one of the following: gram-positive, non-pseudomonal gram-negative, pseudomonal, fungal, or culture-negative. RESULTS: The total peritonitis rate was higher in both the high-risk (p less than or equal to 0.01) and the HIV+ (p less than or equal to 0.02) groups when compared with that in the low-risk population. These differences were attributable to the following: (1) the high-risk group's two-fold increase in gram-positive infections (p less than or equal to 0.01), and (2) a 24-fold increase in pseudomonal (p less than 0.001) infections and seven-fold increase in fungal (p less than 0.005) infections in the HIV+ group. These infections were invariably associated with catheter loss and frequently resulted in conversion to hemodialysis. CONCLUSION: We believe that the use of CAPD in HIV+ patients may be limited by this increased occurrence of pseudomonal and fungal peritonitis.
Survival of human immunodeficiency virus-infected patients on maintenance dialysis.
It has recently been reported that patients on maintenance dialysis with the acquired immune deficiency syndrome (AIDS) survive only 1 to 3 months. We studied all patients on maintenance dialysis at the Baumritter Kidney Center who were known to be infected with the human immunodeficiency virus (HIV). Five patients met the criteria for AIDS; another ten had anti-HIV antibodies but no opportunistic infections. The AIDS patients survived 8 to 18 months, and two are still alive. Mean survival in the AIDS group was 13.2 +/- 1.9 months, while the HIV(+) non-AIDS group survived 15.7 +/- 3.0 months. While these data are not statistically different, the survival curve in the AIDS group predicted a shorter survival than for the HIV(+) patients without AIDS. In fact, the survival of our dialyzed AIDS patients was similar to that reported for AIDS patients in general. Our experience suggests that dialysis may have no adverse effect on survival in AIDS. We conclude that dialysis patients with AIDS may survive 8 to 12 months or more and that the approach to such patients should be individualized.