Biomedical subjects

T Cabralda

Publications and source records attributed to T Cabralda.

At least 19 recordsLinked to original sources

PubMed1998

Use of Amuchina 50% solution versus povidone-iodine 10% solution for transfer-set change in peritoneal dialysis patients.

The goal of this study was to compare the safety and efficacy of Amuchina 50% solution versus that of povidone-iodine 10% solution for transfer-set change in peritoneal dialysis (PD) patients in a tertiary referral university hospital. The transfer sets were changed using povidone-iodine 10% solution as disinfectant prior to March 1995. Thereafter Amuchina 50% solution was used. Thus data were collected on all the transfer sets changed between January 1993 and August 1997. Amuchina is an electrolytic chloroxidizer. Chlorine is the active ingredient with a pH of 9.5-10.5. Amuchina 50% solution contains chlorine (0.55%). One hundred ninety-nine transfer sets were changed using povidone-iodine 10% solution in 60 PD patients from January 1993 to March 1995. One hundred twenty-eight transfer sets were changed using Amuchina 50% solution in 65 patients from April 1995 to August 1997. The soaking times and nursing times were 2 and 5 minutes, respectively, with Amuchina, and 10 and 20 minutes, respectively, with povidone-iodine 10%. No episode of peritonitis occurred related to transfer-set change in either group. The transfer-set change using Amuchina 50% solution is safe and cost-effective in PD patients.

Anti-Infective Agents, Local↗

PubMed1997

Persistent exit-site/tunnel infection and subcutaneous cuff removal in PD patients.

The purpose of our study was to investigate catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis (PD) patients. The patients underwent removal of subcutaneous cuff due to persistent ESI/TI from January 1989 to December 1996 in a tertiary referral university hospital. Two hundred and twenty-three patients (138 male, 85 female) underwent 244 double-cuff coiled Swan neck catheter implantations surgically. Twenty-nine patients (11.8%) had persistent ESI/TI for more than 6 months with the same organism. Sixteen patients (52%) underwent subcutaneous cuff excision. Thirteen (48%) patients refused and were managed conservatively. Two hundred and forty-three episodes of ESI/TI were observed over 4970 patient-months with a rate of 0.58 episodes/patient/year. Twenty-nine patients (11.8%) had persistent ESI/TI with S. aureus in 19, Pseudomonas aeruginosa in 9 (31%), and Serratia marcescens in one (3%) patient. Fourteen (88%) persistent ESI/TIs resolved after subcutaneous cuff excision. None of the patients with ESI/TI responded to conservative treatment. ESI/TI-related peritonitis decreased from 11 episodes to 5 episodes after cuff excision. In contrast, episodes of peritonitis increased from one to 9 with conservative management during a follow-up of mean 18 months (4-38 months). Four (31%) catheters were lost in the conservative group, while 3 (19%) were lost after cuff excision. ESI/TI-related peritonitis decreased after subcutaneous cuff excision but increased with conservative management for ESI/TI. ESI/TI resolved in 88% of the patients after cuff excision, while none resolved with conservative treatment.

Adolescent↗

PubMed1996

Plasminogen activator inhibitor-1 and peritoneal transport in peritoneal dialysis patients.

Plasminogen activator inhibitor-1 (PAI-1) is involved in the accumulation of extracellular matrix in various tissues. Since peritoneal interstitium is one of the resistance sites for transport during peritoneal dialysis (PD), the peritoneal PAI-1 level may have a significant effect on peritoneal transport. It was the purpose of this study to examine the associations between plasma or dialysate PAI-1 levels and the variables of peritoneal transport during peritoneal equilibration tests (PET) in 25 stable, adult PD patients. The dialysate PAI-1 levels increased with dwell time. Hematocrit was a positive predictor of plasma PAI-1 concentration and the change of dialysate PAI-1 amount scaled by body surface area (delta DPAI/ BSA). The peritoneal clearance of PAI-1 was higher than expected for its molecular size, suggesting a local production of PAI-1 in peritoneal tissue. The mass transfer coefficient of creatinine scaled by BSA (MTCcr/BSA) was a positive predictor of delta D PAI/BSA, suggesting the diffusion of plasma PAI-1 into the peritoneal cavity also accounted for part of the increased dialysate PAI-1 levels during PET. delta DPAI/BSA was a positive predictor of MTC of urea (ur) MTCwr/BSA and MTCcr/BSA, parameters for diffusive transport. Our findings are consistent with the hypothesis that peritoneal PAI-1 level has a significant effect on peritoneal transport during PD.

Adult↗

PubMed1996

Antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients.

Our objective was to evaluate antifungal prophylaxis for secondary fungal peritonitis in peritoneal dialysis patients. The study was designed to investigate antifungal prophylaxis for fungal peritonitis and to compare the incidence of fungal peritonitis without (January, 1991-July, 1993) and with (August, 1993-December, 1995) antifungal prophylaxis. In a tertiary-referral university hospital, 122 end-stage renal disease (ESRD) patients (77 male, 45 female) during period A (1/91-7/93) were observed for 1832 patient-months with no antifungal prophylaxis. One hundred and twelve ESRD patients (71 male, 41 female) during period B (8/93-12/95) were observed over 1705 patient-months with antifungal prophylaxis with fluconazole. Fluconazole 200 mg was given orally (po) as first dose at the onset of antibiotic therapy, then 100 mg po every other day, and was continued for one week after the antibiotic therapy. Forty-nine patients (28 male, 21 female; mean age 48.8 years) developed 105 episodes of peritonitis during period A. Forty-eight patients (36 male, 12 female; mean age 53.8 years) developed 95 episodes of peritonitis during period B. Fifteen episodes of fungal peritonitis occurred over 1832 patient-months during period A. while four episodes of fungal peritonitis were observed over 1705 patient-months during period B. Twelve episodes of secondary fungal peritonitis occurred during period A, while only two episodes occurred during period B. This incidence of secondary fungal peritonitis was significantly reduced with antifungal prophylaxis (p < 0.02). No side effect of fluconazole was observed. In conclusion, secondary fungal peritonitis was significantly decreased following fluconazole antifungal prophylaxis at our center.

Adult↗

PubMed1996

Endogenous peritonitis and related outcome in peritoneal dialysis patients.

Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to hemodialysis and 1 patient died in ten days. One patient refused surgery and died in 16 days. Endogenous peritonitis resulted in a high incidence of catheter loss and dropout from PD. Peritonitis due to bowel leak without frank bowel perforation can be managed with antibiotic therapy and antifungal prophylaxis. Aggressive management of constipation may decrease endogenous peritonitis.

Adult↗

PubMed1996

Multiple use of disposable (tubing) set of HomeChoice automated peritoneal dialysis (APD) system in PD patients.

Our objective was to evaluate the multiple use of the tubing set of the HomeChoice automated peritoneal dialysis (PD) system in PD patients. The study was designed to reuse the tubing set of the HomeChoice automated PD system for two to seven treatments, each of 16-24 hours duration, in end-stage renal disease (ESRD) patients, and to continue to use the same set if the patient was disconnected for any reason. In a tertiary-referral university hospital, 17 ESRD patients on PD, admitted to a university hospital from January, 1995 to September, 1995, were studied. The patients were disconnected and connected in between or during PD treatments. Five-liter bags were used. All the fluid was either set initially or added as clinically indicated. One hundred and thirty-eight PD treatments were performed with the HomeChoice automated PD system, using 30 disposable (tubing) sets. Sixty-three disconnections were made for ambulation, transfer to other units, surgery, physical therapy, radiological investigations, and special procedures in between and during PD treatments. No episode of peritonitis occurred. The multiple use resulted in a 78% reduction in tubing sets and drain-line extension sets used, thereby reducing the disposable supplies and creating a substantial saving in nursing time. The multiple use of tubing sets of the HomeChoice automated PD system was safe and economical in patients undergoing automated PD in a hospital setting.

Catheters, Indwelling↗

PubMed1995

Subcutaneous cuff removal in persistent exit-site/tunnel infections in peritoneal dialysis.

The purpose of this study was to analyze catheter outcome of persistent exit-site/tunnel infections (ESI/TIs) in peritoneal dialysis patients who underwent removal of the subcutaneous cuff due to persistent ESI/TI from January 1989 to June 1994. One hundred and sixty-eight patients (98 male, 70 female) from our tertiary university hospital underwent 177 double-cuff coiled Swan neck catheter implantations surgically. Nineteen patients (11%) had persistent ESI/TIs for more than 6 months. Thirteen persistent ESI/TIs responded to subcutaneous cuff removal. One hundred and fifty-four episodes of ESI/TI in 168 patients were observed over 3189 patient-months (0.58 episodes/patient-year). Nineteen patients (11%) had persistent ESI/TI with Staphylococcus aureus in 12 and Pseudomonas aeurginosa in 7 patients without episode of peritonitis except 2 patients with Staphylococcus aureus. Thirteen persistent ESI/TI resolved after subcutaneous catheter removal without catheter loss, 8 with Staphylococcus aureus and 5 with Pseudomonas. Sixteen catheters were lost due to fungal peritonitis and two secondary to recurrent bacterial peritonitis. None of the catheters were removed as a result of ESI/TI and related peritonitis. Subcutaneous cuff removal in persistent ESI/TI in peritoneal dialysis patients can significantly reduce catheter loss related to ESI/TI.

Bacteria↗

PubMed1995

Peritoneal transport in type I (insulin-dependent) and type II (noninsulin-dependent) diabetic peritoneal dialysis patients.

Alterations in the fibrinolytic system have been demonstrated in noninsulin-dependent diabetic patients (NIDDM) but not in insulin-dependent diabetic patients (IDDM). Since the activity of the fibrinolytic system can affect the turnover of extracellular matrix and therefore theoretically can affect the peritoneal transport, we tried to determine if there was a difference in the performance of the peritoneal equilibration test (PET) between IDDM and NIDDM patients receiving peritoneal dialysis (PD). The PET data from 11 IDDM patients (2 female, 9 male) and 13 NIDDM patients (3 female, 10 male) were reviewed. These two groups of patients were matched in gender, duration of end-stage renal disease, PD, and hypertension, blood pressure, degree of uremia, weekly KT/V, and body surface area. The IDDM patients (41.4 +/- 13.9 years) were younger than the NIDDM patients (58.8 +/- 7.1 years, p = 0.0026). There were no differences in hematocrit and serum chemistry profile including glucose and albumin between the two groups. Our data showed that there was no difference in PET performance between IDDM and NIDDM patients.

Adult↗

PubMed1995

Increased peritoneal solute transport in diabetic peritoneal dialysis patients.

Microangiopathy has been observed in the peritoneum of diabetic patients, and an increase in vascular permeability to small and large molecules has been described in the skeletal muscle of diabetic patients. Therefore, we examined the peritoneal equilibration test (PET) data from 19 diabetic and 19 nondiabetic stable peritoneal dialysis (PD) patients. These two groups of patients were matched in terms of age, gender, duration of PD and hypertension, incidence of peritonitis, levels of blood pressure, degree of uremia, levels of serum lipids, hematocrit, weekly KT/V, and body surface area. Compared to the nondiabetics, the diabetics had higher dialysate-to-serum ratios or mass transfer coefficients of urea or creatinine. These differences were not related to their differences in serum sodium or glucose. Regression analysis showed that the duration of hypertension was a negative determinant of peritoneal transport of urea and creatinine in diabetic patients. Our results suggest that the diabetic patients had a higher peritoneal diffusive transport of small solutes, which was offset by their duration of hypertension.

Biological Transport↗

PubMed1994

Comparison of quality of life in hemodialysis and peritoneal dialysis patients.

This study was designed to compare severity of illness and quality of life variables in chronic peritoneal dialysis (PD) and hemodialysis (HD) patients. The patient sample consisted of 63 PD patients (38 male, 25 female; mean age 54.5 years) and 35 HD patients (23 male, 12 female; mean age 54.9 years). Disease severity was greater in in-center HD patients than in PD patients (p < 0.008), although there were no significant differences in functional status as measured by the Karnofsky Index between HD patients (68.6 +/- 2.3) and PD patients (71.9 +/- 1.7). While both patient groups reported the same number of overall physical symptoms. HD patients reported significantly greater overall discomfort from symptoms than PD patients (p < 0.008). In terms of psychological adjustment, analyses revealed that 22 PD patients (36.7%) and 9 HD patients (25.7%) were classified as clinically depressed. PD patients reported higher anxiety scores than HD patients (p < 0.02) and lower positive mood scores (p < 0.021). HD patients were more severely ill and appeared to suffer from physical symptomatology to a greater degree than PD patients, although they were not more impaired in terms of functional status. Moreover, HD patients showed better psychological adjustment along several dimensions when compared to PD patients. One reason for this finding may be that PD patients experience greater distress, and isolation due to a lack of social support from similar others and medical staff in comparison to in-center HD patients.

Female↗

PubMed1994

Use of private duty nurses for daily CCPD and family relief in pediatric PD patients.

STUDY OBJECTIVE: To evaluate the role of trained home nurses in the care of end-stage renal disease (ESRD) pediatric patients on continuous cycling peritoneal dialysis (CCPD) and/or for family relief. DESIGN: The study was designed to investigate trained home nurses in the care of pediatric ESRD patients receiving peritoneal dialysis (PD) who entered the home program between February 1991 and October 1993. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: We trained the nursing staff of nursing agencies to perform PD with a special emphasis on pediatric care. A weekly nursing summary including daily vital signs, PD flow sheet, medications, and progress notes was sent to the home program. The trained nurses were also utilized for family relief to prevent burn-out. RESULTS: Five children (4 female, 1 male) with ages ranging from 3-14 years were studied. The total number of patient-months was 81 with a range of 4-33 patient-months. During this time, there was only one hospital admission for hyperkalemia and hypertension. Five episodes of peritonitis occurred over 81 patient-months, and all were treated at home. The clinic visit compliance was 100% in patients having nursing help. The administration of erythropoietin at home in these patients was consistent, resulting in higher hematocrit (Hct) levels. The added support to patients and family resulted in a low incidence of complications and infrequent need for hospital admissions. CONCLUSIONS: Our experience suggests that the use of private duty nurses for performing CCPD or for family relief in ESRD children has a favorable outcome and would benefit most pediatric home dialysis programs.

Adolescent↗

PubMed1994

Abdominal wall hernias in ESRD patients receiving peritoneal dialysis.

The study was designed to investigate the incidence of abdominal wall hernias (AWH) and related outcome in all end-stage renal disease (ESRD) patients who started peritoneal dialysis (PD) from January 1989 to December 1993. Between January 1989 and December 1993, a total of 158 ESRD patients (93 male, 65 female) entered our home program and were treated with peritoneal dialysis (PD) over 2789 patient-months. All PD catheters were placed in the lateral by two dedicated surgeons. AWH detected at the time of PD catheter placement was repaired simultaneously. The hernia repair was done using a polypropylene mesh. Inguinal hernias were noted by patients as a mass or discomfort. Umbilical and incisional hernias were observed during clinic visits. Twenty-one (13.3%) abdominal wall hernias were observed in 20 patients (12.7%). Eight (38.1%) inguinal hernias occurred in 8 male patients. Six inguinal hernias were repaired. PD was resumed after a mean of 12 days of hernia repair. Two patients resumed PD in 8 and 14 days without dialysis. One patient transferred to hemodialysis (HD) due to catheter malfunction. No complications occurred related to inguinal hernias. Ten (47.6%) umbilical hernias were observed in 10 patients (7 male, 3 female). The strangulation of umbilical hernias occurred in 2 patients, which required emergency small bowel resection and hernia repair. Both cases were complicated by candida peritonitis and enterobacter peritonitis, requiring PD catheter removal, and patients were then transferred to HD. Three (14.3%) incisional hernias were observed in 3 male patients. Two incisional hernias were repaired. No relation between AWH and PD modalities (CAPD/CCPD/IPD) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1993

Peritoneal dialysis with trained home nurses in elderly and disabled end-stage renal disease patients.

This study was designed to investigate trained home nurses in the care of elderly and disabled end-stage renal disease (ESRD) patients receiving peritoneal dialysis (PD) in all the patients who entered our home program between January 1989 and December 1992. We trained nursing staff from nursing agencies to do PD. A weekly nursing summary including daily vitals, PD flow sheet, medications, and progress notes was sent to the home program. The trained nurses were also utilized temporarily during acute deterioration of patients or partners resulting in the inability to do PD. Eleven patients were female, 10 were male, with a mean age of 62 years (range 30-81 years). Ten patients (48%) had diabetes mellitus. Thirteen patients performed continuous ambulatory peritoneal dialysis (CAPD) and 8 patients continuous cycling peritoneal dialysis. Five patients required home nurses temporarily for a period of 1-8 weeks until the patients became independent. Two patients were transferred to incenter hemodialysis, one because of insurance and one because of fungal peritonitis. One patient recovered renal function after 22 months of PD. Thirty-three episodes of peritonitis occurred over 417 patient-months (one episode/13 patient-months). Three patients needed catheter removal secondary to Candida peritonitis. Hospitalization rate and duration of stay were lower (1 admission/6 patient-months) than patient-months without home nurses (1/4 patient-months). The main causes of these admissions were diabetic complications (38%), cardiac disease (20%), and peritonitis (14%). In conclusion, our experience suggests that elderly and disabled patients on PD with home nurses have a favorable outcome even with multiple, comorbid conditions.

Adult↗

PubMed1993

Peritoneal dialysis in elderly end-stage renal disease patients.

This study was designed to investigate the outcome of all elderly patients older than 65 who started peritoneal dialysis (PD) between January 1989 and December 1992. One hundred and twenty end-stage renal disease (ESRD) patients commenced PD at our institution between January 1989 and December 1992. All the patients who started, completed PD training, and remained on PD for more than one month were included in the study. Of these, 30 patients were elderly (more than 65 years old) with a mean age of 72 years (range 66-81 years). The total number of patient-months observed was 2035, of which the elderly represented 454 patient-months. Twenty-five percent (30 of 120 patients) were elderly. The causes of ESRD were diabetes mellitus in 6 patients (20%), glomerulonephritis in 6 (20%), atheroembolic disease in 4 (13.3%), hypertension in 2 (6.7%), and unknown etiology in 10 (33.3%) patients. Sixteen patients performed continuous ambulatory peritoneal dialysis (CAPD) and 14 patients continuous cycling peritoneal dialysis (CCPD). Five patients required private home nurses for multiple medical problems and for PD. Mean duration of peritoneal dialysis per patient was 15 months. Four patients were transferred to incenter hemodialysis, one each because of failure to thrive, insurance, catheter malfunction, and fungal peritonitis. One patient recovered renal function after 22 months of PD. Twenty-one episodes of peritonitis occurred over 454 patient-months (1 episode/22 patient-months). In conclusion, the elderly patients on PD have a favorable outcome even with multiple comorbid conditions.

Adolescent↗

PubMed1993

Pulse intravenous calcitriol therapy of secondary hyperparathyroidism in peritoneal dialysis patients.

This study was undertaken to evaluate high-dose intravenous (IV) calcitriol therapy in chronic peritoneal dialysis (PD) patients. Nine stable chronic PD patients (7 male, 2 female, mean age 54 years) with secondary hyperparathyroidism and a mean duration of PD of 33 months, were studied for 6 months. Pulse calcitriol was administered IV in dosages of 4-8 micrograms every 2 weeks. Eight patients received oral calcitriol prior to IV pulse. Five patients were on continuous ambulatory peritoneal dialysis, and 4 patients were on continuous cycling peritoneal dialysis. Seven patients were on low-calcium dialysate (2.5 mEq/L) and 2 on high-calcium dialysate (3.5 mEq/L). All patients received calcium acetate or calcium carbonate to control hyperphosphatemia during the study. Mean serum parathyroid hormone N-terminal (PTHN) levels (35.4 +/- 9.5 pg/mL) decreased significantly from premean serum PTHN levels (79.7 +/- 10.4 pg/mL). No significant changes were observed in premean serum total calcium, ionized calcium, and phosphorus levels and posttherapy levels. No correlation was observed between serum PTHN and serum calcium, 1,25(OH)2D3, serum aluminum, and duration of dialysis. No significant difference in total body calcium and total body bone mineral density (BMD) was observed between pre and post study periods. In conclusion, biweekly IV calcitriol therapy is effective in suppressing secondary hyperparathyroidism in PD patients.

Adult↗

PubMed1992

Multiple use of cycler set in cycler peritoneal dialysis.

STUDY OBJECTIVE: To evaluate the multiple use of cycler set with universal connector set. DESIGN: The study was designed to reuse the cycler set for two to three treatments, each of 16-24 hours using Pac-X or Pac-Xtra cycler and to continue to use the same set if the patient was disconnected for any reason. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: 204 ESRD patients on peritoneal dialysis (PD) admitted to University Hospital from January 1989 to July 1991 were studied. The patients were disconnected and reconnected in between or during PD treatments. Five-liter dialysate bags were used. All the fluid was either set initially or added as clinically indicated. RESULTS: 2491 cycler PD treatments were performed with Pac-X and Pac-Xtra cyclers using 940 cycler tubing sets. 1624 disconnections were made in between and 336 were made for radiological investigations, special procedure, physical therapy and surgery during PD treatments. No episode of peritonitis or mechanical failure occurred. The multiple use resulted in 62% reduction in cycler sets thereby reducing the disposable supplies and a substantial saving in the nursing time. CONCLUSIONS: The multiple use of cycler set with universal connector and manifold set was safe and economical in the patients undergoing cycler PD in the hospital setting.

Humans↗

PubMed1992

Exit-site/tunnel infection and catheter outcome in peritoneal dialysis patients.

STUDY OBJECTIVE: To study exit-site/tunnel infections and catheter outcomes in peritoneal dialysis patients. DESIGN: The study was designed to investigate exit-site (ESI)/tunnel infections (TI) and catheter losses in all chronic PD catheters inserted in ESRD patients from 9/88 to 9/91. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Seventy-three patients (40 males, 33 females) underwent 78 double-cuff coiled swan-neck catheter implantations surgically. The curettage of exit site was performed weekly for tunnel infection refractory to medical management. The subcutaneous cuff was excised in persistent ESI/TI. RESULTS: Fifty-nine episodes of ESI/TI in 34 patients were observed over 946 patient-months. Thirty-nine patients experienced no ESI/TI, 27 patients had one and seven had two or more episodes of ESI/TI. Four patients had five episodes of peritonitis associated with ESI/TI. Eight recurrent episodes of ESI/TI with S. aureus in 8 patients were treated successfully with Rifampin. Seven subcutaneous cuffs were excised successfully in 7 patients with tunnel infection, five with S. aureus and two with Pseudomonas aeruginosa. No catheter was removed due to ESI/TI or ESI/TI associated peritonitis. CONCLUSIONS: Aggressive exit site care including repeated curettage, excision of the subcutaneous cuff and appropriate antibiotics reduced significantly catheter losses related to ESI/TI.

Bacterial Infections↗

PubMed1992

Low calcium (2.5 mEq/l) and high calcium (3.5 mEq/l) dialysate in peritoneal dialysis patients.

STUDY OBJECTIVE: To compare the effects of low-calcium and high-calcium dialysate in stable ESRD patients on peritoneal dialysis (PD). DESIGN: Dialysate containing 2.5 mEq/l and 3.5 mEq/l calcium in combination with oral calcium salts as phosphate binders were evaluated. SETTING: Tertiary-referral university hospital. PATIENTS AND METHODS: Fifteen patients (6 male, 9 female) on low-calcium (2.5 mEq/l) and 15 patients (6 male, 9 female) on high-calcium (3.5 mEq/l) dialysate were studied for 6 months. All patients received calcium acetate or calcium carbonate to control hyperphosphatemia before the study. RESULTS: Serum calcium, phosphorus and albumin did not differ before and after between the two groups. Three patients in low-calcium and five in high-calcium group developed hypercalcemia. Three in low-calcium group and four in high-calcium group required sucralfate to control hyperphosphatemia and hypercalcemia. Mean dose of elemental calcium was 1152 mg/day in low-calcium group and 790 mg/day in high-calcium group. A negative correlation (r = -0.82, p < 0.005) was observed between serum calcium and PTH at the end of study period in the low-calcium group. No such relationship was observed in the high-calcium group. CONCLUSIONS: Degree and frequency of hypercalcemia appeared similar with low-calcium and high-calcium dialysate in peritoneal dialysis patients.

Calcium↗