RESUMO
INTRODUCTION: Peritoneal dialysis is a maintenance therapy option for patients with end-stage renal disease. Continuous ambulatory peritoneal dialysis in Cuba was introduced in December 2007, and automated peritoneal dialysis one year later. This paper presents the outcomes attained with this blood purification technique, enabling an assessment to decide on scaling up its use in Cuba. OBJECTIVE: Describe the clinical course of patients in the first five years of the Home Peritoneal Dialysis Program at Havana's Nephrology Institute. METHODS: An observational, descriptive study with a retrospective cohort was conducted. The universe comprised the 40 Nephrology Institute patients who underwent treatment with home peritoneal dialysis from December 20, 2007 to December 20, 2012. Relative and absolute frequencies were calculated for the study variables and the Kaplan-Meier method was used for survival curves for patients and for the peritoneum as dialysis membrane. RESULTS Of the 40 patients in the program, 23 were men and 17 were women, primarily aged 40 to 59 years. The most frequent causes of chronic kidney failure were hypertension (42.5%), glomerulopathies (22.5%), and diabetes mellitus (22.5%). A total of 103 complications occurred, both infectious (68, 66%) and non-infectious (35, 34%). The most common infectious complication was peritonitis (45, 66.2%); the most frequent non-infectious complication was catheter displacement (13, 37.1%). Seven patients left the peritoneal dialysis program. Of these, three died, two lost function of the peritoneum as a dialysis membrane, one received a kidney transplant and one recovered kidney function. Survival was 100% at one year, 97% at 2 years, 93.2% at 3 and 4 years, and 92% at 5 years. However, the peritoneal membrane was functional in 100% of patients during the first 2 years, decreasing to 96% at 3 and 4 years and to 88.6% at 5 years. CONCLUSIONS: In our setting, peritoneal dialysis attained outcomes similar to those obtained internationally, which supports its usefulness as a renal replacement therapy method in Cuban patients with end-stage renal disease.
Assuntos
Falência Renal Crônica/terapia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Diálise Peritoneal Ambulatorial Contínua/métodos , Adulto , Cuba , Feminino , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/instrumentação , Hemodiálise no Domicílio/métodos , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Estudos Retrospectivos , Fatores de TempoRESUMO
INTRODUCTION: Catheter-related complications in patients on peritoneal dialysis lead to decreased effectiveness and discontinuation of the technique, conversion to haemodialysis, hospitalisation, and surgical interventions to replace the catheter. OBJECTIVES: Determine risk factors for early catheter dysfunction that result in the need for replacement. METHODS: We analysed 235 catheters placed by open surgery using an infra-umbilical midline incision. Possible risk factors included the following: age, sex, body mass index, body surface area, diabetes, polycystic kidney disease, previous surgery, time of surgical procedure, omentectomy, omentopexy, wound infection and postoperative incisional hernia. RESULTS: During the first year, 47 patients (20%) required a catheter replacement due to poor function. The most common complications were catheter migration and peritonitis (4.3% in both cases), followed by obstruction from omental wrapping (3.7%). Univariate analysis showed that patients with catheter dysfunction or requiring catheter replacement were younger, with a lower body mass index and body surface area (P<.05). There was a significant association of wound infection and post-operative incisional hernia with catheter replacement. Omentectomy was associated with a low incidence rate of catheter dysfunction/replacement in the univariate and logistical regression analyses (odds ratio: 0.275; 95% confidence interval: 0.101-0.751; P<.012). CONCLUSIONS: Our catheter placement technique offers a low complication rate and good results in the first year after surgery. Except for omentectomy, we did not discover any risk factors for catheter replacement in our study population. Omentectomy had a protective effect in terms of catheter replacement.
Assuntos
Catéteres/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres de Demora , Remoção de Dispositivo , Falha de Equipamento , Feminino , Migração de Corpo Estranho/epidemiologia , Migração de Corpo Estranho/etiologia , Hérnia Abdominal/epidemiologia , Hérnia Abdominal/etiologia , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Omento/cirurgia , Diálise Peritoneal/instrumentação , Peritonite/epidemiologia , Peritonite/etiologia , Estudos Retrospectivos , Fatores de Risco , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia , Adulto JovemRESUMO
Introdução: A partir da vivência no atendimento de crianças/adolescentes portadores de doença renal crônica (DRC) em tratamento dialítico no ambiente hospitalar pensou-se que aspectos seriam relevantes para a aplicação da diálise peritoneal domiciliar. o objetivo deste estudo foi descrever o nível de escolaridade e de informação do cuidador sobre a técnica de diálise peritoneal (DP), a renda familiar e condições gerais do local de realização da diálise e buscar associação com a realização inadequada da técnica. Método: Trata-se de um estudo descritivo do universo de 30 crianças e adolescentes com DRC assistidos pelo HC/UFMG no período de março de 2004 a maio de 2006. os dados foram analisados utilizando-se software SPPS versão 13.0. As seguintes variáveis foram testadas como possíveis fatores de risco para inadequação da técnica de diálise: escolaridade do cuidador, renda familiar, nível de informação do cuidador sobre a técnica de diálise, antissepsia das mãos, ausência de pia no quarto da diálise. Resultados: A qualidade de aplicação da técnica de DP foi considerada inadequada em 18 (60%) pacientes. Todos os valores de Odds Ratio estiveram dentro dos limites dos intervalos de confiança (95%) e foram >1, indicando a possibilidade de associação positiva entre variável independente e variável pesquisada, embora sem diferença estatítica significativa. Conclusões: A análise estatística não mostrou associação entre variáveis, entretanto acredita-se que elas exercem um papel positivo para o sucesso da aplicação da técnica dialítica.
Introduction: From the experience in the care of children / adolescents with chronic kidney disease (CKD) on dialysis in the hospital thought that aspects would be relevant to the application of peritoneal dialysis at home. The aim of this study was to describe the level of education and information about the caregiver's technique of peritoneal dialysis (PD), family income and general conditions of the site of the dialysis and seek association with the inadequate implementation of the technique. Method: This was a descriptive study of the universe of 30 children and adolescents with CKD assisted by HC / UFMG from March 2004 to May 2006. data were analyzed using SPPS software version 13.0. The following variables were tested as possible risk factors for inadequate dialysis technique: the caregiver's education, family income, level of caregiver information on the technique of dialysis, antisepsis of the hands, no sink in the room of dialysis. Results: The quality of implementation of the PD technique was considered inappropriate in 18 (60%) patients. All odds ratios were within the confidence interval (95%) and were> 1, indicating the possibility of a positive association between independent variable and variable investigated, although no significant difference statistic. Conclusions: Statistical analysis showed no association between variables, however it is believed that they exert a positive role for the successful application of the technique of dialysis.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Cuidadores/estatística & dados numéricos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Visita DomiciliarRESUMO
Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeastrelated peritonitis could continue on the program.
La peritonitis fúngica es una complicación infrecuente pero grave de la diálisis peritoneal. Los objetivos de este trabajo fueron el análisis de las tasas de peritonitis, factores asociados, aspectos clínicos y microbiológicos, esquemas terapéuticos y evolución de los pacientes afectados. Se detectaron y documentaron microbiológicamente 183 episodios de peritonitis en 57 pacientes. Se identificaron hongos en ocho episodios (4,37%) en siete pacientes, todos ellos de sexo femenino. La tasa de peritonitis fúngica fue 0,06 episodios/paciente-año. Las coloraciones de Gram y Giemsa revelaron la presencia de microorganismos en cinco de los ocho líquidos de diálisis evaluados. Los microorganismos causales fueron Candida albicans en cinco episodios y Candida parapsilosis, Candida glabrata y Neosartorya hiratsukae en los otros tres. Todos estos pacientes, excepto uno, habían recibido antibióticos en los tres meses previos al episodio de peritonitis fúngica. El catéter de Tenckhoff fue extraído en siete de los ocho episodios. Todos los pacientes evolucionaron favorablemente. Concluimos que en la población estudiada el sexo femenino y la administración reciente de antibióticos estuvieron estrechamente relacionados con el desarrollo de peritonitis fúngicas por levaduras. Sin embargo, la peritonitis causada por el hongo filamentoso ambiental no requirió de la presión antibiótica. La microscopía del sedimento del líquido de diálisis fue útil en el manejo precoz del episodio. La peritonitis fúngica precedida por múltiples episodios de peritonitis bacteriana determinó siempre la exclusión definitiva del paciente del programa de diálisis peritoneal. Los pacientes con peritonitis de novo por levaduras, en cambio, pudieron continuar en él.
Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Candidíase/epidemiologia , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/epidemiologia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Ascomicetos , Antibacterianos/efeitos adversos , Argentina/epidemiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Candidíase/etiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Hospitais de Ensino/estatística & dados numéricos , Micoses/epidemiologia , Micoses/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Diálise Peritoneal/instrumentação , Peritonite/etiologia , Peritonite/microbiologia , Estudos Retrospectivos , Superinfecção/epidemiologia , Superinfecção/etiologia , Superinfecção/microbiologiaRESUMO
Fungal peritonitis is a rare but serious complication of peritoneal dialysis. The aim of this study was to analyze peritonitis rates, associated factors, clinical course, microbiological aspects, therapeutic regimens, and outcome of patients with fungal peritonitis in the dialysis center of a teaching hospital over the last 25 years. A hundred and eighty three episodes of peritonitis were detected and microbiologically documented in 57 patients. Fungi were identified in eight episodes (4.37%) occurring in seven female patients. The fungal peritonitis rate was 0.06 episodes/patient-year. Gram and Giemsa stains were positive in five out of eight dialysate fluids. The causative microorganisms were: Candida albicans in five episodes, and Candida parapsilosis, Candida glabrata, and Neosartorya hiratsukae in the remaining three. Antibiotics were administered to all but one patient, within 3 months before fungal peritonitis was detected. All patients required hospitalization, and antifungal therapy was administered in all episodes. The Tenckhoff catheter was removed in seven out of eight fungal peritonitis. All patients recovered from the fungal episodes. In the group of patients studied, it is concluded that recent exposure to antibiotics and female sex, were strongly associated with the development of fungal peritonitis by yeasts. The peritonitis caused by the environmental filamentous fungus did not require antibiotic pressure. Direct microscopy of the dialysate pellet was extremely useful for the prompt management of the fungal episode. Fungal peritonitis preceded by multiple episodes of bacterial peritonitis always determined the definitive dropout of the patient from the peritoneal dialysis program. Patients with de novo yeast-related peritonitis could continue on the program.
Assuntos
Candidíase/epidemiologia , Cateteres de Demora/efeitos adversos , Infecção Hospitalar/epidemiologia , Diálise Peritoneal/efeitos adversos , Peritonite/epidemiologia , Adulto , Idoso , Antibacterianos/efeitos adversos , Argentina/epidemiologia , Ascomicetos , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Candidíase/etiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/etiologia , Diálise Peritoneal/instrumentação , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Peritonite/etiologia , Peritonite/microbiologia , Estudos Retrospectivos , Superinfecção/epidemiologia , Superinfecção/etiologia , Superinfecção/microbiologiaRESUMO
BACKGROUND/AIMS: Continuous ambulatory peritoneal dialysis is the first-choice treatment for ESRD in Mexico. Peritonitis is the most frequent cause of morbidity and is among the leading causes of technique failure in our country. Our objective was to compare the efficacy of the standard and double-bag disconnect systems for the prevention of peritonitis in a high-risk population with poor living standards, and high prevalence of malnutrition and diabetes rates. METHODS: Episodes of peritonitis registered between July 1989 and June 2003 were included. Patients were divided in conventional and double-bag groups. Between July 1989 and May 1999, all patients used the conventional system. From May 1999, all incident patients were placed on a double-bag disconnect system. RESULTS: Six-hundred and forty-seven patients started dialysis in the study period, 383 in the conventional group, and 264 in the double-bag. The peritonitis rate observed was 1 episode per 7.2 patient-months in the conventional group, and 1 episode per 25.1 patient-months in the double-bag system (p < 0.001). Cumulative peritonitis-free survival rate at 6 (50 vs. 82%), 12 (27 vs. 69%) and 24 (12 vs. 45%) months, respectively, was significantly lower in the conventional group (p < 0.001). Technique survival at 1 (75 vs. 85%), 2 (68 vs. 80%), and 3 years (50 vs. 80%), was worse in the conventional group (p < 0.001). By multivariate analysis, the only factor associated with peritonitis was the connecting system. CONCLUSIONS: We conclude that switching from a standard to a double-bag system using electrolytically produced sodium hypochlorite disinfectant markedly decreased the peritonitis rate, even in a high-risk population like ours.
Assuntos
Desinfetantes/farmacologia , Diálise Peritoneal Ambulatorial Contínua/estatística & dados numéricos , Peritonite/epidemiologia , Peritonite/prevenção & controle , Hipoclorito de Sódio/farmacologia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Estimativa de Kaplan-Meier , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
HYPOTHESIS: Insertion of a Tenckhoff catheter through a small para-median incision results in less catheter dysfunction than in cases where insertion is made through a midline incision. MATERIAL AND METHODS: This is a prospective, longitudinal, comparative, observational study of cause and effect; in other words, it is a study of two cohorts. The study included patients with chronic renal insufficiency aged 16 years and over of either sex who required insertion of a Tenckhoff catheter for peritoneal dialysis treatment. A total of 44 patients were recruited and were divided randomly into two groups: Group A, numbering 23 patients, had their catheter inserted through midline below umbilicus, while Group B numbering 21 patients had their catheter inserted through via para-median approach. The study employed Student t parametric test and chi square trial hypothesis for non-parametric variables. Rejection criterion was p < 0.05. RESULTS: In both groups, cause of chronic renal insufficiency was diabetic nephropathy. After a 30-day follow-up period, the group of patients with catheter inserted through midline incision, i.e., Group A, presented dysfunction in 43.5% of cases. In the group with catheter inserted through para-median incision, i.e., Group B, dysfunction presented in 38% of cases with no other significant statistical difference occurring. Main cause of dysfunction occurring in Group A was catheter migration, whereas in Group B the main cause was dialysis fluid leakage. CONCLUSIONS: This study concluded that there was no significant difference between the two surgical techniques employed for Tenckhoff catheter insertion with regard to incidence of catheter migration, leakage of dialysis solution, catheter obstruction due to adhesions, or post-incisional hernias during the immediate post-surgical period (30 days). Furthermore, no significant difference was found between the two groups with respect to other types of complications such as peritonitis, infection along the subcutaneous catheter pathway, or catheter obstruction due to blood clots.
Assuntos
Cateterismo/métodos , Cateteres de Demora , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Recently, disconnect systems for CAPD that are associated with a reduced frequency of peritonitis have been introduced. Our objective was to compare the incidence of peritonitis using three current CAPD systems in a high-risk population with low educational and socioeconomic levels, and high prevalence of malnutrition. METHODS: In a prospective controlled trial, 147 patients commencing CAPD were randomly assigned to one of three groups: 29 to the conventional, 57 to the Y-set, and 61 to the twin bag systems. The number of peritonitis episodes was registered, and patients were followed up for an average of 11.3 months. RESULTS: The average peritonitis-free interval for the conventional group was 6.1 months, for the Y system was 12.0 months, and for the twin bag was 24.8 months (P < 0.001). By multivariate analysis, the only factor associated with peritonitis was the CAPD system. Peritonitis-related hospitalization was 5.3 +/- 2.0, 2.7 +/- 1.0, and 1.5 +/- 0.9 days/patient/year in the conventional, Y system, and twin bag groups, respectively. The cost per bag was similar for the conventional and Y system, but higher for the twin bag. However, the total costs of treatment (pesos/patient/year) were lower for twin bag (62,159 for the conventional, 70,275 for the Y system, and 54,387 for the twin bag), due to the lower peritonitis incidence and associated hospitalizations. CONCLUSIONS: Y system and twin bag use was associated with a reduction of 50 and 75% peritonitis incidence, respectively, in patients on CAPD. The cost of the twin bag was actually lower, because of savings from a decreased usage of antibiotics and fewer hospitalizations.
Assuntos
Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Diálise Peritoneal Ambulatorial Contínua/métodos , Peritonite/prevenção & controle , Adulto , Desenho de Equipamento , Feminino , Custos de Cuidados de Saúde , Hospitalização , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Diálise Peritoneal Ambulatorial Contínua/economia , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Peritonite/epidemiologia , Estudos ProspectivosRESUMO
Esta técnica quirúrgica de colocación de catéter de Tenckhoff ha sido desarrollada a través de 14 años en el Hospital ®Dr. Darío Fernández¼ del ISSSTE en un total de 412 pacientes. Este procedimiento permite un largo funcionamiento del catéter evitando reoperaciones frecuentes e infecciones, además de proporcionar comodidad al paciente. Lo anterior se logra mediante la perfecta fijación del catéter tanto en la cavidad peritoneal, como en el espesor de la pared abdominal, la adecuada colocación de los cojinetes y la altura de la salida del tercer segmento. El primer segmento, que es el peritoneal, queda perfectamente fijo en el fondo de saco de Douglas, sitio más profundo de la cavidad pélvica, lo que garantiza la fácil entrada y drenaje completo de la solución. El primer cojinete colocado entre peritoneo y aponeurosis permanece fijo, lo que ayuda a la inmovilidad del segmento peritoneal y constituye el punto más importante de fijación del catéter. Lo anterior contribuye también a que el segundo segmento permanezca fijo en el espesor del tejido celular subcutáneo. El segundo cojinete también queda fijo gracias a la distancia entre éste y la emergencia del catéter y el punto de refuerzo en la piel. La salida del segmento libre debe ubicarse a nivel de la cicatriz umbilical y a la izquierda de ésta. Con este procedimiento hemos logrado un buen funcionamiento del catéter hasta por cinco años y con mínimas complicaciones e infecciones
Assuntos
Humanos , Cateterismo , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Diálise Peritoneal Ambulatorial Contínua/métodos , Insuficiência Renal Crônica/terapiaRESUMO
Se realizó un estudio experimental, prospectivo, comparativo, de selección aleatoria y ciego en los Hospitales Nuevo Civil y México Americano de Guadalajara, de enero a diciembre de 1994, en que se analizaron dos procedimientos utilizados para disminuir hiperazoemia en pacientes con insuficiencia renal crónica o aguda, con la finalidad de establecer eficiencia obtenida mediante la aplicación de catéteres de diálisis peritoneal rectos y curvos a la cavidad peritoneal. En ambas técnicas se fijo firmemente el catéter a la aponeurosis peritoneal o posterior del músculo recto anterior del abdomen. Distribuimos 90 pacientes en dos grupos de 45, para comparar la técnica quirúrgica original de colocación de catéter de diálisis frente a una técnica que denominamos "antifuga". El objetivo principal es demostrar que utilizando la técnica antifuga y clasificando la consistencia de la aponeurosis posterior del músculo recto anterior del abdomen (APRA) y utilizando el grosor de la sutura según su firmeza, pudiera existir un menor número de fugas, infecciones del túnel subcutáneo e infección en el sitio de salida de la pared abdominal, además de disminuir otras complicaciones secundarias, como son: dehiscencia, herniación e infección de la herida quirúrgica. Con base a los resultados de este estudio experimental concluimos que existe correlación entre la fuga temprana de soluciones con la técnica original y con la edad, grado de obesidad y APRA de los pacientes. Además, que el de catéteres en espiral fallan que menor frecuencia que los rectos, por lo que recomendamos la técnica antifuga y el empleo de catéteres en espiral en el manejo de diálisis peritoneal ambulatoria para pacientes con insuficiencia renal crónica