PDI 2009 ISDP LAC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Perit Dial Int 27(1): 67-73 2007
© 2007 International Society for Peritoneal Dialysis
This Article
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cox, S. D.
Right arrow Articles by Fan, S. L.-S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cox, S. D.
Right arrow Articles by Fan, S. L.-S.

Clinical

PREDICTORS OF SURVIVAL AND TECHNIQUE SUCCESS AFTER REINSERTION OF PERITONEAL DIALYSIS CATHETER FOLLOWING SEVERE PERITONITIS

Sue D. Cox, Stephen B. Walsh, Muhammad M. Yaqoob and Stanley L.-S. Fan

Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London, United Kingdom

Correspondence to: S.L.-S. Fan, Department of Renal Medicine and Transplantation, Barts and The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom.
s.fan{at}qmul.ac.uk

{diamondsuit} Background: Peritonitis remains the most important complication of peritoneal dialysis (PD). The success rate of restarting PD after severe peritonitis (peritonitis unresolved despite treatment with appropriate antibiotics for 3 days, or fungal or pseudomonas infections) is unclear. We wished to determine PD technique survival and overall mortality when PD is offered to these patients and to identify predictors of successful reinitiation.

{diamondsuit} Method: We conducted a retrospective single-center study of 556 patients undergoing PD between January 2000 and December 2001. We collected demographic information from the 106 patients who had their PD catheter removed for peritonitis, details about their dialysis history and peritonitis, and whether they successfully restarted PD and if not, the reason.

{diamondsuit} Results: We divided patients into groups as follows: group 1 (n = 42) underwent catheter reinsertion, group 2 (n = 16) had no medical contraindication to restarting PD but the patients elected to remain on hemodialysis, group 3 (n = 35) were deemed medically unsuitable to return to PD, and group 4 (n = 13) were those that died within 4 weeks of presenting with peritonitis. If there were no medical contraindications, Indo-Asians were more likely to retry PD. In group 1, after a mean follow-up of 20 ± 7.3 months, 23 of 42 patients restarted PD successfully. Technique survival for group 1 as a whole was 69% at 3 months and 55% at the end of follow-up. Patients of greater dialysis vintage were more likely to develop PD technique failure after restarting. Of those judged suitable for PD, there was no statistically significant difference in the mortality of patients who wished to either restart PD or remain on hemodialysis (group 1 vs group 2). Significant numbers of patients returned successfully to PD after pseudomonas and fungal peritonitis.

{diamondsuit} Conclusion: Restarting PD after severe peritonitis was possible and safe. Ethnicity was an important predictor for wanting to retry PD, but not for technique failure: given the choice, Indo-Asians preferred PD and had a higher failure rate after restarting, but this did not reach statistical significance. Only dialysis vintage predicted technique failure. We conclude that, after severe peritonitis, patients should be given the choice to return to PD but risk stratification based on dialysis vintage is important. Patient retraining and creating a backup arteriovenous fistula might minimize morbidity in these high-risk patients.

KEY WORDS: Peritonitis; technique failure; catheter removal; dialysis vintage.

Received 3 January 2006; accepted 8 August 2006.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Multimed Inc. logo
Copyright © 2007 by Multimed Inc.