Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan–Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.

An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P =  0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation.

BACKGROUND AND AIMS Doppler Ultrasound (DUS) is a superior tool for the assessment of arteriovenous fistula (AVF) functionality. The aim of the study was to determine the association between morphological and haemodynamic characteristics of the blood vessels with AVF maturation. METHOD The study was prospective that analysed 80 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on haemodialysis (CKD5D) with newly created radio cephalic AVF. Haemodynamics and morphological evaluation of blood vessels by DUS was performed in all patients. The diameter of the cephalic vein, radial and brachial artery was measured: before creation, on the first day (24-h after creation) and at 4 weeks. The blood flow (BF) rate of AVF was calculated by DUS on day 1, at 4 and 8 weeks. The successful maturation of AVF was defined with BF ≥ 600 mL/min. RESULTS The mean age of the patients was 59.9 ± 13.5 years, of which 46 (57.50%) were males. Successful AVF maturation at 4 weeks was 43.75% and 62.5% at 8 weeks. The results of six adjusted models in multivariate analyses showed BF rate on day 1 was a predictor for AVF maturation at 4 (P <0.001) and 8 weeks (P <0.001). The receiver operating characteristic (ROC) analyses showed that the highest sum of sensitivity and specificity for the BF on day 1 was 395 mL/min (sensitivity 0.714 and specificity 0.889) for the outcome at 4 weeks; and 344 mL/min (sensitivity 0.860 and specificity 0.867) for the outcome measured at 8 weeks. The diameter of the blood vessel was AVF significantly larger in patients with mature AVF compared with patients with non-mature AVF. Male gender was significantly associated with AVF maturation of AVF at fourth week (P < 0.001) and at eighth week (P = 0.001) compared with the female gender. CONCLUSION Our study showed that BF rate of AVF on day 1 was a predictor for AVF maturation at 4 and 8 weeks. The diameter of blood vessels and male gender were statistically associated with AVF maturation.

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Maintenance of vascular access for hemodialysis remains a challenge for every doctor. Exhausted conventional vascular access is the cause for the placement of the central venous catheter in unconventional sites such as enlarged collateral vessels, hepatic veins, hemiazygos, azygos, renal veins, and the inferior vena cava. The percutaneous translumbar catheter for hemodialysis in the inferior vena cava was described over 20 years ago. In this article, we report on the procedure and complications arising from the percutaneous translumbar approach of a hemodialysis catheter. This was done for the first time in N. Macedonia. This approach is a potential option in adults and children when conventional approaches are limited.