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Intraabdominal pressures were measured during natural activities in 6 men, age 24–62 years, treated with continuous ambulatory peritoneal dialysis. The pressures were measured with a pressure transducer secured at the level of the umbilicus in the supine, sitting, and upright positions with 0–3 liters intraperitoneal fluid during talking, coughing, straining, changing position, walking, jogging, exercycling, jumping and weight lifting. Coughing and straining generated the highest intraabdominal pressures in every position. The pressures with weight lifting were proportional to the magnitude of the weight lifted up to 50 lbs, but were lower than those during coughing and straining. The pressures were generally higher with greater intraabdominal fluid volumes, especially with jumping and coughing. Exercycling was associated with lower intraabdominal pressure than was jogging, and the pressures were only minimally influenced by intraperitoneal fluid volumes. The results of this study can be used as a guide in establishing preventive measures in patients with intraperitoneal fluid to decrease complication rates related to raised intraabdominal pressures such as dialysate leaks, hernias and hemorrhoids.

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We performed 41 cuff-shaving procedures in 38 patients on continuous ambulatory peritoneal dialysis (CAPD) with exit-site infection unresponsive to medical treatment. Cuff shaving was performed on three patients with two catheters each. This procedure was effective in eliminating 50% of S. aureus exit-site infection and all S. epidermidis exit-site infection, but was ineffective in Gram-negative exit-site infection. After cuff-shaving procedure, 20 catheters (49%) were removed; 11 for persistent tunnel infection and nine because of development of secondary peritonitis. The probability of catheter survival at 1 year was 50% and remained stable thereafter. Cuff-shaving procedure may be a valuable mode of therapy for treating patients with S. aureus and/or S. epidermidis exit-site infection unresponsive to medical treatment.

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Background Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule. Objectives To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life. Design Pilot prospective study, not controlled. Setting Nephrology division, public clinical research hospital. Patients Twenty-five patients (19 men, mean age 61 ± 13 years, body weight 63 ± 11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/V. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose. Outcome Measures Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances. Results During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4. Conclusions Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.

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