No abstract

The peritoneal catheter is the PD patient's lifeline. Advances in catheter knowledge have made it possible to obtain access to the peritoneal cavity safely and to maintain access over an extended period of time. Catheter-related infections remain a major problem, solutions for which are being actively researched. Nevertheless, the successful outcome of a catheter is very much dependent on meticulous care and attention to detail. Adherence to the principles of catheter insertion and subsequent management and care remain the cornerstone of successful PD access. The guidelines provided in this publication represent a consensus view based on studies from the literature and opinions of experts in this field; it is hoped that implementation of these guidelines will improve catheter-related outcomes and, therefore, enhance patient care.

The results of our analysis suggest that such informative censoring is independent of treatment modality and that even after correcting for dropout caused by death or transfer to another modality, patients starting on PD have a lower rate of decline in GFR (that is, better preservation of GFR) than patients starting on HD.

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.

Intra-abdominal pressure (IAP), forced vital capacity (FVC), and forced expiratory volume at 1 sec (FEV1) were measured in 18 stable continuous ambulatory peritoneal dialysis (CAPD) patients maintained on 2-liter exchanges, in the supine, sitting, and upright positions after infusing dialysis solutions in 0.5-liter increments up to 4 liters as tolerated. Thereafter, five patients did not increase to 3-liter volumes (RUT-0), four used 3-liter volumes occasionally (RUT-1), and nine chose 3-liter volumes for routine dialysis (RUT-2). IAP was similar in all groups and dependent on the intraperitoneal volume (IPV). The mean IAP increased 2.0, 2.7, and 2.8 cm H2O/liter of IPV in the supine, upright, and sitting positions, respectively. The patients of the RUT-0 group had dramatic deterioration (up to 42%) of FVC and FEV1 in the supine position with IPV above 2 liters. The patients with the greatest deterioration of pulmonary functions could not continue the measurements above 3 liters of IPV. Two of these patients were switched to 1-liter overnight exchanges. Even in patients who tolerated up to 4 liters, FVC and FEV1 decreased significantly in the supine and sitting positions, with IPV greater than 3 or 4 liters, respectively. In the upright position, the values did not decrease significantly below those with the empty abdomen up to 4.6 liters of IPV. Each liter of IPV increased the abdominal girth by 2.1 cm. Exchange volume and frequency should be individualized. In our studies, 50% of the patients could increase daily dialysate volume from 8 to 9 liters while decreasing daily exchanges from 4 to 3.