To study the feasibility of creating a radiocephalic hemodialysis fistula in elderly and diabetic patients, we prospectively studied 176 patients undergoing the first permanent vascular access creation and followed the outcome of fistula until primary failure or success was assessed. Color duplex ultrasonography was used to measure the blood flow rate. Fistula blood flow rate was significantly smaller in elderly patients, however, it was >400 ml/min in over 78% of the elderly patients with successful fistulas. There was no difference in fistula blood flow rate between nondiabetics and diabetics. Dialysis adequacy (Kt/V) via fistula was the same between age groups and between diabetes mellitus status. Old age or diabetes per se did not significantly predispose a new fistula to primary failure, but concurrent old age and diabetes markedly increase the risk. In conclusion, a good primary outcome of newly created radiocephalic fistula and adequate dialysis via fistula were demonstrated for elderly and diabetic patients. However, the longevity of fistula in elderly and diabetic patients needs further study.

The prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and their associations in 64 continuous ambulatory peritoneal dialysis (CAPD) patients (30 males and 34 females) were evaluated. A comparison was also made with 526 normal controls (266 males and 260 females). Forty-seven (75%) CAPD patients were anti-HBc positive, with no significant difference to the control group (81.9%). This probably reflects acquisition of HBV infection by CAPD patients before initiation of chronic dialysis therapy in a region hyperendemic for HBV. On the contrary, 11 (17.2%) CAPD patients were anti-HCV positive and 8 (15.2%) were seropositive for both anti-HBc and anti-HCV – much greater prevalence rates compared to those of the control group. The prevalence of anti-HCV correlated with the history and numbers of blood transfusion, and the length of time on previous hemodialysis. A similar correlation occurred in patients with both anti-HBc(+) and anti-HCV(+). In conclusion, in an HBV endemic area such as Taiwan, the prevalence of coexisting HBV and HCV infection in CAPD patients depends on the latter.

Patients on CAPD are at increased risk of GBV-C/HGV infection, and the risk parallels the number of previously transfused units of blood.

Chyloperitoneum is a rare condition in patients undergoing peritoneal dialysis. We report here a patient who developed chylous ascites during the course of tuberculous peritonitis. The diagnosis was confirmed by cultures of dialysate and peritoneal biopsy, and laparoscopy revealed severe hyperemia and intestine adhesion. Intrinsic lymphatic obstruction and superimposed peritoneal fibrosis together might be responsible for the pathogenesis of this special presentation. Although in most cases of continuous ambulatory peritoneal dialysis, the causes of chyloperitoneum remained unknown, we suggest, from the experience of this case, that tuberculous peritonitis, especially the fibroadhesive form, should be highly suspected in any dialysis cases with chyloperitoneum. Laparoscopy should be initiated early, particularly when the culture is negative for common pathogens or when the patient responds poorly to the usual antimicrobial agents.