Background Peritoneal catheter displacement appears to be related to various causes including omental attachment, bowel contractions, peritoneal adhesions, and the catheter floating in the dialysis fluid. In order to prevent this complication, which can impair peritoneal dialysis efficacy, Di Paolo et al. designed a “self-locating catheter” (SLC) that is similar to the Tenckhoff catheter (TC) and includes a small tungsten cylinder (weight 12 g) at the distal end (Di Paolo N, et al. The self positioning catheter. Proceedings of the VII Italian Congress on Peritoneal Dialysis. Milan: Wichtig Editore, 1993:539–42). The weight of the tip prevents the catheter from floating and migrating by gravitation toward the Douglas cavity. Objective Starting in 1996, we implanted SLC in 15 continuous ambulatory peritoneal dialysis patients. The aim of our study was to compare the ratio of migration and other catheter-related complications between patients with SLC (196 patient-months) and 13 patients with conventional straight TC (295 patient-months). Results Peritonitis ratio, catheter complication rate, dialysate inflow and outflow, and weekly creatinine clearance were similar in the two groups of patients. The incidence of catheter displacement was significantly higher ( p = 0.0349) in the TC group than in the SLC group (4 vs 0). Conclusion In our experience, the SLC seems to be useful in preventing catheter migration by continuous gravitation of its extremity toward the pelvic cavity.

A retrospective clinical assessment of kidney function change was performed on 38 kidney transplant patients over a median follow-up period of 128 weeks. Full records of the patients’ course were available to the clinician, while only the serum creatinine series of each patient was supplied to the computer on which a bilateral CUSUM test was implemented. The frequency of change assessed by the clinician was 146 out of 2,688 patient-weeks. The computer identified the function changes with 84.9% sensitivity and 94.3% specificity and the function deteriorations attributed to rejection with 88.9% sensitivity and 97.2% specificity. Thus we suggest an efficient long-term monitoring of the graft function with this simple and reliable statistical technique.

Elevated plasma levels of fibrinogen, factor VII coagulant activity (F VIIc), and plasminogen activator inhibitor (PAI-1) have been reported to be strictly associated with thrombotic events and are considered to be important risk markers of atherothrombotic caridovascular disease. Therefore, we evaluated in 15 patients on continuous ambulatory peritoneal dialysis (CAPD) the plasma levels of these coagulation factors, basal insulin values, and the lipid pattern in comparison with 33 hemodialysis (HD) patients and 59 healthy subjects. In CAPD the total cholesterol and triglyceride results were significantly increased, but no difference was found in HDL cholesterol. Fibrinogen and F VIIc results were significantly higher In CAPD and HD than In the control group, probably due to an increased hepatic synthesis as a nonspecific response to the peritoneal protein loss. Elevated F VIIc activity may be caused by the presence of large negatively charged lipoproteins, in viva thrombin formation, or reduced hepatic clearance. Both PAl 1 and t-PA results were higher in CAPD, probably due to an increased synthesis by endothelial cells activated by glucose peritoneal absorption and hypertonic dialysis solutions. The contemporary elevation of fibrinogen, F VIIc, PAI-1, and t-PA suggests that CAPD patients present a hypercoagulability and hypofibrinolysis condition, which may promote the development of atherothrombotic events.

The authors evaluated Repl-A-Cath -a replaceable peritoneal catheter, over a three-year period. This device consists of a silicone “percutaneous tunnel”, through which a catheter is inserted into the peritoneal cavity. The catheter, which is hermetically sealed to the silastic tunnel, can be removed and replaced non-surgically if necessary. Because of its system of hermetical sealing, it has the same degree of bacteriological safety as other models in use. Among 31 ReplA-Cath's implanted in 27 patients (21 on CAPD, six on IPD), the incidence of complications was very low. The greatest advantage of this catheter is that it can be replaced in case of obstruction and poor dialysate drainage can be corrected without trauma.

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