Objective No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. Design In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis. Results There were 260 episodes of gram-positive peritonitis, 99 episodes of gram-negative peritonitis, and 40 episodes of polymicrobial peritonitis. Gram-positive peritonitis had a significantly higher resolution rate than either polymicrobial peritonitis or gram-negative peritonitis. Staphylococcus aureus episodes had poorer resolution than other gram-positive infections. Nonpseudomonal peritonitis had a better outcome than Pseudomonas aeruginosa episodes. Among all the gram-negative infections, Serratia marcescens had the worst outcome. Episodes associated with a purulent exit site had poor outcome only on univariate analysis. For those peritonitis episodes in which the PD fluid cell count was > 100/μL for more than 5 days, the nonresolution rate was 45.6%, compared to a 4.2% nonresolution rate when the cell count returned to 100/μL or less in less than 5 days. Those patients that had a successful outcome had been on continuous ambulatory PD for a significantly shorter period of time than those patients that had nonresolution. The nonresolution rate for those patients that had been on PD for more than 2.4 years was 24.4%, compared to 16.5% for those that had been on PD for less than 2.4 years ( p = 0.05). Conclusion The duration of PD and the number of days the PD effluent cell count remained > 100/μL were the only factors that independently predicted the outcome of an episode of peritonitis. Caucasians seem to have a higher nonresolution (failure) rate compared to Blacks. Other variables, such as the number of peritonitis episodes before the episode in question, vancomycin-based initial empiric treatment, serum albumin level, total lymphocyte count and initial dialysate white blood cell count, age, sex, diabetes, previous renal transplantation, and the use of steroids did not affect the outcome of peritonitis.

No abstract

Fatigue is a common complaint in long term dialysis patients that may influence their quality of life. The present study was carried out in order to evaluate the prevalence and course of fatigue in a group of chronic PD patients and to find the possible factor(s) related to its development. We retrospectively reviewed 100 charts of the patients previously on PD. The presence or absence of fatigue in the 1st and last clinic visits and the 1st and 2nd changes in fatigue state were studied according to the monthly clinical records of the primary nurses. Data regarding dialysate volume, urine volume, weekly erythropoietin (EPO) dose, hemoglobin, hematocrit, blood urea, serum creatinine, residual renal creatinine and urea clearances, dialysate to peritoneal creatinine ratio (D/P Cr), total weekly Kt/V and total creatinine clearance/1.73 m2 body surface area (TCrCl) were collected. Fifty-five patients were male and 45 female. The mean age at the 1st clinic visit was 61.3 +/- 16 years. At the 1st visit 55 patients had fatigue and 45 did not. In 32 of the 55 patients fatigue disappeared after a mean duration of 7.9 +/- 8.4 months and in 31 of the 45 patients fatigue appeared after a mean duration of 8 +/- 6.8 months. So at the last visit the frequency of fatigue increased significantly from 55% to 67% (p < 0.001). In patients with fatigue the mean age and female percentage were higher (64.2 +/- 14.1 vs 57.8 +/- 17.6, p = 0.05 and 1.2 vs 0.5, p < 0.05 respectively), mean hemoglobin concentration was lower (104.4 +/- 14.7 vs 110.6 +/- 14.2 g/L, p < 0.04) and mean EPO dose was higher (6379.6 +/- 7142 vs 3395.4 +/- 4337.8 units/week, p < 0.02) at the 1st clinic visit. EPO dose was also higher in patients with fatigue at the last visit (8253.7 +/- 10317.3 units/wk vs 4736.4 +/- 5432.5, p < 0.03). No correlation was found between dialysis adequacy according to either weekly Kt/V or TCrCl and nutritional state according to nPCR and frequency of fatigue. We conclude that fatigue is a common symptom in PD patients and it's prevalence increases over time. Anemia seems to be the most important factor associated with fatigue. Dialysis adequacy and nutritional state did not show any correlation with the frequency of fatigue in our study.

Over the last 10 years an increasing number of patients worldwide have started dialysis or had transplantation. Many are elderly with complex comorbid conditions. Registries across the world all show a rapid and dramatic increase in the number of older patients accepted for renal replacement therapy. In addition, the number of patients who grow old on dialysis is increasing, leading to a marked change in the demographics of the renal population. Changes over time and across registries are discussed with reference to patient characteristics, survival statistics, and the trends seen with transplantation in the elderly.