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Patients initiating dialysis therapy must make a choice between hemodialysis (HD) and peritoneal dialysis (PD). Controversy persists over the relative merits of each modality in the treatment of end-stage renal disease (ESRD). Issues relating to survival, morbidity, economics, and patient characteristics will all determine the final choice of therapy. Non medical factors are the most important determinant of dialysis modality selection. In the United States, HD has been the more commonly used modality, while PD is underrepresented. This disparity arises from multiple factors including reactions (sometimes incorrect) to the healthcare financing structure, physician biases, and changing demographic patterns in the ESRD population. We discuss these issues and present collected evidence showing that increased use of PD may have substantial overall benefit.

The upsurge of new social movements in Latin America has substantially changed the political and social landscape and focussed attention on the hitherto absent voices of these societies. There is a growing interest in the Indian academia towards the continent's recent history as India itself has witnessed an assertion of the marginalised sections of society, evident in the growth of the dalit and women's movements since the 1980s. It is in this context that the Centre for Spanish and Latin American Studies of Jamia Millia Islamia organised a two-day seminar (23-24 March, 2007) on testimonial narratives in India and Latin America under the title: 'Living to Tell their Tale: Testimonio as Subaltern Voice in India and Latin America', which was jointly co-ordinated by Sonya Surabhi Gupta and Vijaya Venkataraman.Testimonio narratives emerged in Latin America in the context of insurgency movements and wars of national liberation during the 1960s and 70s as expressions of cultural resistance, to record the struggles and give voice to the collective experience of the marginalised sections. Hovering at the borders of diverse disciplines like sociology, anthropology, history, ethnography and literature, this hybrid genre was recognised as a literary genre when the prestigious Cuban cultural institution, Casa de las Americas, added an award for this genre to the ones it already had for the genres of the novel, poetry and theatre. The testimonio soon drew attention in academic circles in the context of discussions throughout the 1980s on opening the canon that dominated the metropolitan western and US universities. It has also dominated the debate on issues of race, class and gender, Rigoberta Menchú's I, Rigoberta Menchú: An Indian Woman in Guatemala (1984) being a case in point.

In the early 1960s, peritoneal dialysis (PD) was introduced as a form of long-term maintenance therapy in patients with end-stage renal disease (ESRD). We have come a long way since. Increasing understanding of peritoneal kinetic behavior, its innovative manipulation to meet patient needs, critical monitoring of clinical outcomes, and parallel development in technology have all contributed to the worldwide success of the therapy over the past four decades. In this article we review the evolution of the various PD modalities in the context of these factors.

C atheter thrombosis is a major limiting factor affecting catheter survival in hemodialysis (HD). A previous retrospective study highlighted the utility of outpatient intradialytic high-dose urokinase (HDU) infusion in the treatment of HD catheter thrombosis. The present study was designed to prospectively evaluate the effectiveness of 250 000 IU urokinase given as a 3-hour infusion during HD. The infusion would follow detection of a drop in blood flow thought to be secondary to thrombosis [a "thrombotic event" (TE)] after exclusion of nonthrombotic causes of drop in blood flow [a "nonthrombotic event" (NTE)], such as systemic hypotension or suboptimal position of the catheter on x ray. An "event" was defined as a drop in pump blood flow by greater than or equal to 20% of the prescribed blood flow. Twenty patients (mean age 57.7 years; 13 males) with documented or potentially long-term catheters were recruited (total catheters used, 30) from an outpatient HD unit. A variety of catheter types were used. Catheter position was confirmed on x ray. Hemodialysis sessions were monitored for 6 months or until catheter removal (whichever was earlier). Thrombotic and NTEs (mostly related to drop in blood flow) were noted. The use of intradialytic HDU infusions was monitored. Improvement was defined as reestablishment of blood flow to within 10% of prescription. There were 24 TEs in 11 patients and 15 NTEs in 7 patients. Twenty-one of 22 (95%) TEs responded to HDU, with complete restoration of blood flow; in 1/22 HDU-treated instances there was a partial response. For 2/24 TEs the patients underwent catheter stripping with good results. Twelve of 15 NTEs occurred in the first 2 weeks of catheter placement versus 6/24 TEs (p = 0.001, chi-square). Catheter survival was longer than 24 weeks in 12/30 catheters. Nine catheters were lost to NTEs. No catheter was lost secondary to a TE. It is therefore concluded that intradialytic outpatient HDU is useful for the treatment of HD catheter thrombosis. It may obviate/reduce the need for catheter stripping or replacement. Randomized controlled trials with this approach are needed. A higher proportion of NTEs tended to occur earlier after catheter placement compared to TEs.

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This paper describes a pioneering initiative in urban India, with respect to information networking and knowledge support for service delivery in the water, sanitation and hygiene (WASH) sector that has been impacting policy and practice. What makes the initiative unique is the model and processes it adopted -the scale, support from the national government and a mechanism for the convergence of technical support of national and international agencies. This experience highlights the critical role of knowledge networking through peer exchange in bringing about sustainable changes in service delivery through the Change Management Forum, a network of cities and utilities on water and sanitation reforms.

Creatinine has been used as a convenient tool to determine and follow various aspects of renal function. The aim of this article is to review creatinine kinetics in peritoneal dialysis and its clinical applications, such as monitoring dialysis adequacy and the nutritional status of a patient, control of adherence to an individual dialysis prescription, and modeling of dialysis prescriptions according to the individual needs of a patient. Creatinine MetabolismMost of the creatinine in the human body is produced from nonenzymatic hydrolysis of phosphocreatine. Since muscle is the main reservoir of creatine, total muscle mass and its metabolism account for the majority of creatinine production. The dietary intake of preformed creatinine, or its precursor creatine in meat-based diets, is an additional source. Creatinine is a relatively inert solute of low molecular weight (1 13 daltons) that is excreted unchanged in the urine. Extrarenal degradation in the gut occurs in patients with elevated serum creatinine levels (1).Endogenous creatinine production can be calculated by the formulas of Cockcroft and Gault (2) as modified by Mitch, Collier, and Walser (3): daily creatinine production in men (mg/kg) = 28 -(0.2 x age in years) 23.8 -(0.17 x age in years) daily creatinine production in women (mg/kg) = According to the formula of Mitch, Collier, and Walser (3), the amount of extrarenal degradation of creatinine (mg/day) can be calculated as: 0.38 x serum Cr (mg/dL) x body weight (kg) Creatinine is traditionally used as a marker for nonmeasurable low molecular weight toxins that accumulate in renal failure. High creatinine levels are implicated in uremic thrombopathy (4) and in decreased erythrocyte survival (5) but have otherwise not proven to be toxic in the uremic state (6).