Continuous Ambulatory Peritoneal Dialysis in Diabetic Patients

2015 ◽  
pp. 60-74 ◽  
Author(s):  
L. L. Scarpioni ◽  
S. Ballocchi ◽  
A. Castelli ◽  
M. Cecchettin ◽  
P. G. Poisetti
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

1980 ◽  
Vol 1 (5) ◽  
pp. 54-58 ◽  
Author(s):  
Norbert H. Lameire ◽  
Marc De Paepe ◽  
Raymond Vanholder ◽  
Johan Verbanck ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Average Rate ◽  
Sodium Concentration ◽  
Risk Category ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

The Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 16-20 ◽  
Author(s):  
C.T. Flynn
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Term Survival ◽  
Basic Issue ◽  
Insulin Dependent ◽  
Intraperitoneal Insulin ◽  
Insulin Dependent Diabetic

Insulin-dependent diabetics with renal failure have a relatively poor long-term survival. The basic issue, therefore, is quality of life. CAPD allows the patient to be independent. The procedure can be performed as well by the blind as by a sighted patient and thus is available to blind diabetics. Intraperitoneal insulin offers a safe, consistent and convenient control of the blood sugar. Our experience suggests that continuous ambulatory peritoneal dialysis is the dialytic treatment of choice for the majority of insulin-dependent diabetic patients.

Glycated Albumin in Serum and Dialysate of Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 84 (6) ◽  
pp. 619-626 ◽  
Author(s):  
E. Lamb ◽  
W. R. Cattell ◽  
A. Dawnay
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Glycated Albumin ◽  
Protein Glycation ◽  
Structural Proteins ◽  
Diabetic Patients ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Ultrafiltration Failure

1. Chronic use of hyperosmolar glucose solutions in continuous ambulatory peritoneal dialysis may cause glycation of peritoneal structural proteins which could contribute to membrane dysfunction and ultrafiltration failure. To determine whether glycation can occur in the environment of the dialysate, we have carried out studies using albumin as a model protein. 2. Glycated albumin was measured in the serum and dialysate of 46 patients on continuous ambulatory peritoneal dialysis (31 non-diabetic patients, 15 diabetic patients). Dialysate and serum glycated albumin (ranges 1.0-12.7% and 0.9-10.2%, respectively) were related to each other (r = 0.988, P <0.001), but dialysate glycated albumin was significantly higher than serum glycated albumin (P <0.0001), with the dialysate to serum glycated albumin ratio being greater than unity in 76% of patients (mean ratio 1.14). This implies either preferential transfer of glycated albumin across the peritoneal membrane or intraperitoneal glycation during the dwell period. 3. In vitro, significant glycation occurred in dialysate during a 6 h incubation period (P <0.01) at a rate related to the glucose concentration in the dialysate (rs = 0.63, P <0.05). The glycation rate was not significantly affected (P = 0.05) by factors other than the glucose concentration. 4. Our results demonstrate that protein glycation occurs within the peritoneum during continuous ambulatory peritoneal dialysis. Further studies are required to establish the relationship of glycation of structural proteins in the peritoneal membrane to membrane function.

Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 153-158 ◽  
Author(s):  
Sunny S.H. Wong ◽  
Kwok Hong Chu ◽  
Au Cheuk ◽  
Wai Kay Tsang ◽  
Samuel K.S. Fung ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Local Application ◽  
Diabetic Patients ◽  
Site Infection ◽  
Dialysis Patients ◽  
Exit Site ◽  
Gram Positive ◽  
Exit Site Infection ◽  
Mupirocin Ointment

Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.

Red-Cell Survival in Patients on Continuous Ambulatory Peritoneal Dialysis

1986 ◽  
Vol 6 (2) ◽  
pp. 65-68 ◽  
Author(s):  
Norbert Lameire Erve ◽  
Matthys Marc De Paepe ◽  
Emiel Sys Karel ◽  
Schelstraete ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Cell Survival ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Plasma Volume ◽  
Cell Mass ◽  
Diabetic Patients ◽  
Red Cell ◽  
Red Cell Mass ◽  
Red Cell Survival ◽  
Early Rise

An early rise in hematocrit due to an increase in red cell mass (RCM) and a decrease in plasma volume (PV) has been noted after six months of continuous ambulatory peritoneal dialysis (CAPD). The present study measured red-cell survival (RCS) together with RCM and PV at the beginning and after six months of CAPD in paired observations in 15 patients. RCM increased from 890 ± 98 to 1089 ± 142 ml (p < 0.05) and plasma volume decreased from 3026 ± 295 to 2936 ± 178 ml. Mean red-cellsurvival half life at the start was 22.3 ± 1.06 days and rose to 25.2 ± 1.15 days after six months (p < 0.05). The same results were observed in four diabetic patients on a non-glucose, glycerol-containing dialysate. This study demonstrates that, after six months of CAPD, not only do hematocrit and red cell mass improve but also the red-cell survival is prolonged. However, a correlation could not be demonstrated between the increase in red-cell mass and prolongation of red-cell survival.

Gastric emptying in diabetic and non-diabetic patients on continuous ambulatory peritoneal dialysis

Nephrology ◽  
2007 ◽  
Vol 3 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Sydney TANG ◽  
Wai Kei LO ◽  
Wai Mo HUI ◽  
Henry YEUNG ◽  
Kam Chuen LAI ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Gastric Emptying ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients

Evaluation of glycerol as an osmotic agent for continuous ambulatory peritoneal dialysis in end-stage renal failure

1986 ◽  
Vol 70 (1) ◽  
pp. 23-29 ◽  
Author(s):  
A. Heaton ◽  
M. K. Ward ◽  
D. G. Johnston ◽  
K. G. M. M. Alberti ◽  
D. N. S. Kerr
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fluid Balance ◽  
Serum Insulin ◽  
Control Period ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
High Concentration ◽  
Osmotic Agent ◽  
The Mean

1. Six patients established on continuous ambulatory peritoneal dialysis entered a trial of treatment with dialysis fluid containing glycerol instead of glucose as the osmotic agent in an attempt to decrease the energy load. They were observed for a further 6 months after reconversion to glucose-based dialysis. 2. During the 6 month control period fluid balance was achieved mainly with a solution containing 76 mmol of glucose/l. Fluid balance was maintained during the 6 month period of treatment with glycerol only by the increased use of solutions containing a high concentration of glycerol (152 mmol/l and 272 mmol/l). Thus the energy value of the absorbed osmotic agent did not differ at a mean of 1607 kJ (384 kcal)/day using glycerol and 1669 kJ (399 kcal)/day using glucose as the osmotic agent. 3. In five subjects, fasting and peak blood glycerol levels did not change over the 6 months, but one subject, who accumulated glycerol, developed symptoms of hyperosmolality after 2 months and glycerol therapy was discontinued. In a further subject glycerol-based dialysis was terminated at 3 months when increasing angina was reported. 4. Mean fasting plasma triglyceride concentrations were 50% higher during the 6 months on glycerol (3.12 ± 1.12 mmol/l) than on glucose (2.19 ± 0.97 mmol/l) (P < 0.05). There was a small rise in very low density lipoprotein-cholesterol concentrations with glycerol dialysis but total cholesterol levels were unchanged. 5. The absorption of glycerol was not associated with an acute rise in circulating glucose or insulin but the mean blood glucose, over a 6 h dialysis cycle, had risen by 0.5 mmol/l after 3 months' treatment with glycerol and the mean serum insulin had risen from 5.9 ± 0.7 m-units/l to 9.8 ± 0.6 m-units/l (P < 0.01). 6. This study demonstrated no substantial advantage of glycerol over glucose as an osmotic agent in non-diabetic patients on continuous ambulatory peritoneal dialysis.

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