Maggie Chu

Excessive weight gain during peritoneal dialysis.

The authors carried out a retrospective chart review in 114 patients treated for at least two years at the Toronto Western Hospital Peritoneal Dialysis Unit and identified eight, who gained an “excessive” amount of weight equal to or greater than 10 kg of their initial weight. These patients had gained an average of 13.1 kg over the preceding two years. They are mostly males and their average age is 51 years. They are well-nourished normotenseive nondiabetics with mostly normal cardiac function. They are adequately dialyzed (per KT/V urea), have little residual renal function and typically have peritoneal membranes characterized by high average transport. According to BIA analysis, this weight gain was likely due to an increase in fat mass accompanied by a trend toward decreasing body-cell mass. This weight gain may be due to increased caloric intake secondary to dialysate glucose absorption in the setting of high average (peritoneal membrane) transport. Such excessive weight gain also may occur if these patients have polymorphism of the UCP-2 gene, which can alter metabolic rate.

Differences in survival on peritoneal dialysis between oriental Asians and Caucasians: one center's experience.

Background: Recently it has been suggestedthat the survival of dialysis patients maydiffer among different races. Both registrydata and data from Asian countries indicatesthat Asians on peritoneal dialysis may survivelonger than their Caucasian counterparts. Inthe present study, we performed a detailedanalysis of survival differences betweenoriental Asians and Caucasians on peritonealdialysis in our multiethnic, multiculturalprogram. Methods: Retrospectively we analyzedthe survival data for patients who startedperitoneal dialysis after January 1, 1996 andbefore December 31, 1999, in our hospital. Theywere followed for at least for two years.Excluded from the present analysis were thosewho survived for less than three months onperitoneal dialysis. The patient demographiccharacteristics, comorbidities, and residual renalfunction at the start of dialysis werecollected. Indices for adequacy of dialysiswere collected 1–3 months after the initiationof dialysis. Actuarial survival rates weredetermined by the Kaplan-Meier method. The Coxproportional hazards model was used to classifyrisk factors for a high mortality.Results: There were 87 Caucasians and29 Oriental Asian peritoneal dialysis patients.No differences were found in age, gender,primary renal disease, and residual renalfunction between the two groups. The Caucasianshad significantly higher body surface area andurea volume and higher incidence ofcardiovascular diseases. Even with slightlyhigher dialysis dose, the peritoneal creatinineclearance was significantly lower among theCaucasians than among Asians. There was nodifference in the peritoneal D/P value betweenthe two groups. However, compared to theCaucasians, the 24hr peritoneal fluid removaland total fluid removal volumes weresignificantly lower in the Asian patients. Theone, two, three and four year survival rateswere 95.8%, 91%, 86% and 80% for Asians and91.3%, 78.1%, 64.7% and 54.1% forCaucasians. Significant predictors for a highermortality were the presence of cardiovasculardisease (42% increase in risk), Caucasians(39% increase in risk) and older age (37%increase in risk for age older than 65).Conclusions: Our study confirms thatoriental Asians on peritoneal dialysis patientssurvive much longer than their Caucasiancounterparts; this was partly due to the factthat Asian patients have less cardiovasculardisease when they began peritoneal dialysis.Due to their smaller body size, the Asianstended to have a higher peritoneal small soluteclearances despite their smaller dialysisdoses, indicating that, to achieve the samesolute clearance targets, Asians need a smallerdialysis dose compared to Caucasians.

DISCORDANT PD CATHETER AND EFFLUENT CULTURE RESULTS. THE LIMITED CLINICAL RELEVANCE OF CULTURING PD CATHETERS

♦ Objectives: To determine if discordance in culture results between the effluent and the tip of the peritoneal catheter had an effect on outcome in patients whose peritoneal dialysis (PD) catheter was removed mostly for nonresolving peritonitis. Reasons for and outcomes of PD catheter removal were also analyzed. ♦ Methods: We retrospectively reviewed the charts of all PD patients with recent peritonitis for which the PD catheter was removed between 1 January 2003 and 30 April 2009. Data including basic demographics, the organism isolated from effluent and from the PD catheter, reason for catheter removal, duration of hospitalization, and development of intra-abdominal collection were extracted as well as mortality within 8 weeks post removal and return to PD after catheter removal. ♦ Results: Fungal peritonitis was the most common reason for PD catheter removal. 20% of the patients developed an intra-abdominal collection. Mortality related to PD catheter removal was low (3/53; 5.6%). The patients (n =53) were divided into 3 groups: group 1 (n = 20) had the same culture result of effluent and catheter tip; group 2 (n = 19) had a negative culture of the catheter tip; and group 3 (n = 14) had different organism(s) growing from effluent and catheter tip. We found no remarkable differences in duration of PD, catheter age, peritonitis rate, or mortality. Patients in group 1 had significantly more fungal peritonitis than the other 2 groups. In only 4 of the 53 patients (7.5%), the anti-infectious management was changed according to the catheter culture result. ♦ Conclusions: Discordant results between catheter tip culture and effluent culture did not have a significant impact on patient outcome. Sending PD catheters for culture has limited clinical importance.