Peritoneal dialysis peritonitis

Although the majority of patients with ESKD receive treatment with hemodialysis, approximately 15% of dialysis patients receive one of the multiple variants of continuous peritoneal dialysis. Peritoneal dialysis, like other dialysis modalities, has the potential to affect drug disposition however, drug therapy individualization is often less complicated in these patients owing to the continuous nature of the procedure (see Chap. 45). 

Fig.21.2. Doppler sonography. Shrunken, nearly nonper-fused end-stage kidney in an infant with peritoneal dialysis. Peritoneal fluid within Morrison s pouch...

Dasgupta, K.M. (1997) Silver-coated catheters in peritoneal dialysis. Peritoneal Dialysis International, 17(2), S142-5. 

Fig. 7. Estimate of the total number of patients receiving maintenance dialysis over the past 20 years. Totals include both hemodialysis and peritoneal dialysis, but exclude transplant recipients. The fraction of patients receiving peritoneal dialysis has grown steadily from 0% in 1978 to about 12% in 1992. These data were combined from various regional registries and industry sources demographic estimates of this iLk are accurate to within 5% (46). D,...

R. Gokal, Continuous Ambulatoy Peritoneal Dialysis, Churchill Livingston, Edinburgh, 1987. 

K. D. Nolph, Peritoneal Dialysis, 3rd ed., Martinus Nihjoff, The Hague, 1988. 

Life expectancy < 1 year from other causes Peritoneal dialysis or hemodialysis ... 

All patients with major patterns are monitored for rhabdomyolysis and renal failure. An early sign of rhabdomyolysis is an elevated serum uric acid, associated with an increase in serum CK. Within 8 to 12 hours, the serum tests are repeated. If the uric acid falls and the CK rises, rhabdomyolysis is likely. Renal function tests may also be increased at this time. When the diagnosis of rhabdomyolysis is made, the patient is treated with 40 mg furose-mide IV once, and IV fluids. Urine myoglobin concentrations are obtained. If the patient develops renal failure, hemodialysis or peritoneal dialysis may be necessary. In all cases, multiple drug intoxication, trauma, and rhabdomyolysis are ruled out or treated. All patients are kept under observation until they are asymptomatic. 

Stage 5 CKD on peritoneal dialysis Greater than 3008 0.25 meg orally daily 0.5-1 meg orally 2-3 times weekly Not recommended 2.5-5 meg orally 2-3 times weekly... 

Patients who progress to ESRD require renal replacement therapy (RRT). The modalities that are used for RRT are dialysis, including HD and peritoneal dialysis (PD), and kidney transplantation. The United States Renal Data Service (USRDS) reported that the number of patients with ESRD was 452,957, with 102,567 new cases being diagnosed in 2003.2 The most common form of RRT is dialysis, accounting for 72% of all patients with ESRD. The principles and complications associated with dialysis are discussed below. Chapter 52 discusses the principles of kidney transplantation. 

Even though intermittent heparinization is required, hemostasis parameters are better corrected with hemodialysis than peritoneal dialysis. 

Decline of residual renal function is more rapid compared to peritoneal dialysis. 

From El we 11 RJ, Foote EF. Hemodialysis and peritoneal dialysis. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 852, with permission. 

Freedom from the "machine" gives the patient a sense of independence (for continuous ambulatory peritoneal dialysis). 

Extensive abdominal surgery may preclude peritoneal dialysis. 

Peritoneal dialysis (PD) utilizes similar principles as hemodialysis in that blood is exposed to a semipermeable membrane against which a physiologic solution is placed. In the case of PD, however, the semipermeable membrane is the peritoneal membrane, and a sterile dialysate is instilled into the peritoneal cavity. The peritoneal membrane is composed of a continuous single layer of mesothelial cells that covers the abdominal and pelvic walls on one side of the peritoneal cavity, and the visceral organs, including the GI tract, liver, spleen, and diaphragm on the other side. The mesothelial cells are covered by microvilli that increase the surface area of the peritoneal membrane to approximate body surface area (1 to 2 m2). 

TABLE 23-10. Common Complications during Peritoneal Dialysis... 

Evaluate the patient for complications associated with dialysis. Does the patient develop hypotension or cramps during hemodialysis Does the patient have symptoms consistent with peritonitis or a catheter infection ... 

Piraino B, Bailie GR, Bernardini J, et al. ISPD guidelines/recommen-dations peritoneal dialysis-related infections recommendations 2005 update. Perit Dial Int 2005 25 107-131. 

Primary peritonitis generally is caused by a single organism (.Staphylococcus aureus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and Escherichia coli in patients with cirrhosis). 

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

Patients may not be in acute distress, particularly with peritoneal dialysis. 

Temperature may be only mildly elevated or not elevated in patients undergoing peritoneal dialysis. 

There may be cloudy dialysate fluid with peritoneal dialysis. 

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