Peritoneal dialysis after removing the catheter because of peritonitis
Diálisis peritoneal tras retirada de catéter por peritonitis
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Iglesias Lamas, M.J. Camba Caride, E. Novoa Fernández, J. Santos Nores" "autores" => array:4 [ 0 => array:4 [ "Iniciales" => "E." "apellidos" => "Iglesias Lamas" "email" => array:1 [ 0 => "elei1983@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M.J." "apellidos" => "Camba Caride" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "E." "apellidos" => "Novoa Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "J." "apellidos" => "Santos Nores" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Unidad de Nefrología, Complejo Hospitalario de Orense, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diálisis peritoneal tras retirada de catéter por peritonitis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11005_108_25067_en_11005_t1.jpg" "Alto" => 439 "Ancho" => 600 "Tamanyo" => 152195 ] ] "descripcion" => array:1 [ "en" => "Causative micro-organisms and patient evolution following removal of the peritoneal dialysis catheter" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Peritonitis is the primary cause of morbidity, mortality, and technique failure in peritoneal dialysis (PD).</p><p class="elsevierStylePara">Several studies have shown that catheter removal (CR) is necessary in as many as 16%-18% of cases.<span class="elsevierStyleSup">1</span> The most common causes of peritoneal CR due to peritonitis are: fungal peritonitis, enteric peritonitis, and cases associated with other clinical circumstances (simultaneous infection of the subcutaneous tunnel, cases refractory to treatment, and recurring infections).</p><p class="elsevierStylePara">Following CR, a high percentage of patients decide to stay with the same method of depuration treatment. These patients tend to have a low technique survival due to adherence and ultrafiltration failure.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">If patients decide to reinitiate PD, it is important to keep in mind:</p><p class="elsevierStylePara">1.            There is no reliable, objective method that can indicate the existence of peritoneal damage before inserting a catheter: ultrasound, computed tomography (CT), and magnetic resonance (MRI) have all been shown to have low sensitivity and only provide imprecise detection of alterations.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">2             The catheter should be inserted under open or laparoscopic surgery in order to obtain visual information about the abdominal cavity.</p><p class="elsevierStylePara">3,            The new catheter should be inserted a minimum of 3-4 weeks after the complete recovery from the infection.</p><p class="elsevierStylePara">4.            In the case of early catheter dysfunction, a peritoneography can be useful in the chance of compartmentalisation of the peritoneum.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">We carried out a retrospective study during the last five years on patients in our unit that required CR because of peritonitis and that later decided to reinitiate PD.</p><p class="elsevierStylePara">CR was required in 11 patients from our study population following cases of peritonitis in the last five years.</p><p class="elsevierStylePara">We performed abdominal CT scans for each prior to inserting the second catheter.</p><p class="elsevierStylePara">Only one patient was denied reinitiation of PD when the CT scan revealed an abdominal image indicative of a small abscess two months after the removal of the first catheter.</p><p class="elsevierStylePara">The second catheter was inserted in all cases under general surgery conditions; mild adherence was observed in two cases, which were remedied.</p><p class="elsevierStylePara">The mean age of patients in our study was 62.8 years (range: 30-77).</p><p class="elsevierStylePara">Mean albumin levels were 3.5mg/dl (2.8-4.2); mean D/P creatinine at 240 minutes: 0.75 (0.69-0.8); mean D/P creatinine 240 minutes before removal: 0.78 (0.63-0.9); mean total number of cases of peritonitis per patient: 2.6 (1-5), and the mean time until the appearance of the first case of peritonitis was 18 months (1-47).</p><p class="elsevierStylePara">The micro-organisms responsible for the cases of peritonitis, the existence of associated pathologies, the time until reinsertion of the second catheter, and patient evolution (resolution or lack thereof of the infectious problem before the CR) are summarised in Table 1.</p><p class="elsevierStylePara">In our study sample, almost all patients whose catheters were removed during the infection had poor evolution of the dialysis technique, primarily due to adherences or problems with ultrafiltration, similar to the results from other studies.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Although imaging tests prior to the second catheter insertion have low sensitivity, we believe that they are necessary, since an abdominal pathology secondary to the first case of peritonitis may be present, with no clinical symptoms, as occurred in our case of a patient with an abdominal abscess.</p><p class="elsevierStylePara">In the case of early dysfunction of the peritoneal catheter, a peritoneography is necessary for evaluating the presence of compartmentalisation (Figure 1).</p><p class="elsevierStylePara">In conclusion, a return to PD following CR due to peritonitis should be evaluated on an individual basis, paying special attention to those patients that had peritonitis refractory to treatment, with associated abdominal pathologies, and a high D/P creatinine level before the removal of the first catheter. The impact that the possible loss of residual diuresis would have on the evolution of the patient should also be taken into account.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">The authors have no potential conflicts of interest to declare.</p><p class="elsevierStylePara"><a href="grande/11005_108_25067_en_11005_t1.jpg" class="elsevierStyleCrossRefs"><img src="11005_108_25067_en_11005_t1.jpg" alt="Causative micro-organisms and patient evolution following removal of the peritoneal dialysis catheter "></img></a></p><p class="elsevierStylePara">Table 1. Causative micro-organisms and patient evolution following removal of the peritoneal dialysis catheter </p><p class="elsevierStylePara"><a href="grande/11005_108_25068_en_11005_f1.jpg" class="elsevierStyleCrossRefs"><img src="11005_108_25068_en_11005_f1.jpg" alt="Image of a pseudocavity in the peritoneography "></img></a></p><p class="elsevierStylePara">Figure 1. Image of a pseudocavity in the peritoneography </p>" "pdfFichero" => "P1-E528-S3223-A11005-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11005_108_25067_en_11005_t1.jpg" "Alto" => 439 "Ancho" => 600 "Tamanyo" => 152195 ] ] "descripcion" => array:1 [ "en" => "Causative micro-organisms and patient evolution following removal of the peritoneal dialysis catheter" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11005_108_25068_en_11005_f1.jpg" "Alto" => 442 "Ancho" => 600 "Tamanyo" => 151599 ] ] "descripcion" => array:1 [ "en" => "Image of a pseudocavity in the peritoneography" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Choi P, Nemati E, Banerjee A, Preston E, Levy J, Brown E. Peritoneal dialysis catheter removal for acute peritonitis:a retrospective analysis of factors associated with catheter removal and prolonged postoperative hospitalization. Am J Kidney Dis 2004;43:103-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14712433" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pérez Fontán M, Rodríguez Carmona A. Peritoneal catheter removal for severe peritonitis:landscape after a lost battle. Perit Dial Int 2007;27:155-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17299150" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Scanziani R, Pozzi M, Pisano L, Barbone GS, Dozio B, Rovere G, et al. Imaging work-up for peritoneal access care and peritoneal dialysis complications. Int J Artif Organs 2006;29:142-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16485250" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cox SD, Walsh SB, Yaqoob MM, Fan SLS. Predictors of survival and technique success after reinsertion of peritoneal dialysis catheter following severe peritonitis. Perit Dial Int 2007;27:67-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17179514" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000006/v0_201502091623/X2013251411000110/v0_201502091623/en/main.assets" "Apartado" => array:4 [ "identificador" => "35438" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief papers about basic research or clinical experiences" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000006/v0_201502091623/X2013251411000110/v0_201502091623/en/P1-E528-S3223-A11005-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411000110?idApp=UINPBA000064" ]
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| 2016 August | 188 | 5 | 193 |
| 2016 July | 128 | 5 | 133 |
| 2016 June | 124 | 0 | 124 |
| 2016 May | 111 | 0 | 111 |
| 2016 April | 86 | 0 | 86 |
| 2016 March | 95 | 0 | 95 |
| 2016 February | 91 | 0 | 91 |
| 2016 January | 83 | 0 | 83 |
| 2015 December | 106 | 0 | 106 |
| 2015 November | 82 | 0 | 82 |
| 2015 October | 81 | 0 | 81 |
| 2015 September | 73 | 0 | 73 |
| 2015 August | 69 | 0 | 69 |
| 2015 July | 60 | 0 | 60 |
| 2015 June | 38 | 0 | 38 |
| 2015 May | 54 | 0 | 54 |
| 2015 April | 6 | 0 | 6 |
Show all
