RESUMO
OBJECTIVES: To evaluate patient and technique survival and to provide an analysis of peritoneal dialysis (PD)-related peritonitis in 25 years of experience in a single center. STUDY DESIGN: Retrospective study of incident patients on PD from July 1980 to July 2005. SETTING: Single, university based, Brazilian dialysis program. PATIENTS: 680 patients were analyzed in our study from July 1980 to July 2005, with a cumulative experience of 15 303 patient-months. All patients over 15 years of age entering the dialysis program were included in the study. Patients with less than 30 days of follow-up were excluded. Biochemical and demographic variables, peritonitis episodes, and patient and technique survival were analyzed. RESULTS: Mean age at start of PD was 53 +/- 16 years; diabetic nephropathy was the main cause of chronic kidney disease. Cardiovascular disease was the main cause of death (44%); peritonitis was responsible for 16% of fatal events. The predictors of death in our study were diabetes [relative risk (RR) 1.23, p < 0.01], advanced age (RR 1.58, p < 0.001), low serum albumin level (RR 1.25, p < 0.01), and low serum phosphate level (RR 1.39, p < 0.001) upon starting PD. There were 1048 cases of peritonitis over the 25-year period, with a significant reduction in incidence after the introduction of the double-bag system. The number of incident PD patients originating from hemodialysis increased threefold over the observation period (p < 0.001), with a similar increase in comorbidities over time. CONCLUSION: In the largest single-center report of PD experience in Latin America, we describe the overall rate and trends over time of peritonitis as well as patient and technique survival, which are similar to previous reports. Significant changes in peritonitis rates and causative organisms as well as a significant time-dependent increase in high-risk patients starting PD were observed.
Assuntos
Diálise Peritoneal/estatística & dados numéricos , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Peritonite/etiologia , Fatores de Risco , Análise de SobrevidaRESUMO
This is the first case reported of central venous catheter-related fungemia due to C. neoformans. A patient with chronic renal failure developed a fungemia during the treatment of a dialysis-associated bacteremia. Cryptococcus neoformans grew in the catheter tip and blood culture. We addressed questions about this catheter-related fungemia.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Fungemia/microbiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Evolução Fatal , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversosRESUMO
This is the first case reported of central venous catheter-related fungemia due to C. neoformans. A patient with chronic renal failure developed a fungemia during the treatment of a dialysis-associated bacteremia. Cryptococcus neoformans grew in the catheter tip and blood culture. We addressed questions about this catheter-related fungemia.
Assuntos
Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Fungemia/microbiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Evolução Fatal , Feminino , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Diálise Renal/efeitos adversosRESUMO
The antibiotic treatment currently recommended by the International Society for Peritoneal Dialysis (ISPD) for peritonitis consists of a combination of a first- and a third-generation cephalosporin. The schedule formerly recommended combined a first-generation cephalosporin and an aminoglycoside. No comparison between the treatment schedules has been performed until now. We compared the effectiveness of these two regimens in peritoneal dialysis-related peritonitis at our center. From January 1999 to April 2000, we followed 107 patients in our PD clinic (period 1: 47% men; 32% with diabetes; mean age: 52 +/- 13 years). We followed a similar number of patients from January 2002 to July 2003 (period 2: 109 patients; 54% men; 51% with diabetes; mean age: 56 +/- 18 years). In each period, diagnosis and treatment of peritonitis were based on the recommendations of the ISPD as earlier described. Negative culture rates were similar in period 1 and period 2 (32% vs. 30%). In both study groups, the bacteria that most commonly caused peritonitis were Staphylococcus epidermidis (period 1: 41%; period 2: 39%) and S. aureus (period 1: 27%; period 2: 18%). Gram-positive infections occurred in 59% of patients during period 1 and in 57% during period 2. Gram-negative infections occurred in 16% of patients during period 1 and in 18% during period 2. We observed no significant difference in the peritonitis cure rate from period 1 to period 2 (78% vs. 83%; chi-square: 0.98; p = 0.3), but changes in the primary antibiotic schedule were necessary in 4 patients in period 1 as compared with 1 patient in period 2. The rates of catheter removal were not significantly different during the two periods (period 1: 14%; period 2: 5%; chi-square: 2.5; p = 0.11). Mortality was also not significantly different during the two periods (period 1: 7%; period 2: 5%; chi-square: 0.23; p = 0.62). The two antibiotic schedules were equally effective in the treatment of peritonitis. Cost-effectiveness, impact on residual renal function, and potential development of bacterial resistance must be considered when selecting the antibiotic schedule for peritonitis treatment.
Assuntos
Quimioterapia Combinada/uso terapêutico , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Ceftazidima/administração & dosagem , Cefalotina/administração & dosagem , Esquema de Medicação , Feminino , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/microbiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A realizaçäo de biópsia renal por via percutânea nem sempre é possível, especialmente na vigência de distúrbio de coagulaçäo significativo. Em novembro de 1997, no Hospital Universitário Evangélico de Curitiba, foi realizada uma biópsia renal por via tranjugular (VT) em uma paciente com suspeita de mieloma múltiplo que apresentava-se com um quadro de insuficiência renal e plaquetopenia (contagem de 30.000 plaquetas/mm3).O procedimento mostrou-se seguro, näo apresentando complicaçöes pós-biópsia e obtendo-se dois fragmentos com seis glomérulos em cada amostra, os quais possibilitaram o diagnóstico de "rim do mieloma". A biópsia por VTJ mousto-se um método seguro e eficaz quando da impossibilidde da realizaçäo desse procedimento por via percutânea