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Peritoneal dialysis 4

Peritoneal dialysis 4

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Peritoneal dialysis 4

  1. 1.  Preservation of RRF  Higher Hb concentration  Less risk of acquiring blood borne infections e.g. HCV  Better quality of life  It allows expansion with limited resources  Lower staff / patient ratio  saves vascular access  preferred for children
  2. 2. Complications of PD therapy infectious Non infectious Peritonitis TunnelExit site Acute Chronic
  3. 3. • It is the major complication of PD and remains the main reason for switching patient to HD . • The rate should not be > 1 episode/18 patient-month or 0.67 episode / year at risk (ISPD guidelines)
  4. 4. abdominal pain ( 80% ) fever ( 50%) nausea ( 30% ) diarrhea ( 7-10% ) poor drainage cloudy fluid or drainage loss of UF function
  5. 5. Based on the number of WBCs :100 wbc / mm3.  A gram stain should be done.  Bacteria are present in low concentrations in PD fluid.  positive culture, in the absence of WBCs usually represent contamination  Culture negative ~ 20% of cases.  sterile culture: antibiotic, poor culture technique, early sampling.
  6. 6. Initiate empiric therapy with Cefazolin or Cephalothin and OR Glycopeptide ( Vancomycin or Teicoplanin) and Ceftazidime Continuous dosing Intermitt. dosing Cefazolin or cephalothin 250 mg/L load,then 125 mg/L in each exchange 15 mg/kg in a single exchange/day Ceftazidime 250 mg/L load,then 125 mg/L /change 15 mg/kg in a single exchange /day Vancomycin 500 mg/L load,then 30mg/L /change 30 mg/kg in a single exchange q 5-7 days Teicoplanin 200 mg/L load,then 20mg/L /change 15 mg/kg in a single exchange q 5-7 d.
  7. 7. Staph. aureus Enterococcus strepto. Other gram +ve Methicilin sensitive: continue cephalosporin Discontiue ceftazidime and glycopeptide. Add rifampicin 20mg/kg/day, orally. Mehticillin resistant: Discontinue ceftazidime Continue glycopeptide Discontiue cephalosporin or glycopeptide and ceftazidime,start ampicillin 125 mg/L. Aminoglycoside may be added based on sensitivity result and patient response. Vancomycin for ampicillin resitancs cases Methicillin sensitive: Discontinue ceftazidime and glycopeptide, continue cephalosporin Duration: 21 days 14 days 14 days
  8. 8. Single gram –ve /non Pseudomonas pseudomonas Multiple organisms and /or anaerobe Adjust antibiotics to sensitivity pattern. May continue ceftazidime Discontinue cephalosporin or glycopeptide. Continue ceftazidime, add agent with activity against pseudomonas ( piperacillin,ciprofloxacin, aminoglycoside or aztreonam Consider surgical intervention and add : Metronidazole 15 mg/kg/day in divided doses (max. 1.5gm/day). Duration: 14 days 21 days 21 days
  9. 9. Non-infectious Complications of Peritoneal Dialysis Mechanical complications Metabolic Disturbances Early Pain Bleeding Perforation of a viscera Exit site leak Late Catheter – related complications Pain Bleeding Catheter obstruction Catheter cuff extrusion Increased intra – peritoneal pressure Fluid leak Hernias Low back pain GERD Alteration of diaphragmatic mechanics Alteration of peritoneal transport Peritoneal – membrane related complications Ultrafiltration Failure (UFF) Encapsulating peritoneal Sclerosis Hyperglycaemia Hyperlipidemia Malnutrition Hypokalemia Hypermagnesaemia
  10. 10. PD HD

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  • lucysathish

    Jul. 19, 2016
  • conniejeankelly

    Jun. 25, 2017
  • JRAJENDER

    Jul. 4, 2019

Peritoneal dialysis 4

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