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Peritoneal dialysis 4
This document discusses complications of peritoneal dialysis (PD) therapy, including infectious and non-infectious complications. It provides guidance on diagnosing and treating peritonitis, the major infectious complication of PD. It recommends empiric antibiotic therapy for peritonitis including cefazolin/cephalothin and vancomycin or teicoplanin initially. Therapy should be adjusted based on culture results and patient response. Non-infectious complications discussed include mechanical issues like pain or hernias as well as metabolic disturbances like ultrafiltration failure or encapsulating peritoneal sclerosis. Overall the document provides clinical guidelines for managing common complications of peritoneal dialysis.
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Peritoneal dialysis 4
- 1. Preservation ofRRF 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. Complications of PD therapy infectiousNon infectious Peritonitis TunnelExit site Acute Chronic
- 3. • It isthe 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. abdominal pain (80% ) fever ( 50%) nausea ( 30% ) diarrhea ( 7-10% ) poor drainage cloudy fluid or drainage loss of UF function
- 5. Based on thenumber 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. Initiate empiric therapywith 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. Staph. aureus Enterococcusstrepto. 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. 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. Non-infectious Complications ofPeritoneal 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.