Urinary Tract Disease
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Peritoneal dialysis (PD) offers potential benefits for pregnancy including continuous ultrafiltration, avoidance of hemodynamic fluctuation, and no requirement for anticoagulation. However, progressive distension of the uterus may necessitate reduced dialysate volumes and affect catheter position leading to concern about the capacity to intensify dialysis requirements in pregnancy. Incidence of pregnancy is lower for women on PD compared to hemodialysis; moreover, reports have suggested that, despite comparable rates of preterm delivery, PD is associated with a higher rate of SGA infants and maternal infections than HD. HD therefore remains the modality of choice in pregnancy, with most experts advocating a switch from PD to HD in pregnancy in order to facilitate controlled intensification of dialysis [51].
Nutritional Deficiencies
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Vitamin B6 deficiency may be inherited or acquired. Inborn errors leading to vitamin B6 deficiency may affect its synthesis, transport, or intracellular metabolism. Acquired vitamin B6 deficiency commonly occurs in association with: Alcohol dependence.Pregnancy.Older age.Hemodialysis and peritoneal dialysis.Malabsorption syndromes.Drugs: isoniazid, penicillamine, cycloserine, theophylline, and hydralazine. Vitamin B6 deficiency has also been described in association with phenytoin and carbamazepine.
Renal and Electrolytes
Kristen Davies, Shadaba Ahmed in Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Liposome supported peritoneal dialysis in rat amitriptyline exposure with and without intravenous lipid emulsion
Published in Journal of Liposome Research, 2019
Robin Chapman, Martyn Harvey, Paul Davies, Zimei Wu, Grant Cave
Peritoneal dialysis is the renal replacement dialytic technique used in 11% of renal dialysis patients worldwide (Fresenius Medical 2015). The peritoneum is the membrane lining the abdominal cavity and receives 1.5% of cardiac output with capillaries separated from the abdominal cavity by a thin layer of mesothelium. Dialysis is effected through introduction of fluid to dwell in the abdominal cavity, equilibration of dialysate with peritoneal capillary blood contents, and subsequent fluid drainage. This dialytic technique is presently regarded as having no role in the clinical management of intoxication (Yates et al.2014). In LSPD the affinity of dialysate for intoxicant is increased by the addition of liposomes with an internal pH gradient held in suspension. This technique has demonstrated markedly augmented removal of verapamil, haloperidol, and amitriptyline in animal models. Additionally LSPD has been shown to reduce the duration of hypotension when used in a rat model of oral verapamil intoxication (Forster et al.2014). The technique is also experimentally effective at increasing ammonia clearance (Agostoni et al.2016). Ammonia is implicated in the cerebral edema seen with hepatic failure and LSPD has orphan drug development status in Europe in the treatment of acute and chronic hepatic failure.
Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study
Published in International Journal of Hyperthermia, 2019
Xin Li, Ying Wei, Hongzeng Shao, Lili Peng, Chao An, Ming-An Yu
The age range of the enrolled patients was 42–67 years (53.2 ± 10.3 years). The underlying nephropathy causes included nephritis in 14 cases (70%), hypertensive nephropathy in three cases (15%), obstructive nephropathy in one case (5%) and polycystic kidney in two cases (10%). Sixteen patients were undergoing hemodialysis and four were undergoing peritoneal dialysis, with a dialysis time range of 1–20 years (9.6 ± 6.8 years). The maximum diameter of the 22 ectopic nodules was 1.0–3.3 cm (mean ± SD: 1.68 ± 0.55 cm). Regarding the location of the ectopic SHPT, 18 (81.8%) occurred in the suprasternal fossa, one (4.5%) occurred outside of the left carotid artery, one (4.5%) occurred inside the thyroid and two (9.1%) occurred in the mandibular area. One patient had coronary disease as a comorbidity (1/20, 5%). SHPT-associated complications included soft tissue calcification (2/20, 10%), Achilles tendon rupture (2/20, 10%), anemia (4/20, 20%) and hypertension (10/20, 50%).
Peritoneal dialysis in Sichuan province of China – report from the Chinese National Renal Data System
Published in Renal Failure, 2018
Changwei Wu, Xiuling Chen, Amanda Ying Wang, Jin Chen, Hui Gao, Guisen Li, Li Wang, Daqing Hong
Nowadays, peritoneal dialysis and hemodialysis are currently two major alternatives to RRT. The choice of dialysis modality depends on quality of life, survival rates, costs, patients’ wishes and national and hospital policy [21,22]. Hemodialysis now remains the most widely dialysis mode for ESRD patients. It requires not only patients to come to dialysis units, but also a certain number of doctors and nurses to operate. Peritoneal dialysis has following advantages over hemodialysis: (1) Convenience, Peritoneal dialysis is more convenient, which means patients could dialysis at home. (2) Flexibility, patients can have dialysis at night, so that they could still work during the day. (3) Peritoneal dialysis was more cost-effective [4]. (4) Peritoneal dialysis seems to have a better outcome, for example, the renal residual function (RRF) decline delayed in patients on peritoneal dialysis not hemodialysis [23]. Thus, analyzing center characteristics, summing up experience and controlling the quality of PD are very important.
Related Knowledge Centers
- Hemodialysis
- Hernia
- Kidney Failure
- Peritoneum
- Peritonitis
- Abdomen
- Cardiovascular Disease
- Blood
- Kidney Dialysis
- Electrolyte Imbalance