Abstract:
:Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the lumen of the catheter. The incidence of dialysate leakage is somewhat more than 5% in continuous ambulatory peritoneal dialysis (CAPD) patients, but this percentage probably underestimates the number of early leaks. The incidence of hydrothorax or pleural leak as a complication of PD remains unclear. Factors identified as potentially related to dialysate leakage are those related to the technique of PD catheter insertion, the way PD is initiated, and weakness of the abdominal wall. The pediatric literature tends to favor Tenckhoff catheters over other catheters as being superior with respect to dialysate leakage, but no consensus on catheter choice exists for adults in this regard. An association has been found between early leaks (< or =30 days) and immediate CAPD initiation and perhaps median catheter insertion. Risk factors contributing to abdominal weakness appear to predispose mostly to late leaks; one or more of them can generally be identified in the majority of patients. Early leakage most often manifests as a pericatheter leak. Late leaks may present more subtly with subcutaneous swelling and edema, weight gain, peripheral or genital edema, and apparent ultrafiltration failure. Dyspnea is the first clinical clue to the diagnosis of a pleural leak. Late leaks tend to develop during the first year of CAPD. The most widely used approach to determine the exact site of the leakage is with computed tomography after infusion of 2 L of dialysis fluid containing radiocontrast material. Treatments for dialysate leaks include surgical repair, temporary transfer to hemodialysis, lower dialysate volumes, and PD with a cycler. Recent recommendation propose a standard approach to the treatment of early and late dialysate leaks: 1-2 weeks of rest from CAPD, and surgery if recurrence. Surgical repair has been strongly suggested for leakage causing genital swelling. Delaying CAPD for 14 days after catheter insertion may prevent early leakage. Initiating CAPD with low dialysate volume has also been recommended as a good practice measure. Although peritonitis and exit-site infections are the most frequent causes of technical failure in peritoneal dialysis (PD), dialysate leaks represent one of the major noninfectious complications of PD. In some instances, dialysate leakage may lead to discontinuation of the technique (1). Despite its importance, the incidence, risk factors, management, and outcome of dialysate leakage are poorly characterized in the literature. We will review the limited available information on this topic in the next few sections.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Leblanc M,Ouimet D,Pichette Vdoi
10.1046/j.1525-139x.2001.00014.xsubject
Has Abstractpub_date
2001-01-01 00:00:00pages
50-4issue
1eissn
0894-0959issn
1525-139Xpii
sdi0014journal_volume
14pub_type
杂志文章,评审abstract::In an attempt to improve patient outcomes in peritoneal dialysis (PD), national organizations (such as the National Kidney Foundation Dialysis Outcomes Quality Initiative [NKF-DOQI] process) have formulated clinical practice guidelines based on clinical evidence available at the time of development. For "adequacy" of ...
journal_title:Seminars in dialysis
pub_type: 评论,社论
doi:10.1046/j.1525-139x.2003.03001.x
更新日期:2003-01-01 00:00:00
abstract::Numerous designs for tunneled hemodialysis catheter have been developed in an effort to improve catheter function and survival. In this prospective randomized controlled study, 97 patients were randomized into the palindrome catheter group (PC, n = 47) and step-tip catheter group (SC, n = 50). Demographic characterist...
journal_title:Seminars in dialysis
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-139X.2012.01054.x
更新日期:2012-09-01 00:00:00
abstract::Both the morbidity of the uremic syndrome and the generation of uremic toxins are attributed to malnutrition. If protein intake and catabolism result in the generation of solutes, then nutritional intake should be related directly to toxicity. On the other hand, inadequate nutrition has been linked to inflammation and...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1046/j.1525-139x.2002.00076.x
更新日期:2002-09-01 00:00:00
abstract::The aim of this study was to describe the range and extent of current procedural practices of Nephrologists and trainees in Australia and New Zealand with a specific focus on renal biopsy. A web-based survey was constructed based on a 2009 pilot survey conducted by the authors. The survey was distributed by email. A t...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12072
更新日期:2013-11-01 00:00:00
abstract::Nephrologists offer renal replacement therapy (RRT) to patients who are unlikely to benefit in part because of our discomfort discussing goals of care in the setting of an uncertain prognosis for a given individual. Permanent neurological impairment, terminal illness (life expectancy <6 months), medical conditions pre...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12492
更新日期:2016-07-01 00:00:00
abstract::Physical examination (PE) is an excellent means of predicting arteriovenous fistula (AVF) dysfunction. Although quick and inexpensive, PE is seldom used as a tool to assess stenosis by general nephrologists, dialysis nurses, and dialysis technicians. Previous studies have demonstrated that PE can be taught to interven...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12361
更新日期:2015-09-01 00:00:00
abstract::Cardiac resynchronization therapy with or without a defibrillator (CRT(D)) and implantable cardioverter defibrillator (ICD) may reduce the risk of arrhythmia or heart failure-specific mortality and improves the prognosis of patients with chronic kidney disease (CKD) or dialysis. The aim of this study was to perform a ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12937
更新日期:2020-12-09 00:00:00
abstract::In addition to extracorporeal renal replacement strategies, which in chronic kidney disease (CKD) are largely reserved for the treatment of end-stage kidney failure, conservative measures can be taken to reduce concentration, effects, or both concentration and effects of uremic retention solutes. In this overview, we ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00600.x
更新日期:2009-07-01 00:00:00
abstract::Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Although numerous modifiable risk factors in the pathogenesis of CVD and its associated mortality have been identified, dyslipidemia remains to be a key focus for therapy. In this regard, significant progress has been made in reducing ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12706
更新日期:2018-07-01 00:00:00
abstract::In performing percutaneous renal biopsy (PRB) of native kidneys, an increasing use of 16-gauge automated biopsy needles has been observed. We compare the adequacy and safety of PRBs in adults performed with a 14-gauge (n = 82) vs. 16-gauge (n = 55) automated needle using real-time ultrasound (US) from 1/2010 to 12/201...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12332
更新日期:2015-03-01 00:00:00
abstract::Meta-analyses of the published literature are increasingly being used, allowing similar clinical trials to be combined quantitatively, thereby increasing the precision of the estimation of treatment effect. Four meta-analyses were recently published comparing the impact of dialysis membranes or dialysis modality on cl...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1046/j.1525-139x.2003.16071.x
更新日期:2003-09-01 00:00:00
abstract::Treatment of thrombosed dialysis ateriovenous (AV) grafts in the radiology interventional suite requires percutaneous mechanical thrombectomy, along with angioplasty of the underlying stenotic lesion. We analyzed the anatomic reasons for unsuccessful percutaneous thrombectomy of AV grafts, and assessed the feasibility...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2007.00397.x
更新日期:2008-03-01 00:00:00
abstract::As suggested by its American brand name (Sensipar), the calcimimetic cinacalcet sensitizes the parathyroid cells to the extracellular calcium signal, suppressing parathyroid hormone (PTH) release and synthesis and preventing parathyroid cell proliferation. This primary PTH suppression decreases the release of calcium ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2005.18318.x
更新日期:2005-05-01 00:00:00
abstract::Hyperkalemia is common in patients with end-stage renal disease, and may result in serious electrocardiographic abnormalities. Dialysis is the definitive treatment of hyperkalemia in these patients. Intravenous calcium is used to stabilize the myocardium. Intravenous insulin and nebulized albuterol lower serum potassi...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00312.x
更新日期:2007-09-01 00:00:00
abstract::A procedure-related complication is an unanticipated adverse event that requires therapy. In order to analyze frequency and severity of complications in the process of quality assurance, it is useful to have a classification of complications, indicating the type and severity. The Clinical Practice Committee of America...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2007.00318.x
更新日期:2007-07-01 00:00:00
abstract::Percutaneous peritoneal catheter insertion can be performed by trained nephrologists. The objective of this study was to compare the outcome of peritoneal dialysis (PD) catheters percutaneous inserted with the traditional surgical technique. One hundred twenty-one PD catheters were placed in 121 stage-5 Chronic kidney...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12147
更新日期:2014-05-01 00:00:00
abstract::Catheter malfunction due to poor flow is a common problem. When it occurs early, the cause is generally technical. Late occurrences are most often related to thrombus formation. Several types of thrombus may be seen, differing by location and supposed mechanism of formation. The most common offender, however, is the f...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00109.x
更新日期:2001-11-01 00:00:00
abstract::Analysis of tissues, plasma, urine, other body fluids, and dialysate for glycation adducts has revealed the presence of two major forms: glycation adduct residues of proteins and related glycated amino acids--called glycation free adducts. The major effect on protein glycation in uremia is loss of clearance of glycati...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00589.x
更新日期:2009-07-01 00:00:00
abstract::Appropriate antibiotic dosing in critically ill, infected, patients receiving continuous renal replacement therapy (CRRT) is crucial to improve patient outcomes. Severe sepsis and septic shock result in changes in pharmacokinetic parameters, including increased volume of distribution, hypoalbuminemia, and changes in r...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12496
更新日期:2016-07-01 00:00:00
abstract::The 180 l of glomerular filtrate formed each day contain some 1100 g (2.5 pounds) of sodium chloride, of which only 5-10 g are excreted in the urine--95% is reabsorbed by the tubules. Some 425 g (nearly a pound) of sodium bicarbonate and 145 g of glucose are filtered, and more than 99% of both are reabsorbed. Also fil...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2010.00788.x
更新日期:2010-11-01 00:00:00
abstract::With the current understanding that atherosclerosis is an inflammatory disorder, markers of the associated systemic inflammatory response have been extensively studied as predictors of cardiovascular disease. Recently the use of high-sensitivity C-reactive protein (hsCRP) has been proposed for risk assessment in indiv...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00138.x
更新日期:2006-03-01 00:00:00
abstract::Several neurologic disorders have been treated with therapeutic plasma exchange (TPE). Case reports, case series, and clinical trials have published results regarding the outcomes in such patients. The data gathered have been used to formulate evidence-based guidelines, which can be used to guide therapy in patients w...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2011.01023.x
更新日期:2012-03-01 00:00:00
abstract::Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12479
更新日期:2016-05-01 00:00:00
abstract::Automated peritoneal dialysis (APD) has experienced significant growth in highly developed nations in the last few years, while in developing countries with important social, educational, and financial constraints this treatment modality is, at best, trying to emerge. APD offers advantages that make it popular. Some o...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1046/j.1525-139x.2002.00096.x
更新日期:2002-11-01 00:00:00
abstract::This report reviews the most common surgical interventions and complications of chronic peritoneal dialysis (PD) patients. Based on the current knowledge as well as our experience we detail the role of these surgical procedures. We supplement the reported knowledge in the field with our own experience in this area. Th...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12538
更新日期:2017-01-01 00:00:00
abstract::Continuous Renal Replacement Therapy (CRRT) usually requires anticoagulation to prevent clotting of the extracorporeal circuit. Interruptions due to filter clotting significantly reduce total therapy time and CRRT efficacy. Although heparin has traditionally been the most common anticoagulant used for CRRT, increasing...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12503
更新日期:2016-07-01 00:00:00
abstract::Home dialysis (home HD or home PD) remains underutilized in most jurisdictions. Physicians, advanced-practice nurses, and policy makers working with chronic kidney disease populations can provide insights into patient, healthcare professional, and system-level barriers to home dialysis selection by suitable patients. ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12183
更新日期:2014-03-01 00:00:00
abstract::Intravenous iron is an important component of the treatment of anemia of end-stage renal disease (ESRD), but it is biologically plausible that iron could increase the risk of infection through impairment of neutrophil and T-cell function and promotion of microbial growth. Any such increase in risk would be particularl...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12168
更新日期:2014-01-01 00:00:00
abstract::The prevalence of arrhythmia has increased in hemodialysis (HD) patients and the most frequent is atrial fibrillation (AF). It was reported that the amount of epicardial fat tissue (EFT) in the population without renal disease is closely related to AF. In the present study of ours, the relation between EFT thickness a...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12901
更新日期:2020-09-01 00:00:00
abstract::Hyperhomocysteinemia is an independent cardiovascular risk factor, according to most observational studies and to studies using the Mendelian randomization approach, utilizing the common polymorphism C677T of methylene tetrahydrofolate reductase. In contrast, the most recent secondary preventive intervention studies, ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00579.x
更新日期:2009-07-01 00:00:00