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  • 1
    Online Resource
    Online Resource
    Peritoneal Dialysis Exit-Site Care Protocols in Portugal and Its Association with Catheter-Related Infections
    S. Karger AG ; 2023
    In:  Blood Purification Vol. 52, No. 4 ( 2023), p. 366-372
    Details
    In: Blood Purification, S. Karger AG, Vol. 52, No. 4 ( 2023), p. 366-372
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Exit-site infection (ESi) prevention is a key factor in lowering the risk of peritonitis. This study aimed to evaluate the associations between exit-site (ES) care protocols and the annual incidence rates of ESi and peritonitis in Portugal. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We performed a national survey using two questionnaires: one about the incidence of catheter-related infections and the other characterizing patients’ education and ES care protocols. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In 2017 and 2018, 14 Portuguese units followed 764 and 689 patients. ESi incidence rate was 0.41 episodes/year, and the peritonitis incidence rate was 0.37. All units monitor catheter-related infections on a yearly basis, use antibiotic prophylaxis at the time of catheter placement, and treat nasal carriage of 〈 i 〉 S. aureus 〈 /i 〉 , although with different approaches. Screening for nasal carriage of 〈 i 〉 S. aureus 〈 /i 〉 is performed by 12 units, and daily topical antibiotic cream is recommended by 6 out of 14 of the units. We did not find statistical differences in ESi/peritonitis, comparing these practices. The rate of ESis was lower with nonocclusive dressing immediately after catheter insertion, bathing without ES dressing, with the use of colostomy bags in beach baths and was higher with the use of bath sponge. The peritonitis rate was lower with bathing without ES dressing and if shaving of the external cuff was performed in the presence of chronic ESi. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 We found potential proceedings associated with ESi and peritonitis. A regular national audit of peritoneal dialysis units is an important tool for clarifying the best procedures for reduction of catheter-related infections.
    Type of Medium: Online Resource
    ISSN: 0253-5068 , 1421-9735
    URL: Article
    DOI: 10.1159/000528641
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
    detail.hit.zdb_id: 1482025-0
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  • 2
    Online Resource
    Online Resource
    Early Fungal Infection in an Aortic Prosthesis with Probable Cerebral Metastasis: The Success of a Conservative Strategy
    Springer Science and Business Media LLC ; 2013
    In:  Clinical Drug Investigation Vol. 33, No. S1 ( 2013-2), p. 41-45
    Details
    In: Clinical Drug Investigation, Springer Science and Business Media LLC, Vol. 33, No. S1 ( 2013-2), p. 41-45
    Type of Medium: Online Resource
    ISSN: 1173-2563 , 1179-1918
    URL: Article
    DOI: 10.1007/s40261-012-0020-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2013
    detail.hit.zdb_id: 2043793-6
    SSG: 15,3
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  • 3
    Online Resource
    Online Resource
    A Diálise Peritoneal na Actual Crise Pandémica: Uma Oportunidade de Reflexão
    Ordem dos Medicos ; 2020
    In:  Acta Médica Portuguesa Vol. 33, No. 5 ( 2020-05-04), p. 357-358
    Details
    In: Acta Médica Portuguesa, Ordem dos Medicos, Vol. 33, No. 5 ( 2020-05-04), p. 357-358
    Abstract: N/a.
    Type of Medium: Online Resource
    ISSN: 1646-0758 , 0870-399X
    URL: Article
    DOI: 10.20344/amp.13887
    Language: Unknown
    Publisher: Ordem dos Medicos
    Publication Date: 2020
    detail.hit.zdb_id: 2133563-1
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  • 4
    Online Resource
    Online Resource
    Availability of assisted peritoneal dialysis in Europe: call for increased and equal access
    Oxford University Press (OUP) ; 2022
    In:  Nephrology Dialysis Transplantation Vol. 37, No. 11 ( 2022-10-19), p. 2080-2089
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. 11 ( 2022-10-19), p. 2080-2089
    Abstract: Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilized in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. Methods Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow and their top three priorities. Results Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD, with all respondents mentioning the need for nephrology team education and/or patient education and involvement in dialysis modality decision making. Conclusions and call to action Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and in all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policymakers and healthcare providers to develop and support assistance for PD.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac193
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    Peritoneal Protein Loss, Leakage or Clearance in Peritoneal Dialysis, Where do we Stand?
    SAGE Publications ; 2019
    In:  Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis Vol. 39, No. 3 ( 2019-05), p. 201-209
    Details
    In: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, SAGE Publications, Vol. 39, No. 3 ( 2019-05), p. 201-209
    Abstract: Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD) treatment since its inception. Investigation has focused mainly on PPL quantitative and qualitative determinations and evaluation of its prognostic value. A comprehensive review of the pathophysiology of PPL (3-pore model revisited), methods of quantification, dialysate protein composition, and impact on clinical outcomes is presented herein. The author summarizes a brief analysis of associated cardiovascular disease and nutritional consequences, exploring the controversial cause-effect on mortality and technique failure. Therapeutic modalities aiming to reduce PPL (angiotensin-converting enzyme inhibitors [ACEI]s and vitamin D therapies) were explored, although it is unclear whether PPL represents a valid therapeutic target or, on the other hand, is solely a manifestation of endothelial dysfunction.
    Type of Medium: Online Resource
    ISSN: 0896-8608 , 1718-4304
    URL: Article
    DOI: 10.3747/pdi.2018.00138
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2075957-5
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  • 6
    Online Resource
    Online Resource
    Acquired perforating dermatosis with associated complicated cellulitis and amputation in a hemodialysis patient
    Dustri-Verlgag Dr. Karl Feistle ; 2021
    In:  Clinical Nephrology – Case Studies Vol. 9, No. 01 ( 2021-01-01), p. 33-38
    Details
    In: Clinical Nephrology – Case Studies, Dustri-Verlgag Dr. Karl Feistle, Vol. 9, No. 01 ( 2021-01-01), p. 33-38
    Type of Medium: Online Resource
    ISSN: 2196-5293
    URL: Article
    DOI: 10.5414/CNCS110297
    Language: English
    Publisher: Dustri-Verlgag Dr. Karl Feistle
    Publication Date: 2021
    detail.hit.zdb_id: 3015786-9
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  • 7
    Online Resource
    Online Resource
    Statins for Renal Patients: A Fiddler on the Roof?
    Hindawi Limited ; 2012
    In:  International Journal of Nephrology Vol. 2012 ( 2012), p. 1-7
    Details
    In: International Journal of Nephrology, Hindawi Limited, Vol. 2012 ( 2012), p. 1-7
    Abstract: Atherosclerotic cardiovascular disease is the main cause of morbidity and mortality in chronic kidney disease patients. There is a raft of evidence showing that in the general population dyslipidaemia is associated with an increased risk of cardiovascular events, as well as with a greater prevalence of chronic kidney disease. Consequently, the use of statins in the general population with dyslipidaemia is not controversial. Nevertheless, the benefits of statins in patients with chronic kidney disease are more elusive. The authors review the possible effects of statins on the progression of renal disease and cardiovascular events in chronic kidney disease patients.
    Type of Medium: Online Resource
    ISSN: 2090-214X , 2090-2158
    URL: Article
    DOI: 10.1155/2012/806872
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2012
    detail.hit.zdb_id: 2573904-9
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  • 8
    Online Resource
    Online Resource
    Over Ten-Year Kidney Graft Survival Determinants
    Hindawi Limited ; 2012
    In:  International Journal of Nephrology Vol. 2012 ( 2012), p. 1-5
    Details
    In: International Journal of Nephrology, Hindawi Limited, Vol. 2012 ( 2012), p. 1-5
    Abstract: Kidney graft survival has been mainly evaluated using an up to 10-year threshold. Instead, in this study our aim was to evaluate predictive variables that impact long-term kidney graft survival (≥10 years). We enrolled 892 patients in our analysis: 638 patients with functioning graft at 10 years PT and 254 patients with graft failure at 10 years PT (considering patient death with a functioning graft 〈 10 years PT as graft failure). Between groups comparisons were done using Mann-Whitney and chi-square test. To determine independent predictive variables for long-term graft survival a multivariate-adjusted logistic regression was performed. Significant predictors of long term graft survival were lower 12-month PT creatinine (, ), lower donor age (, ), shorter time on dialysis (, ), recipient positive CMV IgG (, ), absence of AR episodes (, ), 0 to 1 (versus 2) HLA-B mismatch (, ), and recipients male gender (, ). Our results show that an early KT, younger donor age, and an optimal first year graft function are of paramount importance for long-term graft survival. Measures that address these issues (careful donor selection, preemptive KT, and effective immunosuppressive protocols) are still warranted.
    Type of Medium: Online Resource
    ISSN: 2090-214X , 2090-2158
    URL: Article
    DOI: 10.1155/2012/302974
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2012
    detail.hit.zdb_id: 2573904-9
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  • 9
    Online Resource
    Online Resource
    P1132EXIT-SITE CARE PROTOCOLS IN PORTUGAL AND ITS ASSOCIATION WITH CATHETER-RELATED INFECTIONS RATE
    Oxford University Press (OUP) ; 2020
    In:  Nephrology Dialysis Transplantation Vol. 35, No. Supplement_3 ( 2020-06-01)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 35, No. Supplement_3 ( 2020-06-01)
    Abstract: Exit-site infections (ESi) are frequent complications in peritoneal dialysis (PD) patients and their prevention and treatment are key aspects to lower peritonitis’ risk. The aim of this study was to evaluate the annual incidence rate of ESi and peritonitis in Portugal and to study possible associations between exit-site (ES) care protocols in each Portuguese unit and the number / rate of ESi and peritonitis. Method We performed a national study using two questionnaires at each Portuguese PD Unit: one about the incidence of catheter-related infections, the other characterizing patients’ education and ES care protocols. ESi and peritonitis were defined according to ISPD guidelines. Associations between variables were performed using T-student test or pairwise correlation test. STATA software was used. Results Of the 23 Portuguese PD Units, 14 units answered both questionnaires. In the last two years (2017 & 2018), those units followed 1453 patients. Portuguese ESi incidence rate was 0.41 episodes per year [1 episode per 29.2 months (MSSA incidence rate 0.13; MRSA incidence rate 0.03; Pseudomonas incidence rate 0.07)] and the peritonites incidence rate was 0.37 (1 episode per 32.5 months). We found a trend between the absolute number of ESi episodes and the number of peritonites in each unit (r=0.5, p=0.05). Although ESi prevention guidelines were known by 100% of the Portuguese units, only three out of 5 of the selected guidelines for this study were followed by 100% of the units: monitoring catheter-related infections on a yearly basis; using antibiotic prophylaxis at time of catheter placement and treating nasal carriage of S. aureus. The other 2 guidelines have variable implementation: 12 out of 14 units (86%) perform screening of nasal carriage of S. aureus and only 6 out of 14 (43%) of the units recommend daily topic antibiotic cream at the ES. We didn’t find associations between those differences and ESi incidence. Whenever S. aureus carriage is detected, 100% of the units proceed treating with mupirocine using different posology (twice or three times a day, 5 or 7 or 21 days, with/out chlorexidine). Also, the screening of nasal carriage of S. aureus is different: only pre catheter implantation (n=4); annually (n=4); semi annually (n=3); bimonthly (n=2). Oral antibiotics are prescribed after catheter placement in 4 units. We didn’t find statistical differences in ESi / peritonitis, comparing those practices. Regarding to ES care protocols, ESi rate was lower with non-occlusive dressing (0.38 vs. 0.57) immediately after catheter insertion. ESi and peritonitis rate were lower in units where bathing without ES dressing is advocated (n=9, 0.58 & 0.37 vs. 0.32 & 0.34). The use of bath sponge is associated with higher ESi rate (0.57 vs. 0.34). The use of colostomy bags in beach baths was associated with lower incidence rate of ESi compared to regular dressing or waterproof dressing (o.32 vs. 0.54). 100% of units use two different empirical antibiotics for initial ESi treatment. In the presence of chronic ESi, 3 units don’t perform shaving of external cuff and peritonitis rate is higher in those who do not apply this procedure (0.38 vs. 0.31). Conclusion in Portuguese PD units there is a wide variability in ISPD guidelines implementation and ES care protocols. We found that using non-occlusive dressing immediately after catheter insertion, removing ES dressing before shower, bathing not using a sponge and using colostomy bags at beach baths were associated with lower incidence rate of ESi. Shaving of the external cuff was associated with lower incidence rate of peritonitis. A regular national audit of PD Units is an important tool of quality improvement to clarify the best procedures for reduction of catheter-related infections in PD.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfaa144.P1132
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 10
    Online Resource
    Online Resource
    P1200PERITONEAL PROTEIN LOSSES: WHAT DO WE MEAN
    Oxford University Press (OUP) ; 2020
    In:  Nephrology Dialysis Transplantation Vol. 35, No. Supplement_3 ( 2020-06-01)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 35, No. Supplement_3 ( 2020-06-01)
    Abstract: The report of peritoneal protein loss should be related with a timely collection (24-hour measurement or 4-hour PET assessment) or concentration. Standardized and reproducible estimation of peritoneal protein transport is obtained during PET. The 24-hour measurements estimate the real amount of PPL, but may be affected by other factors unrelated to the prognosis of PD patients, as inconsistencies in collection and management of the samples. Overall, PET protein loss quantification may be a more specific marker of peritoneal large-pore dysfunction and is seemingly more convenient than 24-hour measurements. The aim of this study was to compare the results of both sampling methods. Method A total of 144 adult incident PD patients were included. A standard peritoneal equilibration test, 24-hour urine and dialysate collection, and multifrequency bioimpedance analysis were performed. Independent-samples t test and Pearson correlation coefficient were performed to evaluate relevant clinical associations. Results Statistically significant univariable relationships for 24h PPL were found for continuous ambulatory PD technique (CAPD) and, with a correlation coefficient & gt;0.20, for pulse pressure, 4-hour dialysate/plasma creatinine and extracellular water/total body water. Studying 240 min PPL, only with 4-hour dialysate/plasma creatinine, creatinine clearance and bicarbonate levels were statistically significant. In both samples there was no significant association with age, gender, type of effluent (biocompatible solutions or lactate plus bicarbonate comparing with bicarbonate), comorbidity Charlson Index, or presence of diabetes. Correlation between 240 min PPL and 24h PPL ensues, but it is not strong (p & lt;0.001; r=0.365). Conclusion The weak correlation between 24h and 240 minutes show that these two measurements should not be considered equivalent. Measurements of a 24h sample might be more close to patients’ clinical status and prognosis, despite more frequent sampling errors. PET protein loss quantification should be regarded as a marker of peritoneal large-pore dysfunction.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfaa142.P1200
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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