Swan-neck versus straight peritoneal dialysis catheter: Long-term effect on patient and method survival

Peritoneal dialysis (PD) is limited mainly by a higher technique failure rate as compared to hemodialysis (HD), catheter malfunction being an important reason. Intra- and extra-peritoneal catheter configuration may be associated with mechanical and infectious complications affecting method survival. We report our experience with two extra-peritoneal catheter configurations: the straight and the swan-neck (SN) catheters. A total of 85 consecutive patients, 58 males and 27 females were included in the study. Among them, 26 were diabetics; 52 were treated with automated PD (APD) and 33 with continuous ambulatory PD (CAPD). Straight catheters were used in 38 patients (straight group) and SN catheters in 47 patients (SN group). Straight catheters were mostly used in the first 6-year period while SN catheters in the last 6-year period. The baseline demographics were similar between the two groups. A significantly higher frequency of APD use was observed in SN group. Technique survival was better with SN versus straight (log-rank test, P = 0.01) while patient and catheter survival were similar. A better technique survival is noted in our group of patients with SN catheters. An additional factor could be the significantly higher frequency of APD use in this group. Changes in PD solutions′ composition could also contribute to improvement in technique survival. The outcome for patients and catheter types used was similar

IgA nephropathy in association with Crohn's disease: A case report and brief review of the literature

A case of immunoglobulin A nephropathy (IgAN) complicating a 10-year history of biopsy-proven Crohn's disease in a 31-year-old man is described. The patient presented with mild proteinuria and impaired renal function in the setting of an exacerbation of Crohn's disease. Renal biopsy showed IgAN. The patient responded to steroid treatment with clinical remission of the bowel disease and improvement of renal function, while proteinuria remained unchanged. IgA glomerulonephritis is rarely associated with Crohn's disease with only a few previously described cases. We briefly review these cases together with an overview of potential pathophysiological connections between these two diseases. © 2010 Informa UK Ltd

Long-Term Control of Hypertension in Dialysis Patients by Low Dose Atenolol

Hypertension in dialysis patients is considered a major factor in cardiovascular mortality. We investigated long-term efficacy of intermittent atenolol (AT) administration in 10 (7M/3F) hypertensive dialysis patients, age 60.5 (38–72), on dialysis for 56.5 months (8–156) thrice per week (10.5–13.5 h/w) (A). A similar group of 11 normotensive patients served as controls (B). Hypertension was defined as BP&gt;140/90 (day) and &gt;120/80 mmHg (night) by a 44-h ambulatory BP monitoring (ABPM) after the mid-week session. Dialysis ultrafiltration, hematology, biochemistry were similar in A and B. Atenolol was started on an alternate day, 37.5 mg/w and increased as needed. After 34 days (6–80) and a dose of 68.75 (37.5–450) mg/w, BP dropped (ABPM: MAP 104±11.5 to 95.6±10.4 mmHg, P=0.0025) similar to controls and daytime HR dropped: 84.6±9.2 to 69.3±8.2, P=0.0008 and at night: 79.5±7.6 to 68.6±8.6 b/1' becoming lower than in B: 83±10.8/69.3±8.2, P=0.009 and 80.5±11.7/68.6±8.6 b/1' (P=0.02). Six months later ABPM in A as well as echocardiography in A and B remained unchanged. Moderate, volume independent hypertension in stable dialysis patients is easily controlled during the interdialytic period by small intermittent atenolol doses. </jats:p