1.
Successful multiple-exchange peritoneal dialysis in a patient with severe hematological toxicity by methotrexate: case report and literature review.
Aristizabal-Alzate, A, Nieto-Rios, JF, Ocampo-Kohn, C, Serna-Higuita, LM, Bello-Marquez, DC, Zuluaga-Valencia, GA
Jornal brasileiro de nefrologia. 2019;(3):427-432
Abstract
Methotrexate is an effective medication to control several diseases; however, it can be very toxic, being myelosuppression one of its main adverse effects, which increases in severity and frequency in patients with renal failure. We present the case of a 68-year-old man with chronic, end-stage renal disease associated with ANCA vasculitis, under treatment with peritoneal dialysis, who received the medication at a low dose, indicated by disease activity, which presented as a complication with severe pancytopenia with mucositis that improved with support measures and multiple-exchange peritoneal dialysis. We reviewed 20 cases published to date of pancytopenia associated with methotrexate in patients on dialysis and found high morbidity and mortality, which is why its use in this type of patient is not recommended. However, when this complication occurs, a therapeutic option could be the use of multiple-exchange peritoneal dialysis in addition to supportive therapy for drug-related toxicity, although it is recognized that studies are required to show the role of multiple-exchange peritoneal dialysis in the removal of this medication.
2.
Posttransplant encapsulating peritoneal sclerosis: presentation of cases and review of the literature.
Dębska-Ślizien, A, Konopa, J, Januszko-Giergielewicz, B, Wołyniec, Z, Wołyniec, W, Chamienia, A, Rutkowski, B
Journal of nephrology. 2013;(5):906-11
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). EPS almost exclusively occurs in patients treated longer than 3-5 years on PD. The more severe clinical features of EPS may develop if PD is discontinued (patient transferred to hemodialysis or transplanted). METHODS All PD patients diagnosed with EPS after transplantation were identified, and their data were compared with those of non-EPS PD patients transplanted in our unit between 1994 and 2010. RESULTS Four EPS cases were diagnosed among 157 transplanted PD patients. Mean renal replacement therapy and PD-only duration were 103.8 and 83.5 months in EPS and 26.5 and 22.2 months in non-EPS patients, respectively. All EPS patients (n = 4) required high-volume dialysis, 2 received icodextrin, 3 were high transporters, 1 had recurrent intraperitoneal bleeding, 4 received beta-blockers and 3 had peritonitis incidents. All required surgical intervention within 1-3 months after kidney transplantation (KT). Diagnosis of EPS was based on clinical symptoms, surgery, radiologic and histopathology findings. Treatment consisted of adhesiolysis (all), parenteral nutrition (PN) (3/4) and tamoxifen (all). One patient died 49 months after EPS diagnosis. CONCLUSIONS First, bowel obstruction symptoms in long-term PD patients undergoing KT may suggest EPS. Second, long-term PD patients showing features of technique failure are at high risk of EPS after KT. Third, adhesiolysis, PN and tamoxifen are the available treatment options in EPS patients post KT. And finally, referral of eligible patients to a transplant waiting list early after starting PD may contribute significantly to EPS prevention in clinical practice.
3.
Successful treatment of Candida infections in peritoneal dialysis patients: case reports and review of the literature.
Kleinpeter, MA
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis. 2004;:58-61
Abstract
Infections with Candida species have been associated with significant morbidity and mortality in peritoneal dialysis (PD) patients. Such infections include peritonitis and exit-site infections attributable to Candida species, disseminated candidiasis in immunocompromised patients, and Candida esophagitis. In peritonitis and exit-site infections, both success and failure have been reported with commercially available medications. In disseminated candidiasis and Candida esophagitis, successful treatment and patient recovery depend on the overall nutritional and immune state of the patient. One case each of peritonitis and exit-site infection with non Candida albicans species were successfully treated with oral voriconazole. No literature currently exists on the use of this new product in dialysis patients. Presented here is a treatment strategy that resulted in maintenance of PD in the home setting and catheter survival following completion of treatment. A review of the English-language literature shows mixed outcomes associated with continuation of PD during treatment for Candida infection in PD patients. In conclusion, a commercially available product can be used to successfully treat PD patients who have Candida infections and to maintain the PD catheter for PD.