Zi Chan

Background: Peritoneal dialysis (PD) patients with impaired hand–eye function require helper assistance. Our centre developed a connection device that assists patients with impaired hand–eye function to perform PD exchange themselves, but the clinical outcomes in these patients have not been investigated. Methods: We retrospectively reviewed patients who had device-assisted continuous ambulatory peritoneal dialysis (CAPD) during 2007–2016 and compared their clinical outcomes with age- and sex-matched patients receiving helper-assisted CAPD. Results: One hundred seventy-two patients (86 each in the device- and helper-assisted CAPD groups) were followed for 29.9 (19.4–43.3) months. The device- and helper-assisted groups had comparable peritonitis rates (0.489 and 0.504 episode per patient-year, respectively, p = 0.814), with no difference in the distribution of causative organisms and the organism-specific peritonitis rates. The device-assisted group showed similar peritonitis-free survival compared with the helper-assisted group (2.58 (1.85–3.31) vs. 1.78 (0.68–2.88) years, p = 0.363) and time-to-PD discontinuation (6.27 (3.65–8.90) vs. 4.35 (3.48–5.22) years, p = 0.677). The median patient survival was similar between the two groups (3.89 (2.22–5.55) vs. 3.81 (3.27–4.36) years in the device- and helper-assisted groups, respectively, p = 0.505). Conclusion: Device-assisted CAPD confers comparable outcomes as helper-assisted CAPD and is a viable option in PD patients with impaired hand–eye function.

BACKGROUND: Eosinophilic peritonitis is a well-known complication at the initiation of peritoneal dialysis. It is often due to an allergic reaction to peritoneal dialysis solution or sometimes to the peritoneal dialysis catheter itself. Most cases are self-limiting with expected spontaneous resolution within a few weeks. Treatment is necessary for severe or persistent cases. However, the optimal treatment has not yet been defined. There have been only a few case reports on the use of anti-histamines and/or steroids for the treatment of eosinophilic peritonitis. We reported a case of severe eosinophilic peritonitis successfully treated by switching the brand of peritoneal dialysis fluid (same glucose concentration). To the best of our knowledge, this is the first reported case employing such a treatment strategy. CASE PRESENTATION: An eighty-two-year-old man with end-stage renal failure was started on continuous ambulatory peritoneal dialysis with Dianeal® (Baxter) peritoneal dialysis solution. He developed eosinophilic peritonitis 19 days after initiation of peritoneal dialysis. Infectious causes were ruled out by bacterial, fungal and tuberculosis smears and cultures. In view of the persistent and severe symptoms, we intervened by switching from Dianeal® (Baxter) peritoneal dialysis solution to Stay-Safe Balance® (Fresenius) solution with the same glucose concentration. His eosinophilic peritonitis resolved 5 days after switching the peritoneal dialysis solution. CONCLUSION: In severe or persistent cases of eosinophilic peritonitis requiring treatment, other than the use of steroids and anti-histamines, switching to a different brand of peritoneal dialysis solution can be considered.