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     After a change for the dialysate provider four weeks ago to a solution of 2.3%, we have observed in 12 patients out of 24 the following changes: it starts with myalgia, arthralgia, disconfort, asthenia, adynamia, and a change in the colour of the draining dialysate which becomes cloudy, reddish to red, or yellowish, or bloodstained. You can see pictures on the online folder: https://www.dropbox.com/sh/p6aomjsmrtshuvm/AACQR3wZvTgmuBLS4BJ29tdPa?dl=0 // After this, we proceed to reduce the interval and the concentration of the dialysate liquid. After 4 days, the patients present an increase in fibrine with subsequent obsruction of the PD Cathether. We never observed this pattern with the previous fluids provider.CORRECTIVE MEASURES 1.- reduce the frequency and concentration of the PD Fluid 2.- culture and antibiogram of the peritoneal liquid 3.- culture and antibiogram of the catheter exit site 4.- change to HD 5.- communicate as an adverse effect 6.- analysis of the PD liquid 7.- hospitalisation with antibiotherapy //We should remark that we have obtained a positive culture result for Candida.
    ANSWEREDPatricio G answered June 4, 2019
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     My wife is on CAPD for over 2 years. She is doing well and is comfortable. Her ultrafiltration levels ranges between 1700-ml to 1900-ml per day. But now I see that her fluid levels in the body is low. She is also having low BP (90/60). Presently we are doing 4 exchanges per day (1.5% PD solution twice and 2.5% PD solution twice. Even then there is no gain in body weight. Could you please advise how to normalize her BP and increase her body weight. Her Albumin levels are around 4.
    ANSWEREDSushant K Santra answered May 9, 2019
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     We had a PD patient whom presented to the Emergency Department with abdominal pain x one week (he never contacted us- Home Dialysis). He subsequently had an appendectomy. His PD catheter is in the lower right quadrant. Our on call Nephrologist requested the PD catheter be removed; the surgeon continues to disagree and wants to save the catheter. The pathology report is below: Gross Description (See result below)Received in formalin labeled “appendix” is a 6.2 x 1.6 x 1.5 cm tubular tan appendix with abundant attached mesoappendix and proximal staple line. The serosa is pink-tan. The lumen is focally dilated to 0.8 cm and contains no fecaliths. The soft tissue immediately adjacent to stapled margin is inked black and representative sections are submitted labeled (A1-A2).Microscopic Description (See result below)Sections show an edematous appendix with acute inflammation on the peritoneal surfaces. No inflammation is present in the appendiceal wall or the mucosa of the appendix . No true appendicitis or perforation is identified.The appearance is consistent with acute peritonitis of unknown cause.Home Dialysis was requested to obtain cell count, cultures and gram stain. Small volume (500 ml) was utilized to obtain these specimens as follows:9/11: WBC’s 658 (91% neutrophils); no growth in cultures (he has been receiving IV antibiotic since his surgery on 9/9- Zosyn) (1.5% Dialysate used for flush)9/13: WBC’s 840 (81% neutrophils); on call Nephrologist ordered Vancomycin for today and it was hung around the time I was obtaining specimens today. (Normal Saline used for flush)9/14 specimen obtained as well but no results so far.We would appreciate any Best Practice Recommendations concerning removal or preservation of this PD catheter.
    ANSWEREDA.Clark answered February 7, 2019
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     I have a patient that developed cloudy fluid post pd catheter placement. He was asymptomatic, no belly pain, fever ect. Total WBC was 450, PMN 3, Eosinophils 1 but Mononuclear cells were 97 Gram Stain was NOS and so far nothing has grown on the Culture after 3 days. This is not the first time I have seen a higher total WBC (greater than 100), normal polymorph cells and eosinophils but very high mononuclear cells (greater than 90%). What could be the cause?
    ANSWEREDAmy O answered February 5, 2019
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     Have a CCPD patient who has been on PD for 4 years. He recently developed drain problems unrelated to constipation/fibrin. He was recently seen by his surgeon.Findings: a lot of adhesion and a small bowel wrap in pelvis. This was corrected but patient still having drain problems. Drains better supine and or on left side. Patient would probably do better on CAPD but declines due to his life style. I have placed him on Tidal but still positional drain problems. Any suggestions he would like to remain on PD .
    ANSWEREDDiane M. answered January 31, 2019
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     Patient completed treatment of cefepime and Vancomycin for a no growth peritonitis. Cultures that were repeated one week after completion and again three weeks are growing sphingomonas paucimobilis however the patient does not currently have an active peritonitis. Cell count of pd fluid is negative. Could this possibly be a biofilm on the catheter and if so any suggestions on treatment? The patient has refused catheter removal and temporary hemodialysis.Thank You
    ANSWEREDLaura V answered January 28, 2019
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     I have a young ESRD Pt on PD who was admitted for migraines. She was receiving IP heparin at 1000 units per exchange for fibrin clots in her PD fluid. Also receiving SQ heparin for DVT prophylaxis. She developed progressive thrombocytopenia and HIT Ab was positive. Hematology has started angiomax (argatroban not on hospital formulary). I want to know if anyone has experience with an alternative agent for fibrin clots in PD fluid. Has anyone used fibrinolytics in PD fluid ? and what dose to use in 2 liter PD exchanges. I have done literature search and there are case reports of Pt’s developing HIT from heparin in PD fluid
    ANSWERED answered September 28, 2018
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     I had a 75 year old man who started CAPD since December in 2017. He suffered from CAPD peritonitis on 9th of Jan in 2018 and ascites culture revealed proteus mirabilis. Ceftazidime IP was given for three weeks and peritonitis totally subsided. However, he suffered from another episode of peritonitis on 18th of Feb in 2018 (ascites white blood cell 10786/uL with neurophil 94%). We collect ascites culture by blood culture bottle but this time ascites culture revealed no bacteria growth. Ceftazidime IP and cefazolin IP was given for two weeks according to ISPD guideline for culture negative peritonitis. My Question is how to define these episodes? repeat peritonitis or different peritonitis? What’s your suggestion about protocol of ascites culture collection to avoid culture negative? What’s the regimen you will give this patient for his second CAPD peritonitis? Thank you very much.
    ANSWERED answered September 28, 2018
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     I am a second year nephrologist fellow in SUNY downstate medical center, Brooklyn, NY. We have a large HD program but very limited PD program. I will be attending the PD university course for the fellows coming up in March/April of 2019.After this course I am interested in a self sponsored 1 month PD fellowship /clinical exposure .I would be grateful if you could provide me with recommendations/information on list of institutions with strong PD programs in Canada, Mexico, Europe or South Africa that can accommodate my need.After my nephrology fellowship training in june 2019, i plan to start a clinical practice of nephrology in US.Thank you.
    ANSWEREDAbayomi answered September 17, 2018
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     Good morning. Does the ISPD have a position on use of Effluent Sample Bags specifically developed and designed to collect specimens from the patient transfer set for culture when peritonitis is suspected? The sample bag that I have seen is made by a well known vendor of CAPD solutions and supplies (dual bag, y-connection), and the procedure for collection of the specimen mirrors that used for connection and disconnection during an exchange. The product is essentially a miniature drain bag. There is no instillation of solution involved.
    ANSWEREDCheryl G answered April 19, 2018
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