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.
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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.
1 answer
Thanks for your question. This is not something that has been typically observed with solutions from either of the major PD providers. As you have done, this should be communicated to the provider to ensure that there was no safety issue with the batch of solutions provided to the affected patients. For the patient with candida growth in the dialysate, catheter removal is necessary.