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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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     We currently have a patient with a profuse pseudomonas aeruginosa exit site infection (nil tunnel involvement). It was treated PO Ciprofloxacin and has not responded. The treating Nephrologist was interested to know if topical Gentamicin has ever been used and if so if it has proven effective against pseudomonas exit site infections. Any other information you have on successfully treating pseudomonas exit site infections would be appreciated also.
    ANSWEREDLauren M answered November 2, 2016
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