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Structural damage to polyurethane PD (peritoneal dialysis) catheters in patients using mupirocin ointment is widely appreciated, but damage to silicon rubber PD catheters is less well described. Ten catheters (6.6%) out of 152 were found to have structural alterations such as opacification, ballooning, thinning, and rupture. The duration of PD in these 10 patients ranged from 23 months to 80 months (mean duration 51.1 months). The frequency of mupirocin application varied from daily (2 cases) to 2–3 times per week (7 cases). In eight catheters opacification occurred at the exit site whereas one catheter showed opacification midway between the exit site and the titanium adaptor. One catheter showed opacification, ballooning, and thinning at the exit site ruptured in the form of two slit-like openings. In conclusion, various structural changes such as opacification, ballooning or thinning were seen in 6.6% of silicon rubber PD catheters in patients using mupirocin at the exit site. Although the mechanism remains elusive, mupirocin or the antiseptic solution alone or in combination may be contributory. We believe that this is an under-reported complication and encourage other health care givers to incorportate a search for such changes during clinic visits.

The authors carried out a retrospective chart review in 114 patients treated for at least two years at the Toronto Western Hospital Peritoneal Dialysis Unit and identified eight, who gained an “excessive” amount of weight equal to or greater than 10 kg of their initial weight. These patients had gained an average of 13.1 kg over the preceding two years. They are mostly males and their average age is 51 years. They are well-nourished normotenseive nondiabetics with mostly normal cardiac function. They are adequately dialyzed (per KT/V urea), have little residual renal function and typically have peritoneal membranes characterized by high average transport. According to BIA analysis, this weight gain was likely due to an increase in fat mass accompanied by a trend toward decreasing body-cell mass. This weight gain may be due to increased caloric intake secondary to dialysate glucose absorption in the setting of high average (peritoneal membrane) transport. Such excessive weight gain also may occur if these patients have polymorphism of the UCP-2 gene, which can alter metabolic rate.

By convention, septicemia occurring from an infected vascular catheter is treated with antibiotics and removal of the catheter. This approach, used with surgically implanted long-term catheters would be expected to result in loss of the vascular access site. During a 57 month period, we treated 21 episodes of septicemia secondary to infection of long term indwelling double lumen jugular venous catheters in our hemodialysis unit. Seventeen of 21 episodes were managed successfully by changing the catheter over a guidewire, thus preserving the access site. No relapse was observed after the antibiotic therapy was stopped. Only four patients required complete removal of the catheter and subsequent use of another site.

For 3 years starting in April 1989, in a 17-station, in-centre haemodialysis unit at the Toronto Western Hospital, re-use of dialysers was performed using the Renatron-2 Dialyser Reprocessing System with peracetic acid as a sterilant. During this period 40,234 treatments were carried out and dialysers were used an average of 4.2 times. Net savings, after taking into account the total costs of re-use, averaged Can $309,000,000 per year. There were no deaths and no discernible morbidity attributable to the practice of re-use. We conclude that dialyzer re-use is an effective way to reduce the costs of haemodialysis and is entirely safe providing that it is carried out properly.