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A 67-year-old Japanese woman with end-stage renal disease due to autosomal dominant polycystic kidney disease was initiated on continuous ambulatory peritoneal dialysis after insertion of a straight Tenckhoff catheter. Peritoneal dialysis exchanges were uncomplicated until 3 weeks after the operation, when the catheter was found to be suddenly obstructed during both fluid infusion and drainage. The patient complained of abdominal pain in the lower left quadrant, especially during attempted peritoneal exchanges. She was suspected of having catheter obstruction by intra-abdominal viscera, and underwent surgical exploration, which revealed that the catheter was obstructed by an incarcerated sigmoid colon wall (Figure 1). The colon wall was separated from the catheter and the catheter was fixed to the posterior wall of the bladder. After surgery, the catheter functioned properly.

Effect of dwell time on carbonyl stress using icodextrin and amino acid peritoneal dialysis fluids.BackgroundDeterioration of the peritoneal membrane limits the technical survival of peritoneal dialysis (PD). Advanced glycation of the membrane has been incriminated in this evolution. Advanced glycation end products (AGEs) develop under the influence of glucose and of its degradation products, mainly reactive carbonyl compounds (RCOs) such as glyoxal (GO), methylglyoxal (MGO), and 3-deoxyglucosone (3-DG). The present study was undertaken to evaluate the impact of recently developed glucose-free PD fluids on AGE generation.MethodsRecently developed glucose-free PD fluids containing either icodextrin or amino acids were investigated. GO, MGO, and 3-DG [high-performance liquid chromatography (HPLC)] and total RCOs (spectrophotometry) were measured in fresh solutions and in effluents after various dwell duration. The AGE formation potential of PD fluids and effluents was assessed by incubation at 37°C, for one week, with bovine serum albumin and by the eventual measurement of pentosidine (HPLC) and Nε-carboxymethyllysine (CML; gas chromatography/mass spectrometry).ResultsGO, MGO, and 3-DG (P < 0.001) as well as total RCOs levels (P < 0.01) were significantly lower in icodextrin and amino acid PD fluid than in commercial, heat-sterilized, 1.36% glucose PD fluid. Pentosidine and CML generation were also significantly lower (P < 0.001) in icodextrin and amino acid PD fluid than in conventional 1.36% glucose PD fluid. The levels of total RCOs, however, increased in icodextrin and amino acid PD fluid effluents with dwell time. AGE formation potential rose accordingly, as demonstrated by a parallel increase in the generation of pentosidine and CML during incubation of PD effluents.ConclusionThe present data demonstrate lower RCO contents and AGE formation potential in fresh icodextrin and amino acid PD fluids than in fresh heat-sterilized glucose PD fluids. However, this difference decreases progressively during dwell time, mainly as a result of the influx of total RCOs.

An 89-year-old Japanese woman on continuous ambulatory peritoneal dialysis presented with an obstructed peritoneal catheter (both inflow and outflow) 8 weeks after the initiation of dialysis. To investigate the cause of the catheter obstruction, we adapted a gastrofiberscope for percutaneous endoscopic gastrostomy (FP-7RBS, HOYA-Pentax, Tokyo, Japan) whose outer diameter is 2.4 mm, which is comparable to that of a Tenckhoff catheter. Endoscopic examination revealed that the catheter was obstructed with a red-colored tissue (Figure 1), suggesting a visceral organ (intestine, colon, or fallopian tube). The prolapsed tissue was gently reduced back into the peritoneal cavity under direct vision from the side hole of the Tenckhoff catheter. The catheter subsequently functioned properly and she was able to resume peritoneal dialysis. Although catheter obstruction is a frequent and serious complication in peritoneal dialysis, the available non-invasive methods for the diagnosis are limited to date. Endoscopic approach can provide us accurate diagnostic information and another strategy for the treatment of peritoneal catheter obstruction.