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Background: Peritoneal dialysis (PD) related infections are associated with technique failure and mortality. The aim of this multicentre study was to examine epidemiology, treatment and outcomes of PD-related infections in Poland as well as practice patterns for prevention of these complications in the context of current ISPD recommendations., Methods: A survey on PD practices in relation to infectious complications was conducted in 11 large Polish PD centres. Epidemiology of peritonitis and exit-site infections (ESI) was examined in all patients treated in these units over a 2 year period., Results: The study included data on 559 PD patients with 62.4% on CAPD. Practice patterns for prevention of infectious complications are presented. The rate of peritonitis was 0.29 episodes per year at risk, with Gram positive microorganisms responsible for more than 50% of infections and 85.8% effectively treated. Diagnosis and treatment followed ISPD guidelines however most units did not provide an anti-fungal prophylaxis. Although neither of the centres reported routine topical mupirocin on catheter exit-site, the rate of ESI was low (0.1 episodes per year at risk), with Staphylococcus aureus as most common pathogen and full recovery in 78.3% of cases., Conclusion: The study shows rewarding outcomes in prevention and treatment of PD-associated infections, mainly due to a thorough compliance with the current ISPD guidelines, although some deviations from the recommendations in terms of practice patterns have been observed. More studies are needed in large numbers of patients to differentiate the importance of specific recommendations and further support the guidelines.

Purpose: When choosing a dialysis option for ADPKD patients, peritoneal dialysis (PD) is often discouraged, due to its potential drawbacks: risk of abdominal hernias and dialysis fluid leaks, risk of peritonitis and insufficient dialysis adequacy. The present study was designed to compare the outcomes and dialysis efficacy in ADPKD patients treated with PD, in comparison with non-ADPKD subjects., Methods: This study was a retrospective analysis of the data from the national PD registry in which 106 ADPKD and 1606 non-ADPKD incident PD patients were evaluated. Data on dialysis adequacy, risk of dialysis-associated complications, as well as patient and technique survival were compared between the groups., Results: The ADPKD patients did not differ from the non-ADPKD controls in terms of dialysis adequacy. After a median observation time of 32 months, there were no differences in patient or technique survival. The risk of abdominal hernias and dialysis fluid leaks was twice as high in ADPKD subjects, compared to the non-ADPKD group. However, these complications did not result in a need for a permanent transfer to hemodialysis., Conclusions: Dialysis adequacy, and patient and technique survival are similar in the ADPKD and non-ADPKD patients treated with PD. PD seems a feasible treatment option for end-stage renal failure in the course of ADPKD.

Background: Haemodialysis (HD) and peritoneal dialysis (PD) should be regarded as complementary methods of renal replacement therapy. Approximately 10-20% of patients on PD are transferred annually to HD due to technique failure. Much smaller proportion of patients changes modality from HD to PD, predominantly due to vascular access problems, cardiac disease or patient preference. The effects of these transfers on therapy outcome, patient and technique survival have not been studied, with research focusing on outcome measures within the single modality and comparisons between the two methods., Methods: We have analysed retrospectively a cohort of 264 patients treated with PD in a single PD centre during 1994-2006. Patient characteristics, therapy measures and outcome of patients were compared between patients for whom PD was the initial method of renal replacement therapy (group 1, n = 197) and those transferred to PD from haemodialysis because of complications (group 2, n = 67). The Kaplan-Meier method and Cox proportional hazards multiple regression analysis were used to assess patient and technique survival., Results: In patients transferred from HD, significantly less had diabetes (11.9% versus 38.1%, P < 0.0001) and there were also significantly more females (57% versus 42.2%, P < 0.05). Baseline Kt/V was significantly higher in the primary PD therapy group (2.46 +/- 0.57 versus 2.11 +/- 0.48, P < 0.001), due to lower residual renal function in patients transferred from HD. Group 2 had also significantly higher peritonitis rate (0.86 versus 0.62 episode/year, P < 0.05). During the time of observation, 71 patients have died, in 100 patients kidney transplantation was performed, 56 were transferred to HD, renal function recovered in 5 and 32 were still on PD at the end of the study. No significant differences were observed in unadjusted patient survival, but technique survival was significantly lower in group 2 (P < 0.05). In the Cox multiple regression model, diabetes status, age and albumin level significantly influenced survival. Relative risk of death was not increased significantly in patients transferred from HD., Conclusions: Our data suggest that outcome of patients transferred from HD is similar to that achieved in patients in whom PD is the first choice therapy. Thus, this option should be strongly considered in patients experiencing complications on HD, mainly vascular access problems, heart failure or intradialytic hypotension.

Unlabelled: The aim of the study was to evaluate the presence of HCV replication in bone marrow cells derived from patients displaying hematological disorders. We analysed serum, peripheral blood mononuclear cells (PBMC) and bone marrow samples obtained from 27 patients displaying the following dysfunctions: lymphoma, trombocytopenia, haemophilia, pancytopenia and acute myeloid leukemia (AML). The presence of HCV-RNA in samples was detected by RT-PCR. All the serum samples were HCV-RNA positive as well as 9 out of 27 (33%) PBMC and 17 out of 27 (63%) of bone marrow samples. Independently to the disorder type, the co-presence of HCV-RNA in serum and bone marrow with the simultaneous absence of the viral genetic material in PBMC was detected in 5 (18.5%) of patients. This result suggests that bone marrow is a site of active viral replication. To check whether a viral replication generates any mutations, an SSCP analysis of the 5'UTR viral region was performed. The difference in the viral sequence derived from serum, PBMC and bone marrow was detected in one case. This result may indicate the occurrence of mutation process during the viral replication in bone marrow. An immunohistochemical analysis of bone marrow smears showed the presence of HCV antigens., Conclusion: bone marrow cells of patients displaying hematological disorders represent a putative site of extrahepatic HCV replication.

Unlabelled: Silent myocardial ischaemia (SMI), a common disorder, has been studied by different research groups for the last 25 years. It is known that SMI is more common in patients with type 2 diabetes mellitus (type 2 DM) than in the general population, even though pathological mechanisms responsible for SMI are unclear. The aim of the study was to assess the role of SMI and other conditions in predicting adverse outcome in patients with type 2 DM during five years of follow-up., Materials and Methods: 67 males with type 2 DM were enrolled into the study group. 55-healthy men were used as a control group (CG). Precise clinical examinations (medical history, physical examination, laboratory tests) were conducted. Coronary risk factors and the level of diabetes control were assessed. Noninvasive cardiological tests: ETT, 24 h ECG and echocardiography were performed. The prevalence of the following complications: ischaemia, unstable angina, myocardial infarction, heart failure, death and need for invasive procedures was recorded for five years. Parameters responsible for the complications were analyzed with the use of univariate logistic regression test; odds ratio was calculated., Results: The silent myocardial ischaemia was found in 32.8% of patients with type 2 DM and in 9.1% men in control group (p < 0.001). The complications were observed in 24% of men with DM and in 16% in control group (NS). It was found that 25 parameters in the studied group and 16 parameters in the control group were statistically significant for the prediction of complications (among analyzed 92 parameters). The most important of them in type 2 DM group are: duration of diabetes (years) OR--1.18 (p < 0.01), fasting glucose (mg/dl) OR--1.017 (p < 0.01), SMI episodes (ETT) OR--4.72 (p < 0.01), diastolic dysfunction (E/A), OR--0.003 (p < 0.02) and left ventricle hypertrophy OR--3.86 (p < 0.05), whereas in CG--SMI episodes, OR--17.72 (p < 0.002)., Conclusions: (1) The silent myocardial ischaemia is common in patients with type 2 DM. It was diagnosed in 33% of the patients. (2) The presence of SMI significantly increases the risk of complications both in patients with diabetes mellitus and the control group. (3) There are many other factors predisposing to the complications. In patients with diabetes mellitus they included, besides SMI, the duration of diabetes, chronic hyperglycemia and left ventricular diastolic dysfunction.