losartan-potassium and Peritonitis

As with other groups of chronic kidney disease patients, the treatment of anaemia is of paramount importance in the general management of patients receiving regular peritoneal dialysis. The availability of agents able to stimulate erythropoiesis has transformed the management of anaemia in CKD, but questions are still raised as to the optimum means of using these drugs. Iron management is also pivotal to the satisfactory correction of anaemia, and again there is much discussion as to whether oral or intravenous iron is the preferred mode of administration in peritoneal dialysis patients. On the basis of the published evidence to date, PD patients should maintain a haemoglobin above 11 g/dL in line with the US and the European Anaemia guidelines, and intravenous iron should be used to correct any iron deficiency. Oral iron may be effective in a minority of patients. This article aims to explore some of these issues in greater detail so that patients on peritoneal dialysis can derive the greatest benefits from correction of anaemia and maintenance of an adequate haemoglobin.

Topics: Anemia; Epoetin Alfa; Erythropoiesis; Erythropoietin; Hemoglobins; Humans; Iron; Peritoneal Dialysis; Peritonitis; Recombinant Proteins

Topics: Anti-Bacterial Agents; Calcitriol; Calcium Channel Blockers; Cytokines; Dialysis Solutions; Drug Stability; Erythropoietin; Humans; Indomethacin; Injections, Intraperitoneal; Insulin; Peritoneal Dialysis; Peritonitis

Endogenous mechanisms underlying bacterial infection resolution are essential for the development of novel therapies for the treatment of inflammation caused by infection without unwanted side effects. Herein, we found that erythropoietin (EPO) promoted the resolution and enhanced antibiotic actions in

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Disease Susceptibility; Drug Resistance, Bacterial; Erythropoietin; Escherichia coli; Escherichia coli Infections; Host-Pathogen Interactions; Macrophages; Mice; Peritonitis; Phagocytosis; PPAR gamma; Signal Transduction; Staphylococcal Infections; Staphylococcus aureus

The effect of erythropoietin (Epo) and granulocyte colony-stimulating factor (G-CSF) alone or in combination with the hepatoprotective antioxidant curcumin (Cur) was evaluated in a model of delayed liver regeneration.. Sprague Dawley rats underwent 70% liver resection with simultaneous cecal ligation and puncture and were randomised to five groups: no treatment, G-CSF (100 microg/kg), Epo (1,000 IU/kg), each alone or in combination with Cur (100mg/kg). Twenty-four hours after surgery, blood and tissue samples were collected. Markers of liver regeneration (liver weight, mitotic index, Ki-67 index), function (bilirubin, bile flow) and hepatocellular damage (liver enzymes, histomorphology) were determined. In addition, cytokine expression and hepatic glutathione concentrations were measured.. Liver regeneration was not improved by G-CSF or Epo monotherapy. Epo more effectively increased liver weight and regeneration markers, but the difference was not significant. Whereas liver regeneration was slightly inhibited in the G-CSF plus Cur group, Epo plus Cur significantly improved liver regeneration. This was accompanied by reduced oxidative stress. Liver function and the expression of pro-inflammatory cytokines were comparable in all treatment groups.. In the present model, Epo, at a relatively low dosage, did not improve liver regeneration. However, the combination of Epo and Cur showed a synergistic effect with highly significant stimulation of liver regeneration.

Topics: Administration, Oral; Animals; Antioxidants; Cell Division; Curcumin; Drug Administration Schedule; Drug Synergism; Erythropoietin; Granulocyte Colony-Stimulating Factor; Injections, Intraperitoneal; Intestinal Perforation; Liver Function Tests; Liver Regeneration; Organ Size; Peritonitis; Premedication; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Sepsis

A statistical survey conducted at the end of 2005 covered 3985 medical facilities across Japan, and 3940 facilities (98.87%) responded. The dialysis population in Japan at the end of 2005 was 257,765, which showed an increase of 9599 patients (3.87%) from the end of the previous year. The number of patients per million was 2017.6. The crude death rate for one year (from the end of 2004 to the end of 2005) was 9.5%. The mean age of the patients who began dialysis (in 2005) was 66.2 years, and the mean age of the entire dialysis population was 63.9 years. The primary diseases of the patients who began dialysis were diabetic renal disease (42.0%) and chronic glomerulonephritis (27.3%). The mean (+/-SD) serum ferritin concentration of all the dialysis patients was 191 (+/-329) ng/mL. The percentages of antihypertensive agents administered to the hemodialysis patients were as follows: calcium-channel blocker, 50.3%; angiotensin-converting enzyme inhibitor, 11.5%; and angiotensin II-receptor blocker, 33.9%. Of the peritoneal dialysis patients, 33.4% used automated peritoneal dialysis devices. Moreover, 7.3% of the peritoneal dialysis patients received dialysis treatment only in the daytime, and 15% received the treatment only at night. Icodextrin solution was used by 37.2% of the peritoneal dialysis patients. The average amount of dialysis solution used by the peritoneal dialysis patients was 7.43 (+/-2.52) L/day and the average amount of removal fluid was 0.81 (+/-0.60) L/day. A peritoneal equilibration test was conducted on 67% of the patients, and the mean dialysate to plasma creatinine ratio was 0.65 (+/-0.13). The annual incidence of peritonitis in the peritoneal dialysis patients was 19.7%. Of the 126 040 patients who responded to the inquiry of the therapeutic situation of peritoneal dialysis, 676 (0.7%) had a history of encapsulated peritoneal sclerosis and 66 (0.1%) were treated for encapsulated peritoneal sclerosis. The mean life expectancy of the dialysis population in 2003 was calculated according to sex and age. Results showed that the mean life expectancy of the dialysis population was approximately 40-60% of that of the general population of the same sex and age.

Topics: Aged; Antihypertensive Agents; Blood Pressure; C-Reactive Protein; Cause of Death; Erythropoietin; Female; Ferritins; Health Care Surveys; Humans; Iron; Japan; Kidney Diseases; Life Expectancy; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Renal Dialysis; Survival Rate

TNF is considered one of the inflammatory cytokines and contributes mainly to the generation of anemia of chronic disease (ACD). In nude mice TNF has been reported to impair iron metabolism and erythropoiesis, leading to anemia with a low serum iron and preserved iron stores. In this work, we established a murine model for ACD based on sublethal cecal ligation and puncture (CLP) with ensuing protracted peritonitis. Starting on Day 3 after CLP, a severe protracted depression of erythropoiesis in the bone marrow was noted. Two weeks after CLP, we observed a moderate normochromic anemia, low serum iron concentration, and preserved iron stores consistent with transient ACD. To determine whether TNF contributes to the development of ACD in vivo, we neutralized TNF after CLP shortly before and during the phase of most severe bone marrow depression to prevent anemia. Additionally, we studied TNF-deficient mice undergoing CLP. Two weeks after CLP, we determined red blood count, hemoglobin concentration, hematocrit, serum iron concentration, and iron stores in spleens of wild-type mice, TNF-deficient mice, and mice after neutralization of TNF. Neutralization of TNF after CLP could not prevent mice from contracting anemia. Accordingly, TNF-deficient mice developed anemia to the same extent as wild-type mice. Serum iron concentration was lowered and iron stores were overloaded in both TNF-deficient and wild-type mice after CLP. Our results clearly demonstrate that TNF is not a mediator of ACD in our model with transient anemia induced by protracted septic peritonitis.

Topics: Anemia; Animals; Antibodies, Blocking; Bone Marrow; Cecum; Disease Models, Animal; Erythrocyte Count; Erythropoiesis; Erythropoietin; Female; Hemoglobins; Iron; Ligation; Male; Mice; Mice, Inbred Strains; Mice, Knockout; Peritonitis; Sepsis; Tumor Necrosis Factor-alpha

Topics: Abdominal Pain; Adult; Analgesics, Non-Narcotic; Anemia, Iron-Deficiency; Appendicitis; Epoetin Alfa; Erythropoietin; Fever; Gastrointestinal Hemorrhage; Glomerulonephritis; Hematinics; Humans; Hypertension; Ibuprofen; Kidney Failure, Chronic; Male; Nursing Diagnosis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recombinant Proteins; Renal Dialysis

This study was performed to investigate the factors that influence intraperitoneal absorption of recombinant human erythropoietin (rHuEPO) and to evaluate the differences of the pharmacokinetics of intraperitoneally administered rHuEPO before peritonitis and after recovery. First, the pharmacokinetics in different groups of continuous ambulatory peritoneal dialysis (CAPD) patients was studied. Thirty-six CAPD patients were enrolled and divided into four groups. Group 1 included 20 patients who were either just placed on CAPD therapy or had been on CAPD for < 1 year, but with a low frequency of peritonitis episodes. Group 1 was divided into four subgroups by body weight (20-30, 31-45, 46-55, and > 55 kg). Group 2, patients who had received CAPD treatment for more than 1 year, was further divided into group 2a and group 2b according to a low or a high frequency of peritonitis episodes, respectively. rHuEPO (100 U/kg) was administered as a single bolus of intravenous, subcutaneous, or intraperitoneal injection. Intraperitoneal rHuEPO was retained for 10 h. The results showed no significant differences between subcutaneous and intraperitoneal administration in group 1 patients. However, peak concentration, time to reach peak serum level, area under the curves, and bioavailability were substantially lower after intraperitoneal than after subcutaneous administration in group 2a and group 2b patients. There was no influence of body size on peak concentration and area under the curve in group 1 patients. Second, comparison of the pharmacokinetics of intraperitoneal administration before and after recovery from peritonitis in group 1 patients revealed that the serum levels of rHuEPO became lower after the occurrence of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Body Weight; Child; Drug Administration Routes; Erythropoietin; Hemoglobins; Humans; Kidney Failure, Chronic; Longitudinal Studies; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recombinant Proteins; Retrospective Studies; Time Factors

Twelve patients presenting postoperative acute renal failure (ARF), developing after peritonitis, are subjected to follow-up study. A comparative assessment of the renal function and anemic syndrome is done during three different periods: immediately after the operative intervention, after renal failure development, and at treatment completed. For the purpose a number of indicators are monitored, namely: hemoglobin, hematocrit, erythrocytes, blood platelets, urea, creatinine, serum calcium and iron levels, diuresis and creatinine clearance (Ccr). Two patients are given human recombinant erythropoietin (rHuEpo). As demonstrated by the results, erythropoietin (Epo) deficiency is the underlying cause of concurrent anemia occurring in postoperative ARF; the anemia syndrome develops parallel to renal failure development. In patients given rHuEpo the anemia lends itself readily to control, renal failure subsides completely within shorter periods of time, and the incidence of hemorrhagic accidents is reduced.

Topics: Acute Kidney Injury; Aged; Anemia; Combined Modality Therapy; Erythropoietin; Female; Humans; Kidney; Male; Middle Aged; Peritonitis; Postoperative Complications; Recombinant Proteins

Ten continuous ambulatory peritoneal dialysis (CAPD) patients experienced 23 episodes of peritonitis and were treated with intraperitoneal (IP) antibiotics as per sensitivity report. Serum ferritin was measured before and after the treatment. In 6 patients, erythropoietin (EPO) was also measured before and after the treatment. There was a significant drop in the serum EPO levels after therapy compared to the levels before, whereas serum ferritin levels did not change.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Erythropoietin; Female; Ferritins; Hematocrit; Hemoglobins; Humans; Infant; Infections; Kidney Failure, Chronic; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Staphylococcus aureus nasal carriage status (SANCS) has been recognized as a risk factor for patients on CAPD, due to a higher probability of suffering peritoneal catheter infections. The use of subcutaneous drugs (insulin dependent diabetics, drug addicts, HD patients and antiallergic vaccines), has been associated with increased risk of SANCS. On CAPD, erythropoietin (EPO) is almost universally used by the subcutaneous route. The objective of this paper was to evaluate the incidence and prevalence of SANCS in 85 CAPD patients by means of nasal smear and the influence of SANCS on peritoneal and catheter infection rate. Patients were divided in four groups according to diabetic status and EPO treatment (mean dose 2000 u. twice a week). The prevalence of SANCS in control groups was 30% in non-diabetics and 23% in diabetics. EPO treated patients showed a prevalence of SANCS of 39% in non-diabetics and 45% in diabetics due to the presence of 7 and 5 carrier patients respectively. SANCS patients (29% of the population), suffered 45% of peritonitis and 42% of exit-site infections caused by S. aureus. In a prospective part of the study, there was no difference in the frequency of developing positive cultures among EPO and control (30% of patients). No male EPO treated patients developed SANCS. We conclude that it is necessary to monitor S. aureus nasal carrier status periodically in CAPD patients especially in women. Whether or not subcutaneous erythropoietin treatment is implicated pathogenetically with SANCS, is not clarified by our data because of the frequent spontaneous appearance of SANCS among CAPD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cross-Sectional Studies; Erythropoietin; Female; Humans; Infections; Male; Middle Aged; Nasal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Recombinant Proteins; Retrospective Studies; Risk Factors; Staphylococcus aureus

In 16 children treated by continuous ambulatory peritoneal dialysis (CAPD) recombinant human erythropoietin was administered intraperitoneally for the treatment of renal anaemia. The mean treatment period was 8.3 months. Mean haemoglobin values increased from 4.9 mmol/l at start of therapy to 6.2 after 6 months. While 11 out of 16 children needed a total of 22 transfusions during the 6 months prior to therapy, no transfusions were needed after initiation of therapy. Patients started with a dose of 300 units/kg per week. After 6 months of therapy, the mean dose was 370 and after 12 months 279 units/kg per week. No major side-effects were observed. The incidence of peritonitis was not increased. We conclude that intraperitoneal administration of erythropoietin is effective in the treatment of renal anaemia in children treated by CAPD.

Topics: Adolescent; Anemia; Child; Child, Preschool; Erythropoietin; Female; Ferritins; Hemoglobins; Humans; Infant; Male; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recombinant Proteins; Transferrin

Topics: Biopsy; Data Collection; Databases, Factual; Diagnosis-Related Groups; Erythropoietin; Female; Humans; Kidney; Kidney Failure, Chronic; Male; Peritonitis; Research; United States

Topics: Adult; Aged; Anemia; Erythropoietin; Female; Hemoglobins; Humans; Hypertension; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recombinant Proteins