phenylephrine-hydrochloride and Kidney-Failure--Chronic

The importance of Staphylococcus aureus as etiological agent for catheter-related infections and peritonitis in peritoneal dialysis patients is well established. To evaluate groups at risk of developing Staphylococcus aureus infections, nasal and exit-site cultures were performed in 76 peritoneal dialysis patients monthly over a period of 3 yr. The risk of Staphylococcus aureus catheter infection was significantly higher in diabetic (group 1) and immunosuppressed (group 2) patients compared with nondiabetic and nonimmunosuppressed (group 3) patients. In diabetic patients, Staphylococcus aureus-positive nasal cultures were more frequent than positive cultures taken from the bland exit-site (73.3% versus 60.0%). On the other hand, both positive and negative exit-site cultures had a better prognostic value for Staphylococcus aureus catheter infection compared with nasal cultures. In immunosuppressed patients, both nasal and exit-site carriages were associated with a very high risk of Staphylococcus aureus catheter infection, but nasal swabs were far more often positive than swabs from the bland exit-site (72.7% versus 25.0%). However, the risk of infection was also high for non-nasal and non-exit-site carriers in this group. In nondiabetic and nonimmunosuppressed patients, the risk of Staphylococcus aureus catheter infection was increased only if two or more positive nasal cultures were detected. It is concluded that in diabetic patients, antibiotic prophylaxis should be performed in all Staphylococcus aureus exit-site carriers. All immunosuppressed patients should be treated prophylactically. In contrast, in nondiabetic and nonimmunosuppressed patients, prophylactic treatment should be considered only in nasal carriers with two or more positive cultures. The overall low peritonitis rate does not influence this prevention strategy.

Topics: Adult; Aged; Analysis of Variance; Catheterization; Diabetes Complications; Female; Humans; Immunocompromised Host; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Nose; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Complaints about sleep and daytime alertness are common in ESRD patients. Eight consecutive ESRD patients with a sleep complaint were studied with all-night polysomnography. All were found to have significant sleep apnea with a mean apnea/hypopnea index (AHI) of 64 +/- 41.6 episodes per hour of sleep (range 7.5 to 140/hr of sleep). The majority of apneas were of the central or mixed variety causing severe fragmentation of sleep and frequent awakenings. Treatment was attempted with nasal continuous positive airway pressure (NCPAP). NCPAP was highly successful in six of the eight patients, reducing the mean AHI to normal or near normal levels (6.0 +/- 3.8/hr of sleep, P < 0.02 vs. baseline). The quality of sleep was significantly improved with statistically significant decreases in light stage 1 sleep, and nocturnal oxygenation improved with statistically significant increases in low SaO2 values. Five of six responders reported that they awoke feeling more alert and fewer times from sleep. The etiology of sleep apnea in ESRD is unknown although the frequent central apneas suggest a dysfunction of central respiratory control resulting from the effects of renal failure. Sleep-related complaints in patients with ESRD are likely to result from sleep apnea, a sleep disorder that can be diagnosed with polysomnography and treated with NCPAP.

Topics: Body Weight; Female; Humans; Kidney Failure, Chronic; Leg; Male; Middle Aged; Movement; Nose; Oxygen; Positive-Pressure Respiration; Sleep Apnea Syndromes; Surveys and Questionnaires

Staphylococcal infections can cause significant morbidity in patients undergoing dialysis. This study evaluated the effects of HIV infection on nasal carriage of Staphylococcus aureus, staphylococcal peritonitis, and catheter infection rates in patients with end-stage renal failure managed with continuous ambulatory peritoneal dialysis (CAPD).. Sixty HIV-positive and 59 HIV-negative CAPD patients were enrolled and followed up for up to 18 months. S. aureus nasal carriage (detected by nasal swab culture), Staphylococcal peritonitis (diagnosed by clinical presentation, and CAPD effluent Staphylococcal culture and white blood cell count ≥100 cells/µL), and catheter infections (including exit site and tunnel infections) were assessed monthly.. At 18 months, S. aureus nasal carriage rates were 43.3% and 30.5% (p = 0.147) and the methicillin-resistant S. aureus (MRSA) nasal carriage rates were 31.7% and 13.6% (p = 0.018) for the HIV-positive and HIV-negative cohorts, respectively. The HIV-positive cohort was associated with increased hazards for staphylococcal peritonitis, (adjusted hazard ratio [AHR] 2.85, 95% confidence interval [CI] 1.19-6.84, p = 0.019) due to increased coagulase-negative staphylococcal (CNS) peritonitis rate in the HIV-positive cohort compared with the HIV-negative cohort (0.435 vs. 0.089 episodes/person-years; AHR 7.64, CI 2.18-26.82, p = 0.001). On multivariable analysis, CD4+ cell count <200 cells/µL, diabetes, and S. aureus nasal carriage were found to be independent predictors of S. aureus peritonitis.. These findings suggest that HIV infection may be a risk factor for MRSA nasal colonization and may increase the risks of CNS peritonitis, while a CD4+ cell count <200 cells/µL and S. aureus nasal carriage may be important predictors of S. aureus peritonitis.

Topics: Adult; Carrier State; Catheter-Related Infections; Catheters, Indwelling; Female; Follow-Up Studies; HIV Infections; Humans; Kidney Failure, Chronic; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Risk Factors; Staphylococcal Infections

The tricho-rhino-phalangeal syndrome type III (TRPS III) is a rare autosomal dominantly inherited condition. The main clinical features are sparse and slow-growing hair and nails, a pear-shaped nose with a bulbous tip, elongated and flat philtrum, thin upper lip, cone-shaped epiphyses of the phalanges, and short stature. All patients have a point mutation in the TRPS1 gene.. In this paper, we present a 13-year-old female with the typical clinical features of TRPS III, extreme growth retardation, severe deformities of both proximal radii resulting in limited extension of the elbows, and chronic renal failure (CRF) in addition. Molecular diagnostics revealed a missense mutation in exon 6 of TRPS1 that she inherited from her father who is also affected with TRPS III, but does not have CRF. In the index patient, the CRF was found to be due to bilateral renal hypodysplasia (RHD).. Beside the renal dysplasia, the girl had severe deformities of the proximal radii - findings which have not been reported so far in TRPS III.

Topics: Abnormalities, Multiple; Adolescent; DNA-Binding Proteins; Female; Fingers; Growth Disorders; Hair Diseases; Humans; Kidney; Kidney Failure, Chronic; Langer-Giedion Syndrome; Nose; Point Mutation; Radius; Repressor Proteins; Syndrome; Transcription Factors

In this study, we aimed to determine the nasal carriage rate of Staphylococcus aureus and risk factors in hemodialysis (HD) patients.. One hundred eighty-four HD patients were evaluated. A second sample was taken from the subjects, the wipe samples of whom were isolated as S. aureus. And subjects whose second samples' results were the same were deemed as S. aureus carriers.. Fifty-two (28.3%) patients were identified as S. aureus carriers. In the control group, S. aureus carriage has been found out as 14.9% in 116 healthy subjects. The isolation rate of S. aureus has been found statistically significantly high in the age group of 41-61 years. But, methicillin-resistant S. aureus (MRSA) isolation ratio has been statistically high in the group over the age of 61 years. Sepsis history and gastrointestinal system disease development is closely related to bacterial isolation. MRSA isolation ratios have been found high in chronic lung disease patients, diabetic patients, patients with infection history, and patients with impaired general state of health. The carriage ratios have been found higher in the patients who are settled in urban areas, are subjected to dialysis for more than 10 years, and are hospitalized in the past year. However, the difference between the other groups is not statistically significant.. S. aureus carriage must be screened on regular intervals in HD patients. Nasal S. aureus carriage follow-up and treatment is a process that will protect patients from more severe clinical pictures.

Topics: Adult; Aged; Carrier State; Drug Resistance, Bacterial; Female; Humans; Kidney Failure, Chronic; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prevalence; Risk Factors; Staphylococcal Infections; Turkey

Renal osteodystrophy is a common complication of uremic patients, mainly when they are in long-term regular dialysis treatment. The craniofacial skeleton is one of the peculiar targets of renal osteodystrophy, the more dramatic pattern of which is a form of leontiasis. To assess facial deformities in uremic conditions and to understand the possible relation with hyperparathyroidism, the three-dimensional coordinates of 50 soft tissue facial landmarks were obtained by an electromagnetic digitizer in 10 male and 10 female patients (aged 53-81 years) with chronic renal insufficiency and regular dialysis treatment. Similar three-dimensional coordinates were also collected for 34 healthy individuals of the same age, ethnicity, and sex. From the landmarks, facial distances, angles, and volumes were calculated according to a geometrical model of the face. Data were compared with those collected in the normal subjects by computing z-scores. Facial volumes of the chronic renal insufficiency patients were significantly larger than those of the control subjects. The increment was particularly evident in the facial middle third (maxilla), leading to a significant inversion of the mandibular-to-maxillary ratio. The lips tended to be more prominent (reduced interlabial angle). Some of these facial modifications (facial and nose height, maxillary dimensions, mandibular shape) were significantly related to the clinical characteristics of the patients (duration of renal insufficiency, duration of dialysis, parathormone (PTH) plasma levels). In regular dialysis treatment, some of the facial modifications are related to hyperparathyroidism, which supports the need for a strict metabolic control also in the early phase of uremia.

Topics: Aged; Aged, 80 and over; Case-Control Studies; Cephalometry; Chronic Kidney Disease-Mineral and Bone Disorder; Face; Facies; Female; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged; Nose; Parathyroid Hormone; Renal Dialysis; Time Factors; Uremia; Vertical Dimension

Dialysis patients, often carriers of Staphylococcus aureus in their nares, are at high risk of S. aureus infections.. We examined whether RNAIII inhibiting peptide (RIP), which interferes with quorum sensing mechanisms, reduces adherence of S. aureus to host cells and to dialysis catheter polymers in vitro. Adherence was tested by spectroscopy using safranin staining, by confocal scanning laser microscopy and by atomic force microscopy.. RIP inhibited bacterial adherence to HaCat and HEp-2 cells and reduced adherence and biofilm formation not only on polystyrene, but also on both polyurethane- and silicone-made dialysis catheters, with a preponderant effect on silicone, to which bacteria were more adherent.. RIP opens a new perspective in anti-S. aureus prophylaxis, particularly in dialysis patients.

Topics: Bacterial Adhesion; Biofilms; Catheters, Indwelling; Cell Line, Tumor; Humans; In Vitro Techniques; Keratinocytes; Kidney Failure, Chronic; Nose; Oligopeptides; Renal Dialysis; Skin; Staphylococcal Infections; Staphylococcus aureus

Two male patients with chronic renal failure maintained on hemodialysis developed progressive clinical features of ischemic necrosis (so called calciphylaxis) of their extremities and penis. Both patients died. In one patient, penectomy provided tissue for histopathologic examination and there were changes of small artery calcification. A role of iron overload on the production of calciphylaxis is reviewed. This report is perhaps the first in nephrology literature on the occurrence of calciphylaxis involving penis and prepuce.

Topics: Aged; Arterial Occlusive Diseases; Calciphylaxis; Fatal Outcome; Foot; Gangrene; Hand; Humans; Iron; Ischemia; Kidney Failure, Chronic; Male; Necrosis; Nose; Penile Diseases; Penis; Renal Dialysis; Uremia

Surveillance of 101 hemodialysis patients for Staphylococcus aureus positive nasal cultures was performed by monthly nasal swabs over a 27-month period. All positive cultures were treated with a prophylactic antibiotic regimen. Forty-seven (46.5%) patients had one or more positive cultures. The surveillance period was longer in the S. aureus nasal carriers (p = 0.004). The frequency of positive cultures correlated with the duration of surveillance (p = 0.029). The incidence of S. aureus bacteremia was greater in patients with two or more positive cultures (p = 0.030). This study suggests that continuous surveillance for S. aureus nasal colonization is essential to properly identify all patients at risk of developing S. aureus bacteremias.

Topics: Anti-Bacterial Agents; Bacteremia; Cohort Studies; Drug Therapy, Combination; Female; Hemodialysis Units, Hospital; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Nose; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Topics: Humans; Kidney Failure, Chronic; Nose; Patient Care Team; Renal Dialysis; Skin; Staphylococcus

Thirty patients undergoing long-term home-based peritoneal dialysis were monitored for 13 months for carriage of Staphylococcus aureus in the nares and for the development of infectious complications. The patients could be divided into three groups with regard to S aureus carriage: chronic, intermittent, and noncarriers. Twenty-five episodes of peritonitis and 20 episodes of catheter exit-site infections occurred during 268 patient-months of observation. Staphylococcus aureus accounted for eight episodes of peritonitis and 12 episodes of exit-site infection. Chronic and intermittent carriers of S aureus were found to be at higher risk of development of infection than noncarriers.

Topics: Adult; Aged; Carrier State; Catheterization; Female; Hemodialysis, Home; Humans; Kidney Failure, Chronic; Male; Middle Aged; Nose; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Prospective Studies; Risk; Staphylococcal Infections; Staphylococcus aureus