Biomaterial Database

[Peritoneal dialysis in patients with chronic kidney-graft failure]. 2005

Heidi Puttinger

Abteilung für Nephrologie und Dialyse, Klinik für Innere Medizin III, Medizinische Universität Wien, Wien, Austria. heidi.puttinger@meduniwien.ac.at

Patients with chronic kidney-graft failure who are starting peritoneal dialysis (PD) treatment need special consideration. The question of whether mortality is higher in these patients than in those who have not received a transplant is controversial. However, some studies suggest that differences in mortality between these groups are mainly explained by variations in age, duration of dialysis and comorbidity. One study showed similar survival between patients with chronic graft failure treated with hemodialysis (HD) and those on PD, but there is some evidence that residual renal function in PD patients with chronic graft failure declines faster than in PD-patients without transplants. Until now there have been no data on whether PD has a positive influence on the course of residual renal clearances compared with the influence of HD. The fact that PD patients with transplants show significantly higher peritoneal transport rates than patients without transplants may have an influence on technique survival. In patients with chronic graft failure, the type and dose of immunosuppressive therapy, as well as its influence on the incidence of acute rejections, residual renal function and infection rates, are also controversial. Immunosuppressive therapy may preserve residual graft function, but these patients have a higher risk of Gram-negative peritonitis, a shorter interval between start of dialysis and first episode of peritonitis, and a higher risk of catheter infections with Staphylococcus aureus than PD patients without transplants. In conclusion, PD is an acceptable treatment option for patients with chronic kidney-graft failure provided that the above clinical aspects are considered (e.g., intensified monitoring of infections and residual renal function).

UI	MeSH Term	Description	Entries
D007166	Immunosuppressive Agents	Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging.	Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D010530	Peritoneal Dialysis	Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure.	Dialyses, Peritoneal,Dialysis, Peritoneal,Peritoneal Dialyses
D010818	Practice Patterns, Physicians'	Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.	Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D011379	Prognosis	A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.	Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D002908	Chronic Disease	Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2).	Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic
D006084	Graft Rejection	An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient.	Transplant Rejection,Rejection, Transplant,Transplantation Rejection,Graft Rejections,Rejection, Graft,Rejection, Transplantation,Rejections, Graft,Rejections, Transplant,Rejections, Transplantation,Transplant Rejections,Transplantation Rejections
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001317	Austria	A country located in Central Europe, north of Italy and Slovenia. The capital is Vienna.
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D015897	Comorbidity	The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.