BACKGROUND:The National Kidney Foundation-Dialysis Outcome Quality Initiative (NKF-DOQI) recommends a weekly creatinine clearance (CrCl) of 60 L/wk/1.73 m2 or greater and a Kt/V of 2.0 or greater as peritoneal dialysis (PD) adequacy standards. It has been described that approximately one quarter of patients may have discrepancies between these goals. The purpose of this study is to identify associated factors in patients reaching both criteria, none, or only weekly Kt/V, where K is clearance, t is time, and V is volume.METHODS:We studied 64 patients and their adequacy results in a cross-sectional analysis. Patients were divided in three groups. Group 1 reached both weekly Kt/V and CrCl criteria. Group 2 did not reach either criteria. Group 3 reached only the weekly Kt/V criterion. A new weekly Kt/V also was calculated, assigning to all patients a male V. One patient who met only the CrCl criterion was excluded.RESULTS:Groups 2 and 3 had significantly less residual renal function (RRF) than group 1 (residual CrCl, 5.50 and 1.33 versus 37.3 L/wk/1.73 m2, respectively; P < 0.001). Other differences, such as age, weight, peritoneal membrane transport, nutritional parameters, or number of patients with diabetes, were not significantly different. Group 3 made up 19% of patients and was predominantly females. Conversely, group 2 was predominantly males. Using a male V, we obtained a weekly Kt/V below the NKF-DOQI recommendations for group 3 (1.9 versus 2.2; P < 0.05).CONCLUSION:Conservation of RRF was the main factor in reaching both PD adequacy criteria. Discrepancies were frequent, accounting for 19% of our population. Female gender explained why patients reached weekly Kt/V only. This difference disappeared when we calculated Kt/V using a male V.

The prevalence of human immuodeficiency virus (HIV)-infected patients with end stage renal disease (ESRD) is likely to increase and many of them will be on peritoneal dialysis as renal replacement therapy. Infectious complications are a major problem associated with peritoneal dialysis (PD). It has been speculated that the HIV-positive peritoneal dialysis population may develop peritonitis more frequently than other peritoneal dialysis patients. We present the complications and unexpected good response to medical management of PD-associated peritonitis in a young HIV-infected black male. He had two unusual and serious infections; the first was a polymicrobial peritonitis which predisposed the patient to an unusual infection caused by Corynebacteria JK for which he was successfully treated without catheter removal.

There are an increasing number of reports about unusual causes of peritonitis in peritoneal dialysis (PD) patients. The Propionibacteria species is a microorgasnism that is a normal skin flora. Under the presence of certain risk factors, it may produce serious infections. Patients at risk of having Propionibacteria sp infections have malignancy, diabetes mellitus, foreign bodies, or immunodeficiency. We describe a PD-associated peritonitis in a 51-year-old woman that was caused by Propionibacteria sp. This patient's risk factors for developing Propionibacteria sp peritonitis include a history of CREST syndrome, malignancy of the breast, and recent catheter surgery. To our knowledge, this is the first case of a PD-associated peritonitis caused by Propionibacteria sp reported in the literature.