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In recent years, it has become possible to examine an individual's daily glucose profile with a continuous glucose monitoring system (CGMS). The aim of the present study was to use a CGMS to evaluate the difference in glucose fluctuation between diabetic patients on automated peritoneal dialysis (APD) and those on continuous ambulatory peritoneal dialysis (CAPD). We retrospectively studied 20 diabetic patients on peritoneal dialysis (16 men, 4 women; mean age: 55 ± 10 years) who used a CGMS a total of 23 times (12 times by APD users, 11 times by CAPD users). The difference in the maximum and minimum blood glucose over 72 hours (ABG) and the standard deviation of blood glucose were used as indicators of glucose fluctuation. Average blood glucose levels as evaluated by CGMS and by glycosylated hemoglobin were not significantly different between the APD and CAPD patients. However, the ABG (181 ± 64 mg/dL vs. 238 ± 67 mg/dL, p = 0.02) and the standard deviation of blood glucose (36.3 ± 14.5 mg/dL vs. 49.2 ± 14.1 mg/dL, p = 0.03) were significantly lower in the APD patients than in the CAPD patients. The present study indicates that, compared with CAPD, APD might reduce glucose fluctuation in diabetic peritoneal dialysis patients.

Peritoneal dialysis (PD) catheter-related infection is still is the most troublesome problem for continuation of PD without the need to switch to hemodialysis. We have been performing subcutaneous pathway diversion (SPD) as a surgical treatment for refractory exit-site and tunnel infection (ESTI). To clarify the efficacy and safety of SPD, we conducted a retrospective study. From August 2008 to August 2013, 30 SPDs were performed in 26 patients (16 men, 10 women; mean age: 58 +/- 13 years; 54% with diabetes; mean body mass index: 23.9 +/- 3.5 kg/ m2). The reasons for the SPDs were ESTI in 25 patients, and outer cuff extrusion in 1 patient. All patients resumed PD immediately after SPD, and the duration of hospitalization was 11.7 +/- 10.1 days. After SPD, one patient experienced a dialysate leak, and another patient experienced a mild subcutaneous hematoma. Another 4 patients developed exit-site infection (ESI) and underwent a second SPD. Of those 4 patients, 3 presented with another ESI unrelated to the first episode, and all developed an ESI after 6 months or more. The remaining 20 patients experienced no such complications. Furthermore, catheter survival after SPD was 17.4 +/- 13.4 months. To eradicate ESTTI we suggest that SPD, which does not require catheter removal or interruption of PD, is useful compared with the unroofing technique or catheter removal.

Lanthanum carbonate (LC) has been administered in a chewable tablet form for patients with hyperphosphatemia undergoing dialysis. However, some patients have difficulty chewing the tablets. LC oral powder has recently been released in Japan. The purpose of this study was to clarify the efficacy of LC oral powder form compared with that of chewable tablet form. The efficacy and safety of LC oral powder was retrospectively assessed in hemodialysis patients who switched from chewable tablet form to oral powder form without dose modification. Thirty-six patients (mean age, 66.8 ± 10.5 years; male, 64%; 39% with diabetes; mean duration of dialysis treatment, 99.2 ± 95.6 months) were enrolled in this study between June and July of 2012. Changes in clinical data and adverse events after the switch to oral powder form were investigated. The average dose of LC was 1180 ± 520 mg/day. Serum phosphorus levels were significantly decreased after the switch from chewable tablet form to oral powder form (5.3 ± 1.7 mg/dL at baseline vs. 4.9 ± 1.2 mg/dL at after 1 month after, P = 0.038). In contrast, no significant differences were observed in serum calcium and parathyroid hormone levels. Furthermore, no significant differences were evident in weight gain after the switch to oral powder form (2.5 ± 1.2 kg at baseline vs. 2.4 ± 1.1 kg at 1 month after the switch, P = 0.29). No serious adverse events were recorded. Our results suggest that LC is more effective in oral powder form than chewable tablet form for hemodialysis patients.

Peritonitis is still the major complication associated with peritoneal dialysis (PD). Microbacterium spp., a type of coryneform bacteria, is an environmental bacterium isolated from soil, waste water and animals. Human infection is rare, and only few cases have so far been reported in immunocompromised hosts, such as PD patients. Microbacterium paraoxydans, one type of Microbacterium spp. was identified for the first time in 2003. Only two cases of infection of Microbacterium paraoxydans have so far been reported. We herein report the first case of PD-related peritonitis caused by Microbacterium paraoxydans, which was identified by a sequence determination of the 16S rRNA gene. Based on the results of antibiotic sensitivity, the intravenous administration of erythromycin (EM) and oral administration of sulfamethoxazole/trimethoprim (ST) were selected, and PD was interrupted. EM administration was stopped after a total of 14 days. ST was administered for a total of 21 days, and later PD was resumed. Thereafter, no recurrence or relapse of peritonitis without removal of the PD catheter was observed. Microbacterium spp. exhibits multidrug resistance and such an infection is refractory in many cases. We assume that both accurate species identification and the use of antibiotic sensitivity tests are essential to effectively treat this kind of infection.

The incidence of metabolic syndrome is about 50% in peritoneal dialysis (PD) patients. The positive association of metabolic syndrome with lower physical activity (PA) has been reported in the general population, but the effect of PA in PD patients has not been clarified. The purpose of the present study was to evaluate PA in PD patients and to clarify the correlations between PA and various clinical parameters in PD patients. We assessed 38 PD patients (22 men; age: 63.9 +/- 10.8 years; body mass index: 24.0 +/- 3.9; 15 with diabetes) who had been treated with PD at least for 3 months. We defined PA as the average number of steps per day measured using a pedometer for 1 month. Blood biochemical findings and dialysis adequacy were measured as clinical parameters. Of the 38 patients, only 11 (29%) reached the steps per day of healthy individuals. In addition, steps per day were significantly correlated with serum albumin (r = 0.45, p = 0.01), C-reactive protein (r = -0.33, p = 0.04), and age (r = -0.34, p = 0.04). Multiple regression analysis showed that serum albumin was the only variable that significantly correlated with steps per day (beta = 0.42, p = 0.01). Our study showed that PA declines significantly in PD patients, which might correlate with malnutrition-inflammation-atherosclerosis syndrome.

To clarify the influence of neutral dialysate (ND) on peritoneum, we examined changes in peritoneal permeability and in various markers of the coagulation and fibrinolytic system in effluent and the correlations between peritoneal permeability and those markers in peritoneal dialysis (PD) patients using ND. We evaluated 14 patients (8 men, 6 women; mean age: 58.6 +/- 12.0 years) who started PD using ND. The peritoneal equilibration test (PET) was performed to assess dialysate-to-plasma ratio for creatinine (D/P Cr) as peritoneal permeability. Coagulation markers [thrombin-antithrombin complex, fibrin monomer (FM), prothrombin fragment 1+2 (F1 + 2)] and fibrinolytic markers (fibrin degradation products, D-dimer) in effluent were also measured. At 2 years, FM in effluent was significantly lower (p = 0.006). The other markers and the D/P Cr did not change significantly. At the initiation of PD and at 2 years, D/P Cr was significantly correlated with F1 + 2 (r = 0.70 and 0.76 respectively, p0.01). Furthermore, multiple regression analysis showed that only F1 + 2 was correlated with D/P Cr at 2 years (r = 0.79, p = 0.004). These results suggest that ND has little influence on coagulation and fibrinolytic markers in effluent. In addition, F1 + 2 is a useful marker for peritoneal permeability in PD patients using ND.