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The use of aspirin or warfarin to maintain patency of tunneled hemodialysis catheters
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TENTH ANNUAL CLINICAL NEPHROLOGY MEETING ABSTRACTS
61
63
ELDERLY PATIENTS ON PD DO NOT HAVE A HIGHER RISK OF ENTERIC PERITONITIS THAN DISTINCTLY YOUNGER PATIENTS ON PD. Fadi Najjax, Judith Bernardini, Beth Pir'aino. University of Pittsburgh, Pittsburgh PA USA A recent study from Spain showed that enteric peritonitis (enterocoecus or GNR excluding pseudomonas) was more common and less likely to resolve in the elderly (PDI,16,2000). However the study compared <65 y.o to =:>65 y.o. patients which may not clearly separate young from old patients. To address this problem, we examined patients 65 or older to patients ages 18-40 who are distinctly younger. Data was gathered prospectively on all patientts beginning PD after 11-90 with follownp to 7/1/00. Peritonitis rates (episodes/pt/yr) were compared using Poisson analysis. There were 110 patients, 49 pts >65y.o., 86% white, 49% women, 31% DM, with 47:7yrs on CAPD and 37.6yrs on APD, not different from the 61 pts ages 18-40 who were 85% white, 61% women, 41%DM, 47.6yrs on CAPD and 37.6yrs on APD. Peritonitis rates were: gegitonitis/pt/yr all on CAPD on APD enteric catheter related catheter removed admitted for P %P requiring admission
Ages 18-Ad)_ Age=>65 0.39 0.28 0.46 0.23 0.32 0.24 0.04 0.07 0.04 0.02 0.05 0.07 0.27 0.09 70% 33%
0.064 0.007 0.24 0.29 0.20 0.29 0.01 0.007
We conclude that enteric caused peritonitis was not significantly more common in the elderly when compared to a group of much younger pts on PD, and was as likely to resolve without catheter removal.
62 THE USE OF ASPIRIN OR WARFARIN TO MAINTAIN PATENCY OF TUNNELED HEMODIALYSIS CATHETERS. Obialo C. I., Conner A.C., Lebon L. F. Morehouse Dialysis and Morehouse School of Medicine, Atlanta, Georgia. Anecdotal studies have indicated that aspirin (A) and or Warfarin (W) can prolong the patency of tunnded hemodialysis catheters (eaths). The true effielcacy of these agents is unknown. We prospectively monitored the effect of chronic use of either A or W on primary cath pateney in patients who were awaiting maturation of their arteriovenous fistulae. The patients were grouped according to their long term use of either A (325 rag/day) or W (titrated INR 2-3). Patients must have been on these medications for at least six months prior to eath implantation. Those on neither medication served as control (C). Sixty-three patients completed the Study : 21 in gronp A; 11 in group W a n d 31 in group C. Their mean age was 57 4- 15 yr. Catheter survival at 120 days were 91%, 73% and 29% [A, W and C, respectively : A > C, p <0.0001; W > C, p < 0.0001; A > W, p = NS]. The mean cath paten~- duration in days were 114± 18, 111 ± 17 and 68 ± 37 [A, W and C, respectively : A > C, p < 0.0001; W > C, p < 0.0001; A > W, p = NS]. Gastrointestinal (GI) bleeding complication rates were 24%, 18% and 0%. [A, W and C, respectively : A > C, p < 0.02 ; W > C, p < 0.02 ; A > W, p = NS]. The relative risk of GI bleeding among elderly A users was 1.14 [95% C1, 1.0 - 1.3, p < 0.008]. Both A and W appear to be equally efficacious in prolonging patency of failing eaths. However, because of the increased GI bleeding risk, they should be used judiciously in elderly hemodialsis patients.
LEPTIN, GROWTH HORMONE AND LIPID 'STATUS IN CHRONIC RENAL FAILURE IN A MULTIRACIAL POPULATION IN THE UNITED ARAB EMIRATES F.nvioma Obineehe 1, Michael Gillett2, Abdishakar Abdalle 1, Mustapha Sulaiman3, Mona E1-Rakhaimi3 1,2 Departments of Internal Medicine and Biochemistry, Faculty of Medicine, UAE University, AI Ai~, Abu Dhabi, United Arab Emirates 3 Nephrology Unit, Public Services Department, Dubai, United Arab Emirates Since the cloning of the ob gone in 1994 and identification of its product leptin, a number of studies have shown that plasma leptin levels are increased in renal disease. Disturbances in levels of insulin, IGF-1 and GH have also been shown in these patients. It is also wellknown that dyslipoproteinaemia occurs in CRF and is a major factor in patient morbidity a M mortality. Renal disease represents a major problem in the United Arab Emirates which has, besides its own nationals, a large expatriate population drawn from all over the world. However, there have been few metabolic studies of ~ patients from this mixed population. The present study included 150 such patients and 50 healthy control subjects from Abu Dhabi and Dubai Emirate. The patient group included subjects on hemodialysis and peritoneal dialysis as well as pre-dlalysis patients in renal failure. Fasting blood samples were taken for the estimation of leptin, insulin, growth hormone and insulin-like growth factor I as well as lipids and lipoproteins by established techniques. Patient levels of leptin (ng/ml), insulin (pmol/ml) and GH (ug/ml) were significantly increased and those of IGF-I (ng/ml) decreased compared to controls (24.6 ± 3.3, 99 a: 13, 2.4 4- 0.3 and 59.5 ± 4.1 versus 14.9 ± 1.7, 71 ± 11,0.6 4- 0.2 and 78.4 ~: 4.1 respectively). No differences were apparent between peritoneal dialysis and hemodialysis patients nor in hemodialysis patients before and after dialysis. No significant correlations were found between hormone changes and lipid parameters. These changes described here for the first time in a large multiracial population are similar to those already recorded in other populations.
64 VANCOMYCIN IS THE PREFERRED ANTIMICROBIAL AGENT F O R EMPIRIC THERAPY IN HEMODIALYSISRELATED INFECTIONS. Steven H. Ong, Karthik Ranganna, Jean Lee, Allan R. Tunkel, Ziauddin Ahmed. MCP Hahnemann University, Philadelphia, PA. The increasing emergence of vancomycin-resistant organisms has led to the suggestion that vancomycin use be curtailed. The use of cefazolin as one alternative for empiric therapy in hemodialysis (HD)related infections has been suggested. We conducted a retrospective review of positive culture results in 54 chronic hemodialysis patients from an outpatient hospital-based HD center over a 32-month period from January 1998 to August 2000. Wound and blood culture in vitro sensitivity to cefazolin and vancomycin was analyzed. O f the 54 positive cultures, 46 were attributable to gram-positive bacteria and 8 to gram-negative bacteria. A table summarizing the gram-positive culture results along with respective organism sensitivity to cefazolin and vancomycin is included below. BACTERIUM NUMBER- SENSITIVE TO SENSITIVE TO CEFAZOLIN VANCOMYCIN Staph. aureus 23 19 (82.6%) 23 (100%) Coagulase- - 18 5 (27.7%) 18 (100%) negative Staph. Corynebacterium 3 3 (100%) 3 (100%) g. faecalis 1 0 1 (100%) Alpha-hemolytic 1 0 1 (100%) Streptococcus TOTAL 46 27 (58.7%) 46 (100%) Eight of the culturas yielded gram-negative organisms of which 7 were susceptible to cefazolin. It should be noted that 2 of the cultures were grown from catheter tips, 6 from wounds, and the remaining 46 from blood. The overall susceptibility of gram-positive bacteria to cefazolin was 58.7% (27/46) and to vancomyclu 100% (46/46). This data does not support the use of cefazolin for empiric treatment of liD-related infections. We conclude that the broad gram-positive coverage provided by vancomycin makes it the preferred empiric antibiotic for use in our ESRD population. Once susceptibil:ity is available, therapy should be modified if the isolated organism is susceptible to other antimJerobial agents.
TENTH ANNUAL CLINICAL NEPHROLOGY MEETING ABSTRACTS
61
63
ELDERLY PATIENTS ON PD DO NOT HAVE A HIGHER RISK OF ENTERIC PERITONITIS THAN DISTINCTLY YOUNGER PATIENTS ON PD. Fadi Najjax, Judith Bernardini, Beth Pir'aino. University of Pittsburgh, Pittsburgh PA USA A recent study from Spain showed that enteric peritonitis (enterocoecus or GNR excluding pseudomonas) was more common and less likely to resolve in the elderly (PDI,16,2000). However the study compared <65 y.o to =:>65 y.o. patients which may not clearly separate young from old patients. To address this problem, we examined patients 65 or older to patients ages 18-40 who are distinctly younger. Data was gathered prospectively on all patientts beginning PD after 11-90 with follownp to 7/1/00. Peritonitis rates (episodes/pt/yr) were compared using Poisson analysis. There were 110 patients, 49 pts >65y.o., 86% white, 49% women, 31% DM, with 47:7yrs on CAPD and 37.6yrs on APD, not different from the 61 pts ages 18-40 who were 85% white, 61% women, 41%DM, 47.6yrs on CAPD and 37.6yrs on APD. Peritonitis rates were: gegitonitis/pt/yr all on CAPD on APD enteric catheter related catheter removed admitted for P %P requiring admission
Ages 18-Ad)_ Age=>65 0.39 0.28 0.46 0.23 0.32 0.24 0.04 0.07 0.04 0.02 0.05 0.07 0.27 0.09 70% 33%
0.064 0.007 0.24 0.29 0.20 0.29 0.01 0.007
We conclude that enteric caused peritonitis was not significantly more common in the elderly when compared to a group of much younger pts on PD, and was as likely to resolve without catheter removal.
62 THE USE OF ASPIRIN OR WARFARIN TO MAINTAIN PATENCY OF TUNNELED HEMODIALYSIS CATHETERS. Obialo C. I., Conner A.C., Lebon L. F. Morehouse Dialysis and Morehouse School of Medicine, Atlanta, Georgia. Anecdotal studies have indicated that aspirin (A) and or Warfarin (W) can prolong the patency of tunnded hemodialysis catheters (eaths). The true effielcacy of these agents is unknown. We prospectively monitored the effect of chronic use of either A or W on primary cath pateney in patients who were awaiting maturation of their arteriovenous fistulae. The patients were grouped according to their long term use of either A (325 rag/day) or W (titrated INR 2-3). Patients must have been on these medications for at least six months prior to eath implantation. Those on neither medication served as control (C). Sixty-three patients completed the Study : 21 in gronp A; 11 in group W a n d 31 in group C. Their mean age was 57 4- 15 yr. Catheter survival at 120 days were 91%, 73% and 29% [A, W and C, respectively : A > C, p <0.0001; W > C, p < 0.0001; A > W, p = NS]. The mean cath paten~- duration in days were 114± 18, 111 ± 17 and 68 ± 37 [A, W and C, respectively : A > C, p < 0.0001; W > C, p < 0.0001; A > W, p = NS]. Gastrointestinal (GI) bleeding complication rates were 24%, 18% and 0%. [A, W and C, respectively : A > C, p < 0.02 ; W > C, p < 0.02 ; A > W, p = NS]. The relative risk of GI bleeding among elderly A users was 1.14 [95% C1, 1.0 - 1.3, p < 0.008]. Both A and W appear to be equally efficacious in prolonging patency of failing eaths. However, because of the increased GI bleeding risk, they should be used judiciously in elderly hemodialsis patients.
LEPTIN, GROWTH HORMONE AND LIPID 'STATUS IN CHRONIC RENAL FAILURE IN A MULTIRACIAL POPULATION IN THE UNITED ARAB EMIRATES F.nvioma Obineehe 1, Michael Gillett2, Abdishakar Abdalle 1, Mustapha Sulaiman3, Mona E1-Rakhaimi3 1,2 Departments of Internal Medicine and Biochemistry, Faculty of Medicine, UAE University, AI Ai~, Abu Dhabi, United Arab Emirates 3 Nephrology Unit, Public Services Department, Dubai, United Arab Emirates Since the cloning of the ob gone in 1994 and identification of its product leptin, a number of studies have shown that plasma leptin levels are increased in renal disease. Disturbances in levels of insulin, IGF-1 and GH have also been shown in these patients. It is also wellknown that dyslipoproteinaemia occurs in CRF and is a major factor in patient morbidity a M mortality. Renal disease represents a major problem in the United Arab Emirates which has, besides its own nationals, a large expatriate population drawn from all over the world. However, there have been few metabolic studies of ~ patients from this mixed population. The present study included 150 such patients and 50 healthy control subjects from Abu Dhabi and Dubai Emirate. The patient group included subjects on hemodialysis and peritoneal dialysis as well as pre-dlalysis patients in renal failure. Fasting blood samples were taken for the estimation of leptin, insulin, growth hormone and insulin-like growth factor I as well as lipids and lipoproteins by established techniques. Patient levels of leptin (ng/ml), insulin (pmol/ml) and GH (ug/ml) were significantly increased and those of IGF-I (ng/ml) decreased compared to controls (24.6 ± 3.3, 99 a: 13, 2.4 4- 0.3 and 59.5 ± 4.1 versus 14.9 ± 1.7, 71 ± 11,0.6 4- 0.2 and 78.4 ~: 4.1 respectively). No differences were apparent between peritoneal dialysis and hemodialysis patients nor in hemodialysis patients before and after dialysis. No significant correlations were found between hormone changes and lipid parameters. These changes described here for the first time in a large multiracial population are similar to those already recorded in other populations.
64 VANCOMYCIN IS THE PREFERRED ANTIMICROBIAL AGENT F O R EMPIRIC THERAPY IN HEMODIALYSISRELATED INFECTIONS. Steven H. Ong, Karthik Ranganna, Jean Lee, Allan R. Tunkel, Ziauddin Ahmed. MCP Hahnemann University, Philadelphia, PA. The increasing emergence of vancomycin-resistant organisms has led to the suggestion that vancomycin use be curtailed. The use of cefazolin as one alternative for empiric therapy in hemodialysis (HD)related infections has been suggested. We conducted a retrospective review of positive culture results in 54 chronic hemodialysis patients from an outpatient hospital-based HD center over a 32-month period from January 1998 to August 2000. Wound and blood culture in vitro sensitivity to cefazolin and vancomycin was analyzed. O f the 54 positive cultures, 46 were attributable to gram-positive bacteria and 8 to gram-negative bacteria. A table summarizing the gram-positive culture results along with respective organism sensitivity to cefazolin and vancomycin is included below. BACTERIUM NUMBER- SENSITIVE TO SENSITIVE TO CEFAZOLIN VANCOMYCIN Staph. aureus 23 19 (82.6%) 23 (100%) Coagulase- - 18 5 (27.7%) 18 (100%) negative Staph. Corynebacterium 3 3 (100%) 3 (100%) g. faecalis 1 0 1 (100%) Alpha-hemolytic 1 0 1 (100%) Streptococcus TOTAL 46 27 (58.7%) 46 (100%) Eight of the culturas yielded gram-negative organisms of which 7 were susceptible to cefazolin. It should be noted that 2 of the cultures were grown from catheter tips, 6 from wounds, and the remaining 46 from blood. The overall susceptibility of gram-positive bacteria to cefazolin was 58.7% (27/46) and to vancomyclu 100% (46/46). This data does not support the use of cefazolin for empiric treatment of liD-related infections. We conclude that the broad gram-positive coverage provided by vancomycin makes it the preferred empiric antibiotic for use in our ESRD population. Once susceptibil:ity is available, therapy should be modified if the isolated organism is susceptible to other antimJerobial agents.