bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Na, K-Atpase Inhibitors in Hypertension and End-Stage Renal Disease
Authors: Bargman Joanne M.
Published: February 2020

Objective

To review the role of Na, K-ATPase inhibitors in the pathogenesis of essential hypertension and hypertension associated with end-stage renal disease.

Data Sources

MEDLINE search, 1966 to 1997.

Results

There is a suggestive physiologic and epidemiologic relationship between Na, K-ATPase inhibition and hypertension. However, clearance data cannot support the hypothesis that differential metabolism of this family of compounds explains the improved hypertensive control seen in patients on peritoneal dialysis compared to those on hemodialysis.

Conclusions

As a result of the complex methodologies involved, it is unclear whether Na, K-ATPase inhibitors playa significant role in the hypertension of endstage renal disease in general and peritoneal dialysis in particular.
Symptomatic Ascites after Discontinuation of Continuous Peritoneal Dialysis
Authors: Haq Muhammad Z. , Tzamaloukas Antonios H. , Malhotra Deepak , Gibel Lawrence J.
Published: February 2020

Objective

To analyze pathogenetic associations, clinical features, management, and outcome of ascites following discontinuation of continuous peritoneal dialysis (CPD).

Design

Retrospective analysis of symptomatic ascites, defined as ascites requiring at least one therapeutic paracentesis, developing in patients who discontinued CPD.

Setting

Dialysis unit of one tertiary care center.

Participants

Twelve patients with 13 episodes of symptomatic ascites diagnosed soon after (a few days to 2 months) discontinuation of CPD.

Interventions

Diagnostic tests to characterize the pathogenesis of ascites; management of ascites by hemodialysis or CPD.

Main Outcome Measures

Evolution of clinical features and nutritional parameters, survival.

Results

Ascites was infectious in 3 episodes (nontuberculous mycobacterial peritonitis) and noninfectious in the remaining 10 episodes. Serum-to-ascites albumin concentration gradient (AG) was 6.3 ± 1.5 g/L in infectious ascites and 17.3 ± 2.7 g/L (>11 g/L in every episode) in noninfectious ascites. Infectious ascites was managed with hemodialysis, prolonged courses of antimicrobial agents, and repeated paracentesis. Paracentesis ceased after 3 9 months. The patients were alive after 52 ± 19 months. Seven episodes of noninfectious ascites were managed by hemodialysis and repeated paracentesis. Five patients died within 6 months from cardiac causes or sepsis. The remaining 2 patients died after 14 and 16 months from cardiac causes. Three episodes of noninfectious ascites in 2 patients were treated by restarting CPD within 2 -5 months. Patients were alive at 16.9 ± 13.2 months. They were asymptomatic and achieved fluid control. On the same CPD schedule, peritoneal clearances of urea and creatinine and normalized protein nitrogen appearance were unchanged between the initial and restarted CPD. Serum albumin was 33.3 ± 2.5 g/L at the end of the first CPD period, 23.6 ± 2.5 g/L soon after restarting CPD, and 31.3 ± 5.5 g/L 4 months after restarting CPD.

Conclusions

Noninfectious ascites after discontinuation of CPD is often characterized by an AG > 11 g/L, suggesting portal hypertension. Restarting CPD in noninfectious ascites may be associated with improvement in ascites symptomatology and nutritional parameters and with satisfactory survival.
Abdominal Catastrophe: Visceral Injury as a Cause of Peritonitis in Patients Treated by Peritoneal Dialysis
Authors: Harwell Carla M. , Newman Lynda N. , Cacho Carolyn P. , Mulligan David C. , Schulak James A. , Friedlander Miriam A.
Published: February 2020

Objective

Peritonitis is considered an acceptable and controllable risk in patients undergoing chronic peritoneal dialysis (PD). In contrast, peritonitis due to visceralleakage represents a true “abdominal catastrophe” because of striking morbidity and mortality. To delineate the incidence, causes, and outcomes of catastrophic peritonitis, we compared patients who developed peritonitis due to documented visceral leakage with patients who developed peritonitis due to enteric organisms without evidence of visceral leakage.

Design

Retrospective chart review.

Setting

PD Unit located in tertiary care referral center.

Patients

230 patients treated by PD between January 1988 and June 1996.

Main Outcome Measures

All episodes of PD-related peritonitis occurring over an 8-year period. Hospital course of all patients with or without renal failure who were treated at University Hospitals of Cleveland for ischemic bowel disease, cholecystitis, viscus perforation, or diverticulitis.

Results

Anatomically documented visceral injury caused 32.5% of episodes of enteric bacterial peritonitis in 72 patients between January 1988 and June 1996. The overall incidence of this “abdominal catastrophe” was 11.3%, or 26 of a total of 230 patients treated by PD. Of the 26 patients, 50% died, 30.7% survived but switched permanently to hemodialysis, and only 19.2% remained on, or returned to, PD. Compared to renal failure patients treated by hemodialysis or transplantation and to nonrenal failure patients, the incidence of abdominal catastrophe was 20 -60 times greater in patients treated by PD.

Conclusions

Evidence for injury of an abdominal organ should be sought in all patients treated by PD who develop peritonitis with enteric organisms. Surgical intervention is definitive for diagnosis, and if performed early may reduce morbidity and mortality.
Inflammatory Demyelinating Neuropathy in Patients with End-Stage Renal Disease Receiving Continuous Ambulatory Peritoneal Dialysis (Capd)
Authors: Toepfer Marcell , Schiffl Helmut , Fricke Harald , Lochmüller Hans , Held Eckhard , Pongratz Dieter , Müller-Felber Wolfgang
Published: February 2020

Objective

To report on 3 patients with inflammatory demyelinating peripheral neuropathy in strong temporal coincidence with the initiation of peritoneal dialysis (PD) therapy.

Setting

Nephrology and Neurology Department of the University Hospital, Munich, Germany.

Patients

Three patients with end-stage renal failure presented with the clinical picture of inflammatory demyelinating peripheral neuropathy within 4 to 10 weeks after start of continuous ambulatory peritoneal dialysis (CAPD). They had acute or subacute onset of lower extremity or generalized weakness, diminished reflexes, elevated spinal fluid protein levels, and signs of demyelinating neuropathy on electrophysiological testing.

Measures

Clinical follow-up, nerve conduction studies, cerebral spinal fluid (CSF).

Results

All patients did not improve under intensified PD therapy but took profit from immunomodulatory therapy. One bed-bound patient improved after change to hemodialysis and showed complete remission after renal transplantation.

Conclusion

Because of strong temporal coincidence, a causal relationship between CAPD and inflammatory demyelinating peripheral neuropathies can be suspected in these 3 patients.
Replacement of Amino Acid and Protein Losses with 1.1% Amino Acid Peritoneal Dialysis Solution
Authors: Jones Michael R. , Gehr Todd W. , Burkart John M. , Hamburger Richard J. , Kraus Alfred P. , Piraino Beth M. , Hagen Tricia , Ogrinc Francis G. , Son Marsha Wolf
Published: February 2020

Objective

Losses of nutrients into dialysate may contribute to malnutrition. Peritoneal dialysis (PD) patients are reported to lose 3 -4 g/day of amino acids (AAs) and 4 -15 g/day of proteins. The extent to which one exchange with a 1.1% AA dialysis solution (Nutrineal, Baxter, Deerfield, IL, U.s.A.) offsets these losses was investigated in a 3-day inpatient study in 20 PD patients.

Design

Simple, open-label, cross-over study on consecutive days in a clinical research unit. On day 1 all patients were given a peritoneal equilibration test (PET). On day 2 they received 1.5% dextrose Dianeal (Baxter) as the first exchange of the day and their usual regimen thereafter. On day 3, the first exchange of the day was the 1.1% AA solution in place of 1.5% Dianeal and the usual PD regimen thereafter. On days 2 and 3 all dialysate effluent was collected and analyzed for AAs and proteins. Patients were maintained on a constant diet.

Results

Losses of AAs and total proteins on day 2 were 3.4 ± 0.9 g and 5.8 ± 2.4 g, respectively, totaling 9.2 ± 2.7 g. The net uptake of AAs on day 3 was 17.6 ± 2.6 g (80 ± 12% of the 22 g infused). Mean gains of AAs on day 3 exceeded losses of proteins and AAs on day 2, p < 0.001. Losses of total proteins, but not losses of AAs, and the net absorption of AAs from the dialysis solution were correlated directly with peritoneal membrane transport characteristics, obtained from the PET.

Conclusion

Daily losses of AAs and proteins into dialysate are more than offset by gains of AAs absorbed from one exchange with 1.1% AA-based dialysis solution. Net gains of AAs exceeded losses of proteins and AAs in all patients studied. The difference was relatively constant across a wide range of membrane transport types. Net AA gains were approximately two times the total AA and protein losses.
N-Acetylglucosamine Changes Permeability of Peritoneum during Chronic Peritoneal Dialysis in Rats
Authors: Wu George , Tobis Katarzyna Wieczorowska , Polubinska Alicja , Korybalska Katarzyna , Filas Violetta , Tam Paul , French Ian , Breborowicz Andrzej
Published: February 2020

Objective

To evaluate the effect of supplementation of dialysis fluid with N-acetylglucosamine (NAG) on the permeability of peritoneum during chronic peritoneal dialysis in rats.

Design

Experiments were performed on rats with surgically implanted peritoneal catheters. Dialysis solution [DianeaI1.5% (Baxter, Deerfield, IL, U.S.A.) supplemented with either NAG 50 mmol/L or glucose 50 mmol/L (control)] was infused intraperitoneally twice, every day, for 8 weeks. Peritoneal equilibration tests (PET) were performed in all animals at the beginning of the study and after 8 weeks of dialysis. Additionally, at the end of each week, dialysis solution infused in the morning was drained after 4 hours of intraperitoneal dwell. White blood cell count, creatinine, and total protein concentrations were measured in the effluent dialysate. After 8 weeks of dialysis, the morphology of the peritoneum was studied.

Results

In rats exposed to dialysis fluid supplemented with NAG, peritoneal permeability to creatinine and proteins was reduced when compared to animals dialyzed with glucose solution. In NAG treated animals, staining with alcian blue for polyanions in the peritoneal interstitium was significantly stronger than in rats dialyzed with glucose solution.

Conclusions

Chronic peritoneal dialysis with dialysis solution supplemented with N-acetylglucosamine causes accumulation of glycosaminoglycans in the peritoneal interstitium, which results in a change of peritoneal permeability.
A Randomized Prospective Comparison of Oral Levofloxacin plus Intraperitoneal (IP) Vancomycin and IP Netromycin plus IP Vancomycin as Primary Treatment of Peritonitis Complicating Capd
Authors: Cheng Ignatius K.P. , Fang Guo Xing , Chau PakYin , Chan Tak Mou , Tong Kwok Lung , Wong Andrew K.M. , Li Chun Sang , Lo Wai Kei , Cheung King On , Kumana Cyrus R.
Published: February 2020

Objective

To compare the therapeutic efficacy of daily oral levofloxacin plus intermittent intraperitoneal (IP) vancomycin (group 1) versus daily IP netromycin and intermittent IP vancomycin (group 2) in the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD).

Design

A randomized multicenter prospective openlabel comparative clinical study.

Setting

University and Hospital Authority hospitals in Hong Kong.

Patients

All CAPD patients who developed bacterial or culture-negative peritonitis beyond 28 days of a previous episode and without evidence of septicemia, associated tunnel infection, or known sensitivity to trial medications were accepted into the clinical trial.

Results

A total of 101 patients entered the trial. The primary cure rate was 74.5% for group 1 and 73.6% for group 2. Baseline culture results appeared to influence the clinical outcome: the primary cure rate for culture negative, gram-positive, and gram-negative episodes was 83.3%, 78.6%, and 42.9% for group 1 and 69.1 %, 76.9%, and 71.3% for group 2, respectively. The primary cure rate also varied considerably among individual centers and was particularly noticeable in group 1. In the latter group, it correlated closely with in vitro levofloxacin resistance which in turn correlated closely with previous exposure to fiuoroquinolones.

Conclusion

Oral levofloxacin in combination with intermittent IP vancomycin has comparable efficacy to IP netromycin combined with intermittent IP vancomycin as primary treatment in CAPD peritonitis, but is simpler and more cost-effective to administer. It may be recommended as primary therapy in centers with relatively low exposure and, therefore, low background resistance to fiuoroquinolones.
Serum C-Reactive Protein: A Predictor of Mortality in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Noh Hyunjin , Lee Seoung Woo , Kang Shin Wook , Shin Sug Kyun , Choi Kyu Hun , Lee Ho Yung , Han Dae Suk
Published: February 2020

Objective

To evaluate the predictive value of a single baseline serum C-reactive protein (sCRP) as a marker of mortality in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

A review of prospectively collected data in a 2-year follow-up study.

Setting

Tertiary medical center.

Patients

The study included 106 patients who were stable and had been on CAPD for a minimum of 3 months.

Main Outcome Measures

Patient survival rate was the main outcome measure of this study. Other outcome measures were technique survival rate, peritonitis rate, and hospitalized days. Covariables used in the survival analysis were age, sex, the presence of cardiovascular disease or diabetes mellitus, sCRP, serum albumin, hematocrit, cholesterol, HDL-cholesterol, malnutrition by subjective global assessment (SGA), weekly Kt/V urea, and weekly standardized creatinine clearance (SCCr).

Results

The 2-year patient survival rate was significantly lower in the increased sCRP group than in the normal sCRP group (66.7% vs 94.1%, p = 0.001), although there was no significant difference in technique failure, peritonitis rate, and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were: cardiovascular disease (relative risk, RR = 8.96, p < 0.005); increased sCRP level (RR = 1.19, p < 0.05); and high hematocrit (RR = 1.18, p < 0.05).

← Conclusion

Serum CRP at enrollment is an independent predictor of 2-year patient survival in CAPD patients.
Comparison of Growth during Continuous Ambulatory Peritoneal Dialysis and Renal Transplantation using Conventional Immunosuppressive Drugs in Children
Authors: Litaka Kikuo , Hojo Midori , Moriya Shunsuke , Sakai Tadasu , Endo Tadao
Published: February 2020

Objective

Growth during continuous ambulatory peritoneal dialysis (CAPD) and after renal transplantation (Tx) was assessed in children under the age of 12 years.

Design

Growth was assessed by calculating the standard deviation score for height of normal children of the same age and gender.

Patients

Twenty-one patients undergoing CAPD and 13 patients who had received renal Tx at Kitasato University Hospital.

Results

Overall growth in those children undergoing CAPD and after renal Tx was not good, but growth during CAPD seemed to be slightly better than after renal Tx using conventional immunosuppressive drugs. Only young children who had started CAPD or received renal Tx before the age of 5 years with functioning graft showed catch-up growth, but the final height of these children may still be smaller than normal.

Conclusion

Growth in children with end-stage renal disease is poor but growth during CAPD seems to be slightly better than after renal Tx using conventional immunosuppressive drugs.
The Effects of Ouabain and Potassium on Peritoneal Fluid and Solute Transport Characteristics
Authors: Park Min Sun , Lee Eun Young , Lee Nam Soo , Waniewski Jacek , Lindholm Bengt , Lee Hi Bahl
Published: February 2020

Background

We reported anomalous transport characteristics of potassium during experimental peritoneal dialysis in rats and suggested that mechanisms of peritoneal potassium transport could be other than simple passive transport. Intracellular transport of potassium in cultured human mesothelial cells was reported to be regulated by three different pathways, such as channels blocked by ouabain, channels blocked by furosemide, and other.

Objective

To investigate the effect of ouabain on peritoneal potassium and water transport characteristics.

Methods

A single 4-hour peritoneal dwell was performed in 28 5prague-Dawley rats. To minimize the diffusive transport of potassium, 4.5 mmol/L of KCI was added into conventional dialysis solution with 3.86% glucose [acidic peritoneal dialysis solution (APD)]. To evaluate the effect of the pH of dialysis solution on the transport of potassium and water, 4 mmol/L of NaOH was added into the potassium -containing study solutions [neutral peritoneal dialysis solution (NPD)]. To evaluate the effect of a potassium channel blocker on peritoneal potassium transport ATPase sensitive Na+-K+-transport inhibitor, ouabain (10–5 mmol/L) was added to dialysis solutions immediately before the dwell study in eight rats with APD (APD-O) and six rats with NPD (NPD-O). Ouabain was not added in eight and six rats with APD and NPD (APD-C and NPD-C, respectively). They were used as control. Infusion volume was 30 mL. The intraperitoneal volume (V D) was estimated by using a volume marker dilution method with corrections for the elimination of volume marker, radioiodinated human serum albumin (RI5A), from the peritoneal cavity (KE). The diffusive mass transport coefficient (KBD) and sieving coefficient (5) were estimated using the modified Babb-Randerson-Farrell model.

Results

VD was significantly higher (p < 0.05 from 90 min to 240 min) and KE (0.027 ± 0.018 mL/min for APD-O, 0.026 ± 0.017 mL/min for NPD-O, and 0.030 ± 0.022 mL/min for NPD-C, vs 0.058 ± 0.030 mL/min for APD-C, p < 0.05 for each) significantly lower during dialysis with APD -O, NPD -O, and NPD-C than with APD-C. The intraperitoneal glucose expressed as a percentage of the initial amount was significantly higher with APD-O, NPD-C, and NPD-Q than with APD-C (p < 0.05 from 90 min to 240 min). KBD for sodium was higher during dialysis with ouabain than without ouabain, while KBD for urea, glucose, and potassium, and 5 for urea, glucose, sodium, and potassium did not differ between the four groups.

Conclusions

The physiologic potassium concentration in neutral dialysis solutions and the use of ouabain decreased the intraperitoneal fluid absorption. The diffusive transport coefficient and sieving coefficient for potassium did not differ, while the diffusive transport coefficient for sodium increased during use of ouabain.
Comparing Mortality Rates on Capd/Ccpd and Hemodialysis the Canadian Experience: Fact or Fiction?
Authors: Schaubel Douglas E. , Morrison Howard I. , Fenton Stanley S.A.
Published: February 2020

← Objective

To compare mortality rates on hemodialysis (HD) to rates on continuous ambulatory/cyclic peritoneal dialysis (CAPD/CCPD), to contrast our results with those of other recent investigations, and to discuss reasons for discrepancies.

← Data Sources

Patient -specific data obtained from the Canadian Organ Replacement Register on patients initiating renal replacement therapy (RRT) between 1 January 1990 and 31 December 1995 (n = 14483). Recent mortality comparisons of CAPD and HD.

← Main Outcome Measures

Mortality rate ratio (RR) based on “as-treated” (AT) analysis incorporating treatment modality switches and adjusting for age, primary renal diagnosis, and comorbid conditions using Poisson regression. Hazard ratios (HR) were estimated using Cox regression and based on an “intent-to-treat” (ITT) analysis wherein patients were classified based on dialytic modality received on follow-up day 90.

← Results

Adjusted mortality rates were significantly decreased on CAPD/CCPD relative to HD [RR = 0.73, 95% confidence interval (CI) = (0.69, 0.77)] based on the AT analysis. Most of the protective effect of CAPD/CCPD was concentrated in the first 2 years of follow-up post-RRT initiation. Based on the ITT analysis, the estimated CAPD/ CCPD effect was greatly reduced, with HR = 0.93 (0.87, 0.99).

← Conclusions

We provide further evidence that CAPD/ CCPD is not an inferior dialytic modality to HD, particularly in the short term. Comparing mortality rates on CAPD/ CCPD and HD is inherently difficult due to the potential for bias. Discrepancies between our results and those of previous investigations, and variability in findings among previous studies, relate to differences in clinical and demographic setting, patient populations, study design, statistical methods, and interaction between the dialytic modality effect and various other covariables.
Clearance of Tracer Albumin from Peritoneal Cavity to Plasma at Low Intraperitoneal Volumes and Hydrostatic Pressures
Authors: Zhu Qing , Carlsson Ola , Rippe Bengt
Published: February 2020

Objective

To assess the clearance of radiolabeled tracer albumin (RISA) from peritoneal cavity to plasma (CI → P) in rats under essentially “normal” conditions, that is, when intraperitoneal hydrostatic pressure (IPP) is subatmospheric and the intraperitoneal (IP) “free” fluid volume (IPV) is low.

Methods

A volume of 0.3 mL of RISA was injected IP into anesthetized Wistar rats (wt = 300 g) when the IPV was approximately 2 mL (normal) or the IPV was approximately 10 mL, and IPP was either -1.8 mmHg (normal) or +1.5 mmHg (produced by an external cuff). Plasma samples (25 μL) were obtained repeatedly during the dwell, which lasted 30 300 min, after which the peritoneal cavity was opened to recover the IPV and residuallP RISA activity. The CI → P was assessed as the mass transfer of RISA into plasma, occurring per unit time,-divided by the calculated mean IP RISA concentration (CD). The interstitial RISA space was measured as the mass of RISA accumulated, per unit tissue weight, in peritoneal tissue samples divided by the CD.

Results

A markedly lower CI → P (2.47 ± 0.67 μL/min), as well as total RISA clearance out of the peritoneal cavity (CI), was found under “normal” conditions (an IPV of approximately 2 mL and an IPP of approximately -1.8 mmHg) compared to the situation during peritoneal dialysis (an IPV of approximately 20 mL and an IPP of +1 mmHg). Furthermore, the interstitial RISA space increased linearly over time even at negative IPPs and at an unchanging peritoneal interstitial fluid volume. At a low (normal) IPV the CI → P did not increase significantly with elevating IPP, and increased only marginally when tracer distribution was improved by artificial vibration of the rats. However the CI → P increased when larger volumes were infused to increase the totallPV.

Conclusions

It is concluded that the CI → P and CI at low IPPs and IPVs are not as high as during peritoneal dialysis. Increases in CI → P were, however, coupled to increases in IPV. This highlights the importance of the IPV per se and of a sufficient IP tracer distribution for direct lymphatic absorption to be efficient. This study was presented in part at the XVIth Annual Conference on Peritoneal Dialysis, Denver, Colorado, U.S.A., 1997 (33).
Effects of Oral Glucose on Intermediary Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients versus Healthy Subjects
Authors: Delarue Jacques , Maingourd Claude , Couet Charles , Vidal Sophie , Bagros Philippe , Lamisse Fernand
Published: February 2020

Objective

To explore the mechanisms and metabolic consequences of the insulin resistance of patients treated by continuous ambulatory peritoneal dialysis (CAPD).

Design

CAPD patients and healthy subjects ingested a similar mean oral glucose load per kilogram of fat-free mass (FFM) [1.20 ± 0.03 g/(kg FFM) vs 1.20 ± 0.06 g/(kg FFM); CAPD vs healthy subjects]. Substrate oxidation was monitored over 6 hours using indirect calorimetry.

Setting

Peritoneal dialysis unit of a tertiary-care institutional center.

Outcome Measures

Glycemia, insulinemia, substrate oxidation.

Patients

Six CAPD patients (68 ± 5 yr) and 6 healthy subjects (24 ± 1 yr). The CAPD patients had similar body mass index (21.4 ± 1.3 vs 22.9 ± 1.1 kg/m2), a higher percent fat (25.8% ± 3.7% vs 16% ± 2.2%; p < 0.05), and a lower FFM (42.2 ± 2.2 kg vs 56.5 ± 2.6 kg; p < 0.01) than healthy subjects.

Results

The CAPD patients displayed a higher glycemic and insulinemic responses to glucose than did healthy subjects (p < 0.05), but similar glucose oxidation and storage. Lipid oxidation and plasma nonesterified fatty acids were not increased in CAPD patients versus healthy subjects, in spite of a higher adiposity. Fat oxidation was related to fat mass in CAPD patients (r2 = 0.77, p < 0.05) but not in healthy subjects (r2 = 0.05).

Conclusion

CAPD patients display an insulin -resistance not explained by an increased lipid oxidation. The maintenance of intracellular glucose utilization at the expense of higher glycemic and insulinemic responses suggests a defective glucose transport.
Plasma Iohexol Clearance in Automated Peritoneal Dialysis -its Role in Adequacy Determination
Authors: Marx Michael A. , Shuler Cathryn L. , Golper Thomas A.
Published: February 2020

Objective

To compare the relationship of plasma iohexol clearance to standard adequacy measures in an automated peritoneal dialysis (APD) population.

Design

Prospective, nonrandomized, open label, simultaneous clearance studies of novel (iohexol) and traditional (urea and creatinine) markers of dialysis quantitation.

Setting

Outpatient peritoneal dialysis units associated with tertiary care university hospitals.

Patients

Eighteen stable patients, 13 undergoing continuous cycling peritoneal dialysis (CCPD) and 5 receiving intermittent dialysis, who underwent 24-hour clearance studies were enrolled in and completed the study.

Interventions

Each subject received 15 mL of iohexol intravenously the morning of a scheduled dialysis night. Blood was obtained for determination of serum concentrations of urea nitrogen and creatinine, and plasma iohexol concentration. Dialysate and urine were collected over 24 hours.

Main Outcome Measures

Urea and creatinine data from the total pooled dialysate and from the 24-hour urine collection were used to calculate daily Kt/V urea and normalized total daily creatinine clearance (CrCI). Total plasma iohexol clearance was calculated using a one-compartment model with the Bröchner-Mortensen correction.

Results

Normalized [to 1.73 m2 body surface area (BSA)] iohexol clearance correlated very well with normalized CrCI (r2 = 0.777; p < 0.001). A weaker correlation was observed between Kt/V urea and normalized iohexol clearance (r2 = 0.213; 0.05 < p < 0.1). When data are not normalized using BSA or urea distribution volume, the regressions are improved for both creatinine (r2 = 0.820) and urea (r2 = 0.533). These results were comparable between those on CCPD and those on intermittent therapy.

Conclusion

Total plasma iohexol clearance provides a simple assessment for APD adequacy by eliminating collection problems inherent to the methodologies currently employed. Such simplicity allows for more frequent assessments of delivered dialysis dose and efficacy of prescription changes.
Thyroid Dysfunction and Nodular Goiter in Hemodialysis and Peritoneal Dialysis Patients
Authors: Lin Chih Ching , Chen Tzen Wen , Ng Yee Yung , Chou Yi Hong , Yang Wu Chang
Published: February 2020

Objective

To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis.

Design

Cross-sectional study.

Setting

Single dialysis unit and outpatient clinic.

Patients

The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls.

Main Outcome Measures

Ultrasonography was used to detect patients’ thyroid function and nodular goiter.

Results

Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p < 0.05). Moreover, the prevalence of nodular goiter increased with age (p < 0.02) in uremic patients. Hemodialysis patients had a higher frequency of reduced total T3 level (46.9% vs 29.5%, p < 0.02). However, CAPD patients had lower T4 levels (6.23 ± 1.82μg/dL vs 7.15± 1.99μg/dL, p < 0.05).

Conclusion

Because of the high incidence of hypothyroidism and nodular goiter in uremic patients, screening of thyroid function and goiter detection with ultrasound should be considered in evaluation of end-stage renal disease patients.
Biocompatibility of a Peritoneal Dialysis Solution with Amino Acids: Histological Evaluation in the Rabbit
Authors: Garosi Guido , Gaggiotti Enzo , Monaci Giulio , Brardi Simone , Di Paolo Nicola
Published: February 2020

Objective

To determine the biocompatibility of a peritoneal dialysis (PD) solution containing amino acids compared to PD solutions containing glucose.

Design

The biocompatibility of three dialysis solutions containing 1.1% amino acids, 1.36% glucose, and 3.86% glucose, respectively, was evaluated in vivo in rabbits.

Methods

After 60 days of PD, peritoneal histological changes in rabbits were investigated by light and transmission electron microscopy. The parameters investigated were: (1) mesothelial damage; (2) submesothelial edema; (3) submesothelial cell infiltration; (4) submesothelial fibrosis; and (5) vascular alterations. Semiquantitative evaluations were performed for all the above alterations; quantitative morphometric evaluation was performed for mesothelial damage (cubic transformation of the mesothelium, areas devoid of mesothelium, submesothelial edema) and thickness of peritoneal arteriole walls.

Results

(1) Mesothelial damage was practically nonexistent in rabbits dialyzed with the solution containing amino acids, and intermediate and severe with low glucose and high-glucose solutions, respectively. Both controls and rabbits dialyzed with amino acid solution showed flat continuous mesothelium; rabbits dialyzed with low-glucose solution showed cubic continuous mesothelium; and rabbits dialyzed with high-glucose solution showed cubic discontinuous mesothelium. Cytopathic mesothelial effects were slight with the solution containing amino acids and severe with both the low and high-glucose solutions. Duplication and thickening of mesothelial basement membrane were never observed. (2) Submesothelial edema showed a worsening trend from controls to rabbits dialyzed with solution containing amino acids, low glucose, and high glucose. (3) No difference in submesothelial infiltration was found between groups. (4) Submesothelial fibrosis was never observed. (5) Vascular alterations were never observed.

Conclusion

These results are evidence that PD solution with amino acids is more biocompatible than high and also low-glucose solutions.
Plasticizers and Inhibition of Leukocyte Function in Vitro
Authors: Fischer Frank-Peter , Machleidt Christoph , Rettenmeier Albert W. , Kuhlmann Ulrich , Mettang Thomas
Published: February 2020

Objectives

To evaluate the influence of the plasticizer metabolites of di(2-ethylhexyl)phthalate (DEHP), mono(2-ethylhexyl)phthalate (ME HP), 2-ethylhexanol (2-EH), and phthalic acid (PA) on various immune functions of poly-morphonuclear blood leukocytes (PMNL) and monocytes (MN). ME HP, 2-EH, and PA are the main hydrolysis products of DE HP. Since DE HP is leached out of the plastic matrix, patients on hemodialysis and continuous ambulatory peritoneal dialysis are exposed to considerable amounts of DE HP and its metabolites.

Setting

Teaching hospital, Department of Nephrology.

Participants

Ten healthy volunteers.

Measurements

After incubation of leukocytes in solutions with different plasticizer concentrations, oxidative respiratory metabolism was determined by luminolenhanced chemiluminescence (CL) after stimulation with phorbol myristate acetate (PMA). Furthermore, superoxide (02) generation was measured by cytochrome c reduction.

Results

At pH 5.4, a dose-dependent decrease of luminol-enhanced CL response was found in all assays. For ME HP and PA the level of significance was reached at 10 mg/L and 1 mg/L, respectively. Superoxide generation by PMNL and MN at pH 5.4 was also suppressed by ME HP and PA. At pH 7.4, only a slight suppression of oxidative metabolism at higher concentrations was observed. After incubation of the cells in a solution containing all DE HP metabolites (ME HP, PA, and 2-EH), a significant suppressive effect of CL at pH 5.4 could be observed at final plasticizer concentrations of 0.5 mg/L.

Conclusions

A dose-dependent impairment of leukocyte oxidative metabolism at a low pH could be demonstrated. The suppressive effect was particularly marked after incubation of the cells in solutions containing a mixture of the main plasticizers. At pH 5.4, we observed a slight alteration even at concentrations very close to those that could be found in commercially available peritoneal dialysis fluids. These results might point toward a possible synergistic detrimental effect of the different DE HP metabolites on leukocyte function, with possible clinical relevance.
Measurement of Continuous Ambulatory Peritoneal Dialysis Prescription Adherence Using a Novel Approach
Authors: Sevick Mary Ann , Levine Douglas W. , Burkart John M. , Rocco Michael V. , Keith Jennifer , Cohen Stuart J.
Published: February 2020

Objective

The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription.

Design

A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time.

Setting

Patients were recruited from an outpatient dialysis center.

Participants

A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston–Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate.

Measures

Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened.

Results

One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent ( p = 0.015).

Conclusions

This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.
Comparison of Peritoneal Fluid Culture Results from Adults and Children Undergoing Capd
Authors: Yinnon Amos M. , Gabay Dorit , Raveh David , Schlesinger Yechiel , Slotki Itzchak , Attias Denise , Rudensky Bernard
Published: February 2020

Background

Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities.

Objective

To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities.

Design

Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD.

Results

We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2 ± 3.5, range 1 – 15) compared to 187 in adults (2.1 ± 1.9, range 1 – 10) ( p < 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) ( p < 0.001). The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8 ± 2.3, range 1 – 12; and 5.3 ± 5.2, range 1 – 27) than in adults (2.0 ± 1.3, range 1 – 6; and 2.7 ± 2.4, range 1 – 10) ( p < 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children ( p < 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults ( p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children ( p < 0.01), whereas S. aureus occurred more often in adults ( p < 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults ( p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults ( p < 0.05 – 0.001).

Conclusions

CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
Pharmacokinetics of Intermittent Intraperitoneal Cefazolin in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Manley Harold J. , Bailie George R. , Asher Rupesh D. , Eisele George , Frye Reginald F.
Published: February 2020

Objective

To investigate the pharmacokinetic parameters of intermittent intraperitoneal (IP) cefazolin, and recommend a cefazolin dosing regimen in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Prospective nonrandomized open study.

Setting

CAPD outpatient clinic in Albany, New York.

Patients

Seven volunteer CAPD patients without peritonitis. Three of the patients were nonanuric while 4 were anuric.

Interventions

Cefazolin (15 mg/kg total body weight) was given to each patient during the first peritoneal exchange. Blood and dialysate samples were collected at times 0, 0.5, 1, 2, 3, 6 (end of the first antibiotic-containing dwell), 24, and 48 hours after the administration of IP cefazolin. Urine samples were collected in nonanuric patients over the study period.

Results

The mean ± SD amount of cefazolin dose absorbed from the dialysate after the 6-hour dwell was 69.7% ± 8.0% of the administered dose. The cefazolin absorption rate constant from dialysate to serum was 0.21 ± 0.1 /hr (absorption half-life 3.5 ± 0.8 hr). The mean serum concentrations reached at 24 and 48 hours were 52.4 ± 3.7 mg/L and 30.3 ± 5.9 mg/L, respectively. The mean dialysate cefazolin concentrations reached at 24 and 48 hours were 15.1 ± 3.4 mg/L and 7.9 ± 1.4 mg/L, respectively. The cefazolin serum elimination rate constant was 0.02 ± 0.01 /hr (elimination half-life 31.5 ± 8.8 hr). The total cefazolin body clearance was 3.4 ± 0.6 mL/min. In the 3 nonanuric patients the mean renal clearance of cefazolin was 0.6 ± 0.4 mL/min. The peritoneal clearance of cefazolin was 1.0 ± 0.3 mL/min. The systemic volume of distribution of cefazolin was 0.2 ± 0.05 L/kg. No statistical difference was detected in pharmacokinetic parameters between anuric and nonanuric patients, although this may be due to the small number of patients in each group.

Conclusion

A single daily dose of cefazolin dosed at 15 mg/kg actual body weight in CAPD patients is effective in achieving serum concentration levels greater than the minimum inhibitory concentration for sensitive organisms over 48 hours, and dialysate concentration levels over 24 hours. Caution is warranted in extrapolation of dosing recommendations to patients who maintain a significant degree of residual renal function.
Intraperitoneal Hyaluronan Production in Stable Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Yamagata Kunihiro , Tomida Chie , Koyama Akio
Published: February 2020

Objective

Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins.

Design

We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals.

Setting

CAPD unit in Hitachi General Hospital.

Patients

The subjects were 46 stable CAPD patients who underwent 104 PETs.

Results

A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate ( r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion ( r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy.

Conclusion

Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.
The Effect of Insulin Delivery Route on Lipoproteins in Type I Diabetic Patients on CAPD
Authors: Nevalainen Pasi I. , Lahtela Jorma T. , Mustonen Jukka , Taskinen Marja-Riitta , Pasternack Amos
Published: February 2020

Objective

To evaluate the influence of subcutaneous and intraperitoneal (IP) insulin on plasma lipoproteins in type I diabetic (IDDM) patients with end-stage renal failure (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

A before–after trial.

Setting

University hospital outpatient care.

Participants

Eleven IDDM patients with stabilized peritoneal dialysis, age 42.9 ± 2.9 (SEM) years and duration of diabetes 31.4 ± 3.4 years.

Intervention

Two treatment periods during stabilized CAPD. All patients were first treated with subcutaneous and then with IP insulin. The studies were performed after a median time of 3 months on each treatment.

Main Outcome Measures

Plasma lipids; apoproteins (Apo) A-I, A-II, and B; high-density lipoprotein (HDL) subfractions; glycemic status; and uremic status.

Results

After changing from subcutaneous insulin to IP insulin, plasma HDL cholesterol decreased (from 1.29 ± 0.13 mmol/L to 0.96 ± 0.06 mmol/L, p < 0.05), and the low density to high density lipoprotein (LDL/HDL) cholesterol ratio increased ( p < 0.05). The HDL cholesterol decreased in both HDL2 and HDL3 fractions, but significantly so only in HDL3 ( p < 0.01). ApoA-I ( p < 0.05) decreased while the ApoB/ApoA-I ratio ( p < 0.01) and the ApoA-I/HDL-cholesterol ratio ( p < 0.01) increased during IP insulin therapy. Intraperitoneal insulin resulted in significantly better glycemic control than subcutaneous insulin ( p < 0.01).

Conclusions

In diabetic patients on CAPD therapy, IP insulin, although inducing better glycemic control than subcutaneous insulin, was associated with lowered plasma HDL cholesterol and ApoA-I levels. The atherogenic potential is probably less than expected as the relative particle size of HDL remained unchanged.
Sclerosing Peritonitis and Systemic Lupus Erythematosus: A Report of Two Cases
Authors: Odama Uninibile O. , Shih David J. , Korbet Stephen M.
Published: February 2020

Objective

To heighten the awareness of a possible association of sclerosing peritonitis in patients with systemic lupus erythematosus (SLE).

Methods and Results

Over the course of 17 years (from January 1981 to December 1997), 371 patients were treated with continuous ambulatory peritoneal dialysis (CAPD) at Rush–Presbyterian–St Lukes Medical Center. The patients were followed on CAPD for an average of 25 ± 21 (SD) months with a median of 19 months (range 0.2 – 115 months). During this time only 2 (0.5%) patients were diagnosed with sclerosing peritonitis, and both had SLE with ongoing evidence of active disease while on CAPD. With a total of 26 SLE patients being treated with CAPD during the observation period, the prevalence of sclerosing peritonitis can be said to be as high as 8% in this patient population.

Conclusion

These cases suggest that autoimmune diseases, such as SLE, that are well known to cause immune-mediated serositis may represent an additional factor predisposing to the development of sclerosing peritonitis in patients treated with CAPD.