bluuebunny/crossref_metadata_2025 huggingface dataset:
Peritoneal Equilibration Test
Authors: Karl Zbylut J. Twardowski , Khanna O. Nolph Ramesh , Leonor Barbara F. Prowant , Ryan P. , Moore Harold L. , Nielsen Marc P.
Published: February 2020

Peritoneal transfer rates of urea, creatinine, glucose, protein potassium, and sodium as well as drain and residual volumes were measured during 103 equilibration tests performed in 18 diabetic and 68 nondiabetic patients. Equilibration test was performed over a 4-hour dwell exchange with 2 L of 2.5% Dianeal solution. Excellent reproducibility was seen after tests were standardized for length of preceding exchange, times of inflow and drainage, patient position, methods of obtaining and processing samples and laboratory assays. Diabetics did not have lower peritoneal solute transfers than nondiabetics. Wide variations were found in the study population.

Measurements of creatinine, glucose and sodium transfer were particularly useful in predicting the patient's response to the standard CAPO. The patients with highaverage peritoneal solute transport did well on standard CAPO even after losing residual renal function. Patients with high peritoneal solute transfer rates were likely to have inadequate ultrafiltration on standard CAPO. These patients did much better on dialysis modalities with short dwell exchanges, i.e. nightly peritoneal dialysis (NPO) or daytime ambulatory peritoneal dialysis (OAPO). Patients with low average, and particularly low peritoneal transport rates were likely to develop symptoms and signs of inadequate dialysis as their residual renal function became negligible, particularly in individuals with high body surface area.

Repeated tests were helpful in evaluating causes of insufficient ultrafiltration and/or inadequate dialysis.
Influence of Continuous Ambulatory Peritoneal Dialysis on Elimination of Drugs
Authors: Maher John F.
Published: February 2020

Renal failure delays elimination of many drugs thus prolonging their half lives. By knowing the half life and distribution volume, one can estimate total plasma clearance. When measured values have not been reported, endogenous total plasma clearance can be estimated and compared with peritoneal clearance to determine the effect of CAPD on half life. When peritoneal clearance has not been reported, it can be estimated knowing molecular mass and unbound plasma fraction. Such estimates suggest that elimination kinetics of most drugs are not appreciably affected by CAPD. Compared to those of untreated anuric patients, plasma levels of carbenicillin, ticarcillin, some cephalosporins, all aminoglycosides, vancomycin, sfluorocytosine, amantadine, atenolol, sotalol, timolol, chlorpropamide, theophylline and lithium may be reduced somewhat by CAPD. Thus one should monitor plasma levels of these agents to insure therapeutic concentrations rather than simply following the dosage guidelines for anuric patient.
Failure of Peritoneal Catheter CUFF Shaving to Eradicate Infection
Authors: Judy Beth Piraino , Peitzman Bernardini Andrew , Sorkin Michael
Published: February 2020

Often the catheter is lost when exitsite infections fail to resolve with antibiotic therapy. Excision of the external cuff has been proposed as an alternative to catheter removal. Prospectively we recorded the results of 22 cuff-shaving procedures and all subsequent CAPD-related infections. After the cuff shaving we encountered six dialysate leaks, which resulted in catheter removal. In 10 other patients, four developed peritonitis, four tunnel infection and two recurrent exit..site infection with the same micro-organism that caused the original exit site infection. Cuff shaving did not decrease the exit-site infection and peritonitis rates. Median catheter survival time after the cuff shaving was 1.5 months (range from 0 to 23 months). In conclusion, cuff shaving often fails to eradicate catheter infection. We need to develop alternative methods for treating and preventing exit-site infections.
Effect of Transfer of Erythrocytes to a Nonuremic Medium on Corpuscular Parameters and Red Blood Cell Deformability in Patients Treated with CAPD and Hemodialysis
Authors: Ana Miguel Perez-Fontan , Zamorano F. , Huarte Emma , De Castro Mercedes F. , Selgas Rafael
Published: February 2020

We studied the effect produced on corpuscular parameters and erythrocyte deformability by transfer of red blood cells to a nontoxic isoosmotic medium. The study groups were uremic patients treated with hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Erythrocyte deformability was estimated by the erythrocyte filtration rate (EFR). Transfer resulted in a significant decrease in mean corpuscular volume (MCV) and an increase in mean corpuscular hemoglobin concentration (MCHC), in comparison with healthy controls. The principal cause for this may be an improvement in erythrotycte membrane function. The change was more marked in the CAPD than in the HD patients; CAPD patients displayed a clear tendency to microcytosis after changing media, not directly attributable to iron deficiency or aluminum intoxication. Erythrocyte deformability was decreased markedly in all the patients, but study of the EFR of washed erythrocytes suggested that there was more impairment in HD. These differences could have some effect on the response of the hemolytic component of the anemia of uremia to HD and CAPD.
Pseudoporphyria Cutanea Tarda and Non-A Non-S Hepatitis in a CAPD Patient
Authors: Zeier Martin , Doss Manfred , Ziegler Traugott , Ritz Eberhard , Rambausek Michael
Published: February 2020

A 47-year-old man was treated by continuous ambulatory peritoneal dialysis (CAPD) because of chronic glomerulonephritis. One year later he developed skin friability and bullous dermatosis resembling porphyria cutanea tarda. The skin lesions were associated with an elevation of serum aminotransferases, most probably due to a blood transfusion-induced, non-A non-B hepatitis.

Urinary, fecal and blood porphyrins including the activity of red cell uroporphyrinogen decarboxylase were normal. Thus we accepted the diagnosis of pseudoporphyria cutanea tarda in view of the relatively frequent association of cutaneous disease with maintenance dialysis.
Fibronectin and Fibrinogen in the Plasma and Dialysate of Patients on CAPD
Authors: Davies Simon J. , Animashaun Aduke , Taylor Albert E. , Young Gerald A. , Turney John H.
Published: February 2020

Plasma and dialysate fluid from 18 patients treated with continuous ambulatory peritoneal dialysis (CAPD) while peritonitis -free, were analysed for fibronectin (FN), fibrinogen (FG), albumin (ALB) and total protein (TP). Mean plasma FG (6.24 g/l) was higher than for normal controls (4.23 g/1; p < 0.001) whereas FN (0.31 g/l) was lower than for normal (0.36 g/l; p < 0.02). Twenty-four hour losses of proteins into the dialysate were as follows: TP = 10.9 g, ALB = 5.2 g, FN = 15.6 mg and FG = 221 mg. Mean dialysate concentration for FN was 2.09 mg/1 and FG 31.1 mg/l. Dialysate FN and FG correlated with dialysate ALB (r = 0.92; p < 0.001, r = 0.60; p < 0.01 respectively) suggesting an ultrafiltrate rather than synthesis within the peritoneum.
Hydrothorax as a Complication of Pediatric Peritoneal Dialysis
Authors: Bunchman Timothy E. , Wood Ellen G. , Lynch Robert E.
Published: February 2020

Hydrothorax is a known complication of peritoneal dialysis (PD) but there is very little in the pediatric literature concerning this complication.

From 1982 to 1984 seven of 29 of our patients who underwent peritoneal dialysis, developed pleural effusions as a complication of PD. These patients varied in respect to age, technique and duration of PD. Four of the seven developed respiratory symptoms at the time when effusions were discovered, while the other three were recognized during evaluation of loss of ultrafiltration. Five of the seven had right-sided effusions, one had a left-sided effusion, and one had bilateral effusions. No technical factors could be identified as causative agents.

We have concluded that pediatric patients may be particularly likely to develop hydrothorax as a complication of peritoneal dialysis. This may present as a pulmonary emergency or as a subtle loss of ultrafiltration ability. The possibility of congenital potential communicating pathways seems more likely than any other single explanation for this phenomena.

Hydrothorax as a complication of peritoneal dialysis (PD) is reported chiefly in the adult PD literature. The first reports were associated with trauma but in most subsequent cases, there was no explanation.

We are aware of only two accounts of this complication in children covering a total of eight cases. Several of these may have been related to surgical trauma (1). However, in our own patient population, we observed seven who developed hydrothorax while on various forms of PD. Review of individual cases did not demonstrate common factors which would explain the hydrothorax. Thus, hydrothorax developed during PD in a significant number of infants over a short period and under a variety of clinical circumstances. This suggests the existence of potential anatomical channels which may open under a variety of circumstances.
Vancomycin Tolerance in Staphylococcus Aureus Isolated during Treatment of CAPD Peritonitis
Authors: Freeman Derek , Cryan Elizabeth M.J. , Falkiner Frederick R. , Keogh J.A. Brian , Keane Conor T.
Published: February 2020

The susceptibility to vancomycin of nine staphylococcal strains responsible for nine episodes of peritonitis in patients on continuous ambulatory peritoneal dialysis was correlated with outcome of therapy. All strains examined had MIC values indicating sensitivity (MIC.:; 4 μg/ml). Tolerance was observed in one strain of Staphylococcus aureus (MIC = 1 μg/ml., MBC = 64 μg/ml).

Time-kill studies using three different media demonstrated this organism's reduced susceptibility to vancomycin and suggested that testmedium composition may also affect the result. The patient with the tolerant strain, required an extended period of treatment.
A Retrospective Analysis of Catheter Configuration and Cuff Type: A National CAPO Registry Report
Authors: Lindblad Anne S. , Hamilton Robert W. , Nolph Karl D. , Novak Joel W.
Published: February 2020

The National CAPD Registry retrospectively collected data on 2000 patients using continuous ambulatory peritoneal dialysis (CAPD) and/or continuous cyclic peritoneal dialysis (CCPD) to determine the natural history of implanted peritoneal catheters and to estimate the survival distributions for the different configurations. The standard straight double-cuff catheter was reported as the first catheter type in 50% of Registry patients; and, as such, is the most widely-used peritoneal access system in the Registry population. In general, patients using double-cuff catheters were reported to have a lower incidence of exit-site complications as a reason for catheter removal as compared to patients using a catheter with a single, subcutaneously placed, cuff (7% vs. 13%, respectively). Improved length of catheter survival for patients using double-cuff catheters as compared to patients using catheters with a single cuff placed in the deep fascia was also observed and standard double-cuff catheters were found to have improved survival over Toronto-Western catheters. Patient selection factors across all centers have an unknown impact on catheter survival and these results should be viewed with these caveats in mind.
Streptokinase Therapy for Occluded Tenckhoff Catheters in Children on CAPO
Authors: Bergstein Jerry M. , Andreoli Sharon P. , West Karen W. , Grosfeld Jay L.
Published: February 2020

Streptokinase was infused through the partially thrombosed Tenckhoff catheters of four children on continuous ambulatory peritoneal dialysis (CAPD). Radiographic contrast studies performed before and after the infusions demonstrated dramatic dissolution of the fibrin thrombi associated with restoration of normal catheter function. The catheters subsequently functioned for an average of 12.5 months. No allergic or hemorrhagic complications were noted in association with the infusions. Coagulation studies revealed no evidence for systemic streptokinase absorption. We suggest that streptokinase, when given in the manner described, is a safe and effective treatment of thrombosed Tenckhoff catheters in children.
The Effect of CAPO on Hypertension Control: A Report of the National CAPO Registry
Authors: Stablein1 Donald M. , Hamburger Richard J. , Lindblad Anne S. , Nolph Karl D. , Novak Joel W.
Published: February 2020

Hypertension and medication histories were collected on a cohort of 209 randomly selected adult patients from the National CAPD Registry. Seventy-seven percent of the patients had a history of hypertension. Over 92% of hypertensives have a medication history for the problem. Mean reductions in systolic blood pressure of > 11 mm Hg were observed in subsets examined at one month and one year, while diastolic pressure decreases were significant at one month but not at a year. Diuretics were used in 32% of treated hypertensives at baseline, but only 9% of treated patients at one year. With initiation of continuous ambulatory peritoneal dialysis (CAPD), patients are significantly more likely to be classified as normal and less likely to be medically uncontrolled hypertensives. Thirty percent of patients who were receiving antihypertensive medication at baseline were not receiving antihypertensive therapy at one year.
Relapsing Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): Treatment by Interruption of CAPO and Prolonged Antibiotic Therapy
Authors: Kant K. Shashi , Goetz Daniel , Marzluff Cynthia , Motz Denise
Published: February 2020

Relapsing peritonitis was assessed in the continuous ambulatory peritoneal dialysis (CAPD) population of a large, outpatient dialysis facility. Prolonged systemic treatment with antibiotics often fails, resulting in the eventual removal and subsequent reimplantation of the catheter. We have tried a new approach to avoid removal of the peritoneal catheter. Patients were treated by the interruption of CAPD, conversion to hemodialysis or discontinuation of dialysis for a period of 7 to 21 days while continuing systemic antibiotics. Over a period of 76.63 patient years, 69 episodes of bacterial peritonitis occurred (0.9 episodes per patient year). Of these, five episodes could be classified as relapsing peritonitis. Five patients with gram-positive relapsing peritonitis were treated by this regimen; all responded with a cure. Our results suggest that relapsing peritonitis can be eradicated without the removal of the peritoneal catheter.
Bowel Erosion Due to a Dormant Peritoneal Catheter in Immunosuppressed Renal Transplant Recipients
Authors: Brady Hugh R. , Abraham Georgy , Oreopoulos Dimitrios G. , Cardella Carl J.
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) patients are not considered to be at increased risk of infection after transplantation when compared to other renal transplant recipients. This article describes two patients who developed bowel erosion and life-threatening peritonitis following irritation from a dormant, indwelling peritoneal catheter. In both cases, the classical signs of peritonitis were masked by immunosuppressive therapy. In one patient, the catheter was removed, but she died of fecal peritonitis and sepsis. The second patient, who was taken to the operating room for laparotomy once peritonitis was diagnosed, survived; he required segmental resection and appendectomy because of multiple bowel erosions. As a result of this experience, we suggest that the peritoneal catheter be removed as early as possible after transplantation once renal function has been established. Furthermore, we believe that peritonitis developing in patients with dormant indwelling peritoneal dialysis catheters should have a prompt exploratory laparotomy to rule out perforation, because in an immunosuppressed host this condition may be rapidly fatal.
Staphylococcus Aureus Peritoneal Catheter-Related Infections: A Cause of Catheter Loss and Peritonitis
Authors: Zimmerman Stephen W. , O'Brien Mark , Wiedenhoeft Frances A. , Johnson Curtis A.
Published: February 2020

To determine the impact of Staphylococcus aureus catheter-related infections in a peritoneal dialysis program we reviewed all S. aureus catheter-related infections in our program over a six-year period. Twenty -five percent (51/204) of patients at risk developed S. aureus catheter exit-site or tunnel infections. S. aureus accounted for 61% of all positive exit-site cultures; of 320 catheters implemented, 65 were infected with S. aureus. Fifty-one S. aureus-infected patients were retrospectively matched with 51 noninfected patients from our peritoneal dialysis program. Patients with S. aureus catheter-related infections had significantly greater catheter loss from catheter infection and peritonitis. There was significantly more S. aureus peritonitis but less coagulase negative staphylococcus peritonitis in patients with S. aureus catheter-related infections. Significantly more noninfected control patients remained peritonitis free.

During this period, 83% of all S. aureus peritonitis was associated with S. aureus catheter infections, and 28 of 57 replacement catheters were reinfected with S. aureus. These findings suggest S. aureus is a major catheter-related pathogen leading to catheter loss and peritonitis. The high recurrence rate suggests that host factors may predispose to S. aureus catheter-related infections.
Effect of Dietary Fish Oil on Lipid Abnormalities in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Jones Richard G. , Dibble John B. , Gibson Jill , Tompkins Lesley , O'Kane Mary , Hobson Shirley M. , Young Gerald A. , Grant Andrew M. , Turney John H. , Brownjohn Aleck M.
Published: February 2020

Fifteen patients receiving continuous ambulatory peritoneal dialysis (CAPD) were given 10 mL of a dietary fish oil rich in omega-3 fatty acids (MaxEPA) b.i.d. for eight weeks without other dietary manipulation. Fasting lipids, vitamins A and E, and glucose were measured at 0, 4, and 8 weeks, and again at 4 and 8 weeks after the cessation of treatment.

Basal serum triglyceride concentrations were raised, and fell by 29% (p < 0.005) with treatment, returning to baseline values over the washout period. The fall in triglyceride during treatment correlated with the initial value (As = 0.57; p < 0.05). Total, HDL and LDL cholesterol, apolipoprotein A, vitamin A, glucose, lean body mass, and dietary fat/CHO intake were unchanged throughout. Apolipoprotein B concentrations tended to rise during the first half of treatment but fell thereafter. Vitamin E concentrations rose significantly during supplementation and fell after withdrawal (p < 0.001 for both).

Supplementation with dietary fish oil significantly reduced hypertriglyceridemia. Its long-term use might be accompanied by beneficial effects on the excess cardiovascular morbidity seen in patients on CAPD.
Six-And-A-Half Years of Experience with Three Two-Liter Daily Exchanges in CAPD
Authors: Henao Jorge E. , Mejia Gonzalo , Arbelaez Mario , Arango Jorge L. , Garcia Alvaro , Sanchez Julieta , Gil Nora Elena , Aramburo Olga
Published: February 2020

Our continuous ambulatory peritoneal dialysis (CAPD) program consists of three 2- L daily exchanges (usually two of 1.5% and one of 4.25% dextrose concentration). Between March 1981 and November 1987, 87 patients were started on this program. Mean age was 35 years, 55% were males, and mean follow-up was 20.1 ± 2 months for a total experience of 1748 patient months. At the end of the study, 27 (31%) were still on CAPD, 43 (49.5%) had received renal transplants, 8 (9.2%) had returned to hemodialysis, 6 (6.9%) had been transferred to other units, 2 (2.3%) died, and 1 (1.1%) voluntarily quit. Actuarial survival rates were 90%, 81 %, and 57% for patients, method, and catheters, respectively, at 66 months. Peritonitis appeared at a rate of one episode per 14 patient months for a total of 121 episodes occurring in 51 patients. Rates of other complications were not higher than those reported by others. Hospitalization rates were low. Hypertension improved, patient weight did not change, and laboratory data tended towards normal levels or normalized. In selected patients, three 2- L exchanges per day appear to be enough for an adequate CAPD, even for long-term treatment. At the same time, it allows a 25% reduction in cost and risk of peritonitis. Larger number of patients and longer follow-up periods will be required to exactly define its real usefulness and safety.
Intraperitoneal Administration of Recombinant Human Erythropoietin in Uremic Animals
Authors: Bargman Joanne M. , Breborowicz Andre , Rodela Helen , Sombolos Kostas , Oreopoulos Dimitrios G.
Published: February 2020

Previous protocols of administration of recombinant human erythropoietin to patients with end-stage renal disease have been by the i.v. route. Because this method would be impractical for the continuous ambulatory peritoneal dialysis patient, we designed an i.p. dosing protocol in uremic rabbits to examine whether significant amounts of this hormone could be absorbed from the peritoneal cavity. Our results demonstrate that almost all of the erythropoietin is absorbed (or adsorbed) during a prolonged dwell when administered undiluted by dialysate.
Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD): Risk Factors, Clinical Severity, and Pathogenetic Aspects
Authors: Tranæus Anders , Heimbürger Olof , Lindholm Bengt
Published: February 2020

This study of 228 episodes of peritonitis occurring during a total observation time of 2365 treatment months over a six-year period in a uniformly selected, trained, and treated continuous ambulatory peritoneal dialysis (CAPD) population (N = 124) showed the following major findings: 1) the risk of developing peritonitis was 55% within the first year and 89% within the first three years on CAPD; 2) high age (≥60 years) and year of CAPD start were risk factors for peritonitis; 3) neither sex, diabetes, or hypoalbuminemia were found to be risk factors for peritonitis; 4) the year of start, but neither the degree of severity, nor the time of the first episode affected the risk of developing a second episode of peritonitis; 5) no specific characteristics were identified in patients with the highest mean peritonitis incidence or in the patients without peritonitis; 6) in 27% of all episodes, turbidity of the dialysate was the only clinical finding; 7) the proportion of asymptomatic episodes was lower in patients ≥ 60 years; 8) the degree of clinical severity of peritonitis was not statistically influenced by the number of previous episodes; 9) the cause of peritonitis was established in only 26% of all cases; and 10) no statistical association was found between the cause of peritonitis and patient characteristics.
A Heat-Sealing Device to Disconnect Peritoneal Dialysis Lines
Authors: Sharp Jean , Coulthard Malcolm G.
Published: February 2020

A heat-sealing device was used to disconnect peritoneal dialysis tubing in children using manual dialysis or an automatic cycling machine in hospital and at home. The technique allows the peritoneum to be left either full or empty and reduces the risk of peritonitis by decreasing the number of times the tubing is opened. Families found it easy-to-learn, rapid, and reliable, with no problems encountered after 4000 usages. It provides a simpier, safer, and cheaper alternative to standard disconnection methods.
Acinetobacter Calcoaceticus Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Ruiz Ana , Ramos Blanca , Burgos Dolores , Frutos Miguel A. , De Novales Eduardo Lopez
Published: February 2020

In eight years with 127 continuous ambulatory peritoneal dialysis (CAPD) patients, peritonitis due to Acinetobacter calcoacetlcus accounted for 1.6% of total peritonitis episodes. These were serious episodes, showing severe pain with fever. paralytic ileus, and leukocytosis, and appeared following peritonitis due to other organisms. An 80% relapse rate led to catheter removal.
Geriatric Nephrology and Urology-1989
Authors: Brown Wendy W.
Published: February 2020

The Sign in the West Virginia lunch counter read: “Don't criticize the coffee. You may be old and weak yourself someday.”

-William Reichel, Editor Clinical Aspects of Aging, 1983
Beta-2 Microglobulin Removal during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Lysaght Michael J. , Pollock Carol A. , Moran John E. , Ibels Lloyd S. , Farrell Peter C.
Published: February 2020

Beta-2 microglobulin (B2M) handling in continuous ambulatory peritoneal dialysis (CAPD) was characterized in acute and chronic clinical studies. Average clearance rate was 0.7 mLlmin and mean mass transfer coefficient, KoA, was calculated to be 0.95 cm2lmin; these values are in the range expected from extrapolation of published data for other large solutes. In chronic studies with both anuric and oliguric populations, CAPD was shown to be much more effective than conventional hemodialysis in removing B2M and, in fact, CAPD removal rates were equivalent to those reported for high flux dialysis therapies. However, this greater extraction was not associated with any clinically significant reduction in circulating plasma concentrations. These trends remained valid in both the anuric and oliguric subsets of the study population.
Peritoneal Vascular Changes in Continuous Ambulatory Peritoneal Dialysis (CAPD): An in Vivo Model for the Study of Diabetic Microangiopathy
Authors: Di Paolo N. , Sacchi1 G.
Published: February 2020

Replication of the basement membrane of the peritoneal capillaries and the mesothelium is observed in all uremic patients after a period of continuous ambulatory peritoneal dialysis (CAPD). Biopsy specimens of the parietal peritoneum were taken in diabetic and non-diabetic patients on insertion or repositioning of the CAPD catheter. The basement membrane of the capillaries and mesothelium was normal in non-diabetics on insertion of the catheter, but after 2 to 66 months of CAPD, multiple replication was found. In nearly all the diabetics there was already replication of the basement membrane of the peritoneal capillaries before CAPD was begun but the basement membrane of the mesothelium was intact. After several months of CAPD thickening of the basement membrane of the capillaries was found in 36% of diabetics, sometimes to the point of occlusion. After CAPD, replication of the basement membrane of the mesothelium has been observed in both diabetics and nondiabetics although it is initially perfectly normal in both. CAPD is proposed as an experimental model for diabetic microangiopathy in man.
Trimethoprim-Sulfamethoxazole Pharmacokinetics during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Walker S.E. , Paton T.W. , Churchill D.N. , Ojo B. , Manuel M.A. , Wright N.
Published: February 2020

Ten adult patients on continuous ambulatory peritoneal dialysis (CAPO) received one dose of trimethoprim320 mg (TMP) and sulfamethoxazole 1600 mg (SMX) orally (p.o.), intravenously (i.v.), and intraperitoneally (i.p.) on three separate occasions to characterize the pharmacokinetics of both drugs. Concentrations of both TMP and SMX were measured in serum and dialysate by HPLC to 48 h. Half-life, total body clearance (TBC), and peritoneal clearance (PCI) were determined. The mean half-life of TMP was 28 h, while for SMX it was 12.5 h. Relative to the i.v. dose, the bioavailability following oral administration for TMP was 98% and 87% for SMX. Intraperitoneal bioavailability was 73% for TMP and 65% for SMX after a 4-h dwell.

After 24 h, regardless of the route of administration, less than 3% of TMP and less than 6% of SMX appeared in dialysate.

We conclude that peritoneal losses contribute insignificantly to TMPISMX elimination during CAPO.
Loss of Ultrafil Tration in Continuous Ambulatory Peritoneal Dialysis: A Role for Acetate
Authors: Faller Bernadette , Marichal Jean-Francois
Published: February 2020

A retrospective analysis of the ultra-filtration (UF) capacity of patients treated by continuous ambulatory peritoneal dialysis since 1978 showed that in all 31 patients using acetatebuttered dialysate the UF decreased whereas it decreased in only two (14%) of 14 patients using lactate dialysate. Prolonged exposure of the peritoneum to acetate dialysate seems to be responsible for this loss of UF.
Exit-Site Location Does Not Influence Peritoneal Catheter Infection Rate
Authors: Piraino Beth , Bernardini Judith , Johnston James R. , Sorkin Michael I.
Published: February 2020

Peritoneal catheter infections are a cause of peritonitis, catheter loss, and permanent transfer of continuous ambulatory peritoneal dialysis (CAPO) patients to hemodialysis. Risk factors for catheter infections have not been delineated. We investigated the location of the peritoneal exit-site location as a risk factor for catheter infection and loss. There was no relationship between catheter infection rates and exit location. Catheters exiting on the beltline had a median infection rate of 0.5 episodesl year, as opposed to 1.2 episodes/year for catheters exiting above the beltline and 0.9 episodes/ year for catheters exiting below the beltline (ns). The percentage of catheters that became infected and required removal was the same for catheters exiting above, below, or on the beltline. Although we recommend avoiding the beltline for patient comfort, exit-site location is not an important determinant of infection rates or catheter outcome.
Prospected Randomized Study of Two Y Devices in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Viglino Giusto , Colombo Adolfo , Scalamogna Antonio , Cavalli Pier L. , Guerra Luisella , Renzetti Gianantonio , Gandolfo Carmen , De Vecchi Amedeo , Barzaghi Valter , Balteau Patrick , Peluso Franco , Cantaluppi Alberto
Published: February 2020

To evaluate acceptability, safety, and efficacy of a y set with two short branches (TAs) filled with electrolytic chloroxidizer solution during the dwell time, 60 patients were randomly allocated to be treated with the traditional y set (TCs) or with the T AS. Twenty-three were new patients whereas the remaining 37 were patients already on continuous ambulatory peritoneal dialysis (CAPD) with the TCs. The follow-up was 416.5 months in the control group and 387.4 months in the test group. During the study period there were 6 peritonitis episodes in each group with an incidence of 1 episode every 69.4 patient-months in the control group and 1 episode every 64.6 patient-months in the test group. Twenty-four patients (80%) in the control group and 27 (90%) in the test group were free from peritonitis. The probability to remain free from peritonitis was respectively 87% and 83% in the test group and in control group after 12 months, 70% and 78% after 21 months. seventy -nine percent of the patients who used both systems preferred the T AS for better handling, lower encumbrance, and major safety. One patient preferred the TCs, three patients did not find any differences between the two devices.
Disconnect during Continuous Ambulatory Peritoneal Dialysis (CAPD): Retrospective Experience with Three Different Systems
Authors: Swartz Richard , Reynolds Janice , Lees Patricia , Rocher Leslie
Published: February 2020

Disadvantages of continuous ambulatory peritoneal dialysis (CAPD), such as inconvenience and bulkiness of the apparatus, inflexibility of infusion volume, and predictable peritonitis incidence may be altered by using systems which allow disconnection from the tubing and bag after each exchange. At University of Michigan we have followed 35 patients using the O set@ with sodium hypochlorite (Baxter Healthcare Corp.) for 15.5 ± 10 months, 16 patients using the Y configuration Ultraset® (Baxter Healthcare Corp.) for 8.1 ± 5 months, and 6 patients using a universal adapter (Delmed Corp.) for 14.3 ± 7 months. Failure occurred in 7 cases (18%) at 12 ± 8 months using the O set (3 elective, 3 related to peritonitis, 1 ultrafiltration difficulty), and 1 (7%) at 3 months using the Ultraset (related to peritonitis). Accidental sodium hypochlorite infusion occurred 8 times in 6 patients, 4 patients still on CAPD without residual effect and 2 in whom infusion contributed to failure but not to ultrafiltration difficulty. Cumulative per-patient-year (episode/ months) peritonitis rates of 0.75 (1/16.4), 0.65 (1/18.4) and 0.88 (1/14.3), respectively, compare favorably with the overall center experience of 0.96 (1/12.2) (NIH-CAPD Registry). Peritonitis rates did not differ during use of any of the disconnect systems between patients with prior CAPD experience compared to patients without prior CAPD experience. More important, however, in patients with prior CAPD experience, peritonitis rates after initiation of the disconnect system tended to be lower than rates before disconnect with both the O set, 0.66 (1/18.1) vs. 1.18 (1/10.2) (n = 16, p < 0.09) and Ultraset, 0.46 (1/26.1) vs. 1.54 (1/7.9) (n = 6, p < 0.03), with insufficient data (n = 2) for the universal set. In conclusion, disconnect systems favorably influence not only patient preference for CAPD and ability to vary CAPD infusion volume, but also the frequency of peritonitis during long term use.
Treatment of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) with Intraperitoneal Cefazolin and Gentamicin
Authors: Weber Jochen , Staerz Elisabeth , Mettang Thomas , Machleidt Christoph , Kuhlmann Ulrich
Published: February 2020

Between 1983 and 1988 57 peritonitis episodes in an unselected patient population were initially treated with intraperitoneal cefazolin and gentamicin. The loading dose consisted of 500 mg cefazolin/L dialysate and 40 mg gentamicin/L dialysate. The maintenance dosage was 125 mg cefazolin and 8 mg gentamicin per liter dialysate. Forty-five (78.9%) patients were primarily cured with this regimen (responder group = RG). Twelve patients (21.1 %) did not respond to the initial therapy (nonresponder group = NG). Eight peritonitis episodes in the NG (14.0% of all patients) were caused by tunnel infections and 2 by diverticulitis (3.5%). The cure rate in patients without tunnel infection or bowel disease was 95.7%. A relapse occurred in 2 patients (3.5%). Duration of therapy was assessed by daily white blood cell count (WBC) in the effluent and treatment was discontinued when the WBC was <100/μ1 for 3 days. The mean duration of therapy with cefazolin and gentamicin was 8.1 days in the RG and 6.0 days in the NG. Nonresponders were subsequently treated with a modified antibiotic regimen on an average 11.9 days.
Phosphatidylcholine Administration in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients with Reduced Ultrafiltration
Authors: De Vecchi Amedeo , Castelnovo Claudia , Guerra Luisella , Scalamogna Antonio
Published: February 2020

To evaluate the possible role of oral phosphatidylcholine administration in improving peritoneal ultrafiltration sixteen continuous ambulatory peritoneal dialysis (CAPD) patients with a reduced ultrafiltration rate (less than 500 mL/4 h after a standard 3.86% glucose exchange) were studied. Three patients spontaneously stopped phosphatidylcholine due to gastric side effects. Three out of the remaining 13 patients showed a mild increase of standard ultrafiltration, which was not followed by any increase in daily dialysate output. No differences in glucose, sodium, potassium, urea and creatinine equilibration curves were seen. In conclusion, in our series oral phosphatidylcholine is not free of side effects, and its efficacy in improving ultrafiltration is scanty, with no clinical relevance in increasing daily ultrafiltration.
Comparison of Patient and Technique Survival in Continuous Ambulatory Peritoneal Dialysis (Capd) and Hemodialysis: A Multicenter Study
Authors: Serkes Kenneth D. , Blagg Christopher R. , Nolph Karl D. , Vonesh Edward F. , Shapiro Fred
Published: February 2020

Patient and technique survival were compared in adult patients new to continuous ambulatory peritoneal dialysis (CAPD) or (primarily) center hemodialysis (HD) in the time period 1981 to 1983, and followed-up in March 1985. Risk factors were identified at entrance into the study, and results were analyzed using Cox's proportional hazards model.

For nondiabetic patients, the difference in survival which favored CAPD (relative risk = 0.62) was not significant at the 5% level (p = 0.08). Age was a significant risk factor in both groups. The average number of hospital visits was the same; however, CAPD showed a small but significant increase in average annual hospital days per year (10.14 vs. 9.18).

For diabetic patients, there was no significant difference in survival between CAPD and HD. The CAPD group showed a significant increase in hospital visits (relative risk 1.81 vs. 1.40) and average hospital days per year (19.43 vs. 13.41).

Both CAPD groups showed significantly higher treatment changeover rates.
Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children
Authors: Levy Maurice , Balfe J. Williamson , Geary Dennis , Fryer-Keene Sue , Bannatyne Robert
Published: February 2020

A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gramnegative organisms were responsible for 23 ESls, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.
Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children
Authors: Levy Maurice , Balfe J. Williamson , Geary Dennis , Fryer-Keene Sue , Bannatyne Robert
Published: February 2020

A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gram negative organisms were responsible for 23 ESls, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.
An Analysis of Peritonitis Rates with Bagless Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Rubin Jack , Case Gay
Published: February 2020

This study was performed to evaluate if the increased number of connections needed to perform bagless continuous ambulatory peritoneal dialysis (CAPD) with the Delmed system was associated with an increased incidence of peritonitis. All patients, from April 1986 through October 1988, using the Delmed bag less connection system, the Delmed bag system, and the Abbott spike system were included. Fifty patients (42.7 years at risk) received bagless CAPD (53 episodes of peritonitis; 1.24 episodes/patient year of dialysis); 56 patients (46.8 years at risk) utilized the Delmed bag technique (76 episodes of peritonitis; 1.63 episodes/patient year); and 45 patients (66.7 years at risk) utilized the Abbott system (155 episodes of peritonitis; 2.36 episodes/patient year of dialysis). The time to the first peritonitis episode was not significantly different between groups. Fifteen patients were switched from the Abbott system (2.3 episodes/patient years) to the Delmed bagless system (0.9 episodes/patient year, peritonitis; p < 0.05) and 9 patients were switched from the Abbott spike system (2.3 episodes/patient years) to the Delmed bag system (1.4 episodes/patient years; p < 0.01). It is concluded that the Delmed bagless system is not associated with an increased incidence of peritonitis and that the Delmed system is at least as good as the spike connection devices.
Amino-Acid-Based Continuous Ambulatory Peritoneal Dialysis (CAPD) Fluid over Twelve Weeks: Effects on Carbohydrate and Lipid Metabolism
Authors: Dibble John B. , Young Gerald A. , Hobson Shirley M. , Brownjohn Aleck M.
Published: February 2020

Aspects of lipid and carbohydrate metabolism were studied in 8 patients established on continuous ambulatory peritoneal dialysis (CAPD) with plasma albumin < 35 g/L, before, during, and after substitution of 1 of the daily glucose exchanges by a commercial 1 % amino acid dialysis fluid for 12 weeks. The amount of glucose absorbed from the dialysis fluid was consequently reduced by about 25%, hence total energy intake decreased by about 100 Kcallday, but peritoneal glucose transfer kinetics were unaffected. Glucose was lost into amino acid dialysate as expected (2 g/day).

Excluding 1 patient with a large rise in calorie intake, total and LDL cholesterol fell at 8 and 12 weeks (LDL cholesterol week 0, 5.26 ± 1.13; week 8, 4.32 ± 0.74; week 12,4.30 ± 1.22; mean ± SD, p < 0.01 for both), but returned to baseline 2 weeks after the restoration of glucose fluid (LDL 4.91 ± 1.22, p < 0.05 vs. week 12). Apolipoprotein B concentration also fell at 12 weeks (p < 0.01). No changes were seen in body weight, body fat, arm muscle circumference, fasting plasma glucose, insulin, growth hormone, triglyceride, non esterified fatty acids, or HDL cholesterol. The response of these biochemical indices to single 8-h glucose and amino acid morning exchanges at 0 and 12 weeks were studied. After 12 week's use of amino acid dialysis fluid, plasma cholesterol and apolipoprotein B were significantly lower throughout the exchange.

The decrease in cholesterol and apolipoprotein B during the substitution of 1% amino acid dialysis fluid may be associated not only with the reduction in glucose intake, but also with a gradual change in lipid metabolism. The routine use of such solutions may lower cardiovascular morbidity and mortality in CAPD but further evaluation is indicated.
Six-Month Overnight Intraperitoneal Amino-Acid Infusion in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients-No Effect on Nutritional Status
Authors: Dombros Nicholas V. , Prutis Krystyne , Tong Mathew , Anderson G. Harvey , Harrison Joan , Sombolos Kostas , Digenis George , Tit Jean Pet , Oreopoulos Dimitrios G.
Published: February 2020

The long-term effect of an AA solution based on Tra-vasol®, a solution for total parenteral nutrition, given in-traperitoneally over a 6-month period was studied in 5 patients 22 to 75 years old, having been on continuous ambulatory peritoneal dialysis (CAPD) for 3 to 57 months. A low oral protein intake (<0.8 g/kg bw /day) and/or a low serum albumin «35 g/L) were used as inclusion criteria. Two liters of 1% AA solution were infused overnight, while a glucose Dianeal® was used for the other exchanges. During the study, BUN increased from 22.04 mM/L to 28.06 mM/L the first month and remained at these levels, indicating the increased protein intake. However, average oral total energy and protein intake, body weight (bw), serum creatinine, cholesterol, triglycerides, total proteins, albumin, transferrin, skinfold thickness, total body potassium, and plasma AA levels remained basically unchanged. The average total body nitrogen decreased from 1.746 to 1.554 Kg, but this decrease did not reach statistical significance (p > 0.05).

We conclude that intraperitoneal overnight administration of 2 L of 1% AA based on Travasol® over 6 months did not improve the nutritional status of CAPD patients. This ineffectiveness might be due to the AA composition of the solution, the timing of administration, or to a low caloric intake and/or that our patients were not severely malnourished.
The Need for Using An Enzymatic Colorimetric Assay in Creatinine Determination of Peritoneal Dialysis Solutions
Authors: Larpent Liliane , Verger Christian
Published: February 2020

The fate of the peritoneal membrane on continuous ambulatory peritoneal dialysis (CAPD) is usually evaluated through the modification of its permeability to various solutes as glucose, creatinine, and urea. Therefore, the accuracy of the methods used for measurements of creatinine is of great importance. A particular problem does exist for creatinine determination as it may be influenced by the presence of glucose.

We studied a new enzymatic colorimetric method for creatinine determination in peritoneal dialysis solutions which contain high dextrose concentrations. Creatinine was measured in plasma, urine, and dialysate from 18 patients on CAPD and in pure dextrose solutions, with an enzymatic test (Boehringer Mannheim) and with Jaffe's reaction on two different analyzers: Astra (Beckman) and Eris (Merck).

Creatinine results were similar with both assays (Jaffe's reaction and enzymatic test) when measured in blood and urine. However the Jaffe's reaction gave higher creatinine results than the enzymatic test (p < 0.001), when assays were performed in peritoneal dialysis solutions and in pure glucose solutions.

In addition, it appeared that other components of dialysis solutions, mainly calcium chloride, influenced unpredictably the results of creatinine with the Jaffe's reaction.

We conclude that specific enzymatic test is a more accurate and reliable method to evaluate creatinine kinetics through the peritoneal membrane when determined in CAPD solutions.
Newer Quinolones in the Treatment of Continuous Ambulatory Peritoneal Dialysis (CAPD) Related Infections
Authors: Nikolaidis Paul
Published: February 2020

Newer fluoroquinolones such as ciprofloxacin, pefloxacin, ofloxacin, enoxacin, and fleroxacin are potent antimicrobial agents against many gram-negative bacteria, including Pseudomonas aeruginosa species and staphylococci-sensitive or resistant to methicillin. They are almost completely absorbed when given orally, reaching therapeutic plasma and dialysate concentrations, and their long half lives permit infrequent dosing intervals.

Clinical studies on fluoroquinolones efficacy in continuous ambulatory peritoneal dialysis (CAPD) infections, although not extensive, demonstrate good results. They are well tolerated and the adverse reactions, consisting mainly of gastrointestinal disturbance, were uncommon, mild, and reversible. The fluoroquinolones offer a promising alternative to standard parenteral treatments in CAPD patients, while their good oral bioavailability makes them attractive and convenient for both patients and hospital staff. However, they must be used with caution until we have more information and gain further experience.
Peritoneal Dialysis Glossary III
Authors: Twardowski Zbylut J.
Published: February 2020

Peritoneal dialysis regimens, flow techniques, and prescriptions are presented as drawings depicting intraperitoneal fluid volumes versus time. The following terms are illustrated: (1) continuous, intermittent, and tidal flow techniques; (2) standard intermittent and continuous regimens; (3) alternate prescriptions of continuous ambulatory and continuous cyclic peritoneal dialysis; and (4) intermittent and tidal nightly peritoneal dialysis.
Campylobacter Jejuni Peritonitis During Chronic Ambulatory Peritoneal Dialysis (CAPD)
Authors: Van den Enden Edwin J. , Cabuy Andries , Daelemans Ronald , Verhaegen Jan , Lins Robert L.
Published: February 2020

A patient treated with chronic ambulatory peritoneal dialysis developed recurrent peritonitis. During a fourth episode, Campylobacter jejuni was cultured from the dialysate. She responded well to streptokinase and imipenem.