bluuebunny/crossref_metadata_2025 huggingface dataset:
Problems in Comparisons of Clearances Prescriptions in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
Authors: Nolph Karl D. , Keshaviah Prakash , Popovich Robert
Published: February 2020

There is currently great interest in defining acceptable doses of dialysis therapy with different techniques. In hemodialysis (HD) and in continuous ambulatory peritoneal dialysis (CAPD), doses of weekly clearances of urea and/or creatinine required for achieving acceptable nutrition and quality of life need better definition (1–2). If control of the peak blood urea nitrogen concentration (BUN) is important in preventing uremic toxicity (the peak concentration hypothesis), then any intermittent therapy requires a greater dose of therapy to maintain the peak concentration below or at the steady state value of CAPD (assuming the same urea nitrogen generation rate and, hence, the same weekly net removal [mass transfer] of urea nitrogen) (2). The peak concentration hypothesis remains unproven, but it is certainly compatible with the apparent need for higher weekly clearances with intermittent therapies. Accordingly, it may be appropriate to increase the weekly KTN urea for intermittent PD therapies, such as nightly peritoneal dialysis, as compared to CAPD. For chronic hemodialysis, most centers strive for a weekly KTN urea value at or above 3.0 (2), whereas in CAPD the typical regimen yields a weekly KTN urea between 1.5 and 1.8.

There was great interest in kinetic modeling of CAPD clearance prescriptions at the 10th Annual Conference on Peritoneal Dialysis in Dallas, Texas, in February of 1990 (1, 3–6). The focus was on defining adequate peritoneal dialysis and optimizing nutrition.

The purpose of this editorial is not to review the pros and cons of modeling dialysis therapy to achieve defined doses of small solute clearances nor to support or refute the peak concentration hypothesis.
Effects of Chondroitin Sulphate on Fluid and Solute Transport during Peritoneal Dialysis in Rats
Authors: Breborowicz Andrzej , Radkowski Maciej , Knapowski Jan , Oreopoulos Dimitrios G.
Published: February 2020

The effect of chondroitin sulphate (CS) on peritoneal fluid and solute transport was studied in rats undergoing peritoneal dialysis. In the presence of CS, net ultrafiltration increased, while absorption of glucose and horseradish peroxidase from the peritoneal cavity decreased. Albumin, used instead of CS, did not modify either fluid or solute transport.

In in vitro experiments on isolated rabbit mesentery, CS decreased transmembrane water flow induced by hydrostatic pressure, and its effect was not fully reversed 60 minutes after “wash-out” of this glycosaminoglycan.

We postulate that the polyanionic CS molecules are trapped in the peritoneal interstitium, thus decreasing its hydraulic conductivity and permeability, which in turn increases net fluid removal during peritoneal dialy sis because of its slower absorption from the peritoneal cavity.
Erythropoietin in Continuous Ambulatory Peritoneal Dialysis: Experience with Subcutaneous Administration
Authors: Eisele George , Bailie George R. , Clement Candace , Wong Edmund
Published: February 2020

Experience in the use of subcutaneous erythropoietin (EPO) in 32 continuous ambulatory peritoneal dialysis (CAPD) patients is presented. All patients were treated with oral iron supplements. The total and mean I SD durations of EPO treatment were 466 weeks and 14.6±10.1 weeks respectively. Twenty -two patients started treatment with normal or elevated iron stores; 10 had an initial iron saturation <20%. The initial hematocrit was 23.8±3.7%. Thirteen patients reached a steady -state hematocrit by the end of the study period, when the mean I SD hematocrit for all32 patients was 34.1±3.6%. All patients responded to EPO. The initial dose of EPO was 147.1 ± 53.8 U/kg/week. Maintenance dose was 72±36 U/kg/week.
Quality of Life Improvements in Capd Patients Treated with Subcutaneously Administered Erythropoietin for Anemia
Authors: Auer Juliet , Simon Gail , Stevens Judith , Griffiths Paul , Howarth Deborah , Anastassiades Efthyvoulos , Gokal Ram , Oliver Desmond
Published: February 2020

Twenty -two continuous ambulatory peritoneal dialysis (CAPD) patients, mean age 48 years, at 3 U.K. renal units were assessed with the Nottingham Health Profile (N HP) before and after treatment with recombinant human erythropoietin (r-HuEPO). Mean (SD) hemoglobin (Hb) at baseline was 7.5 (1.0) gIn/dl and 10.8 (1.5) gIn/dl at retest. There were significant improvements in energy (p<0.0001), social life (p<0.005), relationships at home (p<0.05) and leisure pursuits (p<0.05). Twelve patients, mean age 51 years, who had already completed more than 9 months on r-HuEPO treatment were reassessed to determine the changes sustained. Mean (SD) Hb at second retest was 12.8 (1.3) gm/dl. Improvement in energy continued to be significant, and emotional wellbeing showed further improvement. Problems with household tasks, which had not shown significant improvement at Test B, were now considerably reduced (p=0.016). The study showed far-reaching benefits similar to those reported in hemodialysis patients, in a population with a higher mean age and higher potential coexisting illness or disability than most reported hemodialysis studies.
Peritoneal Ultrafiltration after Chronic Exposure to Dialysis Fluid
Authors: Slater Nicholas D. , Cope Geoffrey H. , Raftery Andrew T.
Published: February 2020

Eleven rats were given twice-daily intraperitoneal injections of 20 mL of dialysis fluid containing 4.5% glucose for 6 weeks. The peritoneal ultrafiltration capacity of this group was compared with that of a control group of 10 rats that had received no injections by measuring the volume and glucose concentration of the dialysate remaining in the peritoneal cavity 2 hours after injection. Animals that had received injections of dialysis fluid showed significant loss of peritoneal ultrafiltration: volume of dialysate remaining in the control group was 31 (13–35) mL, and in the experimental group was 25 (11–45) mL, with p<0.02 (Mann-Whitney). This was associated with enhanced glucose absorption: glucose absorbed by the control group was 382 (312–706) mg, and 595 (435–738) mg in the experimental group (p<0.002, Mann-Whitney).
Chemical Peritonitis following the Intraperitoneal Administration of Vancomycin
Authors: Freiman Joel P. , Graham David J. , Reed Theresa Greene , McGoodwin1 Ermona B.
Published: February 2020

The Food and Drug Administration has received 51 reports of cases in the United States in which chemical peritonitis was associated with the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The clinical presentation of the cases ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). The temporal circumstances suggest that intraperitoneal vancomycin may be associated with chemical peritonitis. A positive rechallenge was reported in 9 cases. The underlying mechanism responsible for this adverse reaction has not yet been identified.

Several adverse reaction reports have been submitted to the Food and Drug Administration (FDA) concerning the development of chemical peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients following the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The reactions reported ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). Although the majority of reactions were self-limited, some resulted in hospitalization and/or a prolongation of antibiotic therapy. Based upon these reaction reports, the FDA issued a Safety Alert Letter in May 1990 to all known dialysis centers in the United States (1). The purpose of this article is to provide additional clinical and laboratory data on the cases cited in the Safety Alert Letter.
Dialysis Efficiency in Continuous Ambulatory Peritoneal Dialysis Patients Treated with Erythropoietin
Authors: Taylor Joanne E. , MacTier R.A. , Henderson I.S. , Belch Jill J.F. , Stewart W.K.
Published: February 2020

Objective

To determine the effect of subcutaneous erythropoietin treatment on dialysis efficiency in continuous ambulatory peritoneal dialysis (CAPD) patients. .Design: Dialysis efficiency, platelet and white cell aggregation, and red cell deformability were measured monthly for six months in nine anaemic CAPD patients treated with erythropoietin, and on a single occasion in seven control CAPD patients with intrinsically high haemoglobin concentrations.

Setting

Renal dialysis unit.

Patients

Nine patients stable on CAPD for a minimum of six months and with haemoglobin concentrations less than 8.5 g/dl were treated with erythropoietin. Seven CAPD patients matched for age and renal function, with haemoglobins greater than 9.0 g/dl served as controls.

Results

Daily peritoneal clearances and net ultrafiltration volumes were unchanged when haematocrit increased from 25.0:1: 2.2% to 36.5:1: 3.5%. Spontaneous whole blood platelet aggregation was significantly increased from week twelve (pre-treatment aggregation 46:I: 23%; 12 weeks: 67:1: 19%, p<0.05; 16 weeks: 64:1: 19%, p<0.01; 20 weeks: 71:1: 16%, p<0.01; 24 weeks: 73:1: 10%, p<0.01).

Conclusions

The increase in haematocrit and platelet aggregation associated with erythropoietin treatment did not affect peritoneal clearances or ultrafiltration capacity.
Bicarbonate versus Lactate-Based Capd Fluids: A Biocompatibility Study in Rabbits
Authors: Schambye Hans T. , Flesner Per , Pedersen Regitze B. , Hardt-Madsen Michael , Chemnitz John , Christensen Hanne K. , Detmer Ann , Pedersen Fritz B.
Published: February 2020

Previous in vitrobiocompatibility studies have shown bicarbonate-based continuous ambulatory peritoneal dialysis (CAPD) fluids to be superior to those based upon lactate/acetate. To evaluate these findings in vivo, 41 rabbits were subjected to CAPD for four weeks in a randomized prospective study using either Dianeal, a commercially available dialysis fluid containing lactate, or 87b, a bicarbonate-based CAPD fluid. Ten rabbits with CAPD catheters, which were flushed with a heparin solution every 36 hours, served as controls.

None of the control rabbits showed clinical or histopathological signs of peritonitis, while 8 of 20 in the Dianeal group and 6 of 21 in the 87b group contracted peritonitis. Four rabbits in the Dianeal group had to be sacrificed early due to severe peritonitis. Post mortem examinations, including scanning and light microscopy, did not reveal any macroscopic or microscopic differences among the three groups of noninfected animals. No significant distinctions between the groups could be made for body temperature, weight gain, dialysate volume, dialysate differential leukocyte count, dialysate protein content, and food intake during the course of the study.

In conclusion, the present animal model did not reveal any major difference in the biocompatibility between the lactate and the bicarbonate-based CAPD fluids.
Intraperitoneal Administration of Recombinant Human Erythropoietin
Authors: Frenken Leon A.M. , Struijk Dirk G. , Coppens Peter J.W. , Tiggeler Roland G.W.L. , Krediet Raymond T. , Koene Robert A.P.
Published: February 2020

Objective

To determine the efficacy and safety of intraperitoneal administration of recombinant human erythropoietin (rHuEPO) in continuous ambulatory peritoneal dialysis (CAPD) patients compared to subcutaneous rHuEPO.

Design

Prospective analysis of an open, nonrandomized investigation.

Setting

Outpatient CAPD clinics in two university hospitals.

Patients

Nine adult CAPD patients receiving rHuEPO intraperitoneally and 8 patients receiving rHuEPO sub-cutaneously.

Intervention

One hundred units of rHuEPO per kilogram of body weight were administered three times a week for 8 weeks or until the target hematocrit of 35% was reached. Thereafter, dosages of rHuEPO were adjusted for response. Intraperitoneal rHuEPO was administered in 1 L of dialysis solution during the night.

Measurements

Efficacy was assessed by measuring the increase in hemoglobin. Tolerance was assessed by monitoring side effects.

Results

In the first 8 weeks of treatment hemoglobin concentration increased from 64.5±12.9 glL to 98.3±16.1 g/L (p<0.0005) in the intra peritoneally treated group. In the subcutaneously treated group hemoglobin increased significantlyfaster (p<0.05) from 72.5±4.8 g/L to 119.2±11.3 g/L (p<0.0005) in the same period. Antihypertensive medication had to be increased or instituted in most of the patients in both groups. The incidence of peritonitis in the intraperitoneally treated group was not increased when compared to the pretreatment incidence.

Conclusions

Subcutaneously administered rHuEPO is superior to intraperitoneally administered rHuEPO with regard to the required dosages. However, the results of this study show that intraperitoneal administration of rHuEPO might be a convenient and safe alternative when subcutaneous administration is undesirable.
A Retrospective Assessment of Risk Factors for Peritonitis among An Urban Capd Population
Authors: Korbet Stephen M. , Vonesh Edward F. , Firanek Catherine A.
Published: February 2020

Peritonitis is a major reason why patients transfer from peritoneal dialysis (PD) to hemodialysis. We evaluated the peritonitis infection rates In 146 peritoneal dialysis patients who underwent dialysis at our facility between 1 January 1981 and 31 December 1989. Peritonit Is was the primary cause for changing treatment, with 24 (16.4%) of the patients transferring because of this complication. This represented 54.5% of all patients discontinuing CAPD due to method failure. A gamma-Poisson regression analysis was performed in an attempt to Identify potential risk factors associated with an increased Incidence of peritonitis. The results indicated that race, education level, and PD system used were significantly associated with the rate at which peritonitis occurred in our patient population. There was an almost twofold increase in the rate of peritonitis among blacks as compared to whites (2.2 vs 1.2 episodes/patient year). The level of education completed at the start of dialysis had a negative correlation with peritonitis rates. Patients with ≤8, 9–12, and ≥13 years of education had peritonitis rates of 2.4, 1.8, and 1.2 episodes/patient year, respectively. Finally, the system used had a significant effect with our patients on CCPD having lower peritonitis rates as compared to patients on either a connect or disconnect system (0.6 vs 2.5 vs 1.8 episodes/patient year, respectively). Recognizing potential risk factors for peritonitis will help us better understand and address this significant problem in our PD programs. Reducing peritonitis rates should facilitate a decrease in patient transfer due to method failure.
Initial Hypoalbuminemia and Hyperlipidemia Persist during Chronic Peritoneal Dialysis in Children
Authors: Scolnik Dennis , Balfe J. Williamson
Published: February 2020

Objective

To document serum lipid values in pediatric peritoneal dialysis (PD) patients, particularly the very young, and investigate relationships with serum albumin levels.

Design

Retrospective review of all PD patients seen in the first 11 years of the PD program at our institution.

Patients and Methods

Any pediatric PD patient was eligible for inclusion if at least four simultaneous measurements of serum lipids and albumin were recorded over a minimum of 90 days of PD.

Results

Thirty-nine continuous ambulatory peritoneal dialysis (CAPD) patients (9, aged <5 years) and 14 continuous cycling peritoneal dialysis (CCPD) patients (7, aged <5 years) were followed for 90–1200 days. Hypoalbuminemia, present In 43% of initial recordings, did not alter significantly during PD in any group; it was most marked in the CAPD <5 year (mean 30.7 g/L) and CCPD >5 year groups (mean 31.4 g/L). Average serum cholesterol levels were 27% higher, and triglyceride 122% higher, than the maximum accepted 18-year-old level and did not change significantly during PD. Similarly, 33% of high-density lipid recordings were below normal and remained unaltered during PD.

Conclusions

Our results confirm the high incidence of hypoalbuminemia, hypertriglyceridemia, and hypercholesterolemia and associated low levels of high density lipids, even in young PD patients, and demonstrate that these remain unchanged during PD. Such results have not previously been reported in PD patients as young as ours. Abnormal lipid profiles are a neglected cardiovascular risk factor in children with renal failure; therapeutic interventions should therefore be seriously considered.
Capd Therapy for Patients over 80 Years of Age
Authors: Gorban-Brennan Nancy , Kliger Alan S. , Finkelstein Fredric O.
Published: February 2020

Objective

The purpose of the study is to review our experience with patients over 80 years of age with end stage renal disease (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

The records of all patients over 80 years of age treated in our unit with CAPD since 1979 were reviewed.

Setting

Outpatient CAPD facility.

Patients

Eighteen patients over 80 years of age were identified and studied.

Main Outcome Measures

The duration of CAPD therapy, duration of CAPD training, mortality rate, hospitalization rate, peritonitis rate, and family assessment were reviewed and analyzed.

Results

The mean ± SD duration of therapy was 20±17 months. Nine patients expired, 3 transferred to hemodialysis, 1 recovered renal function, and 5 remained on CAPD therapy. Peritonitis rates were 1.7 episodes/patient year. Of the organisms causing peritonitis, 56% were gram-positive bacteria. The average hospitalization rate was 13.9 days/patient year. The most frequent causes of hospitalization were peritonitis and cardiovascular disease.

Conclusion

CAPD therapy is a reasonable therapeutic option for patients with end-stage renal disease over 80 years of age.
Assessment of Dialysis Dose by Measured Clearance versus Extrapolated Data
Authors: Burkart John M. , Jordan Jean R. , Rocco Michael V.
Published: February 2020

Objective

To determine whether estimates of daily dialysis clearance of creatinine and urea, based on data from the 4-hour peritoneal equilibration test, correlate well with daily dialysis clearance measured by 24-hour dialysate collection in chronic ambulatory peritoneal dialysis patients.

Design

Prospective study in which each subject collected all dialysate from a 24-hour period and then immediately thereafter underwent a standard peritoneal equilibration test (PET). Daily clearances of creatinine and urea were calculated from 24-hour dialysate collections by standard methods and then were compared with several estimates of 24-hour clearance based on PET data.

Setting

Single peritoneal dialysis unit of a university teaching hospital.

Patients

Thirty-six stable patients on continuous ambulatory peritoneal dialysis (CAPD).

Main Outcome

The estimated values for daily dialysis clearance both overestimated and underestimated the measured 24-hour clearance. The correlation coefficient between the extrapolations and the actual 24-hour clearances ranged from 0.63–0.68. The range of discordance for daily creatinine clearance was from -2530 mL/dayto +2199 mL/day. For daily urea clearance, the range of discordance was from -21 03 mL/ day to +1940 mL/day. The peritoneal membrane transport characteristics of the individual patient did not predict whether the extrapolation overestimated orunder estimated the measured daily clearance.

Conclusion

Extrapolation of PET data is not a reliable method to estimate the dose of dialysis delivered to the patient. A 24-hour collection of dialysis is necessary for this determination.
In Vitro Study of the Mechanism of Potassium Transport into Human Mesothelial Cells. I: Effect of Hyperosmolality
Authors: Breborowicz Andrzej , Witowski Janusz , Knapowski Jan , Serkes Kenneth D. , Martis Leo , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To study the mechanism(s) of potassium transport into human mesothelial cells (HMC) exposed to osmotic solutes.

Design

Using potassium analog 86Rb, we evaluated its intracellular transport through three pathways: 1. blocked by ouabain; 2. blocked by furosemide but not by ouabain; 3. blocked by neither furosemide nor ouabain. Experiments were performed in a normotonic medium (control) or in a medium supplemented with osmotic solutes (glucose, glycerol, mannitol). Both the acute and chronic effects of osmotic solutes on potassium transport were studied.

Results

The acute exposure of mesothelial cells to osmotic solutes modifies the intracellular transport of potassium through all studied channels, and the effect is specific for every solute. In mesothelial cells exposed over 7 days to glucose (90 mM), the intracellular transport via ouabain and furosemide-blocked channels is decreased, whereas it is increased through the third pathway. Total intracellular accumulation of 86Rb (potassium) ions in mesothelial cells cultured in a medium supplemented with various concentrations of glucose is decreased, and this effect is proportional to the concentration of glucose in the medium.

Conclusions

The intracellular transport of potassium in mesothelial cells is regulated through at least three independent mechanisms. Acute or chronic exposure of mesothelial cells to a hypertonic medium affects the intracellular accumulation of potassium, an d this effect is specific for the various osmotic solutes.
The Serum Complement System in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Reddingius Roel E. , Schröder Cornelis H. , Daha Mohamed R. , Monnens Leo A.H.
Published: February 2020

Objective

During continuous ambulatory peritoneal dialysis (CAPD), the loss of complement factors via the dialysate may cause complement deficiencies. This hypothesis was tested in a group of children treated with CAPD.

Design

Classical (CH50) and alternative (AP50) complement activity and serum levels of factors C1 q, C3, C4, C3d, B, D, and P in CAPD patients were compared to normal controls and to children with preterminal renal failure.

Setting

Patients were seen in a university hospital; normal controls were seen in an outpatient clinic of a general hospital.

Patients

A group of 22 children on CAPD was compared to a normal control group of 44 children and to a group of 12 children with preterminal renal failure with a creatinine clearance below 25 mL/min/1.73 m2.

Results

CH50, AP50, C3, and B were not significantly different from the control group in both the CAPD and preterminal groups. Factors C1q (p=0.01) and C4, C3d, D, and P (p<0.001) were higher in the CAPD group in comparison to the normal control group. The factors D (p<0.001) and P (p=0.02) were also elevated in the preterminal group. For the measured factors there was no significant difference between the CAPD group and the preterminal group.

Conclusions

There is no deficiency of complement in children treated with CAPD. High levels of C3d and D can be explained by the reduction of their elimination by the kidney. The increased levels of the other factors are presumably due to increased synthesis in renal failure. This does not seem to be caused by CAPD.
Influence of Mothers on School Adjustment of Continuous Ambulatory Peritoneal Dialysis Children
Authors: Fukunishi Isao , Honda Masataka , Kamiyama Yasunori , Ito Hiroshi
Published: February 2020

In school children on continuous ambulatory peritoneal dialysis (CAPD), school adjustment is regarded as an important indicator for comprehensive medical care. The aim of the present study was to examine the influence of mothers on school adjustment of CAPD children. The children tended to indicate school maladjustment with school absenteeism and poor relationships with friends. The mothers were characterized by poor independence, poor achievement orientation, strong emotional reliance, and lack of social self-confidence, indicating emotional instability. The family environment, including the mother's psychological condition, was strongly associated with the children's maladjustment to school. The results suggested the necessity of comprehensive medical care for these children and their mothers.
Serositis: Comparative Analysis of Histological Findings and Pathogenetic Mechanisms in Nonbacterial Serosal Inflammation
Authors: Dobbie James W.
Published: February 2020

Peritonitis is the established term for infective inflammation of the peritoneum, while serositis generally refers to nonorganismal inflammation in any serous cavity, including the peritoneum. In continuous ambulatory peritoneal dialysis (CAPD) literature, however, culture-negative peritoneal inflammation is referred to as “sterile” or “chemical” peritonitis. These terms not only imply unwarranted etiologic assumptions, but may also deflect attention from the existence of medical conditions to which the peritoneum is subject. This is evident in CAPD literature where there is little recognition that the peritoneum, as a member of the serosa and a secretor of lamellar bodies, is prey to a wide range of disorders. Thus before, during, and after CAPD, the membrane is liable to fall victim to disease states unconnected with the process of dialysis. Significant peritoneal pathology occurs as part of a pan-serositis, which may be metabolic (uremia, cholesterolosis), autoimmune (systemic lupus erythematosus, rheumatoid disease, acute rheumatism, endocrinopathies), genetic (recurrent hereditary polyserositis), allergic (eosinophilic serositis), and granulomatous in nature. This paper presents a comparative analysis of histopathological presentation and pathogenetic mechanisms involved in all forms of peritoneal serositis. It incorporates recent advances in molecular biology of the membrane into a holistic reappraisal of peritoneal pathology, revealing hitherto unrecognized homologies in peritoneal reaction to diverse disorders.
Quantitation of Lymphatic Drainage of the Peritoneal Cavity in Sheep: Comparison of Direct Cannulation Techniques with Indirect Methods to Estimate L Ymph Flow
Authors: Tran Lisa , Rodela Helen , Hay John B. , Oreopoulos Dimitrios , Johnston Miles G.
Published: February 2020

Objective

It has been suggested that lymphatics may contribute to ultrafiltration failure in patients on continuous ambulatory peritoneal dialysis (CAPD) byabsorbing dialysate and ultrafiltrate from the peritoneal cavity. In most studies lymphatic drainage has been estimated from the disappearance of an instilled tracer from the peritoneal cavity or estimated from the appearance of an intraperitoneally administered tracer in the bloodstream. However, in sheep it is possible to cannulate several of the relevant lymphatics that drain the peritoneal cavity and assess lymph drainage parameters directly. The purpose of this study was to estimate lymph drainage from the peritoneal cavity in sheep using the disappearance of tracer from the cavity and the appearance of intraperitoneally instilled tracer in the bloodstream and to compare these results with those obtained from our previous studies using cannulation techniques.

Design

Experiments were performed in anesthetized and nonanesthetized animals. Volumes of 50 mL/kg of Dianeal 4.25% containing 25 μCi of 1251-albumin were infused into the peritoneal cavity.

Results

In anesthetized sheep the calculated peritoneal lymph drainage from monitoring the disappearance of tracer from the peritoneal cavity over 6 hours was 1.873±0.364 mL/kg/hour. Monitoring the appearance of tracer in the blood gave significantly lower peritoneal lymph flow rates of 1.094±0.241 mL/kg/hour. Directly measured lymph flow rates from our earlier publication were lower still and ranged from 0.156±0.028 -0.265±0.049 mL/hour/kg, depending on how we estimated the right lymph duct contribution to peritoneal drainage, since we could not cannulate this vessel. We repeated these experiments in conscious sheep. The value for lymph flow estimated from the disappearance of tracer from the peritoneal cavity was 2.398±0.617 mL/hour/kg and from the appearance of tracer in the blood, 1.424±0.113 mL/ hour/kg. The1ymph flow rates monitored from indwelling lymphatic catheters ranged from 1.021 ±0.186 -1.523±0.213 mL/hour/kg (again, depending on our estimates for the right lymph duct).

Conclusions

Lymph flow rates measured from indwelling lymphatic catheters provided the most conservative values for lymphatic drainage of the peritoneal cavity under dialysis conditions. Estimates of lymphatic drainage based on the appearance of tracer in the blood gave values that were on average higher. The method using the disappearance of tracer from the cavity to estimate lymph flows overestimated peritoneal lymph drainage. Fluid was lost from the peritoneal cavity, and the estimated proportion of liquid lost through lymphatic drainage depended on the technique used to measure lymph flow rates.
Enhanced Ultrafiltration in Rabbits with Bicarbonate Glycylglycine Peritoneal Dialysis Solution
Authors: Yatzidis Hippocrates
Published: February 2020

Objective

The aim of the study was to investigate net ultrafiltration (NUF) with a new bicarbonate glycylglycine (BiGG) peritoneal dialysis solution compared to the standard lactate (La) solution.

Design

In six groups of 12 normal rabbits each we measured NUF after a 2-,4-, and 6–hour peritoneal dialysis with a BiGG solution (pH 7.35) and a standard La solution (pH 5.5) of similar glucose, electrolyte, and osmolality formulation. Furthermore, we studied the phosphatidylcholine concentration in the effluent of the two solutions.

Results

NUF volume was significantly greater with the BiGG rather than with the La solution by approximately 15% (p<0.05), 30% (p<0.01), and 40% (p<0.005) at 2,4, and 6 hours, respectively. The glucose absorption rate was greater with the La solution than with the BiGG solution, but the difference was significant only at 2 hours (p<0.05). pH was increased in the La solution from its initial value of 5.5 to 7.18,7.32, and 7.40 at 2,4 and 6 hours, respectively, while it remained almost unchanged in the BiGG solution. Phosphatidylcholine (PC) in the peritoneal effluent was significantly higher in the BiGG solution in all instances (p<0.0001).

Conclusion

It is concluded that the BiGG solution, which has a stable pH, 7.35, due to the potent buffering capacity of bicarbonate and glycylglycine, enhances peritoneal NUF by maintaining a higher osmotic gradient and retarding lymphatic absorption through an increase in PC concentration in the peritoneal cavity.
Continuous Ambulatory Peritoneal Dialysis Connection Systems
Authors: Buoncristiani Umberto
Published: February 2020

The history of the various connection systems proposed and tried during the first 15 years of clinlcal application of continuous ambulatory peritoneal dialysis (CAPD) is reviewed.

In order to understand the reasons for their success or lack of success, the main technical and operating characteristics regarding their efficacy In preventing peritonitis are examined in detail, together with a range of other pros and cons (I.e., reliability, simplicity, ease of use, cost, aesthetlcal aspects).

The result Is an updated state-of-the-art review In the field of CAPD connectology, with a look at future trends.
An Indirect Estimation of Effective Peritoneal Capillary Blood Flow in Peritoneally Dialyzed Uremic Patients
Authors: Grzegorzewska Alicja E. , Antoniewicz Krystyna
Published: February 2020

The aim of this study was to evaluate the effective peritoneal capillary blood flow (EPBF) during intermittent peritoneal dialysis in uremic patients through the calculation of the diffusive mass transfer coefficient (KBD) of carbon dioxide gas. Examinations were performed during dialysis with the use of dialysis solution No. 1 (Polfa, Poland) with pH 6.30 (n=10) or pH 7.25 (n=10). The KBD of carbon dioxide was calculated at 2.5 minutes’ dwell time. EPBF was estimated at the beginning (exchanges 3–5), in the middle (exchanges 9–11), and at the end (exchanges 15 -17) of dialysis. KBD values of carbon dioxide, obtained during the above exchanges, yield EPBF of, respectively, 2.56;1:0.31, 2.63;1:0.25, and 2.59±0.44 mL/min/kg body weight for the pH 6.30 solution, and 1.84±0.25, 2.38;1:0.27, and 2.21;1:0.29 mL/min/kg body weight for the pH 7.25 solution. Our results yield EPBF greater than previously estimated and confirm suggestions that EPBF in humans exceeds 100 mL/min.
Prevalence of Symptomatic Arterial Disease and Risk Factors for its Development in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Webb Alan T. , Brown Edwina A.
Published: February 2020

The prevalence of coronary, cerebral, and peripheral arterial disease was assessed using a standard cardiovascular questionnaire in a cohort of 70 patients on continuous ambulatory peritoneal dialysis (CAPD).

Symptomatic vascular disease was found in 47% of patients, 72% of whom were smokers and 30% diabetic. In 39% of these patients vascular disease was evident prior to the commencement of peritoneal dialysis. A case control study matching for age and sex revealed patients with vascular disease to have higher median systolic blood pressure (162 mmHg vs 150 mmHg, p=0.026), cholesterol (6.60 mmol/L vs 6.00 mmol/L, p=0.014), and LDL cholesterol (4.80 mmol/L vs 3.80 mmol/L, p=0.009).

Vascular disease is common in patients on peritoneal dialysis, a considerable proportion of whom have the disease prior to the commencement of dialysis. Elevated systolic blood pressure and hypercholesterolemia, but not smoking, are most closely associated with vascular disease in these patients.
Does Continuous Ambulatory Peritoneal Dialysis Induce Hypercholesterolemia?
Authors: Panarello Giacomo , Calianno Giuseppina , De Baz Hamurabi , Signori Daniela , Cappelletti Piero , Tesio Franco
Published: February 2020

Hypercholesterolemia has been recognized as a significant risk factor for atherosclerosis and coronary artery disease. The aim of this study was to evaluate the prevalence of hypercholesterolemia and the role, if any, of type of dialysis.

In 19 hemodialysis (HD) and 20 continuous ambulatory peritoneal dialysis (CAPD) subjects, body weight, body mass index (BMI), arm muscle area (AMA), total choles terol (C), HDL and LDL fractions, triglycerldes, C/HDL ratio, glycosilated hemoglobin, and apolipoproteins AI, All, B, CII, CllI, and E were evaluated. Hypercholesterolemia was defined as cholesterol greater than 220 mg/dL and LDL greater than 150 mg/dL.

Body weight, body mass index, and arm muscle area were higher (p<0.05) in CAPD as compared with HD; so were total cholesterol, LDL, C/HDL ratio, and glycosllated hemoglobin (Hbalc). Hypercholesterolemia prevalence was 3/19 in HD and 11/20 in CAPD (p<0.05). A relationship between Hbalc and C/HDL ratio was found in the CAPD group (r=0.48; p<0.05).

We are greatly concerned about these metabolic effects of CAPD; therefore, we should carefully select patients to be treated by CAPD. Aggressive nutritional and pharmacological treatment for glucose Intolerance and hypercholesterolemia In CAPD patients must be performed in order to reduce the incidence of coronary artery disease (CAD).
Ca2+ Concentration in the Peritoneal Dialysis Solution Regulates Peritoneal Fibroblast Proliferation and Peritoneal Macrophage and Lymphocyte Cytokine Release
Authors: Carozzi Silvia , Nasini Maria Grazia
Published: February 2020

Peritoneal fibrosis remains one of the major causes of dropout In continuous ambulatory peritoneal dialysis (CAPD), because it reduces ultrafiltration capacity.

Since studies In vitro have demonstrated that cytoplasmic Ca2+ regulates the proliferation of most cell lines and the release of cytokines from immune cells, we evaluated In 8 uremic patients at the start of CAPD and in 4 control patients the effects in vitro of different peritoneal dialysis solution Ca concentrations (1, 1.25, 1.75, and 2 mmol/L) on peritoneal fibroblast (PF) proliferation, peritoneal macrophages (PMΦ), and peritoneal lymphocyte (Ply) release of interleukin-1 (11–1) and Interferon-gamma (IFN-gamma) (cytokines which are known to induce PF proliferation), and cytoplasmic Ca2+ concentration in PF, PMΦ, and Ply.

Results showed that in both the uremic and control patients, increasing the dose of Ca2+ In the medium induced a dose-dependent increase in PF proliferation and the release of IL-1 and IFN-gamma from PMΦ and Ply. Meanwhile, the cytoplasmic parameters PF, PMΦ, and Ply Ca2+ in the uremic patients were below normal; they exceeded the norm with a Ca2+ concentration of 1.75 and 2 mmol/L and were normal with a Ca2+ concentration of 1.25 mmol/L.

These data suggest that In CAPD patients the use of a physiological Ca peritoneal dialysis solution (1 and 1.25 mmol/L) may be useful in reducing the proliferation of PF and the production of IL-1 and IFN-gamma thus preventing peritoneal sclerosis.
Effect of Hypertriglyceridemia Correction by Omega-3 Fatty Acids on Peritoneal Transport in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Fracasso Agostino , Toffoletto Pierpaolo , Landini Silvano , Morachiello Paolo , Righetto Flavio , Scanferla Flavio , Genchi Rosangela , Roncali Oavide , Bazzato Giorgio
Published: February 2020

Lipid abnormalities, both hypercholesterolemia and particularly hypertriglyceridemia (hyperTg), are common in long-term continuous ambulatory peritoneal dialysis (CAPO) patients. Hyperviscosity and rheological alterations have been proposed as major hemodynamic problems in hyperTg patients.

The aim of this study was to evaluate whether a hyperTg correction by employing omega-3 fatty acids (ω-3) affects peritoneal transport.

Six hyperTg (>700 mg/dL) CAPO patients were treated with 2–3 g/day of ω-3 until normal Tg values were achieved. The assessment of peritoneal dialysis efficacy was performed by evaluating the peritoneal equilibration test (PET) before ω-3 supplementation, when normal Tg levels were reached, and 3 weeks after stopping therapy when hyperTg returned.

When normal Tg levels were reached, a small but significant Improvement of urea and creatinine O/P was noted: 0.85±0.05 versus 0.93±0.03 (p<0.05) and 0.78±0.03 versus 0.86±0.05 (p<0.05), respectively, with negative correlation between O/P of urea and Tg.

These preliminary data demonstrate that a hyperTg correction with ω-3 may Induce an Increase In peritoneal transport of small molecules in CAPO.
Procollagen Type-I in the Serum and Dialysate of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Digenis George E. , Dombros Nicholas v. , Christophoraki Mary , Grapsa Irene , Savidis Nicholas , Datseris John , Samuilidou Elisa , Zerefos Nicholas , Tourkaritonis Achilleas
Published: February 2020

Procollagen-1 carboxylterminal extension peptide (PICP) was determined In the serum and dialysate of 26 continuous ambulatory peritoneal dialysis (CAPD) patients and in the serum of 11 healthy controls. PICP serum levels were significantly higher in CAPD patients than in healthy controls (p<0.001). There was no correlation between serum PICP levels and those of calcium, phosphorus, magnesium, alkaline phosphatase, osteocalcin, and intact parathyroid hormone (IPTH). Serum and dialysate levels of osteocalcin and lPTH showed a significant correlation (p<0.001). The dialysate-to-serum PICP ratio in 21 patients was lower than 1.0. In the remaining 5 patients, however, the above ratio was higher than 1.0.

We conclude that In CAPD patients serum PICP levels do not correlate with biochemical parameters of renal osteodystrophy. A dialysate-to-serum PICP ratio above 1.0 could implicate an increased local peritoneal fibro blastic activity and could be a useful marker of peritoneal fibrosis In CAPD.
An Animal Model for the Study of Amino Acid Metabolism in Uremia and during Peritoneal Dialysis
Authors: Oreopoulos Antigone K. , Balaskas Elias V. , Rodela Helen , Anderson G. Harvey , Oreopoulos Dimitrios G.
Published: February 2020

We tried to determine the suitability of the rabbit as an animal model to study amino acid (AA) metabolism in continuous ambulatory peritoneal dialysis. We also measured the effect of intraperitoneal (ip) infusion of AA on blood AA changes and food consumption.

Plasma AA levels were measured in 10 normal rabbits after an overnight fasting and 30, 60, and 120 minutes after a meal. Following these baseline observations, rabbits were randomly divided into two groups. One group of five rabbits was made uremic after surgical partial nephrectomy, whereas the remaining (controls) underwent sham operations. Two weeks after the induction of uremia we measured the effect of chronic renal failure on fasting and postprandial (30,60,120 minutes) plasma AA levels. Upon the completion of the second experiment (4 weeks after the induction of uremia) we studied the effect of an ip AA on plasma AA profile 1, 2, 4, and 6 hours after the infusion in both uremic and control rabbits. We also measured the food intake in all experiments.

The results of our experiments showed the following: 1. plasma AA in the rabbits decreased after induction of chronic renal failure and increased after food ingestion and ip infusion of AA solution; 2. neither induction of uremia nor ip AA infusion have an effect on food consumption; 3. the majority of the alterations in plasma AA levels we observed in the uremic rabbits were similar to those observed in humans, indicating that the rabbit may be a suitable model for the study of AA metabolism in chronic renal failure and during peritoneal dialysis.
Longitudinal Assessment of Body Composition in Continuous Ambulatory Peritoneal Dialysis Patients using Bioelectric Impedance and Anthropometric Measurements
Authors: Bergia Roberto , Bellini Maria Eletta , Valenti Michelangelo , Berto Ilario Mauro , Caramello Elisa , Dionisio Piero , Pellerey Marina , Bajardi Pietro
Published: February 2020

We assessed the utility of bioelectric impedance analysis (BIA) and anthropometry for longitudinal evaluation of body composition In continuous ambulatory peritoneal dialysis (CAPD) patients. Eleven subjects were studied at the beginning of CAPD and again at regular Intervals during the first 6 months of treatment. The significant weight gain that occurs In our patients Is mainly due to a rise in total body water (TaW), as measured by BIA, during the first weeks of CAPD, and later on due to a body fat increase. Anthropometry seems more reliable than BIA In the evaluation of body mass, because the latter Is derived from TBW in BIA. Therefore, any change In TBW that occurs in a CAPD patient necessarily causes a similar change in the fat-free mass. In our experience, only the combined use of both anthropometry and BIA allows a proper assessment of body composition In patients on CAPD.
The Initial Decrease in Effective Peritoneal Surface Area is Not Caused by an Increase in Hematocrit
Authors: Struijk Dirk G. , Krediet Raymond T. , Koomen Ger C.M. , Boeschoten Elisabeth W. , Hoek Franciscus J. , Arisz Lambeztus
Published: February 2020

The possible relationship between Initial changes In functional characteristics of the peritoneal membrane In time and hemoglobin (Hb) or hematocrit (Ht) was analyzed as part of a prospective longitudinal study. The patients were Investigated twice: the first time within 3 months after the start of continuous ambulatory peritoneal dialysis (CAPD), and again 4 months later. Mass transfer area coefficients (MTC) for low molecular weight solutes and net fluid removal were calculated during a 4-hour dwell, glucose 1.36%. Thirty-four patients were analyzed. MTC (mean±SD, mL/min/1.73 m2) were higher during the first examination: urea 22.6 versus 19.9, p<0.05; lactate 15.6 versus 13.8, p<0.001; creatinine 10.5 versus 9.3, p<0.05; glucose 9.4 versus 7.9, p<0.001. Net fluid removal was lower during the first examination: 28 versus 99 mL/mln/1.73 m2, p<0.05. Hb and Ht increased between the two examinations (Hb: 5.4 vs 6.1 mmol/L, p<0.001; Ht: 0.26 vs 0.29, p<0.001). No relation was found between the absolute or relative change In Hb or Ht and the absolute or relative change In solute and fluid transport between the same examinations. In conclusion, Hb and Ht Increased between the first and second examinations. The simultaneously observed changes in peritoneal transport kinetics could not be attributed to changes In Hb or Ht. Therefore, the changes In transport kinetics during the first months on CAPD are probably due to the recent start of the treatment, possibly by an Increase In peritoneal surface area. LocalIrritation by the dialysate may be the causative mechanism.
Phosphatidvlcholine and Intraperitoneal Adhesions
Authors: Kappas Angelos Michael , Fatouros Michael , Siamopoulos Kostas , Mylonakis Manolis , Cassioumis Diamantis
Published: February 2020

Phosphatidylcholine (PC), which has successfully been used in the past to increase ultrafiltration in continuous ambulatory peritoneal dialysis (CAPD) patients, has recently been found to prevent experimental adhesion formation after intraperitoneal irrigation with warm saline.

The aim of this study was to determine the most effective route(s) of PC administration in the aforementioned model. Eighty Wistar rats underwent laparotomy and intraperitoneal irrigation with saline at 40°C, which in 20 rats was followed by closure of the abdomen (control group, Gc). In another 20 rats PC was given per os before and after irrigation (per os PC group, GoPc). In the third group PC was diluted in the irrigation fluid (intraperitoneal PC group, GIPC), and in the last group PC was given per os and intraperitoneally (combined PC group, Gcpc)

Assessment of adhesions was performed 2 weeks after the irrigation. Adhesions were found in 12 rats in the Gc, 5 rats in the Gopc (p=0.05, Fisher's test), 17 rats in the GIPC, and 3 rats in the Gcpc (p=0.007, Fisher's test). The difference between Gopc and Gcpc was not statistically significant.

The decreased adhesion formation after PC administration combined with the increased ultrafiltration may be of considerable importance in CAPD patients.
Catheter Obstruction with Omental Wrap Stimulated by Dialysate Exposure
Authors: Moncrief Jack , Popovich Robert , Simmons Everett , He Zhengzhi
Published: February 2020

A new Implantation technique and catheter design (Moncrlef-Popovlch Catheter) were tested in the continuous ambulatory peritoneal dialysis (CAPO) dog model. With this technique the catheter distal (external) segment was Implanted in a subcutaneous tunnel for 4–6 weeks. Therefore, no irrigation of exposure to dialysate was present. Secondary exteriorization and irrigation (CAPO exchanges) demonstrated no episodes of primary catheter obstruction.

Fifteen mongrel female dogs had 30 catheters implanted; 2 catheters simultaneously in each dog. One catheter was implanted with the interabdominal segments in the pelvis and the second interabdominal segment directed upward In direct contact with the omentum. Following initial irrigation, all catheters were patent, but within 24–48 hours all upwardly directed catheters were obstructed. Nine of the 15 downwardly directed catheters became obstructed by omentum wrapping around the catheter within 5 days.

Preliminary studies have failed to demonstrate the cause of this “omental stimulation,” which occurs with peritoneal contact with fresh dialysate. Possible explanations include pH, osmolality, flow direction, volume, vasodilator effect of osmols or lactate, and glucose, among others.

This effect needs study, and this model would allow evaluation of improvements in the biocompatibility of dialysis fluids.