bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Malnutrition Assessed by Bioimpedance Analysis and Anthropometry in Children on Peritoneal Dialysis
Authors: Edefonti Alberto , Picca Marina , Damiani Beatrice , Garavaglia Rosanna , Loi Silvana , Ardissino Gianluigi , Marra Giuseppina , Ghio Luciana
Published: February 2020

Objective

To evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short- and long-term PD duration, using anthropometric and BIA-derived indices.

Patients

Eighteen children treated with automated PD (11 males, 7 females; mean age 8.7 ± 4.7 years).

Design

Eighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540–5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7 – 12 and 4 – 6 were calculated in order to detect patients with severe or moderate derangement of nutritional status.

Results

The mean SDS values of Xc, PA, and D significantly improved ( p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system.

Conclusion

BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD. The prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.
Intraperitoneal Ciprofloxacin and Rifampicin versus Cephradine as Initial Treatment of (C)Apd-Related Peritonitis: A Prospective Randomized Multicenter Comparison (Cipper Trial)
Authors:   for the CIPPER Trial Group, De Fijter Caroline W.H. , Ter Wee Piet M. , Oe Liem P. , Verbrugh Henri A.
Published: February 2020

Objective

The initial treatment of peritonitis has evolved from single-agent to combination regimens. The initial response rates improved with these newer regimens but relapsing peritonitis continues to occur. For biofilm-embedded or intracellularly sequestrated bacteria, a combination of intracellularly- and biofilm-active agents such as ciprofloxacin and rifampicin might be beneficial. Many Dutch centers continue to use cephradine as initial treatment, claiming clinically adequate responses with this regimen. We compared the impact of these two regimens on outcome in patients who developed a new episode of peritonitis.

Design

Prospective randomized open trial.

Setting

Multicenter study including 14 Dutch dialysis units.

Patients and Interventions

From October 1996 to October 1999, 367 patients from 14 centers were randomized to be treated with ciprofloxacin + rifampicin (CR; each 50 mg/L) or cephradine (C; 250 mg/L) in case of peritonitis. Of these 367 patients, 98 developed peritonitis, 44 of whom were treated with CR and 54 with C.

Main Outcome Measures

Clinical response, divided into early (during the 2 weeks of therapy) and late (including the following 4 weeks) response. Success was defined as disappearance of all signs and symptoms by days 4 - 6, through day 42. Bacteriological response was either success (eradication) or failure (persistence, superinfection, or eradication with relapse/reinfection).

Results

The groups were comparable for age, sex, duration of continuous ambulatory/automated peritoneal dialysis, and occurrence of diabetes. Bacteriological cultures in both groups revealed predominantly gram-positive micro-organisms. Initial and late clinical successes were obtained in 27/54 and 20/54 episodes (50% and 37%) in the C group, and 33/44 and 28/44 episodes (75% and 63.6%) in the CR group ( p = 0.021 and p = 0.019). Bacteriological success occurred in 29.6% in the C group, and in 59.1% in the CR group ( p = 0.026), with failure in 46.3% and 18.2%, respectively. Peritonitis episodes were bacteriologically not evaluable in 24.1% of episodes in the C group and 22.7% of episodes in the CR group, due mostly to no growth in the initial culture.

Conclusion

The CIPPER Trial showed ciprofloxacin + rifampicin to be superior to cephradine as empiric treatment of peritonitis.
Neuropsychological Studies of CAPD: Preliminary Findings
Authors: Kenny Frank T. , Oreopoulos Dimitrios G.
Published: February 2020

A neuropsychological study of CAPD was initiated to assess potential neurotoxic complications. Results are presented for the first year of treatment. A significant improvement in psychometric performance over this time indicated that there was a substantive decline in the relative degree of neurotoxic impairment among the patients as a group. Individually, 70% of patients found to be cognitively impaired before CAPD reach normal psychometric levels by the end of the first year. A reduction in dialysis from eight to six liters/day in a limited number of highly stable patients did not increase their levels of neurotoxic impairment. Correlations between psychometric scores and biochemical indices could not be established either before or after CAPD.
The Organization and Implementation of a Peritoneal Dialysis Program
Authors: Clayton Sheila
Published: February 2020

The organization of a chronic peritoneal dialysis program requires careful planning and close collaboration between nurses and doctors. In-center peritoneal dialysis should be used primarily for back-up dialysis of home PD patients with complications, and for those who cannot be dialyzed at home. If a unit has a large number of patients at home, it needs a larger number of in-center nurses to care for the increased numbers of hospitalized patients.

The home peritoneal dialysis unit should be located near the center unit. The home nurses should be responsible for training, home visits, for clinics and for monthly tubing changes. The unit also needs a number of auxiliary personnel to complement the work of the training nurses.
Clinical Aspects of Peritonitis in Patients on CAPO
Authors: Fenton Stanley , Wu George , Cattran Daniel , Wadgymar Arturo , Allen Ann Frances
Published: February 2020

Recurrent peritonitis remains the most frequent cause of CAPD failure and is potentially preventable.

Patients’ non-compliance with the technique and exit-site infection may be important factors in recurrent peritonitis.

Patients who remain free of peritonitis for one year are unlikely to develop recurrent peritonitis.

Treatment of peritonitis should be initiated as soon as symptoms develop. Delay in treatment may lead to septicemic shock and death.

Patients who have three or more episodes of peritonitis within the first year should be withdrawn from the CAPD program, if another mode of dialysis is appropriate for that patient.

The reduction in the overall incidence of peritonitis in 1980 may reflect the elimination of patients with recurrent peritonitis rather than improvement in technique.
An Approach to the Statistical Analysis of Peritonitis Data from Patients on CAPD
Authors: Corey Paul
Published: February 2020

1. The distribution of peritoneal infections at any time during the CAPD program is random. This does not necessarily mean that the patients with high infection rates do not have identifiable characteristics that could be used in patient selection, but rather that these characteristics themselves could be randomly distributed among the patients.

2. The median time to first infection is about 260 days and is the same for males and females.

3. The median time between first and second infection is approximately 300 days.

4. The time to first infection and the infection rate per patient are negatively related to the calendar time of entry into the CAPD program, i.e., patients who entered the program later, tended to experience a lower infection rate.

5. The increase in risk of failure on the CAPD program for patients who have at least one infection in the first 90 to 150 days in the program is greater than three.

6. The increase in risk of failure on the CAPD program increases by at least 3% per annum, i.e., for each additional year on CAPD, the risk of failure increases over that of the previous year by 3%.
Heating of Peritoneal Dialysis Fluid by a Microwave oven in Hospital Practice -A Method of Choice
Authors: Wadhwa Nand K. , Kenward David H. , Kennedy Brian , Rowe Susan M.
Published: February 2020

We investigated microwave heating in an effort to find a technique, which would allow the nursing staff and patients to choose the precise strength of solution they would use at the time of exchange. No patient showed any adverse effects related to the fluid heated in the microwave oven, and we did not detect any alterations in pH or biochemistry of the fluid. We concluded that heating the fluid in a microwave oven in the hospital environment represents a rapid, cheap and safe technique during the training period of patients on CAPD or IPD.
Spontaneous Hypogl Ycemia during Contlf\iuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Smithard David , Khanna Ramesh , Ryan Douglas , From George , Oreopoulos Dimitrios G.
Published: February 2020

We report a CAPD patient with peritonitis who developed spontaneous hypoglycemia. In spite of dialysis with hypertonic solutions and intravenous infusions of dextrose, the plasma glucose remained low. Subsequently the patient was found to be suffering from acute liver failure; hypoglycemia improved only when liver function improved four days later.

In previously reported cases of spontaneous hypoglycemia among patients on hemodialysis, the main causes seem to have been impaired hepatic gluconeogenesis due to Bblockade, mild hepatic necrosis or some specific effect of azotemia on hepatic enzymes
Six Years of Experience with Peritonitis in a CAP D Program
Authors: Prowant Barbara , Ryan Leonor , Nolph Karl D.
Published: February 2020

This paper updates previous reports from the University of Missouri and summarizes six years of experience in diagnosing and treating peritonitis at this center. The incidence of peritonitis remains much lower than in early years. In 1981, the trend appeared to be towards more frequent hospitalization and more frequent catheter removal with peritonitis. In 1982, these trends rever sed; with lower frequencies of tunnel infection, hospitalization, and catheter removal.
In-Vitro Evaluation of an UL TRA Violet Germicidal Connection System for CAPD
Authors: Holmes Clifford J. , Miyake Cynthia , Kubey Winnie
Published: February 2020

We have evaluated UV irradiation of the setlbag connection as a method of eliminating organisms causing peritonitis among CAPD patients. In the first phase of the study, spike lumens of CAPD transfer sets were inoculated with C. albicans, which are known to be relatively resistant to UV light. After irradiation, results showed a 61og 10 reduction in microbial population. In the second phase, the spikes were contaminated by touch. Following irradiation, 100% of the contaminated spikes were disinfected. These data indicate that UV germicidal systems can achieve a significant reduction of contaminating microbial population on a CAPD transfer-set spike.

Continuous ambulatory peritoneal dialysis (CAPD) is now a well-accepted therapy for end-stage renal disease (I). However, peritonitis remains a potential complication of this therapy. Several methods have been proposed for preventing microorganisms from entering the peritoneum via the primary (set-to-bag) connection. Such approaches have included placement of membrane filters in the fluid transfer set (2), use of disinfectant solutions (3), and recently the “sterile welding” technique (4). A gennicidal system, which uses ultraviolet (UV) light as the disinfecting source, has recently become available. Ultraviolet light has beeen utilized in industry and medicine for a number of years and for a number of applications, e.g., disinfecting operating rooms (5) and sterilizing water and packaging materials (6). The present paper describes the evaluation of ultraviolet irradiation as a means of disinfecting the CAPD transfer set-to-bag connection.
Gallbladder Stones, Cholecystitis and Cholecystectomy in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Nelson William , Khanna Ramesh , Mathews Raymond , Yeung Harry , Wu George , Vas Stephen , Oreopoulos Dimitrios
Published: February 2020

This paper describes a prospective three-year study using abdominal ultrasound examination in 114 new CAPD patients. Gallbladder disease was common (22.8%) and four of 16 patients with gallstones (25%) required cholecystectomy after 1–14 (i 7.8 months) on CAPD. Two of these four had evidence of peritonitis in association with cholecystitis. Also we analyzed the clinical course of eight patients on chronic PD who underwent cholecystectomy. They had no serious morbidity, and all returned to chronic PD.

While abdominal pain is one of the main features of CAPD-related peritonitis, other causes of abdominal pain may be more difficult to evaluate in the patient on peritoneal dialysis (PD); such causes potentially are more serious because they threaten the continuance of PD as a mode of therapy. Cholecystitis related to cholelithiasis is one such possible cause of abdominal pain. However, since ultrasonography can reliably and non-invasively detect the presence of gallstones, we have used it prospectively to screen patients entering our CAPD training program. This paper reports our findings and the subsequent course of those found to have gallstones during a three-year period. In addition we also reviewed the feasibility of cholecystectomy, its hazards and outcome in eight patients on chronic peritoneal dialysis who underwent this procedure at Toronto Western Hospital in the past seven years.
The Assessment of Peritoneal Function Using a Single Hypertonic Exchange
Authors: Nikolakakis Nik , Stuart R. , Timothy C. Rodger , Goodship H. J. , Fletcher Kate , Ashcroft Rosalind , Wilkinson Robert , Ward Michael K.
Published: February 2020

Peritoneal ultrafiltration, creatinine clearance and glucose absorption were measured in 56 CAPD patients using a single hypertonic exchange with a four-hour dwell. The intraindividual coefficient of variation for these parameters was less than 5 % and the results obtained correlated significantly with those obtained using a six-hour dwell. Ultrafiltration capacity was independent of clearance values but glucose absorption correlated directly with clearance and inversely with ultrafiltration levels (p < 0.001). Multiple regression analysis showed a decline in four-hour clearance values with time on CAPD (p < 0.001), and an increase in glucose absorption after four hours with Frezenius hypertonic solution (p < 0.02) but no other effect of patient age, sex, body surface area, serum albumin, duration of CAPD treatment, peritonitis history or dialysate brand on these indices of peritoneal function. It is important to monitor peritoneal function in patients treated by CAPD and these results indicate that a single, timed, hypertonic exchange is a reproducible test of ultrafiltration, clearance and glucose absorption.

Loss of peritoneal function is reported as a cause of failure of CAPD (1–5) although we have limited information concerning sequential changes in the peritoneal membrane with time (6–8) and no agreement over the most appropriate investigation to monitor its permeability (9–11). The International Co-operative Study measured ultrafiltration capacity using a four-hour, two-litre hypertonic exchange (9). This study examines the reliability of such a single, timed exchange to measure peritoneal clearance, glucose absorption and ultrafiltration and evaluates the influence of demographic factors on these parameters.
Peritoneal Cavity Lymphatics
Authors: Khanna Ramesh , Mactier Robert , Twardowski Zbylut J. , Nolph Karl D.
Published: February 2020

Lymphatic drainage of particulate matters from the peritoneal cavity occurs mainly from lacunae located in the diaphragm. These are a triple-layered structure consisting of mesothelium, a loose network of connective tissue and endothelium. Absorption of particles may occur via gap junctions, through the cells or via vesicles.

Whole blood can be removed fairly rapidly from the peritoneal cavity. Respiration plays an important role in the absorption of particles through lymphatics. Intra-abdominal pressure and posture are other factors which influence lymphatic flow rate in the peritoneal cavity. Little is known about the influence of drugs on lymphatic flow rate from the peritoneal cavity.
IgG2 Deficiency in Young Children Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Schröder Cornelis H. , Bakkeren Jan A. J. M. , Weemaes Corry M. R. , Monnens Leo A. H.
Published: February 2020

In most series of children treated with continuous ambulatory peritoneal dialysis (CAPO), the incidence of peritonitis is higher than in adults. This phenomenon has been insufficiently explained. In the serum of 12 young children treated with CAPO, the serum immunoglobulins IgA, IgM, and IgG, as well as the IgG subclasses, were evaluated. In 11 of them, IgG2 was not detectable. Total IgG was also slightly decreased in these patients. In control groups, consisting of children before CAPO was started, children treated with hemodialysis, and adult CAPO patients, no clear abnormalities were found. It is concluded that in young patients peritoneal dialysis causes IgG loss leading to IgG2 deficiency.
Change in the Transport of Uric Acid under the Influence of Pyrazinoic Acid: In Vitro Studies with Human and Rabbit Peritoneum
Authors: Czyźewska Krystyna , Grzegorzewska Alicja , Knapowski Jan
Published: February 2020

Bidirectional transport of uric acid (UA) through human and rabbit peritoneum, and its change under the influence of pyrazinoic acid (PA) was investigated in vitro. Fragments of parietal peritoneum were taken from the region of anterior abdominal wall from rabbits (the animal series) and from patients undergoing abdominal operations (the human series). Under control conditions, higher values of the UA transport were found in the rabbit peritoneum in comparison with the human peritoneum, but in both series it was maintained at a constant level throughout the experiment lasting 120 min. In rabbit as well as in human peritoneum it was found that PA depressed about 50% of the UA transport from the interstitial to the mesothelial side, leaving the opposite direction intact. The results obtained in vitro are in agreement with previous observations in a patient undergoing peritoneal dialysis that showed decreased peritoneal UA excretion evoked by pyrazinamide. The comparative analysis proves the rabbit peritoneum to be a good experimental model for further investigations of peritoneal urate transport in man.
Dialysate Dumping: A Novel Cause of Inadequate Dialysis in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Caruana Ralph J. , Smith Kenneth L. , Hess Charlene P. , Perez John Charles , Cheek Patricia L.
Published: February 2020

Inadequate control of serum chemistries and extracellular fluid volume may result in patients being changed from continuous ambulatory peritoneal dialysis (CAPD) to another form of dialysis. We report 2 patients in whom apparent inadequacy of CAPD resulted from dialysate dumping. The first patient could not control her fluid intake and required frequent hypertonic exchanges. She felt too full with these exchanges and drained a substantial portion of each exchange 30 to 60 min after infusion. Patient 2 had similar complaints but simply drained a large portion of each fresh bag directly into the drain bag at the start of the fiush-before-fill step. Both patients had improved results from CAPD once they stopped their dialysate dumping. Partial wasting of each exchange because of abdominal discomfort should be added to the causes of inadequate dialysis in CAPD.
Peritoneal Functional Parameters after Five Years on Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of Late Peritonitis
Authors: Selgas R. , Muñoz J. , Cigarran S. , Ramos P. , L-Revuelta K. , Escuin F. , Miguel J. L.
Published: February 2020

Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 ± 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 ± 2.6 mL/min.

Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different.

Early episodes of peritonitis (those occurring <36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occuring >36 months since initiation) induced a decrease in urea-MTC (22.3 ± 6 to 15.8 ± 3.9, p < 0.05), creatinine-MTC (9.4 ± 3.1 to 7.4 ± 2.5, p < 0.05), and a corresponding increase in UF (1.25 ± 0.4 to 1.4 ± 0.3, mL/min, p < 0.05).

Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed.

After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.
Peritoneal Catheters and Exit -Site Practices: Toward Optimum Peritoneal Access
Authors: Gokal Ram , Ash Stephen R. , Helfrich G. Baird , Holmes Cliff J. , Joffe Preben , Nichols W. Kirt , Oreopoulos Dimitrios G. , Riella Miguel C. , Slingeneyer Alain , Twardowski Zbylut J. , Vas Stephen I.
Published: February 2020

The peritoneal catheter is the CAPD patient's lifeline. Advances in catheter knowledge have made it possible to access the peritoneal cavity safely and maintain access over an extended period of time. Infection at the exit site remains a major problem, a solution for which is being extensively researched.

The successful outcome of a catheter in an individual depends on meticulous care and adherence to sound principles of catheter insertion and management. The guidelines provided in this publication represent the consensus based on the extensive experience of several major centers worldwide.
Effective Continuous Ambulatory Peritoneal Dialysis following Abdominal Aortic Aneurysm Repair
Authors: Schmidt Rebecca J. , Cruz Cosme , Dumler Francis
Published: February 2020

+ Objective

To review a single center's experience with the initiation and maintenance of continuous ambulatory peritoneal dialysis (CAPD) in 8 patients with a history of abdominal aortic aneurysm repair (AAAR).

+ Design

Retrospective case review with long-term follow-up.

+Patients (or Participants)

Eight patients with multiple medical problems including a history of abdominal aortic aneurysm repair and end-stage renal failure who received peritoneal dialysis catheters between December 1986 and July 1991.

+ Main Outcome Measures

Success of catheter implantation and maintenance of continuous ambulatory peritoneal dialysis; incidence of peritoneal infection and long-term complications; overall clinical course.

+ Results

Over five years 8 patients with a history of reconstructed abdominal aortic aneurysm received peritoneal dialysis catheters without complication and dialyzed successfully for 88 patient-months in total. Three patients had a total of five episodes of peritonitis, at an incidence of 0.68 episodes per patient per year, a rate not significantly different from that of our overall CAPD patient population (1.09) and that reported by other groups.

+ Conclusion

Our experience suggests that historical AAAR poses no significant risk to and should not preclude the implementation of continuous ambulatory peritoneal dialysis. Indeed, CAPD offers a safe and optimal dialytic alternative for patients with historical abdominal aortic aneurysm repair in whom compromised cardiovascular hemodynamics may significantly influence morbidity and survival.
Endothelin-1In Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients: A Preliminary Study
Authors: Lightfoot Barbara O. , Caruana Ralph J.
Published: February 2020

Objective

To determine the effects of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) on endothelin-1 (ET-1) levels in patients with endstage renal disease (ESRD) and to assess the relationship between plasma ET-1 levels and selected patient parameters.

Design

Prospective, non randomized comparison study.

Setting

Outpatient CAPD and HD units of a university medical center.

Participants

Twelve ESRD patients (6 on CAPD and 6 on HD) and 5 healthy normotensive subjects.

Interventions

CAPD patients had blood and peritoneal dialysate samples collected and measurements made following an overnight exchange. HD patients had blood collected and measurements made at 0 hours (basal) and again at 3 hours during a midweek HD session. Blood samples were also collected from normal subjects and served as ET-1 controls.

Measurements

ET-1 and patient parameters (creatinine, peritoneal dialysate volume, blood pressure, bodyweight, age, and treatment duration) were determined. Data are reported as the mean ± one standard deviation.

Results

Plasma and dialysate ET-1 levels in the CAPD group were 19.5±4.2 pglmL and 9.2±4.2 pglmL, respectively. The control group plasma and unused dialysate contained no detectable ET-1 «3.0 pg/mL, the limit of detection). The peritoneal clearance of ET-1 was less than that of creatinine (2. 29±0.69 mL/minute vs 4.22±0.66 mL/minute, p=0.005). The basal (0 hour) plasma ET-1 level in the HD group (16.5±7.8 pg/mL) did not differ from that of the CAPD group, p=0.423. Furthermore, no differences in patient parameters were detected between the CAPD and basal HD groups. Although the mean arterial pressure (MAP) decreased during HD, the plasma ET-1 level at 3 hours (13.5±5.4 pg/mL) remained unchanged from the basal level, p=0.307. An analysis of pooled data from the CAPD and HD groups revealed no significant correlation between plasma ET-1 and MAP, body weight, creatinine, or treatment duration. There was, however, a positive correlation between plasma ET-1 and age (r=0.643, p=0.024).

Conclusions

Plasma ET-1 levels are elevated in both CAPD and HD patients. Despite the clearance of ET-1 by the peritoneal membrane, plasma ET-1 levels in CAPD patients are elevated to the same extent as levels observed in HD patients. Preliminary results show a positive correlation between plasma ET-1 and age in the absence of renal function. This finding remains to be examined in a larger ESRD population.
Continuous Ambulatory Peritoneal Dialysis Catheter Infections: Diagnosis and Management
Authors: Flanigan Michael J. , Hochstetler Linda A. , Langholdt Donita , Lim Victoria S.
Published: February 2020

Purpose

To develop diagnostic and treatment strategies for peritoneal dialysis catheter exit-site and tunnel infections.

Population

All consenting peritoneal dialysis patients performing home dialysis through the University of Iowa Hospitals and Clinics Home Dialysis Training Center. This is a state-owned teaching hospital serving a rural population of approximately one million people in Iowa and western Illinois.

Methods

Four dialysis nurses collected information on a prospectively designed data acquisition tool. Patients were randomly assigned to one of two treatment groups, intraperitoneal vancomycin plus oral rifampin or oral trimethoprim/ sulfamethoxazole (TMP/SMX), and their initial antibiotic therapy determined by that assignment. If the infection was gram -negative, the initial antibiotics were discontinued and an alternative therapy begun. Therapy was initiated by the nursing staff and required physician notification within 48 hours.

Results

There were 126 recorded catheter infections (exit-site, tunnel, or cuff infection) resulting in a rate of 0.67 episodes per patient year of exposure. Staphylococcus aureus was isolated from the majority (60%) of these events. Pseudomonas aeruginosa was the next most common isolate and accounted for 21% of infections. Rubor, dolor, and turgor are the classic signs of inflammation, and at least one of these was present in 79% of the episodes. Isolated pericatheter erythema or serous discharge was associated with a minimal risk «2%) of catheter loss. The presence of a purulent exit-site discharge identified patients who had a 30% chance of failing systemic antibiotic therapy and a 20% risk of catheter loss. The concurrent presence of exit-site tenderness or swelling identified the most severe infections. Staphylococcal infections responded equally well to local cleaning and vancomycin plus rifampin (86% cured) or oral trimethoprim/sulfamethoxazole (89% cured) therapy. Gram-negative infections were frequent (27%) and appeared to respond best to a combination of tobramycin and ciprofloxacin.

Conclusion

Exit-site/tunnel inflammation is detectable by patients and can be used to guide therapy. An isolated finding of erythema or serous discharge is not indicative of an acute infection and may not require systemic antibiotics. The presence of purulence identifies patients at risk for catheter loss, and these patients benefit from systemic therapy. The combination of a purulent exit-site discharge plus pericatheter tenderness or swelling identifies patients likely to suffer treatment failure and require subsequent catheter removal. The cure rate of gram -positive catheter infections treated with vancomycin plus rifampin was indistinguishable from that achieved with oral trimethoprim/sulfamethoxazole (p = 0.99).
Are Aldehydes in Heat-Sterllized Peritoneal Dialysis Fluids Toxic in Vitro?
Authors: Wieslander Anders P. , Andrén Anders H.G. , Nilsson-Thorell Carin , Muscalu Natalia , Kjellstrand Per T.T. , Rippe Bengt
Published: February 2020

Objective

Chemical analysis of several brands of peritoneal dialysis fluids (PD fluids) has revealed the presence of 2-furaldehyde, 5-HMF (5-hydroxymethylfuraldehyde), acetaldehyde, formaldehyde, glyoxal, and methylglyoxal. The aim of this study was to investigate if the in vitro side effects caused by glucose degradation products, mainly formed during heat sterilization, are due to any of these recently identified aldehydes.

Design

Cell growth media or sterile filtered PD fluids were spiked with different concentrations ofthealdehydes.

Measurements

In vitro side effects were determined as the inhibition of cell growth of cultured mouse fibro blasts or stimulated superoxide radical release from human peritoneal cells.

Results

Our results demonstrate that the occurrences of 2-furaldehyde, 5-HMF, acetaldehyde, formaldehyde, glyoxal, or methylglyoxal in heat-sterilized PD fluids are probably not the direct cause of in vitro side effects. In order to induce the same magnitude of cell growth inhibition as the heat-sterilized PD fluids, the concentrations of 2-furaldehyde, glyoxal, and 5-HMF had to be 50 to 350 times higher than those quantified in the PD fluids. The concentrations of acetaldehyde, formaldehyde, and methylglyoxal observed in the heat-sterilized PD fluids were closer to the cytotoxic concentrations although still 3 to 7 times lower.

Conclusion

Since none of these aldehydes caused in vitro toxicity at the tested concentrations, the toxicity found in PD fluids is likely to be due to another glucose degradation product, not yet identified. However, it is possible that these aldehydes may still have adverse effects for patients on peritoneal dialysis.
Malfunctioning Peritoneal Dialysis Catheter Repaired by Laparoscopic Surgery
Authors: Julian Thomas B. , Ribeiro Ulysses , Bruns Frank , Fraley Donald
Published: February 2020

Objectives

To review peritoneal dialysis catheter failures and to describe a technique of repairing malpositioned catheters.

Design

Two prospective case reports utilizing this technique are reported.

Setting

A tertiary care hospital.

Patients

Two patients on chronic peritoneal dialysis with malfunctioning catheters.

Intervention

Both patients underwent reposition of their malpositioned continuous ambulatory peritoneal dialysis catheters by laparoscopic suture technique.

Main Outcome Measures

Outcome was measured by the successful return of adequate peritoneal dialysis.

Results

Both case studies show correction of malpositioned catheters with the return of successful peritoneal dialysis.

Conclusion

The repositioning and suture application of malpositioned Tenckhoff catheters by laparoscopic surgery is a viabletechnique that can salvage the majority of mal positioned catheters and save the patients additional hospital time and recovery.
Analysis of Ultrafiltration Failure in Peritoneal Dialysis Patients by Means of Standard Peritoneal Permeability Analysis
Authors: Pannekeet Marja M. Ho-Dac , Atasever Bektaş , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Background

Ultrafiltration failure (UFF) is a complication of peritoneal dialysis (PD) treatment that occurs especially in long-term patients. Etiological factors include a large effective peritoneal surface area [measured as high mass transfer area coefficient (MTAC) of creatinine], a high effective lymphatic absorption rate (ELAR), a large residual volume, or combinations.

Objective

The prevalence and etiology of UFF were studied and the contribution of transcellular water transport (TCWT) was analyzed. A new definition of UFF and guidelines for the analysis of its etiology were derived from the results.

Setting

Peritoneal dialysis unit in the Academic Medical Center in Amsterdam.

Design

Cross-sectional study of standard peritoneal permeability analyses (4-hr dwells, dextran 70 as volume marker) with 1.36% glucose in 68 PD patients. Patients with negative net UF (change in intraperitoneal volume, dlPV < 0 mL) were analyzed further using 3.86% glucose, whenever possible.

Results

Among 68 patients (duration of PD 0.3 -178 months), 39 had negative net UF with 1.36% glucose. These patients had greater MTAC creatinine and glucose absorption, and higher ELAR (p < 10–4) than the patients with positive UF. dIPV and transcapillary UF rate (TCUFR) were lower (p < 10–5). Twenty of these patients could be studied using 3.86% glucose. dlPV was greater than 400 mL/4 hr in this test in 12 patients, implying that no clinically important UFF was present. Ultrafiltration failure (dIPV < 400 mL) was found in 8 patients, giving a prevalence of 23%. This last group had been treated with PD for a longer period (p = 0.03), had higher ELAR (p = 0.07), but lower residual volume (p = 0.03), and lower TCUFR (p = 0.01). Ultrafiltration failure was associated with a high MTAC creatinine in 3 patients, a high ELAR in 4 patients, and a combination of factors in one. As an additional possible cause, TCWT was studied, using the sodium gradient in the first hour of the dwell, corrected for diffus ion (dNA). Five patients had dNA > 5 mmol/L, indicating normal TCWT. The 3 patients with dNA < 5 mmol/L tended to be treated longer (p = 0.19) and had lower TCUFR (p = 0.04). A smaller difference was found between dlPV 3.86% and 1.36% (p = 0.04) compared to the dNA > 5 mmol/L group, but no differences were present for MTAC creatinine, ELAR, residual volume, or glucose absorption.

Conclusions

ln addition to known factors, impairment of TCWT can be a cause of UFF. A standardized dwell with 1.36% glucose overestimates UFF. Therefore, 3.86% glucose should be used for identification of patients with UFF, especially because it provides additional information on TCWT. Ultrafiltration failure can be defined as net UF < 400 mL/4 hr with 3.86% glucose during a 4-hour exchange.
The Absence of Toxicity in Intraperitoneal Iron Dextran Administration: A Functional and Histological Analysis
Authors: Pecoits-Filho Roberto F.S. , Twardowski Zbylut J. , Kim Yong-Lim , Khanna Ramesh , Moore Harold , Nolph Karl D.
Published: February 2020

Objective

To determine the influence of iron dextran intraperitoneal administration on the function and histology of the peritoneum in rats undergoing chronic peritoneal dialysis.

Design

Prospective, randomized experimental study.

Materials

Fifty-four Sprague-Dawley rats were divided into five groups: 3 study groups -high dose group (H), n = 12; intermediate dose (M), n = 12; and low dose group (L), n = 12 a dialysis control group (D), n = 12; and a tissue control (C), n = 7.

Interventions

The study groups were given Dianeal containing iron dextran in a concentration of 0.5,0.25, and 0.125 mg/L (groups H, M, and L respectively). Group D was given standard Dianeal. Group C was never dialyzed.

Main Outcome Measures

A 2-hour peritoneal equilibrium test (PET) was performed on the eighth day, at 3 months, and at 6 months. After the final PET, the animals were sacrificed and the peritoneal membrane was evaluated by gross inspection and light microscopy (silver, prussian blue, and trichrome staining).

Results

Peritoneal transport of small solutes followed the same pattern in all groups, increasing over time. The peritonitis index was similar in the groups. No iron deposits or morphologic differences were seen in the gross inspection of the peritoneal cavity. No peritoneal iron deposition was detected in the histological analysis with prussian blue staining. No differences were noted in the light microscopic analysis of the mesothelial cell layer (silver staining), nor did the morphometric analysis of the submesothelial space show any differences in thickness between the groups.

Conclusion

These findings suggest the absence of toxic effects of iron dextran on the peritoneal cavity of rats in the concentrat ions studied. Further studies should be performed to evaluate the effectiveness of these dosages delivered intraperitoneally to maintain iron homeostasis.
Human rights implications of introducing a new mental health act – principles, challenges and opportunities
Authors: Gill Neeraj S , Allan John A , Clark Belinda , Rosen Alan
Published: February 2020

Objective:

The United Nations Convention on the Rights of Persons with Disabilities (CRPD), 2006 has influenced the evolution of mental health legislation to protect and promote human rights of individuals with mental illness. This review introduces how the human rights agenda can be systematised into mental health services. Exploration is made of how some principles of CRPD have been incorporated into Queensland’s Mental Health Act 2016.

Conclusion:

Although progress has been made in some areas, e.g. heavier reliance on capacity assessment and new supported decision-making mechanisms, MHA 2016 has continued to focus on involuntary treatment. A Human Rights Act 2019 has been passed by the Queensland parliament, which may fill in the gap by strengthening positive rights.
Stimulant prescribing for attention deficit hyperactivity disorder (ADHD): what guides clinicians in their choice of an upper limit for dose titration?
Authors: Poulton Alison S , Paterson Roger
Published: February 2020

Objective:

There is little evidence to support the current stimulant dose upper limit restrictions in the treatment of attention deficit hyperactivity disorder (ADHD). Within Australasia, there is inconsistency in dose maxima in different jurisdictions. Clinician experience in this area may be worth gauging when trying to improve the understanding of optimal maximal dosing. Our objective was to survey prescribers’ experience of whether the current stimulant maximum doses ever conflict with dose optimisation and how such conflicts are managed.

Method:

We conducted an anonymous online survey of health professionals treating children, adolescents and adults with ADHD.

Results:

Responses were received from 128 prescribers, mainly paediatricians (52%) and adult psychiatrists (39%). The designated maximum dose of stimulant was a constraint to dose optimisation experienced by 91% for the Product Information maxima and 82% for their respective state/territory regulations maxima. When clinically indicated, 72% would exceed the designated maxima, either with or without obtaining a second opinion or applying for special authority. Of the remaining 28%, the majority (16%) would opt for polypharmacy, with only two accepting a suboptimal dose.

Conclusion:

The current stimulant dose maxima act as a constraint to stimulant dose optimisation and may promote undertreatment and polypharmacy.
Hispanic Transgender Individuals: A Forgotten Diaspora
Authors: Yockey R. Andrew
Published: February 2020

This article addresses gaps and warrants further investigation among Hispanic transgender individuals.
Association of diabetes mellitus with postoperative opioid consumption in patients undergoing primary unilateral hip arthroplasty
Authors: Regnier Shane M , Khatibi Bahareh , Gabriel Rodney A
Published: February 2020

Opioids are an indispensable component of perioperative pain management; however, the burgeoning opioid epidemic necessitates research into the risk factors for the development of opioid dependence and abuse following surgery. Diabetes has been identified as a risk factor for prolonged opioid utilisation following non-orthopaedic surgery; however, this association has not been investigated following orthopaedic surgery. To bridge this gap in the literature, we performed a retrospective propensity-matched cohort study in patients undergoing primary unilateral total hip arthroplasty. Propensity-matched cohorts were created to compare patients with and without preexisting diabetes mellitus. Outcomes of interest were opioid utilisation and subjective pain on postoperative day 1. Our results did not identify an association between preexisting diabetes and postoperative pain or opioid utilisation. While this study did not identify an association between diabetes and opioid utilisation following total hip arthroplasty, future studies should pursue a prospective, longitudinal approach and investigate other common orthopaedic procedures.
Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study
Authors: Pedersen Carsten M , Green Jacob S , Bigler Dennis R , Andersen Niels EO , Cromhout Pernille F
Published: February 2020

Intubation with a double-lumen left-sided endotracheal video tube has been the standard procedure for nearly five years in the Department of Cardiothoracic Surgery, Copenhagen University Hospital, but no systematic evaluations have been done. For a 12-month period ending November 2017, data were collected from 579 consecutive patients, scheduled for thoracic surgery with a requirement for one-lung ventilation; 35 anaesthetist trainees (nurses or doctors) (287 cases), 27 nurse anaesthetists (239 cases) and 8 anaesthesiologists (53 cases) managed intubation with a double-lumen tube. Time to intubation was relatively equal across healthcare professionals with a mean time of 53 (anaesthetist trainees), 40 (nurse anaesthetists) and 63 (anaesthesiologists) seconds. The shorter time for nurse anaesthetists and prolonged time for anaesthesiologists might be due to the small number of cases and the fact that anaesthesiologists carried out 60% of the cases, where a third attempt was needed, and 25% of cases for the anaesthesiologists were assessed to a Cormack-Lehane grade of 3 or 4 compared to 6% for anaesthetist trainees and 5% for nurse anaesthetists. The rate of successful placement in the first attempt of placing the double-lumen left-sided endotracheal video tube was high, which emphasises that intubation with a double-lumen left-sided endotracheal video tube is suitable for use by different healthcare professionals.
Surgical Management of Right Aortic Arch Obstruction Associated With Rare Form of Vascular Ring
Authors: Krivoshchekov Evgeny V. , Cetta Frank , Egunov Oleg A. , Sviazov Evgenii A. , Kiselev Valeriy O. , Troshkinev Nikita M.
Published: February 2020

This clinical case demonstrated surgical management for a rare case of vascular ring associated with an elongated and kinked aortic arch and a right descending aorta in a ten-year-old male using an extra-anatomic bypass grafting method and dividing the vascular ring. Computer tomography performed at six-month follow-up showed a favorable surgical outcome.
Modified Warden Operation With the Use of Femoral Vein Homograft for Repair of a Variant of Right-Sided Partial Anomalous Pulmonary Venous Connection
Authors: Chery Josue , Ramakrishnan Karthik , Cross Russel , Jonas Richard A.
Published: February 2020

Surgical repair of right-sided partial anomalous pulmonary venous return (PAPVR) involves baffling the pulmonary vein across a naturally occurring or surgically created atrial septal defect without causing pulmonary venous or superior vena cava obstruction. A nine-year-old male presented to us with an unusual anatomical variant of right-sided partial anomalous pulmonary venous connection. The pulmonary veins draining the right upper and middle lobes connected to the azygous vein that drained in the usual fashion into the superior vena cava. The Warden operation was modified, with the use of femoral vein homograft, to avoid pulmonary venous obstruction.