bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythropoietin Prevents Dialysis Fluid-Induced Apoptosis of Mesothelial Cells
Authors: Vorobiov Marina , Malki Myriam , Shnaider Alla , Basok Ana , Rogachev Boris , Lewis Eli C. , Chaimovitz Cidio , Zlotnik Moshe , Douvdevani Amos
Published: February 2020

Background

In peritoneal dialysis (PD)-treated patients, denudation of the mesothelium correlates with peritoneal fibrosis and vascular changes. Since recombinant human erythropoietin (rHuEPO) induces a range of cytoprotective cellular responses, rHuEPO treatment may reduce PD fluid (PDF)-induced damage.

Methods

To investigate the antiapoptotic effect and mechanism of rHuEPO in peritoneal mesothelial cells (PMCs), isolated mice PMCs were used for in vitro characterization of rHuEPO effects. To confirm the in vitro effects, active caspase-3 was analyzed in imprints of liver visceral peritoneum of mice pretreated overnight with rHuEPO (5000 U/kg intraperitoneally) and exposed to PDF (Dianeal 4.25%; Baxter Healthcare, Deerfield, Illinois, USA) for 4 hours.

Results

Mouse PMCs expressed EPO-receptor mRNA and protein. Short exposure to rHuEPO (5 U/mL) induced phosphorylation of JAK2, STAT5, and ERK1/2. PMCs pretreated for 1 hour with rHuEPO showed reduced PDF-induced caspase-3 activation (49.6%) and DNA fragmentation (38.4%) in comparison to cells treated by PDF alone ( p < 0.05). rHuEPO treatment induced an increase in ERK1/2 phosphorylation and reduced levels of PDF-induced phospho-P38. PD98059, a specific inhibitor of ERK activation, fully blocked the protective effect of rHuEPO. In mice, rHuEPO reduced the apoptotic effect of PDF, as assessed by the level of active caspase-3.

Conclusions

Our study presents new insights into clinical use of rHuEPO in the setting of PD. We found that rHuEPO provides ERK1/2-dependent protection to PMCs from PDF-induced apoptosis. The use of rHuEPO, or any of its new derivatives that do not stimulate erythropoiesis, should be considered for peritoneal preservation.
Management of Renal Osteodystrophy: THe Heart and Bone of Pediatric Dialysis
Authors: Schmitt Claus P. , Schaefer Franz
Published: February 2020

Control of mineral homeostasis is a particularly challenging task in children and adolescents on dialysis. Treatment efforts must not only ensure patient survival and the absence of debilitating complications of bone disease, but in view of a potentially long lifespan, must also consider how to best promote long-term cardiovascular health and successful psychosocial transition into adult life. In that context, avoidance of cardiovascular calcifications and accomplishment of adequate statural growth and a normal final height are major objectives of uremic bone disease management in children. Unfortunately, current pediatric management guidelines operate on a small evidence base, and major controversy surrounds key issues such as optimal target ranges for serum parathyroid hormone, calcium, and phosphorus in the individual childhood phases, and individual risk–benefit ratios for the use of phosphate binders, vitamin D analogs, and calcimimetics in children. The present review summarizes the current state of knowledge and outlines future research requirements in bone disease associated with pediatric end-stage renal disease.
3,4-Dideoxyglucosone-3-Ene Induces Apoptosis in Human Peritoneal Mesothelial Cells
Authors: Lee Duk-Hyun , Choi Soon-Youn , Ryu Hye-Myung , Kim Chan-Duck , Park Sun-Hee , Chung Ho-Young , Kim In-San , Kim Yong-Lim
Published: February 2020

Objective

Glucose degradation products (GDPs) are formed during heat sterilization and storage of peritoneal dialysis (PD) fluids. 3,4-dideoxyglucosone-3-ene (3,4-DGE) has been identified as the most bioreactive GDP. 3,4-DGE induces apoptosis in leukocytes and renal tubular epithelial cells. Our aim was to evaluate the apoptotic effects of 3,4-DGE on human peritoneal mesothelial cells (HPMCs).

Methods

Primary cultured HPMCs were treated with 25 or 50 μmol/L 3,4-DGE. MTT assay was used to determine cell viability. Apoptosis was measured using TUNEL assay and flow cytometry. Expressions of procaspase-3, Bax, and Bcl-2 were estimated by Western blot. Activity of caspase-3 was measured and the effect of the caspase inhibitor zVAD-fmk (Z-Val-Ala-DL-Asp-fluoromethylketone) was evaluated by TUNEL assay.

Results

3,4-DGE treatment accelerated cell death in HPMCs in a dose- and time-dependent manner. Treatment with 3,4-DGE (25 and 50 μmol/L) significantly increased apoptosis compared to control ( p < 0.05 and p < 0.01 respectively) by TUNEL assay. Flow cytometry showed treatment with 50 μmol/L 3,4-DGE significantly increased apoptosis compared to control ( p < 0.05). Decreased expression of procaspase-3 and increased activity of caspase-3 were observed in the presence of 50 μmol/L 3,4-DGE compared to control and 25 μmol/L 3,4-DGE ( p < 0.05). 3,4-DGE-induced HPMC apoptosis was decreased after pretreatment with the pan-caspase inhibitor zVAD-fmk in the 50 μmol/L 3,4-DGE-treated group ( p < 0.001). The ratio of Bcl-2 to Bax expression was decreased in the 25 μmol/L and the 50 μmol/L 3,4-DGE-treated groups compared to control ( p < 0.05).

Conclusions

3,4-DGE promotes apoptosis in HPMCs by a caspase-related mechanism.
Effects of Interleukin-6 T15A Single Nucleotide Polymorphism on Baseline Peritoneal Solute Transport Rate in Incident Peritoneal Dialysis Patients
Authors: Hwang Young-Hwan , Son Min-Jeong , Yang Jaeseok , Kim Kiwon , Chung Wookyung , Joo Kwon-Wook , Kim Yonsu , Ahn Curie , Oh Kook-Hwan
Published: February 2020

Objective

To study the genetic effects of various inflammatory cytokines on peritoneal solute transport rate (PSTR) in incident Korean peritoneal dialysis (PD) patients.

Design

Case-control association study.

Methods

132 patients with baseline peritoneal equilibration test within 1 – 3 months after starting PD were enrolled. We analyzed the influence of single nucleotide polymorphisms (SNPs) of interleukin-6 (IL-6; -572G/C, T15A), tumor necrosis factor-alpha (TNF-α; -1031C/T, -863C/A, -308G/A), and IL-10 (-1082A/G, -592A/C) on baseline PSTR. Clinical parameters such as age, gender, presence of diabetes mellitus, comorbidity, C-reactive protein, and residual renal function were also included as covariates.

Results

The T15A SNP of IL-6 (rs13306435) was associated with PSTR. Patients with TA genotype ( n = 18) had significantly lower D4/P creatinine (0.65 ± 0.087 vs 0.73 ± 0.110, p = 0.0046) and higher D4/D0 glucose (0.39 ± 0.174 vs 0.31 ± 0.119, p = 0.027) than patients with TT genotype ( n = 114). The log value of the dialysate appearance rate of IL-6 had a strong positive correlation with D4/P creatinine ( r2 = 0.1294, p < 0.0001) and was significantly lower in the TA genotype than the TT genotype (201.7 ± 14.42 vs 116.8 ± 88.91 pg/minute, p = 0.0358). By multiple logistic regression, TA genotype was negatively associated with a higher PSTR (high or high average; odds ratio 0.18; 95% confidence interval 0.048 – 0.666).

Conclusions

In incident Korean PD patients, T15A polymorphism of IL-6 is associated with dialysate IL-6 concentration and baseline PSTR.
Previous Comorbidity and Lack of Patient Free Choice of Technique Predict Early Mortality in Peritoneal Dialysis
Authors: Portolés José , del Peso Gloria , Fernández-Reyes M. José , Bajo M. Auxiliadora , López-Sánchez Paula
Published: February 2020

Objective

To study the prognostic factors for mortality and hospital admission for patients on peritoneal dialysis (PD).

Method

Biannual data on individual characteristics, clinical and analytical progress, treatment, and events were studied for a cohort of incident patients undergoing PD (2003-2006) in a reference area of 8.8 million people.

Results

489 patients (age 53.58 years, 61.6% male) with 3-year follow-up were included. They presented at inclusion with Charlson Comorbidity Index (CCI) of 5.25; previous cardiovascular (CV) event, 23.7%; diabetes mellitus (DM), 19.1%; and hypertension (HT), 89.9%. Annual hospitalization rate per patient-year at risk was 0.6. The variables that predicted admission were CCI [odds ratio (OR) 1.14 per point], DM (OR 1.66), and previous CV event (OR 1.90). Anemia maintained significance when corrected for CCI: hemoglobin, 0.79 per 1 g/dL Hb; CCI, 1.15 per point. Annual mortality rate was 5.4%. Those that died were older (67.47 vs 52.78 years) and had a higher CCI (8.35 vs 5.0), a lower initial Hb (11.5 vs 12.2 g/dL), a higher hospital admission rate, a higher annual rate of peritonitis, more previous CV events (50.0% vs 22.1%), and higher prevalence of DM (38.5% vs 17.9%). Survival analysis identified the following prognostic factors: CCI [hazard ratio (HR) 1.51 per point], CV event (HR 2.85), DM (HR 2.52), age (HR 1.06 per year), and mandatory referral to PD (HR 6.54). The effect of CV events and DM persisted after correction for age, and that of choice of technique after correcting for CCI and/or age.

Conclusions

The CCI is useful for risk estimation in PD patients. Previous CV event, DM, and age are the most relevant risk factors. Control of anemia has prognostic value for hospital admissions. Mandatory referral to PD is associated with higher mortality. The prognosis in PD depends on predialysis patient management.
Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis
Authors: Fang Wei , Yang Xiao , Bargman Joanne M. , Oreopoulos Dimitrios G.
Published: February 2020

Background

Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD.

Methods

All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model.

Results

A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 ± 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure ( p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 – 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 – 1.081; p = 0.035).

Conclusion

Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.
A Randomized Trial Comparing Conventional Swan-Neck Straight-Tip Catheters to Straight-Tip Catheters with An Artificial Subcutaneous Swan Neck
Authors: Li Chiu-Leong , Cui Tai-Gen , Gan Hong-Bing , Cheung Kin , Lio Weng-In , Kuok Un-I
Published: February 2020

Objective

To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck.

Design

Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting.

Patients and Methods

Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding.

Results

A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy.

Conclusions

Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.
A Strict Low Protein Diet during the Predialysis Period Suppresses Peritoneal Permeability at Induction of Peritoneal Dialysis
Authors: Hasegawa Takeshi , Yoshimura Ashio , Hirose Makoto , Komukai Daisuke , Tayama Hironori , Watanabe Susumu , Koiwa Fumihiko , Yamazaki Shin , Ideura Terukuni
Published: February 2020

Background

The factors that predict baseline peritoneal permeability remain largely unknown. We noticed that patients that adhered to a strict low protein diet (LPD) during the predialysis period seldom showed high peritoneal permeability on the peritoneal equilibration test (PET) at the introduction of peritoneal dialysis (PD). Therefore, we investigated whether a strict LPD during the predialysis period affects peritoneal permeability.

Method

We retrospectively analyzed 37 patients that started PD in a single Japanese center. Patients were divided into group A and group B by the median amount of daily protein intake (PI) during the predialysis period using urine collected over 24 hours.

Results

There were no differences between groups A and B in age, gender, proportion of diabetic nephropathy, blood pressure, body mass index, or body surface area. There were also no differences between the groups in laboratory findings, including hematocrit, serum albumin, and serum creatinine. The PETs showed a significantly lower dialysate-to-plasma ratio of creatinine at 4 hours (Cr D/P) for group A than for group B ( p = 0.02). Furthermore, a significant positive correlation between Cr D/P and PI was observed ( r = 0.53, p < 0.01).

Conclusion

It is suggested that a strict LPD during the predialysis period may suppress peritoneal permeability at induction of PD.
An Original Non-Traumatic Maneuver for Repositioning Migrated Peritoneal Dialysis Catheters
Authors: Tu Wen-Ting , Su Zhen , Shan Yi-Sheng
Published: February 2020

Objective

To describe an original non-traumatic maneuver for repositioning a migrated peritoneal dialysis (PD) catheter.

Methods

First, tissues wrapping the PD catheter are dissociated, then a correct route is selected according to the position of the catheter, and finally the catheter is repositioned manually in 8 steps: pressing, palpating, vibrating, wave vibrating, rotating, back-pushing and vibrating, swaying, and compressing.

Results

Of 30 cases of PD catheter migration, repositioning was successful on the first attempt in 9 cases, on the third attempt in 10 cases, on the seventh attempt in 7 cases, and failed in 4 cases. The overall success rate was 86.7%.

Conclusion

Manual repositioning of a migrated PD catheter is safe, painless, economical, and feasible. Repositioning of the migrated dialysis catheter may be attempted before referral for more invasive interventions.
Computed Tomographic Findings Characteristic for Encapsulating Peritoneal Sclerosis: A Case-Control Study
Authors: Vlijm Anniek , Stoker Jaap , Bipat Shandra , Spijkerboer Anje M. , Phoa Saffire S.K.S. , Maes Robbert , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Background

Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS.

Methods

We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3).

Results

We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls ( p ≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3.

Conclusion

CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.
The Effect of Oral Niacinamide on Plasma Phosphorus Levels in Peritoneal Dialysis Patients
Authors: Young Daniel O. , Cheng Steven C. , Delmez James A. , Coyne Daniel W.
Published: February 2020

Background

Hyperphosphatemia remains a significant problem for patients requiring dialysis and is associated with increased mortality. Current treatment options include dietary restriction, dialysis, and phosphate binders. Treatment using the latter is frequently limited by cost, tolerability, and calcium loading. One open-label trial found niacinamide to be effective at decreasing serum phosphorus values in hemodialysis patients. Niacinamide may effectively reduce phosphorus levels in peritoneal dialysis (PD) patients already receiving standard phosphorus-lowering therapies.

Methods

An 8 week, randomized, double blind, placebo-controlled trial to evaluate the effectiveness of niacinamide to reduce plasma phosphorus levels in PD patients. Patients had to demonstrate a baseline phosphorus value > 4.9 mg/dL. Patients were randomized to niacinamide or placebo and prescribed 250 mg twice daily, with titration to 750 mg twice daily, as long as safety parameters were not violated. Phosphate binders, active vitamin D, and cinacalcet were kept constant during the study. The primary end point was change in plasma phosphorus. Secondary end points included changes in lipid parameters.

Results

15 patients started on the study drug (8 niacinamide, 7 placebo) and 7 in each arm had at least one on-study phosphorus measurement. The niacinamide treatment group experienced an average 0.7 ± 0.9 mg/dL decrease in plasma phosphorus and the placebo-treated group experienced an average 0.4 ± 0.8 mg/dL increase. The treatment effect difference (1.1 mg/dL) was significant ( p = 0.037). No significant changes in high- or low-density lipoproteins or triglycerides were demonstrated. Two of the 8 patients randomized to the niacinamide treatment arm had to withdraw from the study due to drug-related adverse effects. Adverse effects may limit the use of niacinamide in PD patients.

Conclusion

Niacinamide, when added to standard phosphorus-lowering therapies, resulted in a modest yet statistically significant reduction in plasma phosphorus levels at 8 weeks. [ClinicalTrials.gov number NCT00508885 (ClinicalTrials.gov)]
On Small Solute Clearance and Patient Outcomes: Evidential Practice or Observational Trepidation?
Authors: Vonesh Edward
Published: February 2020

Recent guidelines on peritoneal dialysis adequacy set a minimum target for small solute clearance at Kt/V urea 1.70. While evidence from both observational studies and randomized controlled trials (RCTs) supports such a minimum target, there continues to be debate over what role small solute clearance plays in determining patient outcome. Current ANZDATA Registry results from Australia and New Zealand add fuel to this debate by demonstrating a significant nonlinear U-shaped relationship between peritoneal small solute clearance and patient survival. The ANZDATA results indicate that patients with too low or too high peritoneal Kt/V urea may be at significant risk of death compared to those with a peritoneal Kt/V urea between 1.70 and 2.00. As these results are somewhat at odds with results from published RCTs, we will examine the level of evidence from the observational setting that is the ANZDATA Registry and contrast it against the level of evidence from RCTs, particularly the ADEMEX trial. New results from the ADEMEX study are presented as a possible explanation for the paradoxical U-shaped results seen in the ANZDATA study.
Peritoneal Small Solute Clearance is Nonlinearly Related to Patient Survival in the Australian and New Zealand Peritoneal Dialysis Patient Populations
Authors: Rumpsfeld Markus , McDonald Stephen P. , Johnson David W.
Published: February 2020

Background

The contribution of peritoneal small solute clearance per se to peritoneal dialysis (PD) patient outcomes remains uncertain. The aim of the present study was to determine whether baseline peritoneal small solute clearance predicted subsequent survival in Australian and New Zealand PD patients.

Methods

The study included all adult patients in Australia and New Zealand that commenced PD between 1 April 2002 and 31 December 2005 and had a peritoneal Kt/V (pKt/V) measurement performed within 6 months of PD commencement. Time to death and death-censored technique failure were examined by Kaplan–Meier analyses and both univariate and multivariate Cox proportional hazards models.

Results

pKt/V measurements were available in 2434 (63%) of the 3841 individuals that began PD treatment in Australia and New Zealand during the study period. These patients were divided into 4 groups according to their baseline pKt/V values: <1.45 ( n = 599), 1.45 – 1.69 ( n = 550), 1.70 – 2.00 ( n = 607), and >2.00 ( n = 678). Compared with the reference group (pKt/V 1.70 – 2.00), patient mortality was significantly increased in individuals with pKt/V <1.45 [adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.24 – 2.84; p = 0.003] and tended to be increased in those with pKt/V 1.45 – 1.69 (adjusted HR 1.46, 95% CI 0.96 – 2.21; p = 0.074). Importantly, higher pKt/V values (>2.00) also tended to be associated with higher mortality (adjusted HR 1.42, 95% CI 0.96 – 2.11; p = 0.079). The other independent predictors of death were lower residual renal function (RRF), older age, peripheral vascular disease, diabetes mellitus, late referral, higher peritoneal permeability, and untreated hypertension. No interaction was observed between pKt/V, RRF, and survival. Death-censored technique failure was demonstrated to be significantly worse in the pKt/V 1.45 – 1.69 group (adjusted HR 1.36, 95% CI 1.03 – 1.79; p = 0.028), older individuals, and individuals with Asian racial origin.

Conclusions

Initial peritoneal Kt/V significantly and independently influences patient survival in Australian and New Zealand PD patients. Overall survival appears to be optimal in the pKt/V range 1.70 – 2.00, with poorer outcomes observed above and below these values. In particular, survival is significantly worse when the achieved pKt/V is <1.45. In addition, RRF is an important independent predictor of patient survival in the Australian and New Zealand incident PD patient populations. The results of this study should therefore draw attention to the possible danger of not delivering adequate PD dose to patients with considerable RRF.
Intrinsic Cells: Mesothelial Cells — Central Players in Regulating Inflammation and Resolution
Authors: Yung Susan , Chan Tak Mao
Published: February 2020

Background

Preservation of the structural and functional integrity of the peritoneum is essential to maintain the dialytic efficacy of the peritoneal membrane. Although much improvement has been made to peritoneal dialysis (PD) fluids, they remain bioincompatible, and together with peritonitis, they continue to induce peritoneal inflammation and fibrosis.

Method

This article reviews the putative factors that mediate mesothelial cell inflammation during PD, and the mechanisms by which mesothelial cells attempt to regulate and resolve peritoneal inflammation.

Results

The mesothelium is the first line of defense to foreign particles and chemicals in the peritoneal cavity. Constant exposure of the mesothelium to the bioincompatible constituents of PD solutions results in denudation of the mesothelium and loss of the peritoneal cavity's protective layer. Detached mesothelial cells in PD solutions have the capacity to replenish the mesothelial layer through their ability to migrate and attach to areas of denudation. Mesothelial cells synthesize a plethora of growth factors, matrix proteins, and proteoglycans that aid in the reparative process and regulate the formation of chemotactic gradients that are essential for infiltration of leukocytes to sites of injury.

Conclusions

Far from being bystanders in peritoneal function, mesothelial cells have been shown to play a dynamic role in peritoneal homeostasis and immunoregulation. Studies have highlighted the potential use of mesothelial cells in gene therapy and cell transplantation, both of which may provide novel therapeutic strategies for the preservation of the peritoneum during PD.
An Experimental Model of Encapsulating Peritoneal Sclerosis
Authors: Sawada Tokihiko , Ishii Yasuo , Nakajima Ichiro , Fuchinoue Shohei , Kubota Keiichi , Teraoka Satoshi
Published: February 2020

In Japan, only about 3% of all patients with end-stage renal disease are maintained by continuous ambulatory peritoneal dialysis (CAPD). Although the reasons for the low proportion of patients receiving CAPD are multifactorial, encapsulating peritoneal sclerosis (EPS), a fatal complication of CAPD, is a major factor. In 1995 we developed a rat model of EPS, and in 2001 also developed an EPS model in mice. These rodent EPS models are reliable, reproducible, and inexpensive and have been used by other investigators. The renin–angiotensin system negatively regulates the transforming growth factor-beta signaling pathway, which plays a major role in tissue fibrosis. To investigate the anti-EPS effect of renin–angiotensin system inhibition, an angiotensin-converting enzyme inhibitor, quinapril, was administered to an EPS model in mice. Quinapril was found to inhibit EPS, both macro- and microscopically, in a dose-dependent manner. We report our experience of developing the experimental in vivo EPS model, and the inhibitory effect of this angiotensin-converting enzyme inhibitor on EPS.
Monitoring Clinical Standards in a Chronic Peritoneal Dialysis Program
Authors: Leung Dora K.C.
Published: February 2020

Multiple factors may influence the effectiveness of a chronic peritoneal dialysis program. Continuous monitoring of various aspects of clinical standards with reviews enhances opportunities for bridging the gap between existing practice and good practice, and good practice to best practice.
Improving Technique Survival in Peritoneal Dialysis: What is Modifiable?
Authors: Ersoy F. Fevzi
Published: February 2020

The continuous quality improvement approach in peritoneal dialysis practice necessitates definition of the factors and the procedures that may possibly be contributing to the final success of peritoneal dialysis. The philosophy of continuous quality improvement uses the Plan, Do, Check, Act (PDCA) cycle. To improve the procedures used during peritoneal dialysis, the first step is to create a plan, then to carry out the plan, to check it, and after the collection of satisfactory information, to execute the chosen improvement action.

Several studies have identified the most frequent causes of transfer from PD to HD as infection, catheter problems, inadequate dialysis, and psychosocial factors, among others. According to training guidelines from the International Society for Peritoneal Dialysis, seven points are of major importance to decrease infection risks: exit-site care, catheter placement, antibiotic prophylaxis for procedures, prevention of bowel-source peritonitis, prevention of fungal peritonitis, and connection methods. On the other hand, other factors such as hypoalbuminemia, depression, and obesity should also be taken into consideration for better technique survival in peritoneal dialysis patients.
Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?
Authors: Xu Ying , Dong Jie , Zuo Li
Published: February 2020

Objective

In a single-center retrospective cohort study, we investigated whether the frequency of clinic patient–physician contact (PPC) correlates with quality of care and can predict outcome in peritoneal dialysis (PD) patients.

Patients and Methods

We enrolled 307 incident PD patients who started PD from July 2002 to February 2007. All patients who visited the clinic at least once every 6 months and who lived for at least 6 months were followed until death, transfer to hemodialysis, renal transplantation, or February 2008 (censor date). Throughout the study period, an integrative follow-up strategy was used, including PPC and three other modes of contact between patients and non-physicians. Patients’ PPC frequency was divided into 3 categories: high frequency (monthly or more often), intermediate frequency (every 1 – 3 months), and low frequency (every 3 – 6 months). Baseline demographic and biochemical data were collected. Indices of diet, dialysis adequacy, biochemistry, and nutrition were measured at every visit and then calculated as mean values.

Results

We followed the 307 patients for a mean of 31.45 ± 13.62 months (range: 12 – 64 months). By PPC frequency, 127 patients (41.3%) were in the high-frequency group; 136 (44.3%), in the intermediate-frequency group; and 44 (14.3%), in the low-frequency group. We observed no difference of baseline demographic and biochemical data between the three groups ( p > 0.05). Patients in the low-frequency group had lower mean hemoglobin and total urea clearance rates, but higher serum phosphate than did patients in the intermediate- or high-frequency groups ( p < 0.05). Mean indices of nutrition, including serum albumin, daily protein and energy intake, and lean body mass were not different between the three groups ( p > 0.05). Frequency of PPC did not show an effect on the survival of PD patients ( p = 0.37 by Kaplan–Meier plot). Age ( p = 0.002), Charlson comorbidity score ( p = 0.001), and pre-dialysis albumin ( p = 0.019) were independent negative risk factors for death in multivariate Cox proportional hazard models, which were adjusted for sex, PPC frequency, baseline hemoglobin, and glomerular filtration rate.

Conclusions

Frequency of PPC did not predict outcome in PD patients after an integrative care strategy was implemented. Control of anemia and hyperphosphatemia needs to be strengthened in patients with a low frequency of PPC.
Optimal Use of Peritoneal Dialysis in Patients with Diabetes
Authors: Chung Sung Hee , Noh Hyunjin , Ha Hunjoo , Lee Hi Bahl
Published: February 2020

The survival of patients with end-stage renal disease (ESRD) resulting from diabetes continues to improve, but the survival rate among diabetic ESRD patients remains the lowest among all primary diagnoses probably because of the higher prevalence of cardiovascular comorbidity associated with diabetes. Diabetes, age, and comorbidity all significantly modify the effect of treatment modality on patient survival.

As compared with hemodialysis (HD), peritoneal dialysis (PD) offers an equal or lower risk of death across all subgroups during the first 1 – 2 years of dialysis. The association of PD with better outcomes than are seen with HD is probably a result of a lower prevalence of infections and congestive heart failure and better preservation of residual renal function (RRF) in PD patients.

Use of angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) helps to preserve RRF in ESRD patients and to maintain peritoneal membrane integrity longer in PD patients. Antioxidants can also support preservation of peritoneal membrane function.

Peritoneal dialysis should be the initial modality of dialysis in all ESRD patients. Older patients (age ≥ 45 years) with diabetes and patients without diabetes may switch to HD or receive a kidney graft in 1 – 2 years’ time; younger patients (age < 45 years) with diabetes may stay on PD longer. Use of ACEI and ARB or antioxidants can help to maintain peritoneal membrane function longer.
Tuberculous Peritonitis
Authors: Akpolat Tekin
Published: February 2020

Compared with the general population, dialysis patients are at higher risk of acquiring mycobacterial infections. The aim of the present article is to review case reports and studies published since the report by Talwani and Horvath (2000) and to discuss the main problems that arise in daily practice. After a comprehensive review of the literature, cumulative data about peritoneal dialysis and peritoneal tuberculosis from reports of 98 patients in 21 papers were analyzed.

The clinical and laboratory findings of peritoneal tuberculosis are nonspecific. Diagnosis requires a high index of suspicion. The most difficult cases present as culture-negative peritonitis or culture-positive peritonitis resistant to appropriate antibiotics without any additional clues of tuberculosis. The sensitivity of smears and cultures can be enhanced by centrifuging a 50 – 150 mL dialysate sample.
Monitoring Cardiovascular Risk Factors in Children on Dialysis
Authors: Shroff Rukshana
Published: February 2020

Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). Structural and functional vascular abnormalities and arterial calcification begin early in the course of renal decline and can be found even in children, contributing to their high mortality risk. Here, I discuss the burden of CVD in children with CKD; currently available methods of monitoring cardiac and vascular damage; the sensitivity of monitoring methods; and whether there is a need for regular monitoring in children with CKD.
Prevention of Peritonitis in Children: Emerging Concepts
Authors: Bakkaloglu Sevcan A.
Published: February 2020

Peritoneal dialysis (PD) is the modality of choice for pediatric patients in all over the world. Peritonitis, still the main complication of PD, causes significant morbidity and mortality. Therefore, prevention of peritonitis is of particular importance. Pre-implantation antibiotic prophylaxis, catheter-related interventions (catheter selection, implantation technique, exit-site orientation), acute and chronic exit-site care (dressing protocols and application of an exit-site antibiotic such as mupirocin or gentamicin), antifungal prophylaxis during peritonitis, contamination protocols and prevention of touch contamination, patient and trainer training, tracking and root-cause analysis of infections, and continuous quality improvement programs are all essential for the prevention of peritonitis episodes. In the present review, all those issues and emerging concepts are discussed.
Peritoneal Defense Mechanisms—the Effects of New Peritoneal Dialysis Solutions
Authors: Kazancioglu Rumeyza
Published: February 2020

It remains to be determined whether the peritoneal dialysis procedure induces abnormalities in the normal host defenses of the abdominal cavity and whether these perturbations are important in the pathogenesis of peritonitis. The peritoneum is a smooth membrane that lines the abdominal cavity and participates in the diffusion of water and solutes during peritoneal dialysis. The diaphragmatic lymphatic uptake and the opsonization of micro-organisms, with phagocytosis and killing by peritoneal macrophages, mesothelial cells, lymphocytes, polymorphonuclear leukocytes, and newly defined proteins such as defensins, play a combined role in the peritoneal host defense. Because the composition of earlier peritoneal dialysis fluids is clearly non-physiologic, continuous exposure of peritoneal cells to these solutions may result in an impairment of the local peritoneal host defense mechanisms. However, with the newer solutions, it has been shown that peritoneal defense mechanisms may improve.
Peritoneal Dialysis in Anuric Patients: Old Problems and New Perspectives
Authors: Rodrigues Anabela S.
Published: February 2020

Anuric patients are often excluded from peritoneal dialysis (PD) because of the fear that PD is inadequate to treat this higher-risk group of patients. However, advances in PD knowledge and technique allow better and adjusted treatments. There is now clinical evidence that anuric patients can be successfully treated with PD, while new solutions promise to mitigate some limitations of automated PD, such as sodium and fluid removal and preservation of membrane function.
Histological and Functional Characteristics of the Peritoneal Membrane of a Diabetic Patient after 34 Months of CAPD
Authors: Sorkin Michael I. , Luger Alan M. , Prowant Barbara , Kennedy Juanita , Moore Harold , Nolph Karl D.
Published: February 2020

This report describes the course of a 37-year-old man with diabetic nephropathy over 34 months of CAPD. These data suggest that the functional characteristics and the histology of the peritoneum were not altered by CAPD or repeate4 episodes of peritonitis up to the time of his death from an acute myocardial infarction.
Management of a Massive Hydrothorax in a CAPD Patient: A Case Report and a Review of the Literature
Authors: Yves Rudi Scheldewaert , Bogaerts  , Pauwels Romain , Van Der Straeten Marcel , Ringoir Severin , Lameire Norbert
Published: February 2020

A 51-year-old woman presented with a massive right-sided hydrothorax after 84 days on CAPD. The presence of dialysate in the right pleural cavity was demonstrated by the recovery from the fluid of intraperitoneal methylene blue injected into the peritoneal space. Talcage of the pleura was partly successful in preventing recurrence of the pleural fluid and CAPD was continued without further major problems. This paper has discussed the pathophysiology and treatment of this serious complication of CAPD.
The Employment of Medical Students in the Peritoneal Dialysis Program at the University of Naples during the Years 1973-1981
Authors: Giordano Carmelo , De Santo Natale G. , Capodicasa Giuseppe
Published: February 2020

Medical students participated in the peritoneal dialysis program at the Ist Medical Faculty of the University of Naples. In this way, they learned medicine at the bedside and, while preparing their MD thesis, were taught to monitor in the laboratory the effects of therapy. This program, which combined student training, patient care and research seems most suitable for peritoneal dialysis programs at university hospitals.
Comparison of Psychological Adjustment to Continuous Ambulatory Peritoneal Dialysis and Home Hemodialysis
Authors: Burton Howard J. , De-Nour Atara Kaplan , Conley John A. , Wells George A. , Wais Lokky
Published: February 2020

Two groups of home dialysis patients (40 on CAPD and 37 on home hemo dialysis) matched for length of time on dialysis, and for demographic background were studied and compared. The CAPD patients were significantly more satisfied with the support received from household members and from spouses, more satisfied with the relations with spouses, more understood by them and more understanding of their spouses. Sexual satisfaction declined in both groups. However, sexual satisfaction was slightly higher in the CAPD group and these patients experienced slightly less difficulty in adjusting to the decline; none of these differences were statistically significant.
Effect of Peritoneal Dialysis Fluid on Ventilatory Function
Authors: Epstein Stanley W , Inouye Tetsuo , Robson Michael , Oreopoulos Dimitrios G
Published: February 2020

Lung function was measured in eight patients undergoing continuous ambulatory peritoneal dialysis using two litres of dialysate fluid and in one patient using three litres of fluid. With the patient sitting, lung volumes were measured by body plethysmographic and helium dilution techniques and a forced vital capacity, before and after removal of dialysate fluid from the abdominal cavity. The patients selected were free of lung disease and were at stable dry weight. No significant difference was found in maximum expiratory flow rates or lung volumes measured by the body plethysmography after removal of the fluid. However, the helium dilution technique showed changes in lung volumes; here the functional residual capacity was increased by 590 ml (SE 209 ml, p < 0.05) in the eight patients using two litres of fluid. Others have reported similar findings in patients on continuous ambulatory peritoneal dialysis. The findings suggest that the introduction of fluid into the peritoneal cavity has no detrimental effect on diaphragmatic configuration and function.
Management of the Diabetic Patients with End Stage Renal Disease
Authors: Amair Pablo , Khanna Ramesh , Leibel Bernard , Pierratos Andreas , Vas Stephen , Meema Erik , Blair Gordon , Chisholm Lionel , Vas Magdalene , Zingg Walter , Digenis George , Oreopoulos Dimitrios
Published: February 2020

Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar Even though creatinine clearance decreased significantly (P = 0.001), contro of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04 respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months a rate similar to that observed in nondiabetics. The calculated survival rate was 92 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent.
Intermittent Peritoneal Dialysis in the Treatment of Diabetics with End-stage Renal Disease
Authors: Karanicolas Stavros , Thompson Douglas
Published: February 2020

Intermittent peritoneal dialysis (IPD) in diabetics has varied outcomes. Sixteen patients with end-stage renal disease and diabetes were treated with IPD during the last four years at St. Joseph's Hospital. Patients received subcutaneous insulin besides small amounts intraperitoneally on the days of dialysis. One-year patient survival was 48%. Blood pressure, serum potassium, fluid and blood sugar control was poor compared to CAPD. However, for patients who can not be placed on CAPD, IPD still has its role. For this reason we should continue our efforts to improve the effectiveness of this mode of peritoneal dialysis.
Concerns of the Diabetic Patient on CAPD
Authors: Singh Vara , Saiphoo Carl , Oreopoulos Dimitrios
Published: February 2020

Twenty-three diabetics with endstage renal disease on various forms of chronic peritoneal dialysis were interviewed. All of them had symptoms of neuropathy of varying degree and 17 were complaining of muscular weakness. At the time of the interview, only six patients were sexually active while the remaining 17 had been inactive for periods ranging from two months to 10 years. There was a trend to a decline in sexual activity after commencement of dialysis. We recommend that the routine follow-up of these patients include regular interviews by trained sex counsellors.
Electrophysiologic Studies in Peripheral Nerves of Diabetics Undergoing CAPD
Authors: Blair R.D. Gordon
Published: February 2020

Serial electrophysiologic studies of the peripheral nerves of 12 diabetics maintained on CAPD for one year or more showed no evidence of progression of neuropathy. These findings support the view that CAPD is a reliable method for the treatment of diabetics with end-stage renal disease.
Peritoneoscopic Placement of the Tenckhoff Catheter: Further Clinical Experience
Authors: Ash Stephen R. , Handt Alan E. , Bloch Richard
Published: February 2020

In the past two and one-half years, 80 Tenckhoff peritoneal catheters have been placed by peritoneoscopic technique using a Needlescope R with a surrounding catheter guide. Peritoneoscopic inspection of the abdomen (after filling with one liter of air), allows placement of the catheter guide in a space free of omental involvement or adhesions. The catheter guide then allows the same small hole used for peritoneoscopy to be gently enlarged to the Tenckhoff catheter size. Of the 80 catheters placed, only three have encountered early failure, one of which was corrected by repositioning (3% early failure rate). Follow-up of catheters placed in chronic dialysis patients showed a half life of 17 months (by actuarial table). Late problems of cuff erosion, outflow obstruction after peritonitis, and cuff infection occur as with Tenckhoff catheters placed by standard techniques. Our experience indicates that early success of the Tenckhoff catheter is improved by peritoneoscopic placement.
Penicillium Peritonitis in a CAPO Patient
Authors: Pearson John G. , McKinney T. Dwight , Stone William J.
Published: February 2020

Penicillium peritonitis developed in a CAPD patient who employed poor sterile technique in performing exchanges. Previous antibiotic therapy may have played a contributing role. Physicians caring for CAPD patients should be alerted that fungal colonies and strands may mimic fibrin in CAPD catheters. Early removal of the catheter, which is the treatment of choice, quickly reversed our patient's peritonitis.
A Review of Intraperitoneal Therapy of Human Ovarian Carcinoma
Authors: Knapp Robert C. , Knapp Robert C. , John Elena St. , Bast Robert C.
Published: February 2020

Ovarian carcinoma disseminates by direct seeding throughout the peritoneal cavity. It involves surfaces of the abdominal viscera, as well as the diaphragm. Epithelial ovarian carcinoma responds to multiple-agent chemotherapy, if tumor implants are reduced to 1.5 cm in any single location by cytoreductive surgery. Greater antitumor activity than that achieved by systemic administration may be obtained by increasing the dose and getting high concentrations of the chemotherapeutic agent directly to the site of the residual tumor. Oncologists have administered adriamycin into the peritoneal space using a permanent peritoneal dialysis catheter. Adriamycin added into two liters of dialysis solution can reach concentrations up to 400 times greater than those in plasma. The factor which limits the dose of intraperitoneal adriamycin is chemical peritonitis. Recently investigators have infused cis-diammine dichloro-platinum (CDDP) via the dialysis catheter. With this agent, four patients of 18 who had failed previous chemotherapy, showed an objective response. Finally, Corynebacterium parvum has also been administered intraperitoneally via the dialysis catheter. The permanent peritoneal catheter has at least two advantages: First, it permits intraperitoneal administration of the various chemotherapeutic agents, and second it permits easy sampling of the dialysis fluid for cytological analysis and for measurement of the peritoneal inflammatory activity, using antibody-dependent cell-mediated cytotoxicity assay. A new study now in progress will test the effect of recombinant interferon administered intraperitoneally to patients with ovarian cancer.