bluuebunny/crossref_metadata_2025 huggingface dataset:
Are We Underestimating the Problem of Ultrafiltration in Peritoneal Dialysis Patients?
Authors: McCafferty Kieran , Fan Stanley L.-S.
Published: February 2020

Background

Accurate measurement of ultrafiltration (UF) is important to improve the morbidity and mortality of peritoneal dialysis (PD) patients. The introduction of “flush-before-fill” PD systems has led to improved peritonitis rates. Partly to compensate for dialysate lost during flush-before-fill, extra dialysate was added to each PD bag. A 2-L PD bag now contains a mean volume of 2.225 L. That overfill volume might be erroneously measured as UF. We previously studied how this confounding factor might be affecting the diagnosis of UF failure and found that almost all units were overestimating daily UF by 900 mL. We now repeat the study to determine if the accuracy of UF estimation has improved.

Methods

We conducted a telephone survey of PD units in the UK to determine how drain bags are weighed and how UF is calculated during formal assessment of adequacy and the peritoneal equilibrium test (PET). We also retrospectively analyzed our last 100, 24-hour dialysate collections and PET results to determine the potential clinical impact of overestimating UF.

Results

There has been an improvement since our last study, but 70% of PD units in the UK are still overestimating daily UF in patients on continuous ambulatory PD (CAPD). Half the surveyed units also inaccurately calculate UF during the PET, and 85% were reporting results of PET and 24-hour dialysate collections through the software provided by Baxter Healthcare. By including the overfill volume, 73% of patients with daily UF <750 mL would not be diagnosed as having inadequate daily UF (assuming that all were fluid overloaded and anuric). Similarly, 73% with potential UF failure during the PET (4-hour UF <100 mL) would be missed if overfill volume was misrepresented as UF.

Conclusion

For patients undergoing CAPD, there requires standardization on when drain bags are weighed. Awareness that calculation of UF must exclude overfill volumes has improved but remains poor. The PD Adequest software (Baxter Healthcare, Compton, UK) is widely adopted in the UK and perhaps it could draw attention of users to the potential of UF overestimation in CAPD patients.
Inflammation and Extracellular Volume Expansion are Related to Sodium and Water Removal in Patients on Peritoneal Dialysis
Authors: Ávila-Díaz Marcela , Ventura María-de-Jesús , Valle Delfilia , Vicenté-Martínez Marlén , García-González Zuzel , Cisneros Alejandra , Furlong María-del-Carmen , Gómez Ana María , Prado-Uribe María-del-Carmen , Amato Dante , Paniagua Ramón
Published: February 2020

Background

Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce.

Objectives

To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions.

Design

A prospective, multicenter cross-sectional study in six hospitals with a PD program.

Patients and Methods

Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured.

Results

CRP values positive (≥ 3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 ± 0.69 vs 47.36 ± 0.65, men 43.15 ± 1.14 vs 42.84 ± 0.65; p < 0.05), higher serum glucose (125.09 ± 81.90 vs 103.28 ± 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 ± 0.54 vs 3.17 ± 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 ± 645 vs 1323 ± 413 mL/day, p < 0.005) and total fluid removal (1260 ± 648 vs 1648 ± 496 mL/day, p < 0.001), and less peritoneal (15.59 ± 162.14 vs 78.11 ± 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 ± 142.49 vs 118.60 ± 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly ( p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal ( r = 0.16, p < 0.03) and renal sodium removal ( r = 0.2, p < 0.01).

Conclusion

The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.
World Trend of Peritoneal Dialysis Publications
Authors: Chen Tzen-Wen , Chou Li-Fang , Chen Tzeng-Ji
Published: February 2020

Objectives

To analyze the trend of global peritoneal dialysis (PD) publications, especially of publications in Peritoneal Dialysis International ( PDI), from 1991 to 2005 according to the Institute for Scientific Information databases of the Thomson Corporation.

Methods

Data were downloaded from the Web of Science, which includes the databases of Science Citation Index Expanded and Social Sciences Citation Index. The searching strategies were key-in of “peritoneal dialysis” in general search and of “SO=Peritoneal Dialysis International” in advanced search. Only articles and reviews were included in the analysis. The analysis was stratified by publication year, journal, author, country of each author's affiliation, and citation count of each paper.

Results

There were 7618 PD papers (6991 articles and 627 reviews) in 887 journals; 15.8% of them ( n = 1204) were published in PDI. The annual outputs of global PD publications has been more than 500 papers since 1996, with a peak of 665 articles in 2003. In total, 18531 authors from 102 countries and areas contributed to PD publications. Authors from the USA were present in 30.6% of all papers although their global share decreased with time. A PD paper received an average of 12.7 citations. A review received more citations than an article (17.0 vs 12.3 on average), yet statistical significance was not reached ( p = 0.216, Mann–Whitney U test).

Conclusions

The number of PD research societies in the world has been growing during the past 15 years. More and more research is from countries other than the USA and the United Kingdom. Papers on PD have thus been published in many journals other than PDI, the leading journal in PD. However, the growth rate of PD publications in the world is diminishing. We present here the most likely reasons for the decrease in PD publications and propose suggestions for PDI to keep its leading role in the development of PD.
Use of Icodextrin during Nocturnal Automated Peritoneal Dialysis Allows Sustained Ultrafiltration While Reducing the Peritoneal Glucose Load: A Randomized Crossover Study
Authors: Rodríguez-Carmona Ana , Fontán Miguel Pérez , López Elvia García , Falcón Teresa García , Cambre Helena Díaz
Published: February 2020

Background

Optimization of ultrafiltration and preservation of the peritoneal membrane are desirable objectives in peritoneal dialysis (PD) patients. Mixtures of glucose-and non-glucose-based solutions may help to meet both targets simultaneously.

Aim

To analyze the effects, in terms of ultrafiltration and peritoneal glucose load, of including icodextrin-based dialysate in the nocturnal schedule of patients undergoing automated PD (APD).

Method

Following a randomized crossover design, 17 APD patients underwent two 10-day study periods under identical prescription (including amino acid-based solution for the night schedule), except for the substitution of 2 L glucose-based dialysate in the nocturnal mixture (control) by a similar amount of icodextrin-based dialysate (icodextrin phase) in one period. Dependent variables included ultra-filtration, sodium removal, peritoneal glucose load, and residual renal function. We measured serum and urine levels of icodextrin metabolites at the end of each phase.

Results

Ultrafiltration was marginally higher during the icodextrin phase (median 815 vs 763 mL/day, p = 0.07), while peritoneal sodium removal was similar in both phases (74 vs 71 mmol/L/day). Peritoneal glucose load (median 67.5 vs 104.0 g/day, p < 0.005) and absorption (14.0 vs 35.6 g/day, p < 0.005) were lower during the icodextrin phase. Diuresis was also modestly lower during the icodextrin phase (500 vs 600 mL/day, p < 0.05). Serum levels of icodextrin metabolites were moderately higher in the icodextrin phase ( p < 0.005) in patients both on and off diurnal icodextrin.

Conclusion

Inclusion of amino acid- and icodextrin-based solutions in the nocturnal schedule of APD patients may allow sustained ultrafiltration and sodium removal while significantly reducing the peritoneal glucose load in these patients.
History of Peritoneal Dialysis in Latin America
Authors: Riella Miguel C. , Locatelli Alberto J.
Published: February 2020

Latin America is a region formed by a number of countries of Latin heritage in which the common languages spoken are Spanish and Portuguese. Latin America was not isolated from the evolution of peritoneal dialysis (PD) throughout the rest of the world, as evidenced by the fact that, between the 1940s and the 1960s, PD was used to treat acute renal failure patients and later for the intermittent treatment of end-stage renal failure patients. The true development of PD took place toward the end of the 1970s and beginning of the 1980s with the introduction of continuous ambulatory peritoneal dialysis (CAPD).

It is evident that the introduction of CAPD in most countries was a result of the personal effort and interest of individuals or groups of nephrologists. Initially, PD was not always implemented under ideal circumstances; locally manufactured, improvised supplies were associated with poor results. The arrival of companies with appropriate equipment and supplies led to widespread dissemination of this new modality. Furthermore, regulations and reimbursement by health authorities were additional obstacles.

It is clear that PD in Latin America is still largely utilized to treat acute renal failure patients, particularly in countries where hemodialysis is not readily available. It is still employed intermittently to manage end-stage renal failure patients when hemodialysis is not available. With the exception of Colombia and Mexico, CAPD penetration is below 10%.

While CAPD is nonexistent in certain countries, such as Cuba, due to lack of supplies, in other countries, such as Chile, it is restricted to patients that cannot be placed or continued on hemodialysis, those for example who lack vascular access, or those from remote rural areas. In addition, automated PD is relatively more costly and is therefore restricted in some countries.
Effects of Ionized Sodium Concentrations on Ultrafiltration Rate in Peritoneal Dialysis Using Lactate and Lactate/Bicarbonate Solutions
Authors: La Milia Vincenzo , Limardo Monica , Crepaldi Monica , Locatelli Francesco
Published: February 2020

Objective

To investigate the possible effects of different concentrations of ionized sodium (NaI) on peritoneal ultrafiltration (UF) rate using lactate (Lac) and lactate/bicarbonate (Lac/Bic) dialysis solutions.

Design

Two random consecutive (after an interval of 48 hours) peritoneal equilibration tests (PETs) were performed in 13 patients (4 males and 9 females) on regular continuous ambulatory peritoneal dialysis (PD) treatment for at least 3 months. Two different PD solutions containing anhydrous glucose 3.86% were used: a 40 mmol/L Lac solution and a 15/25 mmol/L mixed Lac/Bic solution. Concentrations of total sodium (NaT) and NaI were measured by flame photometer and direct ion-selective electrode respectively.

Results

Dialysate concentrations of NaT were not different during PETs using Lac and Lac/Bic. Dialysate concentrations of NaI in fresh PD solutions were different (133.3 ± 1.7 vs 128.2 ± 3.9 mmol, p < 0.0001); however, these differences disappeared just after the end of the infusion of the fresh solutions. Peritoneal UF rate was not significantly different during PETs using Lac versus Lac/Bic (609 ± 301 mL vs 542 ± 362 mL). The dialysate-to-plasma ratios of sodium concentrations at 60 minutes of the PETs (which are expressions of free water transport) were not different using Lac versus Lac/Bic (0.89 ± 0.04 vs 0.89 ± 0.04 respectively, p = 0.96). All the other classical parameters of the PET were not different between Lac and Lac/Bic.

Conclusions

The higher dialysate concentrations of NaI due to lower dialysate pH and consequently the higher effective osmolality of the fresh Lac PD solutions did not influence peritoneal UF rate, probably because of the fast reduction of NaI concentrations due to rapid correction of dialysate pH at the end of the infusion of Lac solutions into the peritoneal cavity.
Skin Color is Associated with Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients
Authors: Chen Hung-Yuan , Kao Tze-Wah , Chiu Yen-Lin , Huang Jenq-Wen , Lai Chun-Fu , Tsai Tsen-Fang , Chu Tzong-Shinn , Wu Kwan-Dun
Published: February 2020

Background

Changes in skin color are common among dialysis patients. They are associated with urochrome pigments, hemoglobin, and changes in cutaneous vasculature. Insulin resistance (IR) is strongly linked to cutaneous vascular dysfunction and is prevalent in dialysis patients. We postulated skin color may be associated with IR in dialysis patients because of the alternation in cutaneous vasculature.

Methods

50 nondiabetic peritoneal dialysis (PD) patients were recruited for measurements of skin color by the Commission Internationale de I'Eclairage (CIE; International Commission on Illumination) system (“L” “a” “b” system). The “L” values represent skin brightness, “a” redness, and “b” yellowness. Correlation analysis between skin color, homeostatic model assessment (HOMAIR), high-density lipoprotein cholesterol (HDL-C), and adiponectin was performed.

Results

We divided patients (age 45 ± 13 years, 31 women) into 3 groups according to tertiles of HOMAIR. Patients with higher HOMAIR had a trend to have poor skin color (lower “a” and “b” values; p = 0.038 and 0.064). HOMAIR, adiponectin, and HDL-C levels were correlated with “a” and “b” values in logarithm (all p < 0.05). After adjustments for age, hemoglobin level, duration of PD, and residual renal glomerular filtration rate, only HOMAIR was associated with “a” values ( p = 0.038) and HDL-C was associated with “b” values ( p = 0.048) in logarithm.

Conclusions

Skin color, measured noninvasively, is associated with HOMAIR and HDL-C. Nondiabetic PD patients that had more severe IR had worse skin color.
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Peritoneal Dialysis: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Akbari Ayub , Knoll Greg , Ferguson Dean , McCormick Brendan , Davis Alexandra , Biyani Mohan
Published: February 2020

Background

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in clinical practice. The safety and efficacy of these agents in peritoneal dialysis (PD) patients are unclear.

Objectives

We conducted a systematic review to study the safety and efficacy of ACEI and ARB use in PD patients. Primary outcome measures were mortality and cardiovascular (CV) events; secondary outcome measures were renal function, proteinuria, hyperkalemia, and erythropoietin requirement at 3 months.

Methods

We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, trial registry Web sites, reference lists of eligible and review articles, as well as abstracts from the American Society of Nephrology and Canadian Society of Nephrology meetings. To be eligible, studies had to be randomized controlled trials that allocated PD patients to ACEI and ARB use or to placebo or other antihypertensive medications, included adult patients, and reported on at least one of the outcome measures.

Results

418 citations were identified. Four met the eligibility criteria. Three examined CV events and mortality, of which two studies did not have any events. The third showed no statistically significant difference between control and treatment groups in either CV events or mortality: odds ratio 1.56 [95% confidence interval (CI) 0.24 – 10.05] for mortality and odds ratio 1.00 (95% CI 0.19 – 5.40) for CV events. Two studies reported renal function at 12 months and the weighted mean difference was 0.91 mL/minute/1.73 m2 (95% CI 0.14 – 1.68), favoring ACEI and ARB use.

Conclusions

In PD patients, evidence for the use of ACEIs and ARBs for reduction of mortality and CV events is lacking. Limited data suggest that they slow the loss of residual renal function.
Biocompatibility and Tolerability of a Purely Bicarbonate-Buffered Peritoneal Dialysis Solution
Authors: Weiss Lars , Stegmayr Bernd , Malmsten Gudrun , Tejde Mattias , Hadimeri Henrik , Siegert Carl E. , Ahlmén Jarl , Larsson Rutger , Ingman Bo , Simonsen Ole , van Hamersvelt Henk W. , Johansson Ann C. , Hylander Britta , Mayr Michael , Nilsson Per-Henrik , Andersson Per O. , De los Ríos Tatiana
Published: February 2020

Background

Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo.

Methods

This study was an open label, prospective, crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution (bicPDF) by measuring biocompatibility parameters such as cancer antigen 125 (CA125) in peritoneal effluent. 55 patients were enrolled in the study. After a 2-week run-in phase, 53 patients could be randomized into 2 groups, starting with either standard lactate-buffered peritoneal dialysis fluid (SPDF) for 12 weeks (phase 1) and then switching to bicPDF for 12 weeks (phase 2), or vice versa. Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125, hyaluronic acid, vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interferon gamma (IFNγ), and transforming growth factor-beta1 (TGF-β1). Total ultrafiltration and residual renal function were also assessed. At the end of the study, pain during fluid exchange and dwell was evaluated using special questionnaires.

Results

34 patients completed the study; 27 of them provided data for analysis of the biocompatibility parameters. CA125 levels in overnight effluent were significantly higher with bicPDF (61.9 ± 33.2 U/L) than with SPDF (18.6 ± 18.2 U/L, p < 0.001). Hyaluronic acid levels were significantly lower after the use of bicPDF (185.0 ± 119.6 ng/mL) than after SPDF (257.4 ± 174.0 ng/mL, p = 0.013). Both TNF-α and TGF-β1 showed higher levels with the use of bicPDF than with SPDF. No differences were observed for IL-6, VEGF, or IFNγ levels. We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss. Pain scores could be analyzed in 23 patients: there was no difference between the solutions.

Conclusions

The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured, suggesting an improvement in peritoneal membrane integrity. Additionally, it seems to have a positive effect on residual renal function.
Taming Apoptosis in Peritoneal Dialysis
Authors: Santamaria Beatriz , Ucero Alvaro Conrado , Benito–Martin Alberto , Selgas Rafael , Ruiz–Ortega Marta , Sanz Ana B. , Egido Jesús , Ortiz Alberto
Published: February 2020

Excessive, insufficient, or untimely apoptosis may result in disorders of cell numbers. Peritoneal demesothelization is an example of disease by decreased cell number; untimely leukocyte apoptosis impairs peritoneal defense. Conventional peritoneal dialysis solutions accelerate neutrophil apoptosis. Glucose degradation products such as 3,4-dideoxyglucosone-3-ene (3,4-DGE) decisively contribute to apoptosis induced by these solutions, in both leukocytes and mesothelial cells and in both culture and peritoneal dialysis patients. Pan-caspase inhibition retards neutrophil apoptosis and improves peritoneal clearance of Staphylococcus aureus in animal models. However, regulation of apoptosis in mesothelial cells is more complex than in leukocytes, and caspase inhibitors may not be the optimal drugs to modulate apoptosis in these cells. In this regard, Bax antagonistic peptides protect mesothelial cells from 3,4-DGE. In addition, novel molecular targets have been identified. Short-term modulation of apoptosis may be useful to accelerate recovery and to prevent irreversible peritoneal injury following peritonitis.
Long-Term Outcomes in Automated Peritoneal Dialysis: Similar or Better than in Continuous Ambulatory Peritoneal Dialysis?
Authors: Mehrotra Rajnish
Published: February 2020

In many parts of the world, a progressively larger proportion of chronic peritoneal dialysis (PD) patients are being treated with automated PD (APD). Increasingly, the decision to use APD is being dictated by patient and physician preference rather than being based on medical considerations. It is important to determine if the PD modality has any effect on long-term patient outcomes. Studies examining the effects of APD on residual renal function have been inconsistent, and the effect of cycler use on native renal clearances, if any, is small and probably not clinically significant. The preponderance of the evidence suggests that peritonitis rates are somewhat lower in APD patients than in patients treated with continuous ambulatory PD (CAPD). Two of three recent studies indicated that the risk for transfer to maintenance hemodialysis may be lower in APD patients, particularly in the early period after starting chronic PD. However, the risk for death in patients treated with CAPD and APD appears to be similar in most of the studies that have looked at that question. In summary, the long-term outcomes of CAPD and APD appear to be similar, and patient and physician preference are likely to increase the utilization of APD in many parts of the world.
Optimal Referral to Pre-Dialysis Services: One Center's Experience
Authors: Heatley Susan Ann
Published: February 2020

The number of patients receiving renal replacement therapy in the United Kingdom is rapidly rising. Chronic kidney disease (CKD) is a worldwide public health problem with significant comorbidity and mortality. Several organizational guidelines have been developed in an attempt to identify when appropriate referral to nephrology services should occur; however, many of these guidelines provide conflicting recommendations on referral. Recent surveys suggest that more than 30% of patients with CKD are referred later than the ideal. Late referral of patients with CKD is associated with increased patient morbidity and mortality, increased need for and duration of hospital admission, and increased initial costs of care following commencement of dialysis. Benefits of early referral include the identification and treatment of reversible causes of renal impairment and management of the multiple coexisting conditions associated with CKD. Referral time also affects the choice of modality of treatment.

Patients and their families should receive sufficient information regarding the nature of their CKD and options for treatment so that they can make informed decisions concerning their care. Literature addressing the timing of referral to low-clearance or pre-dialysis clinics is limited. Existing data suggest that such clinics and patient education programs may improve the medical care of patients, promote greater patient involvement in the selection of the mode of dialysis, reduce the need for “urgent start” dialysis, and improve short-term survival and quality of life after initiation of dialysis. Audit of our pre-dialysis clinic has demonstrated improved patient outcomes, and we view this service as an essential component of the patient pathway.
Peritoneal Dialysis in Iran and the Middle East
Authors: Najafi Iraj
Published: February 2020

The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 – 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.
Statistical Analysis of the Incidence of Peritonitis on Continuous Ambulatory Peritoneal Dialysis
Authors: Pierratos Andreas , Amair Pablo , Corey Paul , Vas Stephen I. , Khanna Ramesh , Oreopoulos Dimitrios G.
Published: February 2020

In order to understand and eventually prevent peritonitis, which still is the most frequent complication of CAPD, workers in this field must agree on which statistical methods will be applied to the study of this complication. After a trial of various methods among our CAPD patients, we have concluded that life-table analysis, considering the first episode of peritonitis as an end event, provides the simplest method of expressing the probability of developing peritonitis. The comparison of two subpopulations of dialysis patients or of the performance of two units can be done by the comparison of the two peritonitis probability curves calculated from the respective data.

Finally, regression analysis be tween the probability to develop peritonitis within a specific interval on CAPD and calendar time of entrance into the program ot Ters a simple way to assess changes in the performance of a dialysis center over time.
Amino Acid Absorption following Intraperitoneal Administration in CAPD Patients
Authors: Williams Paul F. , Marliss Errol B. , Anderson G. Harvey , Oren Arie , Stein Arthur N. , Khanna Ramesh , Petitt Jean , Brandes Lidia , Rodella Helen , Mupas Lori , Dombros Nicholas , Oreopoulos Dimitrios G.
Published: February 2020

Six non-diabetic CAPD patients were infused over six hours with two litres of a dialysis solution containing 2 g/ dl amino acids (a mixture of essentials and non-essentials). The osmolality of the solution and the amount of ultrafiltration it induced were simiiar to that of a 4.25 g% dextrose Dianeal solution (control), suggesting that an amino acid solution is an efficient osmotic agent. By the end of the six-hour infusion, 80 to 90% of the amino acids present in the dialysis solution had been absorbed. One hour after the infusion was instituted, plasma amino acid levels increased threefold and subsequently decreased to near the initial value by the sixth hour. The amino acid solution was as effective as the dextrose solution in removing urea nitrogen, creatinine and potassium.

Our data indicate that intraperitoneal administration of amino acids is effective and well-tolerated in patients on CAPD. We believe further work should be done to determine whether long-term administration of amino acids by this route will improve the nutritional status of these patients and prevent the side effects of daily absorption of large amounts of glucose.
Experience with CAPD in Diabetic Patients in Toronto
Authors: Williams Clair , Belvedere Dale , Cattran Daniel , Clayton Sheila , Cole Edward , Fenton Stanley , Gutman Kathy , Khanna Ramesh , Knight Susan , Manuel Arifie , Oreopoulos Dimitrios , Pierratos Andreas , Roscoe Janet , Saiphoo Carl , Vas Stephen
Published: February 2020

During the first four years of the CAPD programs in Toronto, 409 patients completed CAPD training; of these 64 (15.7%) were diahetics. The mean age of the diabetics was 46.7 and of the non-diabetics 51.4 years. One and two-year survival rates were not significantly different between the two groups (93%-82% for the non-diabetics and 90%-72% for the diabetics}. The main cause of death was cardiovascular events, in both groups. During the first year on CAPD, diabetics were transplanted at a higher rate than non-diabetics (20% vs. 9%). The overall technique success rate, the rate of transfer to an alternative dialysis modality and the incidence of peritonitis were similar in the two groups. At least in the short -term, diabetics do well on CAPD. It is suggested that CAPD may be the dialysis modality of choice in diabetics with ESRD.
Control of Blood Glucose in Diabetics on CAPD
Authors: Hanna Amir K.
Published: February 2020

The relationship between diabetic control and the incidence of vascular complications remains a subject of controversy. Hyperglycemia induces glycosylation of different proteins, sorbitol accumulation, disturbance in the function of blood cells, hyperlipoproteinemia and osmotic changes. Pathological studies show that the kidneys of diabetics and kidneys transplanted to diabetics undergo capillary basement-membrane thickening. Clinical studies using a variety of criteria for assessing control clearly show a relationship between hyperglycemia and microvascular, but not macrovascular complications. Animal studies indicate that vascular changes are secondary to the metabolic derangements of diabetics and that they improve with better control. Thus, the data available indicate a strong relationship between diabetic control and microvascular complications, but there is no evidence that hyperglycemia per se is a significant risk factor for macrovascular disease. However, the relationship to microvascular complications makes it highly desirable to strive for strict control of hyperglycemia, especially in young diabetics.
Antimicrobial Activity in Continuous Ambulatory Peritoneal Dialysis
Authors: Diskin Charles J. , Coplon Norman , Feldman Charles , Vosti Kenneth
Published: February 2020

The antimicrobial activity of serum and dialysate from patients on continuous ambulatory peritoneal dialysis (CAPD) was assessed by performing bactericidal assays on serum and both fresh and spent dialysate. Fresh dialysate, whether lactate or acetate based, displayed significant bactericidal activity, which could be abolished by the addition of serum or albumin but not urea. Most patients on CAPD lost that killing activity sometime during the course of their dialysis, but a few retained this capability. Serum bactericidal activity was decreased in CAPD patients when compared to that of normal controls or patients on hemodialysis. These studies suggest the need for further work to assess the relationship of such findings to the pathogenesis of peritonitis in patients on CAPD.
Reproductive Function in Dialysis Patients: CAPD vs Hemodialysis
Authors: Galler Marilyn , Spinowitz Bruce , Tan Chaim Chary , Kabadi Mahesh , Freeman Ruth
Published: February 2020

A variety of hormonal disturbances and reproductive abnormalities occur in women on chronic maintenance hemodialysis. Recently, it has been noted that, when transferred from hemodialysis to continuous ambulatory peritoneal dialysis (CAPD), some women have resumed normal menses with ovulatory cycles. We compared menstrual histories, vaginal hormonal smears and ovulatory curves in 12 women on hemodialysis vs. seven women on CAPD under the age of 45. Eightysix per cent of the CAPD patients and 25% of the hemodialysis patients had regular menses. Upon transfer to CAPD, two amenorrheic females resumed regular menses within 21 months. Only two patients (one in each group) had ovulatory cycles. All patients had a vaginal estrogen effect. The return of regular menses in CAPD patients may be due to improved middle-molecule clearances with secondary normalization of the hormonal imbalances.
Tenckhoff Catheter Repair by the Splicing Technique
Authors: Roman Jorge , Gonzalez Alexandro R.
Published: February 2020

One of the main complications of the double-cuffed chronic peritoneal dialysis catheters is cuff erosion, with or without exit-site infection. We present a simple technique, which allows partial replacement of the external catheter segment with splicing. In addition it can be used to replace the intraperitoneal segment, leaving undisturbed the external segment and exit site.

This technique can be carried out under local anesthesia, as an outpatient procedure, without interrupting treatment and with less trauma than total catheter replacement.

This paper describes our experience with 20 external catheter replacements in 17 patients followed up to 20 months.
Efficacy of Intraperitoneal Clindamycin in Refractory Peritonitis Report of Two Cases
Authors: Cohen Loren , Bailey Deborah
Published: February 2020

Two patients on CAPD developed peritonitis refractory to antibiotics appropriate to the cultured organisms. In one case, cultures remained positive for the offending bacteria (Staphylococcus aureus) and, in the other, cultures of Enterobacter agglomerans rapidly became negative but signs and symptoms of peritonitis persisted. Empiric clindamycin therapy was associated with rapid resolution of peritonitis in both instances without necessitating catheter removal. We suggest that, in selected cases of refractory peritonitis, the addition of clindamycin may lead to clearing of the infection with preservation of the peritoneal catheter.
Successful Use of Combined Intraperitoneal Azlocillin and Aminogl Ycoside in the Treatment of Dialysis Associated Pseudomonas Peritonitis
Authors: Leung Anthony C.T. , Orange Gillian , Henderson Lain S. , Sleigh J. Douglas
Published: February 2020

Pseudomonas peritonitis associated with peritoneal dialysis is usually severe and difficult to treat. Prolonged courses of aminoglycoside antibiotics carry the risk of ototoxicity and nephrotoxicity. Azlocillin, a new acylureidopenicillin with potent antipseudomonal activity, was used successfully in combination with an aminoglycoside in the treatment of two patients with dialysis -associated pseudomonas peritonitis. Serum and peritoneal fluid antibiotic levels were monitored and a marked synergistic effect was observed with this antimicrobial combination. Azlocillin may have a useful aminoglycosidesparing effect in the treatment of pseudomonas peritonitis.
Bicarbonate, L-Lactate and D-Lactate Balance in Intermittent Peritoneal Dialysis
Authors: Richardson Robert M.A. , Roscoe Janet M.
Published: February 2020

Systemic acid-base values and bicarbonate and lactate balance were measured during dialysis in seven patients on chronic intermittent peritoneal dialysis (IPD). Dialysate contained 40 mM lactate, including 20 mM D-Iactate and 20 mM L-Iactate. Mean predialysis plasma bicarbonate concentration was 22 mM and rose to 25 mM after dialysis. The average net alkali gain during dialysis, calculated as lactate gain minus bicarbonate loss, was 80 mmoles/ treatment or 34 mmoles/day. There was considerable variability in alkali gain between patients and between treatments in the same patient. The major factors influencing alkali gain were peritoneal solute clearance and dialysate effluent volume, or ultrafiltration. Both in the balance study, and in a shorter study comparing the effects of consecutive 4.25% or 0.5 % glucose exchanges on net alkali gain, the authors demonstrated that increasing ultrafiltration reduced net alkali gain by about 26 mmoles/liter ultrafiltrate. D-Iactate appears to be quantitatively as important as Llactate in bicarbonate generation. Further longitudinal studies are required to define the relationship between net alkali gain, dietary hydrogen-ion generation and blood acid-base values.
Do Patients on Continuous Ambulatory Peritoneal Dialysis Need Arterio-Venous Fistula?
Authors: Joffe Preben , Skov Robert , Olsen Finn
Published: February 2020

The authors studied 43 patients on continuous ambulatory peritoneal dialysis (CAPD) for 5.8 years. The patients were divided into two groups. Group A consisted of 19 patients with an arteriovenous fistula. In only four of these was it necessary to use the fistula during 269 treatment months. Group B consisted of 24 patients without fistulas. Four of these needed dialysis via a subclavianvein catheter during interruption of CAPD, and one via a jugular-vein access side. The patients in group B were observed for 455 treatment months. Permanent vascular access should be constructed only in CAPD patients with repeated treatment failure. A subclavian catheter should be used whenever the patient needs temporary hemodialysis.
Chemical Peritonitis due to Intraperitoneal Vancomycin (VANCOLED)
Authors: Judith Beth Piraino , Johnston Bernardini James , Sorkin Michael
Published: February 2020

Six consecutive patients treated with intraperitoneal vancomycin for catheter infections developed cloudy dialysate in the exchange to which the drug was added. In all six patients, the dialysate was clear before the addition of vancomycin. All had elevated dialysate leukocyte and polymorphonuclear counts after the intraperitoneal vancomycin. All had sterile cultures. Two continued to have cloudy dialysate while continuing on 500 mg vancomycin per one exchange per day. In one of these patients, the catheter did not appear infected when removed. All episodes occurred after we had changed from Lilly's Vancocin to Lederle's Vancoled. During this time, the per cent of peritonitis episodes with sterile cultures rose from 0% in the previous 3 months to 50%. In all episodes with sterile cultures Vancoled had been administered via the dialysate. Fourteen patients had received intraperitoneal Vancocin in the previous nine months for the same indications; none developed cloudy dialysate. We believe that these cases represent chemical peritonitis due to Vancoled.
Ferroxidase I and IIIN CAPD Patients
Authors: Agroyannis Basil , Yatzidis Hippocrates , Matrona Frangos-Plemenos , Dimitrios Koutsicos , Katirtzoglou Antony , Sarris Evangelos
Published: February 2020

In 32 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and in 56 healthy subjects, ferroxidase I (ceruloplasmin) and ferroxidase II activity were estimated in serum; in 12 of the 32, it was also measured in peritoneal fluid. Serum ferroxidase I was normal, while ferroxidase II was significantly increased. Peritoneal fluid contains appreciable amounts of ferroxidase I, but no ferroxidase II. The serum ferroxidase profile of patients on CAPD differs from that of hemodialysis (HD) patients; in the latter, both ferroxidases are significantly increased. This difference could be accounted by the loss offerroxidase I in the peritoneal fluid.
Further Experience with Two Intraperitoneal Vancomycin Loading Doses for Treatment of Gram-positive or Sterile Peritonitis in CAPD Patients
Authors: Bastani Bahar , Sherman Ruth Ann , Freer Kathryn , Davis Marlean , Read Deborah , Engels Darial , Bailey Sandy , Westervelt Frederic B.
Published: February 2020

We present a new protocol for treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. In this protocol, episodes of gram-positive or “sterile” peritonitis are treated with two intraperitoneal (i.p.) doses of vancomycin (30 mg{kg with 6 h of i.p. dwell) which are given one week apart. Patients whose initial peritoneal fluid Gram stain does not reveal any organisms receive an intramuscular (i.m.) loading dose of tobramycin or gentamycin in addition, until the culture result becomes available at 48 h. Those with a negative peritoneal fluid culture (“sterile” peritonitis) receive maintenance i.p. gentamycine or tobramycin. We report our experience with 24 episodes of gram-positive or “sterile” peritonitis. Except for 1 of the 24 episodes that was followed with two successive relapses, all the other episodes responded well (cure rate of 96%). In only 15% of the instances patients were hospitalized to be assisted with their CAPD exchanges. We conclude this new approach remarkably simplifies treatment of peritonitis in CAPD patients, and based on our preliminary results it seems to be as effective, if not superior to, the currently employed treatment protocols. Further studies with this therapeutic regime with careful audiometric evaluation of those who receive both vancomycin and aminoglycoside are necessary in future.
Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients: A Randomized Clinical Trial of Cotrimoxazole Prophylaxis
Authors: Churchill D. N. , Taylor D. W. , Vas S. I. , Singer J. , Beecroft M. L. , Wu G. , Manuel A. , Paton T. , Walker S. , Smith E. K. M. , Oreopoulos D. G.
Published: February 2020

A double-blind randomized controlled trial compared the effectiveness of prophylactic oral trimethoprim/sulfamethoxazole (cotrimoxazole) to a placebo in preventing peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. A daily trimethoprim/sulfamethoxazole dose of 160/800 mg gives a steady state dialysate concentration of 1.07/4.35 mg/L in the final dwell of each dosing interval. Identification of a 40% reduction in peritonitis probability with 80% statistical power and a type 1 error probability of 0.05 required 52 subjects per group. With stratification by previous peritonitis, 56 were allocated to cotrimoxazole and 49 to placebo. For cotrimoxazole there were five deaths and seven catheter losses. For placebo there were three deaths and nine catheter losses. There were 20 withdrawals from cotrimoxazole and 9 from the placebo group. With respect to time to peritonitis, there was no statistically significant difference between cotrimoxazole and placebo groups (p = 0.19). At 6 months, 64.1% of cotrimoxazole and 62.5% of placebo were peritonitis free; at 12 months 41.9% of cotrimoxazole and 35% of placebo were peritonitis free. There was no effect (p > 0.05) of age, sex, catheter care technique, spike or luer, or dialysate additives. Previous peritonitis increased the risk of peritonitis by 2.06 (95% CI, 3.61–1.18) while frequent (six weekly) extension tubing changes increased the risk of by 1.79, (95% CI, 3.04–1.02) when compared to six monthly changes. Cotrimoxazole appears ineffective in prevention of CAPD peritonitis.
Acute Pancreatitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Donnelly Sandra , Levy Mortimer , Prichard Sarah
Published: February 2020

Four patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for uremia developed acute pancreatitis (AP) over a 10-month period. No patient in the comparatively large hemodialysis population developed AP in the past 10 years. Diagnosis of AP was confirmed by the temporal change in the serum amylase levels and/or by radiographic imaging. Peritonitis was excluded by normal peritoneal fluid WBC counts and bacterial culture. Two patients developed tea-colored peritoneal fluid after the onset of the disease. Two patients required discontinuation of peritoneal dialysis (PD) to manage, their symptoms. Total corrected serum calcium was elevated in all four patients. All patients had complicated peritonitis histories. No patient was ingesting any known pancreatic toxin including alcohol and no patient had cholelithiasis or hepatitis.

A literature review reveals 24 other cases of AP in CAPD patients. Of the cases described in detail, only two did not have peritonitis. AP is an entity which is more common in the CAPD population than previously recognized. Although no etiologic associations have been firmly established, hypercalcemia and a previous history of peritonitis may be important.
Outflow Obstruction: Whiplash Technique for Catheter Mobilization
Authors: O'Regan Sean , Garel Laurent , Patriquin Heidi , Yazbeck Salam
Published: February 2020

A major reason for peritoneal dialysis catheter replacement is outflow obstruction. This is commonly due to adherence of the catheter to the peritoneum. Using a blunted trocar from an acute dialysis kit the catheter can be mobilized under fluoroscopy, thus restoring function and obviating the need for surgery.
Comparison of the in Vitro Activity of Daptomycin and four other Antimicrobial Agents against Staphylococci Associated with CAPD Peritonitis
Authors: Vaudry Wendy L. , Gratton Claudia , Kowalewska Kinga , Wenman Wanda M.
Published: February 2020

The minimum inhibitory concentration (MIC) of daptomycin was compared with that of four other antimicrobial agents against clinically relevant staphylococci. Sixtyfive isolates were obtained from patients on continuous ambulatory peritoneal dialysis (CAPD) who contracted peritonitis. These isolates comprised 29 S. Sureus strains (all sensitive to oxacillin); 25 S. epidermidis strains (14 sensitive and 9 resistant to oxacillin); and 11 unspeciated coagulase-negative staphylococci (2 sensitive and 11 resistant to oxacillin). All of the oxacillin susceptible strains were inhibited by ≤2 mg/L of the five antibiotics tested. The oxacillin resistant staphylococci were also resistant to cefuroxime and variably resistant to cefamandole, but were uniformly susceptible to both vancomycin and daptomycin. Daptomycin possesses equivalent in vitro activity to vancomycin against strains of S. Sureus and coagulase negative staphylococci associated with CAPD peritonitis. If vancomycin resistance becomes a significant problem in these patients, and daptomycin is shown to be active against vancomycin resistant organisms, then it would have potential usefulness as an alternative to vancomycin in the treatment of peritonitis caused by multiply -resistant staphylococci.
Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis: The Effect of Antibiotic on the Adherence of Coagulase-Negative Staphylococci to Silicone Rubber Catheter Material
Authors: Finch Roger G. , Edwards Richard , Filik Rachel , Wilcox Mark H.
Published: February 2020

Peritonitis is the major complication of continuous ambulatory peritoneal dialysis (CAPO) and is caused predominantly by coagulase-negative staphylococci (CNS). Adherence to the silicone rubber Tenckhoff catheter has been identified as one factor in the pathogenesis and persistence of these infections. We have studied the adherence of CNS from patients and controls to silicone rubber in an in vitro model to determine whether this phenomenon can be modified by antibiotics. Adherence was strong for 7/27 (26%) CAPO isolates and for 3/27 (11%) of control strains. The strongly adherent CAPO isolates, when exposed to subinhibitory concentrations of vancomycin, cefuroxime, and ciprofloxacin, showed minimal alteration in adherence with vancomycin in both broth and used dialysate, whereas cefuroxime and ciprofloxacin both significantly reduced it. These observations may have implications for drug selection and prevention of CAPO peritonitis caused by CNS.
Permeability of Different Parts of the Peritoneal Mesothelium to Solutes: An in Vitro Study
Authors: Breborowicz Andrzej , Rodela Helen , Knapowski Jan , Oreopoulos Dimitrios G.
Published: February 2020

The authors studied the in vitro permeability of different fragments of the rabbit's peritoneum to urea, inulin, horseradish peroxidase, and ferritin. Parietal peritoneum has a lower permeability to middle and large molecules than visceral peritoneum. In addition the local anesthetic, bupivacaine had a different effect on the mesothelial permeability of visceral peritoneum than on that of parietal peritoneum.