bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro and in Vivo Efficacy of a New Connector Device for Continuous Ambulatory Peritoneal Dialysis
Authors: Viglino Giusto , Colombo Adolfo , Cantu Paolo , Camerini Corrado , Catizone Luigi , Bonello Franco , Lombardo Vincenzo , Balteau Patrick R. , Cavalli Pier Luigi , Renzetti Gian Antonio , Farfaglia Piera , Cancarini Giovanni , Zucchelli Pietro , Quarello Francesco , Acciarri Pier Marino , Peluso Franco
Published: February 2020

The purpose of this study was to evaluate the In vltro and in vivo efficacy of a new connection system for continuous ambulatory peritoneal dialysis (CAPO), called the T-set. With this system the patient wears a 27–cm extension line filled with Amuchina during the dwell time; the bag is made of a fill container linked to a drainage tube with a Y-shaped set. For bag exchange, only one connection is needed and this is subsequently flushed with the entire drainage volume.

The in vitro efficacy of the system was tested with 20 sets filled with 10 mL of Amuchina and inoculated in the distallumen with 2.1x103 colony-forming units (cfu) of S. aureus. After an Incubation of 4–6 hours at 35–37°C, three dialysate samples per set were collected, respectively, at the beginning of drainage and filling. Al1120 samples were negative, whereas two control sets, filled with a phosphate-buffered saline, had positive drainage samples, and at least one positive Infusion sample, Indicating the efficacy of Amuchina in sterilizing the system under conditions simulating touch contamination.

To evaluate the in vivo efficacy, safety, and acceptability of the T-system, a prospective randomized controlled trial was performed In seven centers: a control group (CG) of 56 patients (follow-up: 952.3 months, mean±SO: 17.0±7.8) was treated with a long branch (21 patients) or short branch (35 patients) Y-set and a test group (TG) of 66 patients (follow-up: 898.1 months, mean±SO: 13.6±7.8) with the T-set. The two groups were comparable for patient and dialysis characteristics. The incidence of peritonitis was 1143.3 months in the CG and 1129.0 months In the TG (p=NS). The percentage of patients without peritonitis was 67.8% In the CG and 68.2% In the TG (p=NS); the probability of remaining free from peritonitis was, respectively, 76% and 75% In the CG and in the TG at 1 year, and 66% and 60% at 2 years (p=NS). In the CG 26 patients and In the TG 21 patients were already on CAPO before the trial; among these 21 patients, 10 of 10 with the long Y-set and 4 of 11 with the short Y-set who transferred to the T-set preferred the latter for better handling (52.4%) or for less encumbrance (14.3%).
Ten Years of Continuous Ambulatory Peritoneal Dialysis: Analysis of Patient and Technique Survival
Authors: Viglino Giusto , Cancarini Giovanni , Catizone Luigi , Cocchi Roberto , De Vecchi Amedeo , Lupo Antonio , Salomone Mario , Segoloni Giuseppe Paolo , Giangrande Alberto ,   Italian Cooperative Peritoneal Dialysis Study Group: Scientific Committee, 1 Registry Commit tee, 2 and Chairman,3 Italy
Published: February 2020

The patient survival (PS) and technique survival (TS) were evaluated in 1990 patients on continuous ambulatory peritoneal dialysis (CAPD) (males: 55.9%, mean age±SD: 58.4± 14.8 years), treated in 30 centers participating in the Italian PD Study Group, from 1980 to 1989 (follow-up: 3953 years; mean±SD: 2.02±1.86 years).

The total PS was 50.7% at 4 years, compared to 73.3% of patients without clinical high -risk condition (HRC) at the beginning of CAPD. In this group (34.0%) PS was significantly higher (p<0.001) compared, respectively, to patients with cardiovascular disease (30.5%), diabetes (13.1%), and age ≥70 years (11.2%). The percentage of death reached the mean value of 11.3% per year without any statistically significant tendency to variation during the follow-up, despite the increased number of patients ≥65 years old and those with HRC (p<0.001).

Cardiovascular diseases (47.3%) and cachexia (17.8%) were the most frequent causes of death, whereas the mortality due to peritonitis showed a progressive in crease in patients with peritonitis Incidence 1 ep/year (G4) compared to those with <0.5 ep/year (G2). Peritonitis (0.68 ep/year) was the most frequent cause of technique failure (30.0%), with clinical complications (18.2%) and peritoneal membrane failure (16.4%) as the second and third causes. The dropout percentage was 8.3% per year with a significant decrease over time (p=0.012) and a positive correlation with the reduction of peritonitis incidence (p=0.035). The total TS was 50.1% at 7 years, and it was significantly worse in G4 compared to G2. The TS was significantly better in patients 65 years of age than in younger ones, who had the same probability and risk of peritonitis, but a higher incidence of membrane failure. In those patients where CAPD was the second dialysis treatment TS was significantly worse (p<0.001), with a higher probability and risk of peritonitis. The TS was not affected by diabetes, and probability and relative risk of peritonitis were similar to that of non diabetic patients.
Patients’ Group Experiences
Authors: Cerruti Gabriella , Cotto Maria , Rivetti Margherita , Servetti Luciana , Baracco Maddalena , Ferrero Renata
Published: February 2020

In 11 years of experience with dialysis, we have tried to supply a kind of treatment In our center that takes the patient's physical, psychological, and social needs Into account.

We have been able to observe how Important It Is to share the common problems connected with a chronic illness in order to make them appear less dramatic. This led to the Idea of organizing a group holiday in which the patients and their families would be able to spend some time together.

As a result of this positive experience, we decided to organize group encounters In which all the problems could be freely discussed. The group Is open to all the patients on dialysis or who have undergone transplants and their families.

The group, which has been meeting once every 3 weeks for the last 2 years, Is coordinated by a psychologist.

This has proved to be Important both for the operators, who have been able to expand their own knowledge, and for the patients and their families for whom these gatherings represent a way of helping themselves face up to and accept the limits imposed by chronic Illness.
Quantification of Adequacy of Peritoneal Dialysis
Authors: Arkouche Walid , Delawari Ehsan , My Horn , Laville Maurice , Abdullah Elias , Traeger Jules
Published: February 2020

Nineteen patients treated by continuous ambulatory peritoneal dialysis (CAPD) were studied according to clinical outcome parameters: insomnia, asthenia, pruritus, arterial hypertension, anorexia, nausea and/or vomiting, anemia, and rate of hospitalization. Using clinical scores, three groups were defined: poor clinical outcome (P), intermediate (I), and good (G). The quantity of treatment by PD was evaluated monthly with urea kinetic tests (weekly Kt/V, weekly urea clearance/1.73 m2 of body surface area (BSA), index of dialysis by Teehan), and with the weekly creatinine clearance/1.73 m2 of BSA. The metabolic index was analyzed: normalized protein catabolic rate (NPCR), serum albumin (Alb) and prealbumin, and reabsorption of glucose.

There was good correlation between clinical scores and quantity of dialysis. The Alb was lower in group P. Group G was differentiated from group I and from group P by quantification tests and NPCR, with lower levels as follows: weekly Kt/V=2.06, urea clearance 70 L/week/1.73 m2, index of dialysis = 0.87, and creatinine clearance = 60 L/week/1.73 m2.

We conclude that the qualitative clinical approach is not sufficient to predict deleterious signs, and the quantitative approach is predictive of the good clinical outcome and good nutritional status. We think that levels proposed to now are insufficient, and we suggest the following: weekly urea clearance >70 L, weekly Kt/V >2, weekly creatinine clearance >60 L, and index of dialysis >0.85.
Bent Subcutaneous Peritoneal Catheter Shape for Regular Dialysis Treatment in Children
Authors: Bonzel Klaus-Eugen , Lettgen Bernhard , Bald Martin , Kleine Ludwig , Erhard Jochen
Published: February 2020

A permanent bowing of the subcutaneous part of the Tenckhoff-type catheter (bent neck -Qulnton, and swan neck -Accurate Surgical Instruments) enables the catheter to turn from an upward direction of the subcutaneous tunnel to a downward direction by a smooth 160°-180° bend creating a downward skin exit° We have used this catheter shape In combination whh a colled Intra-abdominal edge. Two sizes are available for children° We use 2 cuffs and glue them ourselves according to the body size.

In this study we compare the durability of the traditional subcutaneously straight catheter In 8 children aged 0.1-12.6 years (Group A) whh the bent shaped catheter In 8 children aged 3°7–15°8 years (Group B)° Median duration of function was 10°5 (2–34) and 8 (3–36) months, respectively; Frequency of complications was equal In both groups: peritonitis episodes 0°69/year in Group A and 0°53/year in Group B; tunnel Infection 0.16 vs 0°11/year; skin exit infection 0°54 vs 0.53/year; noninfectious complications 0°16 vs 0°32/year; mean number of catheters used was 1°0 vs 1°1/treatment years treatment had to be terminated in some patients: kidney transplantation 5, kidney recovery 1, severe peritonitis 1.

The bent subcutaneous catheter shape did not show any medical or technical disadvantage compared with the straight type, but the downward directed catheter skin exit can be covered Invisibly under bikini or bermuda shorts which means aesthetic and social advantage. Whether the downward drainage of secretes and cell detritus Influences the rate of tunnel Infection positively cannot be answered to date.
Vancomycin Therapy of Experimental Peritoneal Catheter-Associated Infection (Staphylococcus Epidermidis) in a Mouse Model
Authors: Gagnon Raymonde F. , Richards Geoffrey K. , Subang Rebecca
Published: February 2020

Catheter-related sepsis, principally with 5. epldermldls, remains a main complication of continuous ambulatory peritoneal dialysis (CAPD). A possible reason for the antibiotic resistance often displayed by these Infections Is the presence of bacteria growing in a protective biofilm on the catheter surface. We developed a reproducible stable model of experimental peritoneal catheter-assoclated infection with 5. epldermldls In the mouse and used this model to examine the therapeutic efficacy of vancomycin. The response to vancomycin treatment given dally (15 mg/kg body weight) for periods from 1–14 days, relating the proportion of successful outcome (sterilization of Implant Infection) over time, was typical of an S-shaped biological response curve. These results extend our previous observations In vltro of the activity of vancomycin against 5. epldermldls biofilm preparations and serve as a rational basis for the experimental evaluation of synergy and antagonism In the treatment of implant-associated Infection.
Single Daily Dose of Aminoglycosides in the Treatment of Continuous Ambulatory Peritoneal Dialysis Peritonitis
Authors: Vas Stephen I.
Published: February 2020

Toxicity of amlnoglycosides is a major concern in the treatment of continuous ambulatory peritoneal dialysis (CAPO) peritonitis. The relatively high blood levels and prolonged and repeated usage may all be contributory. The recognition of the so-called postantibiotic effect, together with the Increased phagocytosis of antiblotictreated cells, may introduce a new mode of therapy with once-dally dosage. Intermittent therapy with vancomycin Is already generally accepted. The extension of this modality to antibiotic therapy is discussed.
Pharmacokinetics and Pharmacodynamics of Antistaphylococcal Antibiotics in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Keller Erich
Published: February 2020

Staphylococci are the leading pathogens In continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Vancomycin appears to be an outstanding antistaphylococcal drug because resistance to It Is nearly absent. The pharmacokinetics of vancomycin and clinical cure rates of peritonitis with different dosing guidelines have been studied extensively. Different dosing guidelines with IP or IV loading doses followed or not followed by IP maintenance doses are used successfully, despite the fact that some of the dosing schemes produce apparently suboptimal drug levels referring to In vitro data like the MIC value (minimum Inhibitory concentration). Alternatively, amlnoglycosldes, cephalosporlns, Isoxazolyl penicillins, and broad-spectrum penicillins combined with betalactamase Inhibitors may be used for the treatment of gram-positive peritonitis. For the above panicillins pharmacokinetic data are scarce, and clinical experience is limited. Rifampin has excellent Intracellular antistaphylococcal activity and should be used In combination with other antibiotics. Although pharmacokinetic data are lacking, rifampin dosages do not require adaptation to renal function or replacement therapy.
Cardiovascular Disease and Risk Factors in Patients Treated by Continuous Ambulatory Peritoneal Dialysis
Authors: Maher John F. , Hirszel Przemyslaw
Published: February 2020

The opinions and assertions contained herein are private and are not to be construed as official or representing those of the Uniformed Services University of the Health Sciences or the Department of Defense, U.S.A.
Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis
Authors: Warady Bradley A. , Bahl Vicki , Alan Uri , Hellerstein Stanley
Published: February 2020

Objective

To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification.

Design

Prospective case evaluation.

Setting

The Home Peritoneal Dialysis Unit, Children's Mercy Hospital.

Patient

Seven-year-old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum.

Intervention

Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months.

Results

The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months.

Conclusion

Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.
Effects of 3-Month Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Qamar Izhar U. , Levin Leo , Balfe J. Williamson , Balfe Judith A. , Secker Donna , Zlotkin Stanley
Published: February 2020

Objectives

To compare the nutritional and biochemical effects of amino acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective randomized crossover study.

Setting

Pediatric Nephrology Unit in a tertiary care, teaching hospital of the University of Toronto.

Patients

Seven children aged 0.7–16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit.

Interventions

Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months.

Main Outcome Measures

Nutritional and biochemical data were obtained on each patient during each dialysis regimen.

Results

Analysis of the patients’ nutritional data showed comparable weight gain with both regimens but no significant improvement in lean body mass with either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tendency to higher plasma potassium and urea levels with no clinical side effects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma albumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino acid dialysis did not show any significant change. An interesting phenomenon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the amino acid dialysis period. This newly described phenomenon could have been due to tolerance or hepatic enzyme induction.

Conclusions

Overall amino acid dialysis was comparable to dextrose dialysis with no additional proven nutritional benefit, was equally effective in ultrafiltration and creatinine clearance, and produced no adverse clinical or biochemical effects.
Measurement of Peritoneal Fluid Handling in Children on Continuous Ambulatory Peritoneal Dialysis Using Autologous Hemoglobin
Authors: Reddingius Roel E. , Schröder Cornelis H. , Willems Hans L. , Van Den Brandt Frans C.A. , Koomen Gerardus C.M. , Krediet Raymond T. , Monnens Leo A.H.
Published: February 2020

Objective

Previous measurements of peritoneal fluid handling in children treated by continuous ambulatory peritoneal dialysis (CAPD) were performed with human albumin as a fluid marker. A major disadvantage of this substance is that endogenous patient albumin enters the peritoneal cavity during the dwell period. For this reason perito neal fluid kinetics were measured in a group of children on CAPD, using autologous hemoglobin as a volume marker.

Design

Autologous hemoglobin was added to dialysate containing 1.36% glucose as a volume marker. Marker clearance (MC), which is presently the best available approximation of lymphatic absorption in the clinical setting, and transcapillary ultrafiltration (TCUF) were measured during a 4-hour dwell.

Setting

University hospital.

Patients

Children on CAPD (N=9), with a median age of 8.1 years (range 2.1–13.2 years).

Results

MC was 521±166 mL/4 hour/1.73 m2, which is high compared to the literature data on adult CAPD patients. TCUF was 519±92 mL/4 hour/1.73 m2, which is similar to data concerning adult patients. TCUF reached no maximum during the 4-hour dwell, and the deviation of the TCUF curve from linear was markedly less than usually seen in adult patients.

Conclusions

MC in children treated with CAPD is higher when compared to the literature data on adults. Difficulties to achieve sufficient ultrafiltration in children could be caused by relatively small differences between MC and TCUF from the beginning to the end of the dwell.
Minimizing the Drainage Period for Continuous Ambulatory Peritoneal Dialysis
Authors: Kumano Kazuo , Yokota Shinji , Sakai Tadasu , Kazama Haruki , Sofue Katsuyoshi
Published: February 2020

Objectives

To examine features of drainage flow and to determine whether the drainage period could be safely reduced in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Open nonrandomized prospective study in CAPD patients.

Setting

The kidney center in a tertiary care university hospital.

Patients

Fourteen CAPD patients with good catheter function.

Interventions

Drainage flow pattern was studied using a 2-L dialysate. The drainage period was reduced from 28 minutes (mean) to 10 minutes throughout a short-term, 2-month study period and a long-term, 6-month study period for 10 patients.

Main Outcome Measures

Ultrafiltration volume, body weight, and peritoneal clearance.

Results

A kinetics analysis of the drainage period and volume indicated a positive linear correlation with two different slopes: one for rapid drainage for the first 5–7 minutes and one for subsequent slow drainage. The effluent exceded 80% in the former period. Ultrafiltration volume and body weight showed no change due to the reduction. Improved peritoneal clearance of small molecular substances could not be confirmed despite a 5% increase in the effective dialysis period. Nearly all patients were satisfied with the reduction and desired its continuation.

Conclusions

Ten minutes is a sufficient drainage period for most CAPD patients with a 2-L dialysate volume. This may possibly allow an increase in daily activities and an effective peritoneal membrane dialysate contact period.
Magnesium and Parathyroid Hormone Changes to Magnesium-Free Dialysate in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Takahashi Susumu , Okada Kazuyoshi , Yanai Mitsuru
Published: February 2020

Objective

For the normalization of serum magnesium (Mg) concentration, dialysate Mg concentration tends to be reduced in continuous ambulatory peritoneal dialysis (CAPD) patients. The aim of this study was to evaluate the influence of Mg on parathyroid hormone (PTH).

Design

Prospective study of the utilization of Mg-free dialysate for 8 weeks.

Setting

Dialysis service, Itabashi Hospital, Nihon University School of Medicine.

Patients

Five stable CAPD patients (1 male; 4 female; age 49.7±1.3 years; duration of CAPD 27±9 months).

Main Outcome Measures

Serum Mg, serum high sensitive PTH, and Mg content in mononuclear cells were measured at 4-week intervals.

Results

In comparison to baseline, serum Mg concentration was significantly reduced at week 4 (p<0.01) and week 8 (p<0.01), and serum PTH was significantly increased at week 4 (p<0.05) and at week 8 (p<0.05). However, the PTH level at week 8 was lower than that at week 4. Furthermore, the Mg content in mononuclear cells was significantly decreased at week 4 (p<0.01) and at week 8 (p<0.01). Serum -ionized calcium and phosphate concentrations did not change.

Conclusions

The removal of Mg by Mg-free dialysate leads to Mg depletion in CAPD patients. In addition, Mg depletion stimulates PTH synthesis or secretion at 4 weeks, but at 8 weeks PTH synthesis or secretion is also influenced by other factors.
Risk Factors for Peritoneal Dialysis-Related Infections
Authors: Oxton Lisa L. , Zimmerman Stephen W. , Roecker Ellen B. , Wakeen Maureen
Published: February 2020

Objective

To identify factors associated with peritoneal dialysis-related infections at one center.

Design

The study was a retrospective study of a 3 year time period with relatively stable treatment patterns.

Setting

A single center experienced academic peritoneal dialysis program.

Patients

Patients (N = 163) receiving peritoneal dialysis (PD) from January 1989 to December 1991 who had received treatment at home for at least one month.

Interventions

None.

Main Outcome Measures

Catheter-related infection and peritonitis were the main outcome measures. Variables affecting infection rates that were assessed included age, time on PD, prior end-stage renal disease (ESRD) therapy, diabetic status, catheter type, exchange device, nasal carriage of S. aureus, and prophylactic rifampin therapy. Data were analyzed with univariate as well as with a fixed-effects and a mixed-effects gamma Poisson multiple regression model.

Results

Variables associated with an increased risk of new peritonitis included age under 20 years (p < 0.009; rate ratio 4.54) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.75). Decreased new peritonitis risk was associated with the ULTRA Set exchange system (p < 0.008; risk ratio 0.38) and intermittent prophylactic rifampin therapy (p < 0.001; rate ratio 0.99 for each 1% time on therapy). Catheter-related infections were increased in patients who had double-cuff catheters (p < 0.003) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.82). Decreased catheter-related infections were noted in older patients (p < 0.02; rate ratio 0.983/year) and increasing months of study follow - up (p < 0.03; rate ratio 0.97/month).

Conclusion

In our program nasal carriage of S. aureus increased the risk of peritonitis and catheter-related infection. Prophylactic rifampin significantly decreased peritonitis, as did use of the UL TRA Set. Single-cuff opaque catheters had the lowest catheter infection rate. Analysis of the relationships between clinical and demo graphic variables and peritoneal dialysis-related infection rate can identify significant contributing or protective variables and allow peritoneal dialysis programs to develop preventive strategies to minimize the risk of infection.
A Comparison of Clearances on Tidal Peritoneal Dialysis and Intermittent Peritoneal Dialysisa
Authors: Piraino Beth , Bender Filitsa , Bernardini Judith
Published: February 2020

Objectives

To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate.

Design

Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 Llexchange for a total of 30 Lltreatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 Lltreatment.

Patients

Six patients, with a mean dialysatelplasma (DIP) creatinine as determined by the peritoneal equilibration test (PET) of 0.64±0.1 0, were studied. Four had a low -average DIP creatinine, while 2 had a high-average DIP creatinine.

Measurements

Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test.

Results

The dialysate flow rates were 3.7±0.1 Llhour for IPD and 3.8±0.2 Llhour for TPD. The mean dialysate dextrose was 1.9±0.5 gldL for both. The creatinine clearances were 9±2 versus 10±3 mLlminute, the urea nitrogen clearances 19±3 versus 20±3 mLlminute, and phosphate clearances 10±3 versus 11±3 mLlminute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9±0.9 mLlminute on IPD and 3.3±1.6 mLI minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average DIP creatinine were higher than for the 4 patients with low -average DIP creatinine.

Conclusions

When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.
Careful Patient Selection and Dialysis Prescription are Required for Effective Nightl Y Intermittent Peritoneal Dialysis
Authors: Holley Jean L. , Piraino Beth
Published: February 2020

Objective

To evaluate the adequacy of dialysis in patients on nighttime intermittent peritoneal dialysis (NIPD).

Design

Retrospective review of prospectively collected data.

Patients

Seven patients on NIPD.

Measurements

The fast peritoneal equilibration test (PET) was used to determine peritoneal membrane permeability for small solutes. Adequacy of dialysis measured by 24hour collections of dialysate and urine for weekly KT/V and creatinine clearance in liters/week/1.73 m2 was assessed in patients with (n=3) and without (n=4) residual renal function and evaluated in concert with the patient's clinical status. Outcome for each patient was also noted.

Results

Five of the patients had a high-average dialysate/serum creatinine by PET (>0.66). Despite a weekly KT/V of 1.7 or more, four of the seven patients on NIPD were uremic and either transferred to hemodialysis or continuous cycling peritoneal dialysis (CCPD). A fifth patient had a KT/V of 1.4 and was also uremic on NIPD. The patient who was clinically well and continued on NIPD had significant residual renal function.

Conclusions

NIPD should be restricted to patients with high-average dialysate/serum creatinine as determined by PET and residual renal function or those with high dialysate/serum creatinine. Extended dialysis time and large volumes of dialysate are required for successful NIPD in patients without residual renal function. Accepted parameters of dialysis adequacy used for patients on continuous peritoneal dialysis are not appropriate for intermittent forms of peritoneal dialysis.
Cytogenetic Analyses Reveal “Atypical Cells” in the Peritoneal Dialysis Effluent
Authors: Dimkovic Nada B. , Barjaktarovic Nada M. , Kostic Vitana M. , Jovanovic Dragan R. , Radovanovic Ljiljana T. , Radmilovic Aleksandar V.
Published: February 2020

Cytogenetic analyses were performed on dividing cells from the peritoneal effluent of 26 patients undergoing chronic peritoneal dialysis (CPD). Numerical and structural abnormalities of karyotype served as the diagnostic criteria for “atypical cells.” The following cytogenetic abnormalities were observed in 7 patients: hyperdiploidy (in 6 patients), hypodiploidy (in 2 patients), and marker chromosomes (in 2 patients). In 3 patients more than one chromosome abnormality was present. Dividing cells with normal mitoses were observed in 11 patients, while in the remaining 8 patients no dividing cells could be found.

There were no differences in age, sex, duration of dialysis, and peritonitis incidence between patients with pathological mitoses and those without it. The question whether this unexpected finding is a consequence of immunosuppressed uremic status, dialysis procedure, or some other factor remains to be elucidated.
Excellent Technique Survival on Home Peritoneal Dialysis: Results of a Regional Program
Authors: Jindal Kailash K. , Hirsch David J.
Published: February 2020

Objective

To examine peritoneal dialysis technique survival in our regional, continuous ambulatory peritoneal dialysis (CAPD) program.

Design

Retrospective analysis.

Setting

Tertiary care dialysis programatan academic medical center.

Patients

155 patients representing all those in the peritoneal dialysis program between October 1, 1987 and October 1,1990.

Outcome measures

The study analyzed patient and technique survival as well as the reasons for discontinuation of dialysis. In addition, the incidence and type of peritonitis and exit-site infection were also analyzed.

Results

Three-year actuarial patient survival was 66% and three-year technique survival was 86%, with data censored for death and transplant patients. Fiftyseven percent of transfers to hemodialysis were due to peritonitis, usually fungal or multiorganism bacterial. Only 1 patient failed due to exit-site and tunnel infection, and 1 due to inadequate dialysis. The catheter removal rate was 0.04 per patient-year.

Conclusions

Excellent CAPD technique survival can be achieved if exit-site and tunnel infection rates are low.
Bidirectional Solute Transport in Peritoneal Dialysis
Authors: Waniewski Jacek , Heimbürger Olof , Park Min Sun , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Objective

Three transport components are involved in solute transport in peritoneal dialysis: diffusion, convective transport, and peritoneal reabsorption of dialysate (fluid and solutes). The relative impact of these components on measurable transport characteristics (dialysateto-plasma concentration ratio, diffusive mass transport coefficient, unidirectional clearances) may depend on the direction of solute transport, that is, from blood to dialysate or vice versa. The application of the bidirectional characteristics for the assessment of fluid and solute transport in peritoneal dialysis is reviewed and evaluated.

Data Sources

Theoretical analysis as well as computer simulations were applied to discuss available data from our own studies on peritoneal transport as well as from published clinical, experimental, and theoretical studies in the same field.

Study Selection

Thirty-three relevant clinical and experimental studies as well as theoretical analyses derived from the literature were reviewed.

Data Extraction

Data were extracted to highlight current controversies in the literature concerning the assessment of peritoneal reabsorption rate based on transport of macromolecules, middle molecules, and small solutes.

Results

Peritoneal reabsorption is the main component of the transport of macromolecules infused into the peritoneal cavity, and these solutes are currently being used for the assessment of the rate of reabsorption. In contrast, diffusive transport and peritoneal reabsorption cannot be experimentally discriminated for small solutes which exhibit negligible sieving through the membrane in convective transport (i.e., solutes with sieving coefficient equal to 1). For middle molecules each transport component may be of importance and may have an independent impact on bidirectional transport characteristics.

Conclusions

Middle molecules, with sieving coefficients substantially less than 1, may be applied for estimation of peritoneal reabsorption rate using bidirectional transport characteristics, as apparent diffusive mass transport coefficients or unidirectional clearances. However, an independent measurement of sieving coefficient is necessary for this method.
Viscus Perforation in Peritoneal Dialysis Patients: Diagnosis and Outcome
Authors: Wakeen Maureen J. , Zimmerman Stephen W. , Bidwel Denise
Published: February 2020

Objective

To determine the incidence and outcome of spontaneous viscus perforation in peritoneal dialysis (PD) patients and which factors could facilitate early diagnosis.

Design

A retrospective chart review was done on all patients with viscus perforation and on a control group with peritonitis secondary to gram-negative organisms.

Setting

A tertiary care University Hospital Peritoneal Dialysis program.

Patients

All patients with surgically proven spontaneous viscus perforation from 1978 to June 1992 (n = 15). A group of control patients (n = 15) with gram-negative bacterial peritonitis was also reviewed for comparison.

Interventions

None.

Main Outcome Measures

Hospital days, patient survival after perforation, and return to peritoneal dialysis were the main outcomes measured. Peripheral white blood cell (WBC) count, PD fluid WBC count with differential, PD fluid cultures, radiologic information, and surgical intervention were also evaluated. Data were analyzed using the Mann-Whitney test to determine significant differences between the two groups.

Results

Viscus perforation occurred in 15 of the 431 patients on PD from 1978 to June 1992 (3.5%). In comparison to the control group, patients with viscus perforation had a significantly higher peripheral WBC count (p = .016), a higher mean PD fluid WBC count (p = .006), and a higher mean percentage of polymorphonuclear cells in the PD effluent (p = .038). Multiple organisms on PD fluid cultures were noted in 12 of 15 patients with perforation and in only 3 control patients. Pneumoperitoneum was seen on abdominal or chest radiograph or computerized tomographic (CT) scan in 10 of 15 patients with perforation and in only 1 of 15 patients in the control group. All patients with viscus perforation required surgery and 6 expired. Only 1 death occurred in the control group. Only 1 of the 9 patients surviving perforation was able to resume PD, in contrast to 13 of 14 surviving control patients.

Conclusion

We conclude that viscus perforation is associated with high morbidity, mortality, and technique failure. Diagnosis may be made by repeatedly searching for intraperitoneal free air on radiograph or CT scan in patients with persistently elevated peripheral and PD fluid WBC count, and for multiple organisms on PD fluid culture.
Albumin and Amino Acid Levels as Markers of Adequacy in Continuous Ambulatory Peritoneal Dialysis
Authors: Heimbürger Olof , Bergström Jonas , Lindholm Bengt
Published: February 2020

Similar to previous findings in HD patients, a markedly decreased serum albumin level has been found to be a strong predictor of morbidity and mortality in CAPD patients. However, a slight decrease in serum albumin levels (to about 30 g/L if measured with nephelometry or the bromcresol purple method) does not always seem to reflect impaired nutritional status or to be associated with an increased morbidity or mortality in CAPD patients. A low serum albumin level among CAPD patients is related to dialysate albumin loss, comorbidity, age, and a low dietary protein intake. The possible relation between the dialysis dose (as assessed by small solute clearances) and serum albumin levels among CAPD patients is much less established and needs further study, although serum albumin tends to increase in prospective studies of increased peritoneal dialysis dose.

Although the plasma levels of amino acids seem to be lower in CAPD patients compared to HD patients, this does not reflect the intracellular amino acid pattern in muscle which is less abnormal in CAPD patients, possibly because of the sustained hyperinsulinemia during CAPD, resulting in an in creased intracellular to extracellular gradient. It is at present not established to what extent the amino acid abnormalities are related to the dialysis dose.

Malnourished and hypoalbuminemic CAPD patients should be recommended to increase the protein intake, and if this is not effective, the dialysis dose should be increased. Furthermore, the use of amino acid-based peritoneal dialysis solutions is a promising new tool for the treatment of malnourished CAPD patients and may become an important component of CAPD therapy in the future. On the other hand, if the nutritional status deteriorates in spite of these efforts, the patient should be transferred to hemodialysis if possible.
Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis
Authors: Rocco Michael V. , Jordan Jean R. , Burkart John M.
Published: February 2020

Objective

To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis.

Design

Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET.

Setting

Peritoneal dialysis unit of a tertiary medical center.

Outcome Measures

PET results and calculated mass transfer area coefficient (MT AC) values.

Patients

Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group.

Results

In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values.

Conclusion

During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.
Continuous Ambulatory Peritoneal Dialysis in End-Stage Renal Disease Due to Multiple Myeloma
Authors: Shetty Anupkumar , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To evaluate (1) the disease course, (2) the response to recombinant human erythropoietin (rHuEPO), and (3) the morbidity and mortality of patients with endstage renal disease (ESRO) due to multiple myeloma (MM) who were treated with continuous ambulatory peritoneal dialysis (CAPO).

Design

Retrospective study.

Setting

Tertiary teaching hospital -The Toronto Hospital, Toronto, Ontario, Canada.

Patients

Seven patients with ESRO due to MM who were treated with CAPO.

Results

Mean age of the patients was 77.2 years (median 80 years, range 65 88 years). Two were in stage IB, 1 was in stage lIB, and the remaining 4 were in stage IIIB, according to Ourie and Salmon's staging. Three patients received rHuEPO; 2 of these also were receiving chemotherapy for myeloma. The mean rHuEPO requirement was 277 U/kglwk, which was more than other ESRO patients’ requirements. Mean duration of CAPO was 20.6 months (6 –58 months). The peritonitis rate was one episode in 14.4 months. The frequency of hospitalization was once in 5.6 months, and the mean number of days spent in hospital was 20 days per year. Quality of life did not get worse and, if anything, improved marginally while they were on CAPO. Three patients died after a mean survival of 32.7 months, and the remaining 4 patients are still alive.

Conclusions

Myeloma patients with ESRO do fairly well on CAPO without deterioration in their quality of life and with an acceptable peritonitis rate.
Future Approaches to the Treatment of Malnutrition Malnutrition in Peritoneal Dialysis Patients: Etiologic Factors and Treatment Options
Authors: Ikizler T. Alp , Wingard Rebecca L. , Hakim Raymond M.
Published: February 2020

It is clear that malnutrition is common in chronic dialysis patients and is associated with increased morbidity and mortality. Evidence is accumulating that several measures can be taken to improve the nutritional status of these patients. An early start of dialysis, an increase in dialysis dose, the use of biocompatible membranes or dialysis solutions, and intensive nutritional counseling should be applied when necessary. If these measures fail, additional interventions, such as parenteral or enteral nutritional supplements, rhGH, and rhIGF -1, alone or in combination, should be tried.
Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on Capd: Is There a Synergistic Effect with Insulin?
Authors: Fernandez-Reyes Maria Jose , Selgas Rafael , Bajo Maria Auxiliadora , Jimenez Carlos , Del Peso Gloria , Sanchez Maria-Del-Carmen , Dapena Fabiola , De Alvaro Fernando
Published: February 2020

Objective

To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel.

Patients

Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy.

Results

The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics.

Conclusions

According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.
Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in Capd
Authors:   MIDAS Study Group, Gokal Ram , Mistry Chandra D. , Peers Elizabeth M. , Brown C.B. , Smith S. , Edwards D.L. , Junor B.J.R. , Gordon A. , McMillan M. , Robertson M. , Michael J. , McKain J. , Raftery M. , Peters J. , Clutterbuck E.J. , Clemenger M. , Walls J. , Orton C. , Goodship T.H.J. , Grieves J. , Olubodun J. , Jackson F.G. , Dharmasena D. , Hourahane G. , Howarth D.J. , Boyes R.N. , Clisby L.M. , Beran Y.
Published: February 2020

Objective

To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS).

Design

Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients.

Setting

Eleven CAPD units in U.K. teaching hospitals.

Patients

A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study.

Intervention

Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently).

Main Outcome Measures

The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy.

Results

Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patientyear, respectively.

During study

There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patientyear, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01).

Conclusions

Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
Correlations between Plasminogen Activator Inhibitor-1 and Peritoneal Transport in Pediatric Ccpd Patients
Authors: Lin Jen-Jar , Singhal Kamal , Parton Lance , Cascio Clair , Patlak Clifford S. , Stewart Charles L.
Published: February 2020

Objective

Plasminogen activator inhibitor-1 (PAI-1) is an important regulator of plasminogen activators and has been shown to be involved in the accumulation of extracellular matrix (ECM) in various tissues. Since peritoneal ECM is a resistance site for peritoneal transport, the production and release of PAI-1 in the peritoneum may affect the peritoneal transport of water and small solutes.

Design

The linear correlations between the dialysate PAI-1 levels and the variables of peritoneal transport during peritoneal equilibration tests (PET) wereexamined. .Setting A tertiary university hospital.

Patients

Six stable pediatric patients (age 10.8%4 years) undergoing continuous cycler-assisted peritoneal dialysis were included.

Interventions

None.

Results

All data are mean±SD. There was a positive correlation between the infused volume and the net ultrafiltration (UF, 198±127 mL, r = 0.82, p < 0.05). The dialysate PAI-1 levels increased during the dwell time (2.44±2.23 ng/mL or 2.46±1.72 μg at 4 hours vs 0.04±0.1 ng/mL or 0.04±0.09 μg at 0 hour, p < 0.05). The saturation indices (dialysate/plasma ratio) of PAI-1 and albumin at 4 hours were 1.05±1.21 and 0.028±0.004, respectively. The changes from O-hour dwell to 4-hour dwell in the dialysate PAI-1 concentration (PAI4-o, 2.4±2.2 ng/mL) or amount corrected to body surface area (APAI4-0/BSA, 2.61 ±2.11μg/ m2) negatively correlated with UF or UF/body surface area and positively correlated with the number of episodes of peritonitis. There was no correlation between PAI4-o, APAI4-0/BSA, or plasma PAI-1 concentration and the mass transfer coefficient and clearance of either urea or creatinine.

Conclusions

The elevated PAI-1 level during the PET was likely from the local production and release of PAI-1. It had an inverse relationship with the amount of ultrafiltration. Repeated inflammation of the peritoneum was associated with an increased production and release of PAI-1 into the peritoneum.