bluuebunny/crossref_metadata_2025 huggingface dataset:
The Plasma Leak–to–Response Hypothesis: A Working Hypothesis on the Pathogenesis of Encapsulating Peritoneal Sclerosis after Long-Term Peritoneal Dialysis Treatment
Authors: Nakayama Masaaki
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is one of the most serious complications of long-term peritoneal dialysis (PD). Long-term PD therapy has been suggested as a risk factor for EPS development among patients in Japan and Australia. Although the primary mechanism of EPS development has not been clarified, histologic changes of the peritoneum associated with prolonged PD are postulated to be causally related. The present article proposes a working hypothesis—the plasma leak–to–response hypothesis—that vascular alterations in the peritoneum of long-term PD patients play a crucial role in the initiation and development of EPS.
Assisted Peritoneal Dialysis. Experience in a French Renal Department
Authors: Lobbedez Thierry , Moldovan Raluca , Lecame Marie , de Ligny Bruno Hurault , Haggan Wael El , Ryckelynck Jean-Philippe
Published: February 2020

Background

The French healthcare system offers the possibility of increasing the use of peritoneal dialysis (PD) by involving in patient care nurses who work in the private system.

Objective

This study was conducted to evaluate the impact of a private home-nurse network on one dialysis program.

Methods

This was a retrospective study of 239 dialysis patients who started dialysis in our center between 1 January 1998 and 31 December 2003.

Results

Of these 239 patients, 142 were treated with hemodialysis and 97 with PD during the study period. Among the PD patients, 36 of 97 were treated with assisted PD and 61 of 97 with self-care PD. Assisted-PD patients were older (74 ± 10 vs 52 ± 18 years, p < 0.001) and presented more comorbidity (Charlson Comorbidity Index 7 ± 2.5 vs 4.3 ± 2.4, p < 0.05) compared with self-care patients. Continuous ambulatory PD was the modality of choice in the assisted group (32/36). Assisted patients were frequently hospitalized (31/36); actuarial survival free of hospitalization at 6 months was 46%. Patients with nurse assistance had a high risk of peritonitis (actuarial survival free of peritonitis: 52% at 1 year). Technique survival was 85% at 6 months and 58% at 1 year. Actuarial patient survival was 90% at 6 months and 83% at 1 year.

Conclusion

Assisted PD enables increased use of PD in incident dialysis patients. However, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.
Assessing Plasma Total Homocysteine in Patients with End-Stage Renal Disease
Authors: Urquhart Bradley L. , House Andrew A.
Published: February 2020

Elevated plasma total homocysteine (tHcy) is a risk factor for cardiovascular disease; however, in light of several recent randomized trials, the issue of causality has been cast into doubt. Patients with end-stage renal disease are particularly interesting as they consistently have elevated tHcy and their leading causes of morbidity and mortality are related to cardiovascular disease. In the present article, we review the early evidence for the homocysteine theory of atherosclerosis, homocysteine metabolism, mechanisms of toxicity, and pertinent available clinical investigations. Where appropriate, the sparse evidence of homocysteine in peritoneal dialysis is reviewed. We conclude by addressing the difficulties associated with lowering plasma tHcy in patients with end-stage renal disease and suggest some novel methods for lowering tHcy in this resistant population. Finally, to address the issue of causality, we recommend that clinicians and scientists await the results of the FAVORIT trial before abandoning homocysteine as a modifiable risk factor for cardiovascular disease, as this study has recruited patients from a population with consistently elevated plasma tHcy who are known to respond to vitamin therapy.
Effects of Peritoneal Dialysis Solutions Low in GDPs on Peritonitis and Exit-Site Infection Rates
Authors: Furkert Jürgen , Zeier Martin , Schwenger Vedat
Published: February 2020

Background

Peritoneal dialysis (PD) solutions sterilized at a low pH level contain only minimal amounts of glucose degradation products (GDPs). The latter are known to have an adverse effect on the peritoneal membrane. The present study retrospectively analyzes the effects on the incidences of peritonitis and exit-site infections.

Materials and Methods

Data concerning the frequency of peritonitis and exit-site infections for 120 patients treated with PD were collected. Before 2000, 67 of these patients received conventional dialysates and from 2000 on, 53 patients were treated with the new dialysis fluids. Furthermore, a correlation between the incidence of infections and the duration of treatment with dialysis was established.

Results

It was observed that the use of dialysis solutions low in GDPs resulted in significantly lower rates of peritonitis ( p = 0.002) and exit-site infections ( p = 0.02). When using the new treatment, peritonitis occurred, on average, after 48 months of treatment and exit-site infections after 34 months of treatment.

Discussion

The result supports the hypothesis that the use of the new, biocompatible, PD solutions contributes to considerable reduction in the rates of peritonitis and exit-site infections. As it is not expected that randomized prospective studies will be conducted in the future, further observational studies should be carried out in order to affirm the observed tendencies.
Bone Mineral Density, Vascular Calcifications, and Arterial Stiffness in Peritoneal Dialysis Patients
Authors: Adragao Teresa , Branco Patrícia , Birne Rita , Curto José Dias , de Almeida Edgar , Prata Mateus Martins , Pais Maria Joao
Published: February 2020

The objective of this study was to evaluate the correlation of bone mineral density (BMD), evaluated by DXA, with vascular calcifications, arterial stiffness, and vascular disease in patients on peritoneal dialysis. Vascular calcifications were evaluated by vascular calcification score on plain x ray, and arterial stiffness was measured by pulse wave velocity using the Complior device (Artech Medical, Pantin, France). Adjusting for multiple factors, lower BMD at the femoral neck, but not at the lumbar spine, was associated with higher pulse wave velocity ( p = 0.037), higher vascular calcification score ( p = 0.013), and peripheral artery disease ( p = 0.006). These data reinforce the hypothesis of the existence of a link between bone disease and cardiovascular disease in dialysis patients.
Stability of Tobramycin and Ceftazidime in Icodextrin Peritoneal Dialysis Solution
Authors: Pallotta Katie E. , Elwell Rowland J. , Nornoo Adwoa O. , Manley Harold J.
Published: February 2020

Purpose

The data describing the compatibility of tobramycin and ceftazidime in icodextrin-based peritoneal dialysis (PD) solution is limited. The objective of this study was to assess the chemical stability of tobramycin and ceftazidime in icodextrin PD solution in polyvinyl chloride containers.

Methods

Commercially available 2-L bags of icodextrin 7.5% PD solution were used for each sample. Nine tobramycin study samples were prepared by adding 80 mg tobramycin HCl to each bag. Nine ceftazidime samples were prepared by adding 1000 mg ceftazidime to each bag. Three bags of tobramycin–icodextrin solution were stored under each of the following conditions: refrigeration (4°C), room temperature (25°C), and body temperature (37°C). Three bags of ceftazidime–icodextrin solution were also stored at each of the respective temperatures. Samples were withdrawn from each bag immediately after preparation and at predetermined intervals (1, 2, 4, 6, 8, 12, 24, 48, 72, 96, 120, 168, and 336 hours after preparation). Solutions were visually inspected for precipitation, cloudiness, and discoloration at each sampling interval. All samples were immediately frozen (–80°C) after collection and stored prior to assay. Total concentrations of tobramycin and ceftazidime in dialysate fluid were determined by high-performance liquid chromatography. The last time point when tobramycin or ceftazidime concentration was >90% from baseline was used to denote stability.

Results

All solutions were clear in appearance and no color change or precipitation was observed during the study. For tobramycin, under refrigeration, a mean of 94.6% ± 2.3% of the initial concentration remained at 336 hours (14 days); at room temperature, 90.5% ± 4.3% remained at 168 hours (7 days); at body temperature, 90.0% ± 8.1% remained at 24 hours. For ceftazidime, under refrigeration, a mean of 98.0% ± 0.3% of the initial concentration remained at 168 hours (7 days); at room temperature, 91.6% ± 2.0% remained at 48 hours; at body temperature, 93.9% ± 1.1% remained at 8 hours. Stability was not assessed beyond these respective time points.

Conclusion

Premixed tobramycin–icodextrin PD solution remains stable for 336 hours (14 days) when refrigerated (4°C) and for 168 hours (7 days) at room temperature (25°C). Ceftazidime–icodextrin PD solution is stable for 168 hours and 48 hours, respectively, when stored at 4°C and 25°C. It is recommended that the bags be kept refrigerated whenever possible. Tobramycin–icodextrin solution stored at body temperature was stable up to 24 hours, and ceftazidime–icodextrin solutions up to 8 hours, permitting the practice of pre-warming solutions prior to administration.
Novel Low Na Peritoneal Dialysis Solutions Designed to Optimize Na Gap of Effluent: Kinetics of Na and Water Removal
Authors: Nakayama Masaaki , Kasai Kenji , Imai Hirokazu
Published: February 2020

Background

An imbalance between sodium intake to and excretion from the body contributes to overhydration in peritoneal dialysis (PD) patients. Novel low Na solutions were developed based on the concept of optimizing the Na gap of effluent to achieve better Na balance. The present study investigated Na and water removal by those solutions.

Methods

Compositions of low Na (LS) and standard Na (SS) solutions were as follows: Na 133, 126, and 118 mEq/L with respective corresponding glucose concentrations of 0.9%, 1.6%, and 2.5% in LS(90), LS(160), and LS(250) solutions; Na 135 mEq/L with glucose 1.35% and 2.5% in SS(135) and SS(250) solutions respectively. Based on the status of their daily PD prescriptions, respective LS solutions were assigned to 41 patients as follows: LS(90) or LS(160) for SS(135) solution, and LS(160) or LS(250) for SS(250) solution.

Results

In the 4-hour dwell, no differences were found in Na removal between LS(90) and SS(135), whereas Na removal by LS(160) and LS(250) was significantly increased compared to SS(135) and SS(250) ( p < 0.05 respectively). The Na gaps of the 3 respective LS solutions were significantly less than those of controls ( p < 0.05 respectively). With 1-day full-time use of LS solutions, no significant changes were found in daily water removal compared to controls, while Na removal was significantly increased in LS solutions ( p < 0.05), with conversion to a negative Na gap in total daily effluent.

Conclusion

The low Na solutions used in the present study facilitated Na removal by reducing the Na gap. This characteristic is expected to achieve better Na balance in PD patients with excess body fluid retention.
Factors Contributing to Peritoneal Tissue Remodeling in Peritoneal Dialysis
Authors: Schilte Margot N. , Celie Johanna W.A.M , ter Wee Piet M. , Beelen Robert H.J. , van den Born Jacob
Published: February 2020

Peritoneal dialysis (PD) is associated with functional and structural changes of the peritoneal membrane. In this review we describe factors contributing to peritoneal tissue remodeling, including uremia, peritonitis, volume loading, the presence of a catheter, and the PD fluid itself. These factors initiate recruitment and activation of peritoneal cells such as macrophages and mast cells, as well as activation of peritoneal cells, including mesothelial cells, fibroblasts, and endothelial cells. We provide an overview of cytokines, growth factors, and other mediators involved in PD-associated changes. Activation of downstream pathways of cellular modulators can induce peritoneal tissue remodeling, leading to ultrafiltration loss. Identification of molecular pathways, cells, and cytokines involved in the development of angiogenesis, fibrosis, and membrane failure may lead to innovative therapeutic strategies that can protect the peritoneal membrane from the consequences of long-term PD.
Water and Solute Transport through Different Types of Pores in Peritoneal Membrane in Capd Patients with Ultrafiltration Failure
Authors: Waniewski Jacek , Debowska Malgorzata , Lindholm Bengt
Published: February 2020

Free water transport, an estimate of aquaporin function, was evaluated in 7 continuous ambulatory peritoneal dialysis (CAPD) patients with permanent ultrafiltration failure. In 3 patients, peritoneal transport was studied also before the onset of ultrafiltration failure. Transcapillary ultrafiltration and fluid absorption rates were assessed using radiolabeled albumin, and free water transport by kinetics of sodium concentration in dialysis fluid. Diffusive and convective transport rates of small solutes were estimated using the modified Babb–Randerson–Farrell model. Increased diffusive transport of small solutes was found in 5 patients and increased peritoneal fluid absorption in 2 patients. The 3-pore model was fitted to these data. Overall, hydraulic conductivity and the fractional contributions of aquaporins to hydraulic conductivity were either decreased or normal. We conclude that the quantitative role of aquaporins in overall fluid transport may vary substantially in normal patients as well in patients with ultrafiltration failure.
Peritoneal Dialysis and Preservation of Residual Renal Function
Authors: Tam Paul
Published: February 2020

Residual renal function (RRF) is now generally recognized as an important factor in the prognosis of patients on dialysis. This review summarizes the differences between peritoneal dialysis (PD) and hemodialysis (HD) with regard to RRF. The literature supports PD as having a more beneficial effect on RRF.
Encapsulating Peritoneal Sclerosis—Medical and Surgical Treatment
Authors: Lo Wai Kei , Kawanishi Hideki
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication. The patients at high risk for EPS include those on peritoneal dialysis (PD) for more than 8 – 10 years and patients with high peritoneal transport and frequent peritonitis. Effective medical treatment with tamoxifen and immunosuppressives (a steroid with or without azathioprine or mycophenolate) has been reported. Surgical enterolysis is needed when irreversible intestinal obstruction occurs. In experienced hands, mortality can be reduced to a few percentage points, but the recurrence rate is very high. Noble plication has been reported to reduce the recurrence rate. Accelerated EPS development may possibly occur after conversion from PD to HD.
Multicenter Evaluation of a New Peritoneal Dialysis Solution with a High Lactate and a Low Magnesium Concentration
Authors: Barbara Karl D. Nolph , Kenneth D Prowant , Morgan Serkes Linda , Chaim Betty Baker , Gham Chary Tan Kathy , Fred Richard Hamburger , Kleit Husserl Stuart , McGuinness Jayne , Moore Harold , Warren Toni
Published: February 2020

Four co-operating centers evaluated the effects of a new dialysis solution containing 40 mEq/1 of lactate and 0.5 mEq/1 of magnesium on serum total CO2 and magnesium concentrations. The new solution yielded significant increases in serum CO2 and decreases in serum magnesium compared to the standard (35 mEq/1 of lactate and 1.5 mEq/1 of magnesium) solution.
A Technique for Managing Exit Site and Cuff Infection in Tenckhoffcatheters
Authors: Nichols W. Kirt , Nolph Karl D.
Published: February 2020

While not life threatening, outer cuff infection is an annoying and troublesome complication. In addition, it has the potential of leading to more serious infection and subsequent catheter loss. The technique described here helps to avoid the more serious infections and yet maintains CAPD without interruption.
Pediatric CAPD Update -1983
Authors: Alexander Steven R.
Published: February 2020

This paper reviews progress in CAPD in pediatric patients from the treatment of the first child in 1978 through the spring of 1983. It will summarize current approaches to catheters, dialysis mechanics, and nutrition in children and make some observations on growth and complications seen in children on CAPD.

It has been established that this dialysis method is excellent for children, at least for the short term. It remains to be seen whether CAPD will be as successful over the longterm in children.
Early Post Transplantation Infections in CAPO Patients
Authors: Ryckelynck Jean-Philippe , Verger Christian , Pierre Dominique , Sabatier Jean-Claude , Faller Bernadette , Beaud Jean-Marie
Published: February 2020

In order to evaluate the risk of infection during the post-transplantation period in CAPD patients, a retrospective multi-center study was performed among six centers: dialysis and transplantation teams differed in size and experience, and geographically were separated so that the group studied can be taken to represent the overall CAPD population. Seventeen CAPD patients were transplanted between 1980 and 1983: no infectious complication related to CAPD was observed, even in patients whose CAPD was continued after the operation. It is concluded that there is no special risk to CAPD patients receiving a kidney transplant and therefore adults waiting for a renal transplant can be safely maintained on CAPD.

Compared to hemodialysis, CAPD is a relatively new treatment and therefore there is no overall agreement about its indications. This is true particularly for ESRD patients younger than 55 years who are waiting for a kidney transplantation; many teams are reluctant to transplant CAPD patients because of a possible high risk for infection due to the presence of an intraperitoneal catheter and a history of previous peritonitis. To evaluate this risk, we have undertaken a multicenter study of CAPD patients transplanted between January 1980 and January 1983.
Catheter Break-in for Continuous Ambulatory Peritoneal Dialysisuniversity of Missouri Experience
Authors: Zbylut J. , Leonor Twardowski , Ryan P. , Kennedy Juanita M.
Published: February 2020

Retrospective analysis of the results of several break-in techniques in our institution revealed that a 10 day delay in CAPD initiation after a midline Tenckhoff catheter insertion is sufficient to prevent leakage in patients maintained on intermittent peritoneal dialysis. A leak or obstruction related to an insufficient surgical technique can be promptly diagnosed and corrected. An irrigation technique seems to be useful in non-uremic patients, but frequently fails to disclose a one-way obstruction with a consequent delay in a surgical correction. Recently we have introduced a modification of this technique in which the patency of the catheter is checked with one in and out exchange using a small volume of dialysate during outpatient clinic visits every 2– 3 days.
Experience with 150 Consecutive Permanent Peritoneal Catheters in Patients on CAPO
Authors: Odor Alberto , Alessio-Robles L Luis P. , Javier Leuchter I. , Arturo Mendoza V. , Javier Bordes A. , Arturo Wadgymar R. , Gonzalez F Ricardo F. , Peon M Federico Chavez
Published: February 2020

From 1978 to 1984, 150 consecutive CAPD catheters have been implanted in our institution. Early (first-week) and late (up to 44 months) follow-up is presented with special attention to possible surgical related complications.

A paramedian incision and an original antileakage technique were used in 95% of the catheters. With this combination, hernia and leakage rates are very low (0.7%()). With the patient-training program, described here, and the installation of the catheter in the outpatient department, peritonitis during the first week dropped from 20% to 0%() (p < 0.05). Previous abdominal operations significantly increase early failures (p < 0.05). Skin exit-site infections were not seen in our patients. The most frequent long-term complications were catheter colonization, i.e. recurrent peritonitis with the same organism, and repeated peritonitis episodes leading to obstruction. The one year actuarial catheter survival is 40%. This paper discusses factors responsible for as well as possible improvement of this low figure.

Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). Recent surveys show that up to 45% of home-dialysis patients are in CAPD programs (1). Recently Oreopoulos analyzed the benefits and indications of CAPD and showed that the procedure is being used with increasing frequency (2).

The CAPD program in our institution was started in 1978. From January 1981 to October 1984, 150 Tenckhoff catheters were implanted as part of that program. These patients who have had careful metabolic and surgical followup form the basis of this report.
Equilibrium Peritoneal Dialysis (EPD) in Acute Renal Failure (ARF) Secondary to Rhabdiomyolysis
Authors: Trevino-Becerra Alejandro , Cristina A vilez Patricia Munoz , Maimone Ma. Antonieta Schetino , Lopez Ma. Luisa Erbessd
Published: February 2020

The purpose of this work is to assess EPD in ARF patients who have suffered rhabdomyolysis. In preparation for Tenckhoff catheter insertion dialysis exchanges through a stylet catheter were used every 30 minutes; after implantation of the Tenckhoff catheter we started 2L of solution with six four-hour exchanges. Dialysis was discontinued after 16 days on average when patients had a urinary volume of over one litre in 24 hours.

Results allow us to conclude that EPD is an adequate method of treatment for ARF due to rhabdomyolysis.
Mesothelium Secretes Lamellar Bodies in a Similar Manner to Type II Pneumocyte Secretion of Surfactant
Authors: Dobbie James W. , Lloyd John K.
Published: February 2020

In the early 1970s it was found that a specific lipid-fixing technique of tissue preparation for electron microscopy (tannic acid-gluteraldehyde) preserved and thus unmasked distinctive inclusions in Type II pneumocytes which were called lamellar bodies. This discovery was the first crucial step in demonstrating that lamellar bodies were the storage granules from which alveolar surfactant was secreted. In a previous study a comparison between mesothelium and Type II pneumocytes showed close ultrastructural similarities. In the present investigation of normal peritoneal tissue from man, monkey, rabbit and mouse, following primary tannic acidgluteraldehyde fixation and modified embedding procedures similar to those used for lung, examination by transmission electron microscopy demonstrated in all mesothelial cells examined, characteristic lamellar structures similar to those described in Type II pneumocytes. Exocytotic extrusion of lamellar bodies from the apical portion of the mesothelial cell, and the presence of lamellar bodies on the cell surface in a manner identical to that found in Type II pneumocytes was also observed. These findings provide compelling evidence that a process of specialized biosynthesis and secretion of phospholipids similar to that established for Type II pneumocytes also occurs in mesothelial cells.
Peritonitis following Colonoscopy in a Peritoneal Dialysis Patient
Authors: Ray Susan M. , Piraino Beth , Holley Jean
Published: February 2020

A 65-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) developed blood-tinged dialysate and bacterial peritonitis following a colonoscopic polypectomy. She grew multiple anaerobic organisms in her dialysate despite antibiotic prophylaxis with vancomycin and gentamicin prior to the procedure. This case confirms the need for broad spectum antibiotic prophylaxis prior to colonoscopic procedures, especially if polypectomy is planned. The antibiotic chosen should cover anaerobes as well as gram-positive and gram-negative enteric organisms. We suggest the use of ampicillin, clindamycin, and an aminoglycoside antibiotic for this prophylaxis.
A Randomised Prospective Comparison of Oral Ofloxacin and Intraperitoneal Vancomycin plus Aztreonam in the Treatment of Bacterial Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Cheng Ignatius K.P. , Chan Ching-Ying , Wong Woon To
Published: February 2020

Forty six patients who developed 48 episodes of peritonitis while on CAPD were randomised to receive either oral ofloxacin or intraperitoneal (i.p.) vancomycin/ aztreonam. Three patients were excluded from analysis: 2 were transferred to other hospitals and 1 was later found to have candida peritonitis. Of the remainder, 22 episodes were treated with oral ofloxacin and 23 with i.p. vancomycin/aztreonam. The primary cure rate in the oral ofloxacin and i.p. vancomycin/aztreonam group was 77.3% and 87.5% respectively. There were 3 primary failures and 2 relapses in the former and 1 failure and 2 relapses in the latter group. Two of the 4 primary failures were peritonitis episodes secondary to infection with pseudomonas species. The total number of days of hospital stay was 48 and 58 respectively in the two groups. Analysis of the cost of treatment revealed that i.p. vancomycin/aztreonam was 30 times more expensive than oral ofloxacin. Despite a slightly higher cure rate with i.p. vancomycin/aztreonam, oral ofloxacin is a more cost-effective primary treatment of bacterial peritonitis in patients on CAPD especially in countries with a limited health budget.
Host Defense Mechanisms of the Peritoneal Cavity and Continuous Ambulatory Peritoneal Dialysis
Authors: Keane William F. , Peterson Phillip K.
Published: February 2020

Clinical and experimental data reviewed in this paper illustrate the perturbations of normal bio logical functions, which may accompany a major technological advance. There is a marked reduction in opsonic molecules, particularly IgG and C3, that occur after the instillation of large volumes of dialysate into the abdominal cavity. This greatly alters the normal balance in the peritoneal milieu and significantly impairs the normal function of phagocytic cells in the abdominal cavity. The “immunocompromised environment” produced is reflected in the high incidence of peritonitis in CAPD patients. Gram-positive organisms, particularly S. epidermidis, predominate. The higher incidence of gram-positive organisms in CAPD peritonitis probably reflects the more frequent exposure to gram-positive organisms during CAPD. These clinical data coupled with our experimental results suggest that the instillation of IgG locally in the abdominal cavity might enhance host defenses against peritonitis. This approach to prevention would represent a modern application of a treatment that was used extensively in the era before antibiotic therapy.
Ambulatory Peritoneal Dialysis: A Study of National Capd Registry Data
Authors: Lindblad Anne S. , Nolph Karl D.
Published: February 2020

From January 1981 to July 1988, the U.S. National CAPD Registry followed 23,771 patients on CAPD or CCPD for 3 months or more in 498 participating centers. Of these patients, 281 were deemed to have enough recovery of renal function to do without dialysis for at least 3 months. The median time on PD before recovery was 126 days in 138 patients treated only by PD from the start of dialysis. The median time to recovery in 106 patients was 238 days from the start of any chronic dialysis. A Cox model analysis revealed significantly (p<0.05) increased chances for renal function recovery in patients with systemic immunological diseases with renal involvement (relative risk for recovery [rr]=2.48), patients with renal infarction related to renal vascular occlusion (rr=4.13), and patients >60 years of age compared to a younger group (rr=1.72). However, patients >60 and <21 experienced similar recovery rates. Reduced chances (p<0.05) for recovery were associated with diabetic glomerulosclerosis (rr=0.25) and polycystic kidney disease (rr=0.13). These findings show that renal function recovery rates in chronic hemodialysis and chronic peritoneal dialysis cannot be properly compared unless all risk factors (favoring or against recovery) are balanced, as in a prospective randomized trial.
The Effect of Hemoglobin Concentration on Peritoneal Mass Transfer and Drain Volumes in Continuous Ambulatory Peritoneal Dialysis
Authors: Hutchison Alastair J. , Ofsthun Norma J. , Howarth Debbie , Gokal Ram
Published: February 2020

Objective

To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A -hemoglobin less than 8.5 g/dL; Group B hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL.

Setting

Single renal unit of a university teaching hospital. Patients:Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A -14 patients; Group B -13 patients; Group C (subgroup of A) -8 patients.

Main outcome measures

Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy.

Results

No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C.

Conclusions

Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.
Tidal Peritoneal Dialysis: Preliminary Experience
Authors: Flanigan Michael J. , Doyle Cynthia , Lim Victoria S. , Ullrich Gary
Published: February 2020

Objectives

To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD).

Design

An open enrollment pilot study.

Setting

The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital.

Patients

Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time.

Interventions

Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD.

Measurements

Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement.

Results

Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 + 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/ kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription.

Conclusion

TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).
Intraperitoneal Administration of Phospha Tidylcholine Improves Ul Trafil Tration in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Krack Genevieve , Viglino Giusto , Cavalli Pier Luigi , Gandolfo Carmen , Magliano Giuseppe , Cantaluppi Alberto , Peluso Franco
Published: February 2020

Reports in the literature have linked a low phosphatidylcholine content in continuous ambulatory peritoneal dialysis {CAPD) effluent to ultrafiltration loss. Clinical evidence suggests that adding phosphatidylcholine to the dialysis solution enhances ultrafiltration. A clinical study has been designed to clarify the effect of phosphatidylcholine on ultrafiltration in CAPD patients with normal ultrafiltration. A weekly measurement of the peritoneal equilibration test was conducted per patient in the hospital. A comparison between the control dialysis solution {three-week period) and the phosphatidylcholine premixed solution {three-week period) was performed on a total of 12 patients. This study shows that a phosphatidylcholine premixed dialysis solution significantly enhances ultrafiltration. Since ultrafiltration per osmotic driving force (mUg glucose) is enhanced, the patient's glucose load per day is reduced to achieve equal ultrafiltration. In the presence of phosphatidylcholine, peritoneal permeability remained unchanged, as indicated by membrane transport characteristics. No side effects were observed.
Mass Transfer Coefficient: Comparison between Methods
Authors: Teixidó Josep , Cofan Frederic , Borrás Mercé , Bonet Josep , Bonal Jordi , Galimany Roman , Biosca Carme , Caralps Antonio
Published: February 2020

The mass transfer area coefficient (MTC) is the best parameter for solute transport evaluation in continuous ambulatory peritoneal dialysis (CAPD) patients.

We compared three simplified MTC methods (calculated according Garred, Krediet, or Lindholm) and the peritoneal equilibration test (PET) (Twardowskl) to complex MTC (MTCX) (Randerson and farrell) for urea and creatinine, by means of 29 tests performed In 24 stable CAPD patients.

There were no significant differences (paired t-test) between MTCX and each of the simplified MTC, except for creatinine MTC calculated by Krediet's method, which was significantly different (MTCX: 9.36.:1:.4.32, K-MTC: 10.48.:1:.4.55, p<0.05).

Likewise, there was an acceptable correlation between complex MTC and each of the simplified methods including the PET.

However, a more detailed study of the MTC's categorizations shows poor agreement with complex MTC categorization. Better results are obtained by PET categorization, which reaches good likelihood ratios either for positive or negative events.

We conclude that simplified MTC or the dialysatelplasma ratio at 240 minutes for urea and creatinine has an acceptable correlation with complex MTC and can be useful in clinical practice.

There is poor agreement between solute transport categorizations of simplified MTC and complex MTC. There Is a better coincidence between the PET ( DIP at 240 minutes) and complex MTC categorizations.
Cardiovascular Function in a Chronic Peritoneal Dialysis Pediatric Population on Recombinant Human Erythropoietin Treatment
Authors: Bassi Sergio , Montini Giovanni , Edefonti Alberto , Perfumo Francesco , Cattarelli Donatella , Piaggio Giorgio , Fesslova Vlasta , Zacchello Graziella , Bove Sergio
Published: February 2020

Anemia, through a hyperkinetic state, is an Important contributor to myocardial function impairment. To determine the cardiovascular effects of recombinant human erythropoietin (rHuEPO) therapy, 10 chronic peritoneal dialysis (CPD)-treated anemic children were studied be fore and during 18 months of treatment. The following parameters were recorded: hemoglobin (Hb) [percent of target level (TL) = x 2 standard deviations of normal Hb values for age and sex], heart rate (HR, beats/minute), mean arterial pressure (MAP, mmHg), end-diastolic left ventricular diameter (EDLVD, mm/sm BSA), shortening fraction (SF, percent), and Interventricular septal thickness (IVS, mm/sm BSA).

Student's t-test for paired data showed (vs time before treatment, TO) a progressive Increase In Hb, a progressive decrease In HR, and a progressive Increase In MAP. EDLVD progressively decreased, while SF and IVS remalned unchanged throughout the study. Regression analysis showed a close correlation between anemIa cor rection and decrease of HR (p<0.01), while no correlation was found between Hb and EDLVD or SF, IVS, or MAP.

Our data indicate that anemia correction In these patients Is mainly associated with a decrease in hyperkinetic state (HR reduction with SF unvaried), while left ventricular function and dimensions remain normal, despite an Increase in MAP.
Continuous Peritoneal Dialysis in Newborns
Authors: Zaramella Patrizia , Andreetta Barbara , Zanon Giovanni Franco , Murer Luisa , Montini Giovanni , Cantarutti Felice , Zacchello Graziella
Published: February 2020

Objective

To report the complications and outcome of 10 newborns affected by acute renal failure (ARF), treated by continuous peritoneal dialysis (CPD).

Design

All newborns admitted for tertiary treatment to the Neonatal Intensive Care Unit of the University of Padova, who underwent CPD between February 1986 and December 1990, were analyzed retrospectively.

Patients

Ten newborns (mean weight 2077 g, range 540–4930 g) received CPD, 6 of whom were preterm. All the survivors completed the study.

Interventions

A number 9,5 French Tenckhoff catheter was used, and a closed circuit was created by means of a modified continuous ambulatory peritoneal dialysis (CAPD) technique. The mean duration of dialytic therapy was 7 days.

Results

At the end of the dialytic period, 7 of the 10 patients had normal serum potassium and sodium values. CPD produced two different types of complications: leakage of the dialytic fluid in very low weight newborns and one episode of peritonitis during a chronic dialysis treatment. Six died of severe respiratory failure (in no case, however, was this attributable to ARF or CPD procedure). All but one of the survivors regained normal renal function. The only exception necessitated a kidney trans plant.

Conclusion

We believe that this technique, although invasive, improves the outcome of both preterm and low birth weight newborns affected by ARF.
Comparison of Three Different Tests for Assessment of Hepatitis C Virus in Dialysis Patients
Authors: Castelnovo Claudia , Lunghi Giovanna , De Vecchi Amedeo , Grancini Anna , Como Giovanna , Graziani Giorgio , Scalamogna Antonio , Ponticelli Claudio
Published: February 2020

Objective

To evaluate the relationship between hepatitis C virus antibodies (HCV-Ab) and viremia and to compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Cross-sectional study.

Setting

Dialysis unit of a nephrology division in a public university hospital.

Patients

All dialysis patients who came for routine clinic visits during the study period. None denied informed consent. Forty-eight patients on HD and 79 on CAPD were examined.

Intervention

Blood samples were tested by second generation enzyme-Iinked immunosorbent assay (ELISA II) and recombinant immunoblot assay (RIBA II) to look for HCV-Ab and by the polymerase chain reaction (PCR) to look for HCV viremia.

Results

ELISA II was positive in 52% of HD patients and in 14% of CAPD patients. RIBA II was positive in 48% of HD patients and in 11% of CAPD patients. HCV viremia was positive by PCR in 41.6% of HD patients and in 12% of CAPD patients. Two of these PCR-positive patients did not show HCV-Ab by ELISA II and RIBA II. The sensitivity and specificity of ELISA II were 93% and 92%, the sensitivity and specificity of RIBA II were 86% and 94%.

Conclusions

Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.
Nursing Forum: Urea Kinetics and Nitrogen Appearance Rates in Diabetic Patients on Peritoneal Dialysis
Authors: Prowant Barbara F. , Bernardini Judith Y. , Kelman Betty , Bernardini Judith , Piraino Beth
Published: February 2020

Objective

We compared the relationship of protein intake (as measured by protein nitrogen appearance) and dialysis delivery in insulin-dependent diabetic (IDDM) and nondiabetic patients.

Design

One to two 24-hour dialysate and urine collections were obtained in 20 diabetic patients and 42 nondiabetic patients. The protein equivalent of nitrogen appearance (PNA) was calculated by the Randerson formula. KTN was determined using V obtained by the Watson formula. PNA was normalized using three different methods to determine body weight: first, by normal or ideal body weight according to the Metropolitan Table (nPNA); second, by standard body weight according to the NHANES Table (sPNA); and third, by V/0.58 (vPNA).

Results

The mean PNA was not different in diabetics and nondiabetics (53±21 g/day vs 60±14 g/day), nor was weekly KTN (2.1 ±0.6 vs 2.1 ±0.6). Mean normalized PNA was not different in IDDM versus non-DM regardless of the method. KTN correlated with nPNA in IDDM (r = 0.54, p = 0.002 and non-DM, r = 0.31, p = 0.03), and with vPNA in IDDM (r = 0.73, p < 0.00001, and non-DM, r = 0.45, p = 0.0009). KTN also correlated with sPNA in IDDM (r = 0.57, p = 0.001), but not in non-DM (r = 0.25, p = 0.08). The slope for normalized PNA versus KTN was steeper for IDDM than for non-DM.

Conclusion

KTN and PNA are more closely correlated in IDDM patients than in non-DM patients. Thus it is extremely important that IDDM patients receive an adequate level of dialysis.
Low Seroconversion with Hepatitis B Vaccination in Peritoneal Dialysis Patients
Authors: Khan Abdul N. , Bernardini Judy , Rault Raymond M. , Piraino Beth
Published: February 2020

Objective

To compare seroconversion using hepatitis B vaccine between hemodialysis (HD) and peritoneal dialysis (PD) patients.

Design

Data on PD patients vaccinated were collected retrospectively for the period 1992 to 1995. The data on HD patients were collected prospectively from 1991 to 1994.

Setting

A university outpatient dialysis center.

Participants

All adult patients who received all four doses of hepatitis B vaccine while on dialysis were included (47 PD and 50 HD patients).

Intervention

Recombinant hepatitis B vaccine (Engerix), 40 μg IM was administered at 0, 1, 2, and 6 months.

Main Outcome Measure

Seroconversion was measured after completion of the vaccination series.

Results

74% of the HD patients seroconverted compared to 53 % of PD patients (p = 0.03). Older, heavier patients compared to all the other patients had a lower seroconversion rate in both the HD patients (55 % vs. 78 %) and PD patients (38 % vs. 59 %) (p = 0.03).

Conclusion

The seroconversion rate to recombinant hepatitis B vaccine is lower in patients on PD than on HD for unclear reasons. Further studies are required to determine the etiology of this difference.
Demonstration of Aquaporin-Chip in Peritoneal Tissue of Uremic and Capd Patients
Authors: Pannekeet Marja M. , Mulder Jos B. , Weening Jan J. , Struijk Dirk G. , Zweers Machteld M. , Krediet Raymond T.
Published: February 2020

Aquaporin-CHIP is a 28 kD channel forming integral membrane protein. It acts as an osmotically driven, water-selective pore. The presence of aquaporin-CHIP has been demonstrated in the proximal tubule in the kidney and in the pleura, as well as in other tissues. During peritoneal dialysis a dissociation between the transport of water and sodium using hyperosmolar solutions has been reported, suggesting the presence of ultrasmall pores. Water channels, like aquaporin-CHIP, could be the morphological equivalent of these pores.

We investigated the possible presence of aquaporinCHIP in cryo-sections of peritoneal tissue using affinity purified human anti-CHIP IgG (P. Agre, Baltimore, MD).

Peritoneal biopsies (omenta) were obtained at catheter insertion in 2 uremic patients with end-stage renal disease, and at catheter reimplantation of 1 patient treated with continuous ambulatory peritoneal dialysis (CAPD) for two years. Peritoneal tissue obtained at autopsy from 1 patient who had been on CAPD for four years, but in whom CAPD had been discontinued for five months, was also studied.

Aquaporin-CHIP antiserum specific staining was found in the endothelial cells of the peritoneal capillaries in all patients. No obvious difference in the intensity of staining was seen between uremic and CAPD patients.

This demonstration of aquaporin-CHIP in human peritoneal endothelial cells supports the hypothesis of the existence of ultrasmall pores within the peritoneal membrane. These water channels facilitate the transcellular transport of water, induced by an osmotic gradient, in the absence of sodium transport. It may be the explanation for the dissociation of water and sodium transport that occurs during hyperosmolar solutions.

Aquaporin-CHIP is present in human peritoneal endothelial cells in both uremic and CAPD patients. Aquaporin-CHIP may be the morphological equivalent of the ultrasmall pores within the peritoneal membrane.
Nutritional Status in Children Receiving Chronic Peritoneal Dialysis
Authors: Canepa Alberto , Perfumo Francesco , Carrea Alba , Menoni Stefania , Trivelli Antonella , Delucchi Paola , Gusmano Rosanna
Published: February 2020

Chronic peritoneal dialysis (CPD), widely used in uremic children, may have contrasting effects on the nutritional status of patients. Metabolic and nutritional abnormalities due to the combined effects of uremia per se, glucose absorption from the dialysate and catabolic factors, such as protein and amino acid losses into dialysate, poor appetite, and recurrent episodes of peritonitis are the most important.

Although CPD allows for fewer dietary restrictions and supplies an extra amount of calories by glucose absorbed with the peritoneal fluid, when protein and energy intakes are assessed the protein intake was almost sufficient or more than that prescribed, whereas the energy intake was low.

In CPD children the standard deviation score for weight, height, triceps skinfold thickness, and midarm circumference has been reported as more severely impaired in children less than ten years old. Anthropometric parameters did not worsen during CPD treatment.

Plasma proteins and albumin are reported as being low in CPD children. The dietary intake and protein losses have been considered to be the most important determinants of the albumin level in CPD patients.

The reported average dialysate losses of free amino acids (AA) during CPD in children vary from 0.02 to 0.03 g/kg/day in different studies. The patterns of plasma AA in CPD is represented by reduced levels of branched chain AA and of other essential amino acids and increased concentrations of some nonessential AA. Several factors may influence plasma AA profile: uremia per se, hormonal alterations, protein and AA losses, and dietary intake. A more specific uremic AA pattern is found in muscle, the largest pool of free AA in the body. Studies on muscle AA in adults on CPD are conflicting: some authors have reported several muscle AA alterations, but others have shown an almost normal pattern. Low valine and leucine muscle levels have been reported in children on CPD.