bluuebunny/crossref_metadata_2025 huggingface dataset:
Swan Neck Presternal Peritoneal Dialysis Catheter
Authors: Twardowski Zbylut J. , Nichols W. Kirt , Nolph Karl D. , Khanna Ramesh
Published: February 2020

We hypothesized that a swan neck catheter for peritoneal dialysis with the exit in the presternal area will be less likely to develop an exit-site infection than currently used peritoneal dialysis catheters with the exit located on the abdomen.

The chest is a sturdy structure with minimal wall motions; the catheter exit located on the chest wall is subjected to minimal movements decreasing the chances for trauma and contamination. Also, in patients with abdominal ostomies and in children with diapers, a chest exit location will decrease chances of contamination.

The presternal peritoneal dialysis catheter is composed of two flexible (silicone rubber) tubes joined through a titanium connector at the time of implantation.

Four such catheters were implanted in four patients: two in extremely obese patients, one in a patient with a suprapubic catheter, and one in a patient with a chronic exit infection with a previous catheter. Tensile strength tests showed that the two parts of the catheter practically cannot separate spontaneously in the tunnel. Flow rates were adequate in the supine and sitting positions. All catheters functioned and healed well, and the exits have not become infected during the whole observation period up to 11 months. These preliminary experiences support the rationale of catheter design.
Atrial Natriuretic Factor in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Mora-Maciá Jose , Doñate Teresa , Ocón Joan , Rodá Miquel , Del Río Gerardo
Published: February 2020

The aim of this study was to compare the levels of the atrial natriuretic factor (ANF) and the renin system in patients on continuous ambulatory peritoneal dialysis (CAPD) with patients on chronic hemodialysis (HD). We studied three groups. The CAPD group comprised 10 patients (25–66 years); the HD group: 10 patients (35–69 years), before (pre-HD) and after (post-HD) a HD session. The control group comprised 10 subjects with normal renal function (29–65 years), matched for age, height, weight, and diastolic pressure with the CAPD group. Blood pressure (BP) and blood samples for plasma renin activity (PRA), plasma aldosterone (PA), and ANF were taken. The BP and levels of ANF, PRA and PA were: in the control group, 121:1:15/75±4 mmHg, 7.3:1:5.6 pmol/L, 1.1±0.8 ng/mL/hour, 0.4:1:0.3 nmol/L. In the CAPD group, 132:1:26/76:1: 12 mmHg (NS), 8.3:1:3.5 pmol/L (NS), 5.6:1:4.4 ng/mL/hour (p<0.001), 4.9±4.0 nmol/L (p<0.001). In the pre-HD, 159±25/95:1: 12 mmHg (p<0.001), 16.0:1:8.5 pmol/L (p<0.005), 11.99±9.0 ng/mL/hour (p<0.001), 2.6:1:2.3 nmol/L (p<0.001). In the post-HD, 145±29/84:1: 15 mmHg (p<0.05 vs CG), 13.4:1:6.9 pmol/L (p<0.05 vs control), 14.9:1:10.3 ng/mL/hour (p<0.001 vs control), 3.8:1:2.9 nmol/L (p<0.001 vs control). There was a positive correlation between BP and ANF in HD patients before ultrafiltration (r=0.700, r=0.772; p<0.05, p<0.01). These data suggest not only a difference in plasma volume, but an indirect role of BP in HD patients. However, in the CAPD group, the normal values of BP and ANF indicate a better volume balance achieved in these particular patients.
Better Preservation of Cognitive Faculty in Continuous Ambulatory Peritoneal Dialysis
Authors: Buoncristiani Umberto , Alberti Andrea , Gubbiotti Giampiero , Mazzotta Giuseppe , Gallai Virgilio , Ouintaliani Giuseppe , Gaburri Manuela
Published: February 2020

We employed the so-called event-correlated potential (ECP) P300, a neurophysiological test which explores the circuits of attention and memory in the brain and is altered in subjects with a dismetabolic or degenerative encephalopathy, in order to evaluate the cognitive faculty in two groups of uremic patients [18 on continuous ambulatory peritoneal dialysis (CAPD), 15 on hemodialysis (HD)] comparable with respect to age and time on dialysis. The values of latency (msec) of P300 resulted in CAPD patients 356±26 in CZ (central zero electrodes) and 357.5±25 in PZ (parietal zero electrodes), not significantly different from the values in normal controls (341±14.5 in CZ and 340± 15.6 in PZ) and in HD patients postdialysis (354±24.4 in CZ and 354±25.6 in PZ). On the contrary, the predialytic values of HD patients (384±25.6 CZ and 385±25.5 in PZ) were significantly different from the postdialytic values and from the values of CAPD patients and controls (p<0.01). These results support the conclusion that HD Is able to restore a normal cognitive faculty only transiently in the postdialytic phase, while CAPD maintains this important function steadily close to the normal range, thus being clearly better than HD.
Patient-Reported Symptoms and Adequacy of Dialysis as Measured by Creatinine Clearance
Authors: Holley Jean L.
Published: February 2020

A patient-reported checklist was used to assess adequacy of dialysis as measured by 24-hour creatinine clearance in 40 patients on chronic peritoneal dialysis. The checklist consisted of 13 symptoms, each scored from 0-5 with 0=absent and 5=severe. The total possible score was 0-65. Patients completed the checklist at the time of 24-hour dialysate and urine collections (in those with residual function) for creatinine clearance (CrCI). Arbitrary grouping by total CrCI in liters/week/1.73 m2 placed patients in one of two groups: those with CrCI≤48 L/week (n=12) and those with CrCI>48 L/week (n=28). Patient age, sex, diabetes mellitus, months on peritoneal dialysis, mode of peritoneal dialysis, and hematocrit were not different between the two patient groups. More patients with CrCI>48 L/week had endogenous renal function (19/28 vs 2/12, p=0.004). The median total scores for the two patient groups were not significantly different (17 in those with CrCI≤48 L/week vs 13.5 in those with CrCI>48 L/week, p=0.40). The correlation between total score and CrCI was negative in both patient groups and stronger in those with the lower CrCI (-0.55 vs -0.44). Nausea/vomiting, fatigue, and weakness were the best predictors of CrCI≤48 L/week (-0.53, -0.56, -0.49, respectively). The checklist can identify patients with low CrCI and may be useful for following patients over time and altering dialysis prescriptions.
Blood Glucose and Cholesterol Control Improved by Continuous Ambulatory Peritoneal Dialysis in Patients with End-Stage Renal Disease and Diabetes Mellitus
Authors: Wikdahl Ann-Marie , Granbom Lena , Sörensen Jens G. , Stegmayr Bernd G.
Published: February 2020

This longitudinal study was performed to evaluate the change of total cholestererol, triglycerides, and glucose control in patients with insulin-dependent diabetes mellitus (IDDM) and end-stage renal disease (ESRD) during predialysis (PreD), on continuous ambulatory peritoneal dialysis (CAPD) and after kidney graft.

A total of 20 consecutive patients (7 women, 13 men, mean age 42 years) with IDDM and ESRD were studied retrospectively in 1991 during PreD and during CAPD. Twelve were also investigated after obtaining a kidney graft. Insulin was administered Intraperitoneally (CAPD period) and subcutaneously (PreD and transplant). The mean values of weight, serum albumin, glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerldes were calculated during each period. Patients were age and sex-matched with a group of healthy controls (Group 1) and with a group of patients with IDDM without nephropathy (Group 2). T-test statistics were used.

During CAPD, there were significant decreases in HbA1c (mean 8.1 mmol/L vs 12.1, p=0.003) and cholesterol (mean 6.1 mmol/L vs 7.1, p=0.025) compared to PreD. No differences were found between PreD and CAPD stages with regard to weight, serum albumin, or triglycerides. After transplantation an improvement was found In serum albumin compared to PreD and CAPD (mean value 40 g/L.vsvs 34 and 35, p<0.03), and HbA1c compared to PreD (9.6 mmol/L vs 12.1, p=0.014), if the pancreas transplanted were included. Patients compared to Group 1 or 2 showed no differences in total cholesterol or triglycerldes. HbA1c was higher in patients during PreD than in Group 2.

Peritoneal dialysis may not be a poor alternative for glucose and total cholesterol control in diabetic patients with ESRD. Transplantation further Improves serum albumin.
Variability of Peritoneal Protein Loss in Diabetic and Nondiabetic Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Spaia Sophia , Christidou Fotini , Pangidis Panayotis , Tsoulkas Thomas , Pazarloglou Michalis , Pappa Anna , Vayonas George
Published: February 2020

In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months.

In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid.

We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL).

Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02).

Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL).

Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment.

We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.
Exit. Site Care -is it Time for a Change?
Authors: Hasbargen Barbara J. , Rodgers Darlene J. , Hasbargen James A. , Quinn Margaret J. , James Mary K.
Published: February 2020

Peritoneal catheter exit -site Infections (ESI's) continue to Impact significantly on morbidity and catheter longevity. The controversy concerning protocols for dally exit site care continues for frequency, methodology, cleansing agent, and dressing. Routine dally exit-site care prior to January 1991 consisted of dally showers using liquid soap, povidone scrub, rinsing the shower, and drying with a 4x4-in. gauze pad. Catheters have always been immobilized, either with tape or an Immobilizing device. Hydrogen peroxide was used only when needed to soften crust formation prior to showering. A lightdressing, usually 2x2 In., was optional. A recent survey revealed that povidone Iodine was the antiseptic of choice for catheter care In 75% of the respondents. However, povidone Iodine Irritates and dries the skin predisposing It to Infection.

ESI's are prospectively monitored as part of our quality Improvement (01) program. An Incidence of 0.76 episodes/patient-year was noted between January 1989 and May 1991. Given the relative high frequency of ESI's, the protocol was modified and Introduced during the January-May 1991 time frame. Routine care now consists of dally showers using only CC-500, a gentle antibacterial cleanser (Care Tech Laboratories, Inc.), rinsing In the shower, and drying with a 4x4-in. gauze. Use of hydrogen peroxide and dressings has remained the same. Additionally, a protocol addressing the prophylaxis for traumatized exit sites was Initiated. The Incidence of ESI's has dropped significantly to 0.12 episodes/patient-year.

Although our population size Is small (n≅18), this study does point out the utility of prospectively monitoring trends for appropriate Indicators within a 01 program. The problem was Identified and procedures were modified to achieve quality patient outcome.
Staphylococcus Aureus Peritonitis is Associated with Staphylococcus Aureus Nasal Carriage in Peritoneal Dialysis Patients
Authors: Piraino Beth , Perlmutter Jeffrey A. , Holley Jean L. , Bernardini Judith
Published: February 2020

Although the definition of S. aureus nasal carriage in peritoneal dialysis patients Is variable, carriage is often defined as 2 or more positive cultures for S. aureus. We Investigated the relationship between S. aureus Infections and nasal carriage (defined as 1 or more positive nose cultures) In 138 patients on peritoneal dialysis. By this definition, approximately 50% of the patients were carriers. The rates of S. aureus exit-site infection (0.28/year vs 0.43/year, p<0.001) and peritonitis (0.08/year vs 0.20/year, p<0.001) were lower in the noncarriers (patients with no positive nose cultures) than in those patients who had 1 or more positive nose cultures. Patients with only 1 positive nose culture had a similar S. aureus exit-site infection rate (0.31/year vs 0.28/year), but a higher peritonitis rate (0.24/year vs 0.08/year, p<0.001) compared to those petients with no positive nose cultures. However, patients with 2 or more positive nose cultures were at Increased risk for both S. aureus exit-site Infections and peritonitis. This relationship held even when only petients with frequent nose cultures were Included In the analysis. Thus patients with even 1 positive nose culture for S. aureus are at risk for S. aureus peritonitis and should not be classified as noncarriers.
Peritonitis Associated with Intra-Abdominal Pathology in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Tzamaloukas Antonios H. , Obermiller Leo E. , Gibel Laurence J. , Murata Glen H. , Wood Barbara , Simon Denise , Erickson Dale G. , Kanig Steven P.
Published: February 2020

Features helpful in diagnosis and associated with death were evaluated In 26 episodes of peritonitis associated with intra-abdominal pathology (IAP) In continuous ambulatory peritoneal dialysis (CAPD) patients. Culture of multiple enteric pathogens, or of a single unusual enteric pathogen, from the dialysate was useful for diagnosis in 22/26 instances. Other diagnostic features (fecal material in dialysate, diarrhea containing dialysate, Increasing free air in the abdominal cavity) were infrequently found. A comparison of patients who died (n=11, 42%) and those who survived revealed that death was associated with bowel gangrene (5/6 died), recovery of bacteroides from the dialysate, more frequent and severe comorbid conditions (bacteremia, pneumonia, intra-abdominaland intracerebral bleeding, septic shock, hepatic failure), the development of severe malnutrition and thrombocytopenia during infection, and multiple surgical procedures until the diagnosis was established. Peritonitis associated with intra-abdominal pathology In CAPD patients is a severe infection with considerable diagnostic difficulty and high mortality. Early exploratory laparotomy upon suspicion of the nature of the peritonitis, usually raised by the recovery of enteric pathogens from the dialysate, may improve mortality.
Peritoneal Catheter Loss and Death in Continuous Ambulatory Peritoneal Dialysis Peritonitis: Correlation with Clinical and Biochemical Parameters
Authors: Tzamaloukas Antonios H. , Murata Glen H. , Fox Lucy
Published: February 2020

Clinical and biochemical parameters associated with the removal of the peritoneal catheter and death following continuous ambulatory peritoneal dialysis (CAPD) peritonitis were analyzed In 120 episodes of peritonitis. Episodes resulting In catheter removal (n=24, 20%) and those ending in patient death (n=12, 10%) were respectively compared with episodes in which peritoneal catheters were saved and from which the patients survived. Variables associated with catheter removal included advanced age, long duration of peritonitis, coexisting exit-site/tunnelinfection, Infection caused by pseudomonas or fungi, elevated aspartate aminotransferase (AST) and malnutrition at presentation with peritonitis (serum albumin 29.5±7.6 g/L vs 33.8±4.8 glL In episodes In which the catheters were saved, p=0.014), and worsening malnutrition during peritonitis. Variables associated with death from peritonitis included diabetes mellitus, persistence of the infection, removal of the peritoneal catheter, Infection with pseudomonas, malnutrition prior to the infection (serum albumin 29.5±3.2 glL vs 34.7±4.2 glL In survivors, p<0.001), presentation with elevated AST and worsening malnutrition, and the development of pronounced malnutrition during infection (serum albumin 18.1:t4. 1 g/L vs 28.9±5.8 glL in survivors, p<0.001). Deaths were caused primarily by cardiovascular events. Both removal of the peritoneal catheter and death as consequences of CAPD peritonitis are associated with malnutrition and pseudomonas Infection. In addition, death is more frequent in diabetic patients.
The Impact of Peritonitis on Peritoneal and Systemic Acid-Base Status of Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Sennesael Jacques J. , De Smedt Godelieve C. , Van der Niepen Patricia , Verbeelen Dierik L.
Published: February 2020

Objective

To assess the possible effects of peritonitis on peritoneal and systemic acid-base status.

Design

pH, pCO2, lactate, and total leukocyte and differential count were simultaneously determined in the overnight dwell peritoneal dialysis effluent (PDE) and arterial blood in noninfected patients (controls) and on days 1, 3, and 5 from the onset of peritonitis.

Setting

University multidisciplinary dialysis program.

Patients

Prospective analysis of 63 peritonitis episodes occurring in 30 adult CAPD patients in a single center.

Results

In controls, mean (±SD) acid-base parameters were pH 7.41 ±0.05, pCO2 43.5±2.6 mm Hg, lactate 2.5±1.5 mmol/L in the PDE, and pH 7.43±0.04, PaCO2 36.8±3.8 mm Hg, lactate 1.4±0.7 mmol/L in the blood. In sterile (n=6), gram-positive (n=34), and Staphylococcus aureus (n=9) peritonitis PDE pH's on day 1 were, respectively, 7. 29±0.07, 7. 32±0.07, and 7.30±0.08 (p<0.05 vs control). In gram -negative peritonitis (n=14) PDE pH was 7.21 ±0.08 (p<0.05 vs all other groups). A two-to-threefold increase in PDE lactate was observed in all peritonitis groups, but a rise in pCO2 was only seen in gram -negative peritonitis. Acid-base profile of PDE had returned to control values by day 3 in sterile, gram -positive and Staphylococcus aureus peritonitis and by day 5 in gramnegative peritonitis. Despite a slight increase in plasma lactate on the first day of peritonitis, arterial blood pH was not affected by peritonitis.

Conclusion

PDE pH is decreased in continuous ambulatory peritoneal dialysis (CAPD) peritonitis, even in the absence of bacterial growth. In gram-negative peritonitis, PDE acidosis is more pronounced and prolonged, and pCO2 is markedly increased. Arterial blood pH is not affected by peritonitis.
Prosthetic Mesh Repair of Multiple Recurrent and Large Abdominal Hernias in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Imvrios George , Tsakiris Dimitrios , Gakis Dimitrios , Takoudas Dimitrios , Koukoudis Paraschos , Papadimitriou Menelaos , Antoniadis Antonios A.
Published: February 2020

Objective

The aim of this study was to find out whether prosthetic mesh repair of recurrent and large abdominal hernias in continuous ambulatory peritoneal dialysis (CAPD) patients is effective in maintaining them on CAPD.

Design

Retrospective analysis of case notes over a period of 5 years.

Setting

Single renal unit of a university hospital.

Patients

Forty-six of 217 CAPD patients (16%) had their hernias repaired. Among them, 5 women in whom hemodialysis was not possible had multiple or large hernias repaired with polypropylene (PP) mesh.

Results

Radical repair was achieved by a modified operation consisting of a conventional hernioplasty complemented by a supporting prosthetic overlay mesh, without discontinuation of CAPD. The patients continued CAPD for a mean period of 17.6 months without hernia recurrence. Two patients died in the twelfth and fifteenth postoperative month due to cardiac arrest and hepatic failure, respectively, and the remaining 3 are alive and have been doing well on CAPD for 13, 14, and 21 months.

Conclusions

Prosthetic mesh repair of large recurrent hernias in CAPD patients with vascular access problems seems to be a valuable method to maintain them on this renal replacement therapy.
Biocompatibility Studies on Peritoneal Cells
Authors: Topley Nicholas , Goles Gerald A. , Williams John D.
Published: February 2020

This review outlines the problems involved in assessing the biocompatibility of PD fluids. It has summarized the data available from conventional in vitro studies and highlights many of the inadequacies of this approach. In viva data are lacking both on host defense and on the clinical effect of changing conven tional PD fluids for a more “ideal” formulation. The best parameters for assessing biocompatibility need to be defined. Alternative formulation of fluids must be aimed towards (1) a system that interferes minimally with host defense, and (2) a system that maintains the integrity of the peritoneal membrane for ultrafiltration and clearance.

Cell culture studies should be designed to model the in viva situation. Ex viva studies (cells exposed within the peritoneal cavity) should be used to support in viva findings. Finally, in vitra results must be related to clinical significance, and changes in fluid composition should be followed by improvements in clinical outcome.
Adequacy of Fluid/Sodium Balance and Blood Pressure Control
Authors: De Vecchi Amedeo F.
Published: February 2020

Hypotension and orthostatic hypotension are frequently observed in CAPD patients. In the present paper the possible causes of these complications were reviewed, and the roles of sodium and water were pointed out.

In addition, we reported our experience using different sodium concentrations in CAPD dialysis fluid. In 38 CAPD patients sodium concentration in the dialysate was changed from 132 to 137 mEq/L. At first, arterial blood pressure increased in 4 patients (10%), and they were switched to 132 mEq/L sodium. Of the other 34 patients, 3 required larger doses of antihypertensive agents, while 9 reduced the number and/or dose of antihypertensive drugs. Thirst, body weight, residual renal function, 24-hour ultrafiltration, and biochemical examinations did not change using 137 mEq/L sodium concentrations for 6 months. In the 21 patients who did not change their antihypertensive treatment, upright blood pressure tended to increase, but the difference was not statistically significant.

In 3 hypotensive patients sodium concentration was increased to 142 mEq/L. Thirst increased in 2 of the 3, one observed a transient increase in 24-hour ultrafiltration, and none showed changes in plasma sodium level. One patient developed reversible hypertension, one became normotensive, and the third had no changes in blood pressure.
Continuous Ambulatory Peritoneal Dialysis and the Heart
Authors: Alpert Martin A. , Hüting Jürgen , Twardowski Zbylut J. , Khanna Ramesh , Nolph Karl D.
Published: February 2020

Objective

To review clinical research pertaining to continuous ambulatory peritoneal dialysis (CAPD) and the heart.

Data Sources

A Medline computer search was employed to identify appropriate references from 1970 1994. Indexing terms were: continuous ambulatory peritoneal dialysis, hemodialysis, heart or cardiac, left ventricle, coronary artery disease, and survival. English and non-English language abstracts were scrutinized.

Study Selection

Forty-six studies were reviewed and utilized. Numerical data extracted are reported in this review as they were reported in the original article.

Results

This review provides a broad-based survey of studies pertaining to CAPD and the heart. Most of the studies relate to CAPD and left ventricular structure or function. Little information exists concerning CAPD and coronary artery disease, valvular disease, pericardial disease, and cardiac arrhythmias. Studies pertaining to patient survival on CAPD identify coronary artery disease and congestive heart failure as major risk factors, but in-depth quantification of these cardiovascular disorders is lacking in the literature.

Conclusions

CAPD is capable of decreasing left ventricular (LV) volume and improving LV systolic function in patients with L V enlargement and those with L V systolic dysfunction. The effect of CAPD on left ventricular hypertrophy (LVH) and LV diastolic function is variable. CAPD produces symptomatic improvement in patients with refractory congestive heart failure, but its effect on survival in such patients is uncertain. Atherogenic lipid abnormalities occur in CAPD patients. The clinical significance of these abnormalities is uncertain. Coronary artery bypass surgery can be performed safely and effectively on CAPD patients. CAPD is not arrhythmogenic. Survival of CAPD patients is similar to that of hemodialysis patients except in elderly diabetics for whom it is slightly lower.
Comparison of Straight and Curled Tenckhoff Peritoneal Dialysis Catheters Implanted by Percutaneous Technique: A Prospective Randomized Study
Authors: Nielsen Palle K. , Hemmingsen Claus , Friis Steffen U. , Ladefoged Jorgen , Olgaard Klaus
Published: February 2020

Objective

To examine the impact of peritoneal dialysis catheter configuration, curled or straight catheter, on catheter survival and mechanical and infectious complications.

Design

Prospective randomized trial.

Setting

Department of Nephrology of a single university hospital.

Patients

Seventy-two consecutive patients initiating peritoneal dialysis were randomized to receive either a single cuff straight catheter or a single cuff curled catheter, implanted by percutaneous technique.

Results

Significantly higher (p < 0.01) survival rate of the curled as compared to the straight catheter. The difference in catheter survival was due to a significantly higher (p < 0.01) incidence of drainage failure associated with catheter tip migration of the straight catheter than of the curled catheter. No difference in infectious complication between the two types of catheters was seen. Catheter survival at 12 months was 77% for the curled catheter and 36% for the straight catheter.

Conclusion

This study demonstrates superiority of the curled Tenckhoff peritoneal dialysis catheter survival as compared to the straight catheter. This difference in catheter survival is due to the higher displacement rate of the straight catheter.
Chronic Peritoneal Dialysis: Seven-Year Experience in a Large Hispanic Program
Authors: Saade Marien , Joglar Francisco
Published: February 2020

Objective

To analyze the clinical results of our patient population on continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) in relation to treatment modality systems, compliance, rehabilitation characteristics, complications, and survivals.

Design

The medical records of all patients trained on CAPD or CCPD between 1985 and 1992 were reviewed for the above-mentioned outcome objectives.

Setting

Outpatient CAPD facility affiliated to a tertiary care community hospital.

Patients

The total of 305 patients trained during the study period were studied.

Main Outcome Measures

The patients were studied for age, sex, primary renal disease, peritoneal dialysis modality, need of assistance from a partner during the dialysis procedure, causes of transfer and hospitalization, peritonitis, rehabilitation, patient compliance, and outcome including mortality.

Results

Patient population: 179 (58.7%) males and 126 (41.3%) females, aged 1-80 years(mean47.2±15.09) with a total observation time of 15753 patient-months. The most common diagnosis of the renal disease was diabetic nephropathy (41%). Peritonitis was the main cause of hospitalizations(36.7%) and of transfers (69.5%). Patient survival at one, two, and three years was 87.9%, 76.6%, and 67.0%, respectively. Likewise, technique survival was 65.5%,45.5%, and 30.6%. Peritonitis rate for CAPD has improved from 1.9 episodes per patient-year to 1.2 episodes per patient-year and an overall rate of 1.5 episodes per patient-year.

Conclusions

The experience in a large Hispanic program shows a good patient survival rate. Although there is a trend to a lower peritonitis rate, this continues to be the main cause of transfer, hospitalization, and one of the main causes of death.
Hypomagnesemia in Continuous Ambulatory Peritoneal Dialysis Patients Dialyzed with a Low-Magnesium Peritoneal Dialysis Solution
Authors: Ejaz A. Ahsan , McShane Andrew P. , Gandhi Vasant C. , Leehey David J. , Ing Todd S.
Published: February 2020

Objective

Previous studies have shown a decrease in serum magnesium (Mg) concentration when continuous ambulatory peritoneal dialysis (CAPD) patients previously maintained on a 1.0 –1.2 mEq/L Mg peritoneal dialysis solution (PDS) were dialyzed with a 0.5 mEq/L Mg PDS. However, the prevalence of hypomagnesemia in CAPD patients dialyzed with low-Mg PDS is unknown.

Design

A retrospective study to determine the prevalence of hypomagnesemia and the factors associated with its occurrence in CAPD patients dialyzed using a 0.5 mEq/L Mg PDS.

Setting

A CAPD unit in a large Veterans Affairs Hospital.

Patients

All our CAPD patients (33) enrolled over a 52month period.

Results

All patients had serum magnesium levels higher than 1.25 mEq/L prior to use of low-Mg PDS. Hypomagnesemia (serum Mg < 1.25 mEq/L) developed in 21/33 patients (64%) when a 0.5 mEq/L Mg PDS was employed. Hypomagnesemia developed a mean of 8.2 months after beginning treatments. The duration of dialysis and the number of episodes of peritonitis did not differ between patients with and those without hypomagnesemia. Serum albumin levels were significantly lower in patients with hypomagnesemia (2.5±0.12 g/dL vs 3.2±0.12, p < 0.01). Magnesium supplements were given to 13 patients; following this therapy, serum magnesium values became normal.

Conclusions

CAPD patients dialyzed with a 0.5 mEq/L Mg PDS may develop a considerable fall in serum magnesium level and may require magnesium supplements in order to restore normal serum values.
Growth Hormone and Malnutrition in Dialysis Patients
Authors: Blake Peter G.
Published: February 2020

Objective

To review the normal function of the growth hormone (GH) insulin-like growth factor (IGF) axis, how it is altered in end-stage renal failure, how this may contribute to malnutrition in dialysis patients, and how therapy with recombinant human growth hormone (rHuGH) and recombinant human IGF-I (rHuIGF-1)might be used to treat malnutrition in these patients.

Data Sources

Studies in the literature dealing with the GH-IGF endocrine axis and its role in uremic malnutrition.

Study Selection

Eight studies in which uremic adults were treated with either rHuGH or rHuIGF-I.

Data Extraction

Data were abstracted from all of these studies.

Results

The review shows that there are marked abnormalities of the GH-IGF axis in uremic patients and that these lead to a state of GH resistance, which can be overcome by pharmacological doses of rHuGH. A small number of clinical studies in uremic adults suggests that both rHuGH and rHuIGF-I have dramatic beneficial effects on nutritional status in these patients.

Conclusions

rHuGH and rHuIGF-I have both been shown to have a beneficial effect on nutritional status in shortterm studies on small numbers of patients. Further studies need to be done for longer periods in larger groups of patients. Areas for additional research are suggested.
Can Malnutrition be Prevented? Nutrition and Dialysis Adequacy
Authors: Schreiber Martin J.
Published: February 2020

As chronic renal failure (CRF) worsens, the nutritional balance is disrupt ed at several different levels that are normally responsible for maintaining metabolic homeostasis (1–3). These abnormalities may remain constant, improve, or worsen once dialysis is initiated. The success of dialytic intervention in correcting these abnormalities depends not only on the actual dose of delivered therapy, but also on the availability of nutrient substrate and the ease of modulating body composition.

In the general population body composition has long been used as a predictor for mortality (4). Several different approaches have been taken to identify individuals at risk for a poor outcome (5). These techniques may examine specific serological parameters or actual components of body composition thought to more precisely depict nutritional balance.

Historically, many reports have stressed the link between serum albumin levels and patient survival for both hemodialysis and peritoneal dialysis (6–11). However, some authors have questioned the usefulness of this marker (12–14). Based on these concerns, defining nutritional status through body composition measurements may offer a more meaningful assessment than standard serological parameters. Furthermore, in the setting of uremia the ability to successfully modulate body composition may denote the essence of what aptimal dialysis should signify. Conceptually, optimal dialysis represents the therapeutic return of an individual to nutritional balance, with an expected survival comparable to that of age, gender, and disease-matched nonuremic individuals. Because of the complexity of maintaining nutrient balance, the definition of adequate dialysis should be re-evaluated. Contemporary dialysis practice should extend beyond solely quantitating dialysis to include an understanding of nutrient balance, regulation of food intake, and the application of surveillance tools for identifying abnormalities in body composition. Only through expanding the end points of adequate dialysis can we move closer to optimal dialysis synonymous with long-term treatment survival.
The Removal Index for Evaluation of Dialysis
Authors: Chen Tzen Wen , Huang Tung-Po , LiU Ming-Chang , Wang Maw-Ling
Published: February 2020

Objectives

To find an index of adequacy that takes into consideration the effect of the decreasing concentration of urea nitrogen in hemodialysis (HD) and can be used before treatments to quantitate the prescriptions with the same criterion for both HD and continuous ambulatory peritoneal dialysis (CAPD).

Design

The removal index was obtained through mathematical theories and then compared with the urea index (KT/V) values of the sample patients.

Patients

Thirty-two HD and 21 CAPD patients were included. All patients were dialyzed with optimal urea index values and had been stable for at least one year.

Results

The removal index in HD (ξHD) for each dialysis was 0.62±0.07, and the normalized removal index in CAPD (ξCAPD) was 0.59±0.11. There was no statistical significance. This result is consistent with the fact that no difference of morbidity or mortality exists between these two modalities.

Conclusion

After mathematical manipulation, the removal index in HD can be presented in the form of the urea reduction ratio, which is a retrospective measure to estimate the performance of hemodialysis. This study implies that the removal index is able to facilitate the prescriptions for adequate dialysis. The removal index can also be used to explain the reason why the urea index values are always larger in HD than in CAPD.
Peritoneal Dialysa Te Igg/C3 Levels Do Not Predict Susceptibility to Peritonitis
Authors: Anwar Nisar , Hutchison Alastair J. , Manos John , Uttley Linda , Brenchley Paul , Gokal Ram
Published: February 2020

Objective

To investigate the usefulness of dialysate IgG and C3 concentrations in predicting likelihood of developing peritonitis.

Design

Prospective, longitudinal, and comparative study.

Setting

Single university teaching hospital dialysis unit and outpatient clinic.

Patients

Thirty-four uremic patients were studied (20 males, 14 females: mean age 47.2, range 20 73 years). Monthly serum and overnight dialysate (eight to elevenhour dwell) samples were obtained for IgG and C3 estimations over the first six months of the study, and trimonthly samples were obtained thereafter. All patients performed exchanges using standard transfer sets (Baxter system II, Baxter Healthcare Ltd., Thetford, Norfolk, U.K.), used no hypertonic fluid (3.86%) for overnight exchanges, and were followed up for a minimum of 18 months.

Outcome Measures

Dialysate and serum levels of IgG and C3; peritonitis episodes.

Results

Forty-five episodes of peritonitis occurred in 24 patients during the study period. We examined opsonin levels in the group as a whole, and then in two subgroups of patients: those who remained peritonitis-free throughout the study, and those who did not. There were no significant differences between IgG and C3 levels in the two groups at any time point, and large interpatient and intrapatient variation in levels were seen.

Conclusion

Dialysate levels of IgG and C3 from the overnight dwell are not helpful in predicting the risk of developing continuous ambulatory peritoneal dialysis peritonitis in individual patients. No correlation was found between opsonin levels and onset of clinical peritonitis.
Answers to All Your Questions about Peritoneal Urea Clearance and Nutrit Ion in Capd Patients
Authors: Blake Peter G. , Oreopoulos Dimitrios G.
Published: February 2020

In summary, SA and a number of other indices related to nutritional status have been identified as being strongly predictive of outcome in CAPD patients. Evidence connecting these indices to KTN urea, or even to protein intake, remains limited, however. Increased dialytic dose may well increase protein intake, but neither of these parameters have been shown prospectively to raise SA, total body nitrogen, or SGA status on a consistent basis. Studies addressing this issue, however, have been few and small, and more data are required. For now, we will likely continue to deal with malnutrition by attempting to raise small solute clearance and protein intake, but we should be aware that such measures will frequently be unsuccessful, and we must pay attention to other factors, particularly comorbidity.

It is clear from this review that there are many unanswered questions relating to this topic and that, in particular, the effect of prospective increases in the dialytic dose needs to be further elucidated.
The Rationale and Ultimate Limitations of Urea Kinetic Modelling in the Estimation of Nutritional Status
Authors: Bargman Joanne M.
Published: February 2020

Objective

This paper reviews protein flux and amino acid metabolism and the potential inaccuracies inherent in using urea kinetics as an estimate of these processes, particularly in the patient undergoing peritoneal dialysis. The problems of extrapolating these estimates back to the whole patient are examined, addressing assumptions about neutral nitrogen balance, and the difficult issue of normalizing urea-derived indices to body size.

Conclusions

Urea kinetics can be a helpful tool for assessing nutritional indices, but there are many caveats and many pitfalls that must be kept in mind to avoid being lulled into a false sense of confidence by the comfort of numbers.
Intraperitoneal Interleukin-8 and Neutrophil Influx in the Initial Phase of a Capd Peritonitis
Authors: Betjes Michiel G.H. , Visser Carolien E. , Zemel Desiree , Tuk Cornelis W. , Struijk Dirk G. , Krediet Raymond T. , Arisz Lambertus , Beelen Robert H.J.
Published: February 2020

Objective

To investigate whether or not a change in dialysate interleukin-8 (IL-8) concentration precedes the onset of clinically overt peritonitis and is significant in the recruitment of granulocytes during continuous ambulatory peritoneal dialysis (CAPD)related peritonitis.

Design

CAPD patients stored their overnight effluent at 4°C, which was routinely thrown away after 2 days. If peritonitis developed, patients delivered their effluent of the preceding two nights and the peritonitis effluent for analysis. A control study was performed 1 to 3 months after recovery. Dialysate samples were analyzed for number of cells, differential cell count, IL-8 and elastase concentrations, and their neutrophil chemoattractive capacity. In addition, serum samples during peritonitis were analyzed for IL-8 concentrations.

Results

Ten peritonitis episodes in 7 patients were analyzed. Numbers of neutrophils and levels of dialysate IL-8 and elastase started to increase 4 to 12 hours before the first peritonitis effluent. The dialysate/serum IL-8 ratio was 423.5 during peritonitis and 7.0 in the postperitonitis controls. There was a significant correlation between the number of neutrophils and IL-8 concentration in the dialysate. The in vitro neutrophil chemotaxis was increased toward the peritonitis effluents, as compared to control effluents. Incubation of the peritonitis effluents with anti-IL-8 monoclonal antibody blocked the increase in neutrophil chemotaxis above controllevels by an average of 26.7%.

Conclusion

IL-8 is produced in the peritoneal cavity during CAPD treatment and may mediate part of the neutrophil recruitment and degranulation in the initial phase of a CAPD peritonitis.
Biocompatibility of Silver-Coated Peritoneal Dialysis Catheter in a Porcine Model
Authors: Fung Leo C. T. , Khoury Antoine E. , Vas Stephan I. , Smith Charles , Oreopoulos Dimitrios G. , Mittelman Marc W.
Published: February 2020

Objective

Previous studies have shown that silver formulations coated onto implantable materials retard bacterial colonization and reduce the incidence of catheter-related infections. The objective of this study was to assess the histologic effects of sputter-coated silverl silicone implants on host tissue.

Design

Sputter silver-coated silicone peritoneal dialysis catheter segments with and without Dacron cuffs were implanted in the subcutaneous fat and muscle in 4 pigs. Noncoated implants served as controls. The specimens were retrieved at 1,2,3,4,7,8,9,10,12, and 27 weeks.

Experimental Animals

Four 6-week-old male Yorkshire Land race pigs (5–6 kg) were used.

Main Outcome Measures

Histologic parameters evaluated included the degree of inflammation, the number of giant cells, the extent of silver particulate inclusions, and the thickness of the capsules. All specimens were evaluated by a single blinded pathologist. Microbiologic analyses were also performed.

Results

The silver-coated catheters were associated with less inflammation than were the noncoated catheters, both infatand muscle (p=0.04). The number of giant cells was also lower around the silver-coated than the noncoated catheters, which were implanted in subcutaneous fat (p < 0.05). Particulate inclusions compatible with silver or silver oxide were observed only in tissue around silvercoated implants (p < 0.0001). The thickness of the capsules and the extent of the inflammatory zones were not significantly different. There was no evidence of infection-related changes.

Conclusions

These data suggest that the sputter silver coating does not act as a significant tissue irritant.
Recommended Clinical Practices for Maximizing Peritoneal Dialysis Clearances
Authors: Blake Peter , Burkart John M. , Churchill David N. , Daugirdas John , Depner Thomas , Hamburger Richard J. , Hull Alan R. , Korbet Stephen M. , Moran John , Nolph Karl D. , Oreopoulos Dimitrios G. , Schreiber Martin , Soderbloom Robert
Published: February 2020

Data from the Canada-U.S.A. (CANUSA) Study have recently confirmed a long-suspected linkage between total clearance and patient survival in peritoneal dialysis (PD). Recognizing that what we have historically accepted as adequate PD simply is not, the Ad Hoc Committee on Peritoneal Dialysis Adequacy met in January, 1996. This committee of invited experts was convened by Baxter Healthcare Corporation to prepare a consensus statement that provides clinical recommendations for achieving clearance guidelines for peritoneal dialysis. Through an analysis of 806 PD patients, the group concluded that adequate clearance delivered with PD can be achieved in almost all patients if the prescription is individualized according to the patient's body surface area, amount of residual renal function, and peritoneal membrane transport characteristics. Use of 2.5 L to 3.0 L fill volumes, the addition of an extra exchange, and giving automated peritoneal dialysis patients a “wet” day are all options to consider when increasing weekly creatinine clearance and KTN. Rather than specify a single clearance or KTN target, the recommended clinical practice is to provide the most dialysis that can be delivered to the individual patient, within the constraints of social and clinical circumstances, quality of life, life-style, and cost. The challenge to PD practitioners is to make prescription management an integral part of everyday patient management. This includes assessment of peritoneal membrane permeability, measurement of dialysis and residual renal clearance, and adjustment of the dialysis prescription when indicated.
Continuous Peritoneal Dialysis-Associated Peritonitis of Nosocomial Origin
Authors: Troidle Laura , Kliger Alan S. , Goldie Sue J. , Gorban-Brennan Nancy , Brown Eric , Fikrig Margaret , Finkelstein Frederic O.
Published: February 2020

Objective

To describe our experience with nosocomial continuous peritoneal dialysis (CPD)-associated peritonitis focusing on the incidence, possible risk factors, spectrum of organisms, and outcome.

Design

Retrospective review of the medical records of our CPD patients admitted to an acute-care hospital between November, 1993 and December, 1994.

Setting

University-associated acute-care hospitals in New Haven, Connecticut.

Patients

One hundred and eighty-eight patients maintained on CPD therapy and admitted to an acute-care hospital.

Results

Nineteen patients (5%) developing nosocomial peritonitis (NP) were identified from the 408 admissions occurring during the study period. Patients developing NP were older than the hospitalized CPD patients not developing NP(65.5± 14.6vs58.4± 14.7years, p<0.05). Comorbid diseases including diabetes, peripheral vascular disease, gastrointestinal disease, cardiovascular disease, and human immunodeficiency virus seropositivity were not more common in the patients developing NP. Patients developing NP were hospitalized significantly longer than the CPD patients not developing NP (39.5 ± 46.5 days vs 12.7 ± 12.4 days, p < 0.001). The mean serum albumin was lower in the NP patients than in the CPD patients not developing NP (2.35 ± 0.52 g/dL vs 3.02 ± 0.60 g/dL, p < 0.001). Antecedent antibiotic use and performance of invasive procedures were noted in 89% and 68% of the patients developing NP, respectively. Staphylococcal species, enterococcal species, and gram-negative organisms accounted for 26%, 21 %, and 53% of the episodes of NP, respectively. Furthermore, two strains of Enterococcus resistant to vancomycin were cultured. Eight patients developing NP expired, 8 patients continued CPD therapy, 2 patients transferred to hemodialysis, and one patient recovered renal function.

Conclusion

We conclude that NP is uncommon. Increased age, increased length of hospital stay, and hypoalbuminemia may predispose patients to the development of NP. Further studies with case controls should help to clarify whether antecedent antibiotics or prior performance of invasive procedures predispose patients to the development of nosocomial peritonitis. The spectrum of organisms accounting for NP is different than the spectrum of organisms causing community-acquired CPD-associated peritonitis. Some of these organisms may be resistant to standard antibiotic therapies. Patients developing NP do poorly, with 42% expiring while being treated for NP.