bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Hepatitis C Antibodies (HCV) in a Dialysis Population at One Center
Authors: Selgas Rafael , Martinez-Zapico Rosa , Bajo M. Auxiliadora , Romero Jose Ramon , Munoz Jesus , Rinon Carmen , Miranda Blanca , Miguel Jose Luis
Published: February 2020

Hepatitis C (HC) has been recently diagnosed by determination of specific antibodies that represent the former so-called non-A, non-B hepatitis.

We studied the prevalence of plasma HCV antibodies among 61 unselected patients on hemodialysis (HD) and 43 on continuous ambulatory peritoneal dialysis (CAPD). Plasma C-antibodies were determined through the ELISA test system. Transfusion policy was the same in both groups.

The prevalence of hepatitis C virus antibodies was significantly higher in hemodialysis patients than among those on CAPD. Time on dialysis, previous blood transfusions, and renal transplantation seem to increase the prevalence of C hepatitis antibodies among hemodialy sis patients. The effect of these parameters on CAPD was smaller. Understanding the reasons for these differences may help prevent this disease among dialysis patients.
Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis
Authors: Wadhwa Nand K. , Seliger M. , Greenberg Harly E. , Bergofsky Edward , Mendelson Wallace B.
Published: February 2020

Study Objective

To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep.

Design

Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD.

Setting

Tertiary-referral university hospital. Patients and

Methods

Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63±4 (SEM) years were studied.

Results

Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paC02 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, Pa02 was significantly lower (p<0.05) during the night with (Pa02=78±7 mmHg) than during the night without PD fluid (Pa02=92±4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r=-0.94; p<0.005).

Conclusions

This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.
Weekly Clearances of Urea and Creatinine on CAPD and NIPD
Authors: Nolph Karl D. , Twardowski Zbylut J. , Keshaviah1 Prakash R.
Published: February 2020

Weekly creatinine clearance (Ccr) and weekly Curea/ v (kt/v) are popular indices for quantitating the amount of peritoneal dialysis provided. Studies were undertaken on 44 patients on continuous ambulatory peritoneal dialysis (CAPD) and 10 patients on nightly intermittent peritoneal dialysis (NIPD) to compare relationships of weekly creatinine clearance to weekly urea clearance (Curea) divided by total body water (v). With a long cycle therapy such as CAPD, the ratio of weekly Ccr to weekly kt/v is higher than with a short cycle technique, such as NIPD, in the same patient. If patients are shifted from CAPD to NIPD maintaining the same weekly kt/v, the weekly Ccr will decrease. If patients are shifted from CAPD to NIPD maintaining the same weekly Ccr, then the weekly kt/v will increase. The clinical implications of these observations are unknown, but should be kept in mind for future studies comparing CAPD and NIPD.
Comparison of Exit -Site Infections in Disconnect versus Nondisconnect Systems for Peritoneal Dialysis
Authors: Burkart John M. , Jordan Jean R. , Durnel Theresa A. , Case L. Douglas
Published: February 2020

Objective

To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems.

Design

We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Yset, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)).

Setting

A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting.

Patients

All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of endstage renal disease (ESRD) or age.

Intervention

Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care.

Main Outcome

We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections.

Results

Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p=0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit -site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62, spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD).

Conclusion

We found no overall difference in exit site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.
The Effect of Peritoneal Dialysis Fluid on the Release of Il-113 and Tnfa by Macrophages/Monocytes
Authors: Douvdevani Amos , Rapoport Jayson , Konforti Aviva , Zlotnik Moshe , Chaimovitz Cidio
Published: February 2020

Objective

To study the effect of dialysis fluid on the release of interleukin-1β (IL-1β) and tumor necrosis factor (TNFα) by peritoneal macrophages (PM) and peripheral blood mononuclear cells (MNC), and the time course and factors involved in this effect

Design

PM and MNC were incubated for various periods with Dianeal itself, or Dianeal of varying pH and composition.IL-1 β was measured by radioimmunoassay and TNFα by cytotoxicity assay.

Patients

PM were obtained by centrifugation of dialysis effluent from 3 continuous ambulatory peritoneal dialysis (CAPD) patients. MNC were obtained from healthy volunteers.

Results

Dialysis fluid inhibited the release of both cytokines. Indomethacin had no effect on the inhibition of TNFα release caused by dialysis fluid. Thus prostaglandins are not involved in this inhibition. Solutions of pH 5.2 and high lactate concentration caused an identical inhibition to that caused by dialysate, whereas the presence or absence of glucose had no effect. Thus it seems that pH and lactate are the important inhibitory factors. Time course studies showed that the inhibition of TNFα release was substantial after only 15 minutes of incubation with dialysate, whereas the inhibition of IL-1 β became significant only after 60 minutes of incubation.

Conclusions

Even though dialysate pH rises within 15–30 minutes after instillation into the abdomen, the initial low pH present for only a short time could have a significant effect on TNFα release by peritoneal macrophages, and thus on their ability to mount a normal inflammatory response. Lactate also has a significant inhibitory role. It is suggested that commercial dialysis solutions should have a pH of 7. Oandthata physiological buffer other than lactate be used.
Cross Sectional Assessment of Weekly Urea and Creatinine Clearances and Indices of Nutrition in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Nolph Karl D. , Moore Harold L. , Prowant Barbara , Meyer Marianne , Twardowski Zbylut J. , Khanna Ramesh , Ponferrada Leonor , Keshaviah Prakash
Published: February 2020

Objective

To perform a cross sectional analysis in 71 patients on continuous ambulatory peritoneal dialysis (CAPD) to identify significant correlations of weekly small solute clearances and indices of nutritional status with each other and with patient demographics and other commonly monitored clinical and laboratory parameters.

Design

This was a retrospective, cross sectional analysis in 71 patients on CAPD from less than 1 to 105 patient-months (average, 20 months).

Setting

An outpatient CAPD program.

Patients

All patients on CAPD in our program at the time of the study willing to undergo the clearance and nutritional status measurements.

Interventions

No interventions other than the monitoring of their status.

Main Outcome Measures

Weekly small solute clearances, dietary protein intake, serum albumin, lean body mass, net protein catabolic rate, and urinary and dialysate nitrogen.

Results

Weekly K/V urea (weekly urea clearance normalized to total body water) of at least 1.7 and weekly total creatinine clearances (liter/week/1.7 m2) of at least 50 are associated with net protein catabolic rates (PCR) greater than 0.9 g/kg of normalized body weight in average CAPD patients. K/V urea and net PCR correlate significantly with serum albumin. High transporters identified by the peritoneal equilibration test have greater albumin losses and lower serum albumin concentrations. Estimates of lean body mass correlate significantly with serum albumin and net PCR; lean body mass correlates significantly and inversely with age.

Conclusions

Greater small solute clearances are associated with better nutritional status.
Chronic Tunnel Infections in Children: Removal and Replacement of the Continuous Ambulatory Peritoneal Dialysis Catheter in a Single Operation
Authors: Schröder Cornelis H. , Severijnen René S.V.M. , De Jong Maria C.J.W. , Monnens Leo A.H.
Published: February 2020

Objective

Chronic tunnel infections often necessitate the removal of the continuous ambulatory peritoneal dialysis (CAPD) catheter. Most published studies advocate postponing the insertion of a new catheter for several weeks. For young children it will be particularly difficult to wait this length of time, since vascular access may be cumbersome, and hemodialysis may not be well tolerated. The present study describes the results of the simultaneous removal and replacement of the CAPD catheter. .Design: Twenty-three Toronto Western Hospital II catheters were inserted in 17 children because of infectious complications (21 chronic tunnel infections; 2 recurrent peritonitis) in a single operation under appropriate antibiotic prophylaxis. The new catheter was inserted at the contralateral side of the abdomen with the deep cuff in the midline, using the same entrance to the peritoneal cavity. Dialysis was resumed immediately after the operation.

Setting

A university pediatric dialysis unit.

Patients

Seventeen children (mean age 3.7 years; range 1.0–8.5 years) were studied. In this group 23 catheters were replaced.

Results

In four cases a relapse of the tunnel infection was observed within 3 months. All other cases remained free of infection for a period of at least 6 months. The main causative microorganism was Staphylococcus aureus (15 occurrences).

Conclusion

It is not necessary to interrupt peritoneal dialysis for the replacement of a CAPD catheter because of infectious complications.
Survival of 138 Surgically Placed Straight Double-Cuff Tenckhoff Catheters in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Weber Jochen , Mettang Thomas , Hübel Eugen , Kiefer Thomas , Kuhlmann Ulrich
Published: February 2020

Objective

To determine the natural history of a surgically placed Tenckhoff catheter in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective 7–year study analyzing catheter survival of all catheters using the Kaplan-Meier life table methodology.

Setting

Teaching hospital, department of nephrology.

Patients

One hundred and fifteen unselected patients beginning CAPD.

Interventions

Removal of the catheter required for the following complications: exit-site or tunnel infections or relapsing peritonitis, outflow obstruction, pericatheter leak, and development of hernias.

Main Outcome Measures

Period between insertion and removal of the catheter.

Results

The cumulative survival of all catheters after 1,2, and 3 years of CAPD was 87%, 69% and 65%. Catheter survival of the first versus the second catheter after 1 year was significantly longer (p=0.03). The difference was not significant in relation to diabetes, age, and sex. Infectious complications caused 61% (n=19) of all 31 catheter failures, mainly due to tunnel infections caused by Staphylococcus aureus (n=12). “Mechanical” complications accounted for 49% (n=12) of catheter failures. Eight of 12 mechanical complications were outflow failures. Seven patients had to be transferred to hemodialysis.

Conclusions

The straight Tenckhoff catheter is a reliable peritoneal access device for CAPD in an unselected patient population.
Peritoneal Transport during Dialysis with Amino Acid-Based Solutions
Authors: Park Min Sun , Heimbürger Olof , Bergström Jonas , Waniewski Jacek , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Objective

To evaluate the potential clinical role of amino acids as an osmotic agent.

Design

The peritoneal transport of fluid, amino acids, and other solutes was investigated during a 6–hour single-cycle peritoneal dialysis with PDA 1% versus 1.36% glucose (n=6) or PDA 2.7% versus 3.86% glucose solution (n=9).

Patients

Fifteen stable nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients.

Results

The fractional absorption of the osmotic agents at 6 hours was higher with PDA 2.7% versus glucose 3.86% (p<0.005). The diffusive mass transport coefficient, KeD’ calculated for a period of dialysate isovolemia was higher with PDA 2.7% versus PDA 1% for essential, nonessential (p<0.005), and total (p<0.05) amino acids. The intraperitoneal volume-over-time curves and KqD values for urea, creatinine, glucose, albumin, β2microglobulin, and total protein did not differ between the amino acid solutions and the corresponding glucose solutions. KeD for urea was significantly higher during the dwell with PDA 2.7% versus PDA 1% (p<0.05). Plasma amino acid concentrations increased substantially during the first 1– 2 hours and then decreased gradually. Valine and methionine rose to 792% and 1119% of baseline values, respectively.

Conclusions

We conclude that the peritoneal transport of fluid and investigated solutes, except amino acids, was not different with the amino acid solutions compared with the corresponding equimolar glucose solutions. However, ultrafiltration tended to be lower with amino acid solutions. Furthermore, the fractional absorption of amino acids and KeD values for amino acids was higher with PDA 2.7% versus PDA 1 %, suggesting an effect of the hypertonic amino acid solution on the peritoneal membrane transport properties. Also, the hypertonic PDA2.7% solution yielded nonphysiologically high plasma levels of several amino acids. We therefore consider this solution not to be safe enough for long term clinical use.”
Relationships between Dialysis Quantification and Normalized Protein Catabolic Rate in Peritoneal Dialysis
Authors: Mactier Robert A. , Perry Maureen , Henderson Lain S.
Published: February 2020

Normalized protein catabolic rates (NPCR) and urea clearances (Kt/V urea) correlate significantly in peritoneal dialysis suggesting that the adequacy of dietary protein Intake and dialysis dose are Interrelated. However, both of these calculated parameters are mathematical functions of the normalized urea appearance rate (GN). NPCR, GN, Kt/V urea, total creatinine clearance, residual renal clearance, and peritoneal urea and creatinine clearances were determined In 29 stable peritoneal dialysis patients with no history of recent peritonitis or other catabolic illness. Multiple linear regression analysis showed that NPCR correlated closely with both GN (r=0.96; p<0.0001) and Kt/V urea (r=0.77; p<0.0001), whereas GN also correlated with Kt/V urea (r=0.66; p<0.0001). Total weekly creatinine clearances rather than Kt/V urea should be utilized in peritoneal dialysis to permit independent estimations of dialysis dose and NPCR, since both Kt/V and NPCR are related closely to GN. Total weekly creatinine clearances correlated with NPCR (r=0.59; p<0.0002), which supports the hypothesis that dietary protein Intake is dependent on the delivered dialysis dose.
Effects of Subcutaneous Recombinant Human Erythropoietin in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Di Paolo Bruno , Marini Alvaro , Fiederling Barbara , Di Liberato Lorenzo , Santarelli Patrizia , Bucciarelli Sandro , Stuard Stefano , Paolantonio Lucia , Albertazzi Alberto
Published: February 2020

The use of recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of renelanemia, but the dose regimens, the optimal frequency, and the effects on other target organs like the central nervous systems (CNS) are still under discussion.

We designed a prospective, ongoing study with 10 stable continuous ambulatory peritoneal dialysis (CAPO) patients (6 males, 4 females; mean age 64.4±7.8 years), with a pretreatment hemoglobin (Hb) <7.0 901. and requiring regular blood transfusions. Seven patients were treated with 4000 U rHuEPO once weekly (Eritrogen, Boehringer Mannhelm), 2 patients received 4000 U every 5 and 8 days, and the last one 4000 U every 10 days.

The target hematocrit was 33% and Hb 10.0 g%. The CNS activity was recorded as visual (YEP), brainstem (BAER), and somatosensory (SEP)-evoked potentials.

The mean Hb concentration Increased from 6.9± 1.2g% to 10.3± 1.6 g% (p<0.001) over 8 weaks. There were no significant changes In urea, creatinine, and potassium levels, and urine output. rHuEPO Induced a decrease In latency of P100 YEP, In the four main components of BAER, and In the P27–N35 Intertime of SEP.

Parallel to the Improvement of red cell Indices, patients experienced a dramatic Improvement In well-being. The subcutaneous administration of a single vial of rHuEPO Is safe, convenient, and Inexpensive In CAPO.

The role of rHuEPO treatment In Improving the electro-physiological brain function In uremic and anemic patients remains to be studied and may not necessarily be based on Improved cerebral oxygenation.
The Value of Peritoneoscintigraphy in the Investigation of Ultrafiltration Loss during Peritoneal Dialysis
Authors: Pietrzak Bozena , Panasiuk Elzbieta , Przedlacki Janusz , Wankowicz Zofia
Published: February 2020

Perltoneoscintlgraphy (PSG) was performed In 18 patients with ultrafiltration (UF) loss during peritoneal dialysis (PD). In 9 patients PSG was abnormal after peritonitis (PT), and transfer to hemodialysis (HD) was necessary. In three cases peritoneal catheter malfunction was suspected, and PSG provided Information about the catheter's position and function. In two cases loss of UF was connected with extraperitonealleakage of the dialy818 solution (which was confirmed by PSG). In cases of UF 10.. and normal control, the peritoneal equilibration test (PET) was used, and Its result was abnormal for glucose D/Do (too high). PSG was useful for diagnosing the reasons for UF loss during PD.
Experimental Peritoneal Dialysis Solutions
Authors: Martis Leo , Holmes Clifford , Shockley Ty
Published: February 2020

A survey of the literature suggests continued interest in modifying the composition of peritoneal dialysis solutions. Osmotic agents such as glucose polymers and short-chain polypeptides may find a role in peritoneal dialysis fluids as partial substitutes for dextrose. New solutions containing amino acids should serve as more than sinks for uremic toxins by providing nutritional support and by ameliorating uremic lipid abnormalities. Increasing emphasis is being paid to biocompatibility during the development of new peritoneal dialysis fluids.
Lovastatin Treatment of Dyslipoproteinemia in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Tao Li Philip Kam , Mak Tony W.L. , Lam Christopher W.K. , Lai Kar Neng
Published: February 2020

We conducted a single, blinded cross-over placebo versus lovastatin study on 10 continuous ambulatory peritoneal dialysis (CAPD) patients with dyslipoproteinemia who failed to respond to diet control. They were given 8 weeks of lovastatin (20–40 mg) and placebo, respectively. After 8 weeks of lovastatin treatment, total cholesterol was significantly reduced by 28.6% (6.68±0.26 mmol/L, mean±SEM, to 4.77±0.12, p<0.01); low-density lipoprotein cholesterol by 40.5% (4.57±0.27 mmol/L to 2.72±0.09, p<0.01); apolipoprotein B by 32.4% (115.9±6.99 mg/dL to 78.3±2.9 mg/dL, p<0.01); and triglyceride by 17.8% (1.92±0.38 mmol/L to 1.58±0.32, p<0.05). Simultaneously high-density lipoprotein cholesterol increased by 7.6% from 1.24±0.13 mmol/L to 1.34±0.16, p<0.05.

There were no significant changes in other lipid profiles between placebo and drug treatment. No significant adverse effects were observed with lovastatin treatment. Lovastatin appears to be effective in treating dyslipoproteinemia in CAPD patients.
Why the Double-Bag System Still Remains the Best Technique for Peritoneal Fluid Exchange in Continuous Ambulatory Peritoneal Dialysis
Authors: Bazzato Giorgio , Landini Silvano , Fracasso Agostino , Morachiello Paolo , Righetto Flavio , Scanferla Flavio , Toffoletto Pier Paolo , Genchi Rosangela , Roncali Davide
Published: February 2020

Since March 1979 (the Italian-French-Spanlsh meeting in Turin), we have been using the double-bag system for peritoneal fluid exchange in patients on continuous ambulatory peritoneal dialysis (CAPD). This technique, subsequently followed by many others because of the advantages to the patients, still represents the best tool in bag-exchange procedure, because It satisfies the following characteristics: single luer-lock connection; fiush before-fill; simple, safe, and aseptic manipulation; short training period; no carrying bag; good patient acceptance; and low incidence of exogenous peritonitis. In 13 years with 237 patients selected for double-bag treatment, we have observed an incidence of 1 episode of peritonitis every 26.6 patient-months. Few clinical CAPD-related complications like hypotension and alterations of Ca-P metabolism were observed, probably as a result of more personalized peritoneal fluid with high Na+ (136 mEq/L) and Ca2+ (3.5 mEqL) concentrations. In the meantime, we have also had available plasticizer-free bags, which eliminated one of the main risk factors In peritoneal sclerosis. The utilization of the plasticizer-free double-bag system, currently adopted by numerous other centers, still remains the best option from a clinical and psychological viewpoint of the patients on CAPD.
Dialysis Adequacy in Hypoalbuminemic Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Spinowitz Bruce S. , Gupta Bharat K. , Kulogowski Josephine , Charytan Chaim
Published: February 2020

We examined the interrelationship between hypoalbuminemia (HA) and the normalized protein catabolic rate (NPCR; g/kg/day) in the face of adequate Kt/V and weekly creatinine clearances in 40 end-stage renal disease patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We also evaluated serum albumin (SA) levels as an additional marker of nutritional status of the PD patients receiving adequate dialysis therapy in terms of Kt/V greater than 1.5 per week.

Twenty-three of 40 patients had normal serum albumin (NSA; ≥3.4 g/dL) and 17 had HA «g/dL). A correlation between NPCR and SA levels was observed. Also, the NPCR values in patients with NSA (0.98±0.31) differ significantly (p<0.0005) from patients with HA (0.80±0.13). Urea kinetic parameters for adequacy of dialysis, that is, Kt/V, blood urea nitrogen (BUN), and weekly creatinine clearance, did not reveal any statistically significant difference between patients with NSA and HA. These data suggest that low values of NPCR may be seen in hypoalbuminemic CAPD patients despite adequate dialysis therapy and indicate further investigation for associated morbid conditions or supplemental nutrition.
Nutritional Status and Growth in Children Less than 12 kg Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Stefanidis Constantinos , Michelakaki Helen , Koulieri Alexandra , Michelis Kyeiakos
Published: February 2020

Various parameters of nutritional status and growth In 13 children with weight less than 12 kg were estimated at the start of continuous ambulatory peritoneal dialysis (CAPD) and 1 year later. A significant Improvement In weight, triceps skinfold, and serum albumin was noticed. Height and midarm muscle circumference did not change significantly. However, a significant Improvement In height occurred In patients with initial abnormal height «- 2 SDS). There was no significant change In protein Intake and urea nitrogen appearance (UNA) during the study period. A significant correlation between protein Intake and UNA was noticed. All patients had normal serum Insulinlike growth factor.

In conclusion, there was no significant changein either height velocity or muscle mass despite the improvement in many nutritional parameters.
Chronic Peritoneal Dialysis Catheters in Pediatric Patients: Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis
Authors: Verrina Enrico , Perfumo Francesco , Zacchello Graziella , Edefonti Alberto , Bassi Sergio , Capasso Giovanni , Caringella Domenica A. , Castellani Alfonso , Longo Luigi , Rinaldi Stefano , Viglino Giusto , Cantaluppi Alberto
Published: February 2020

During the period 1986–1991, 140 pediatric patients [age≤15 years at the start of chronic peritoneal dialysis (CPD)], belonging to 15 dialysis centers, were enrolled In the Italian Registry of Pediatric Chronic Peritoneal Dlaly 515. Data on 188 peritoneal catheters were collected: 161 catheters were Tenckhoff (144 double-cuff, 17 singlecuff), and 27 were two-cuff Valll-type catheters. All catheters were surgically inserted; the entry site was in the midline In 84 cases and paramedian in 104. An omentectomy was performed in 78.80/0 of the cases.

Apart from peritonitis, there were 161 catheter-related complications (103 exit-site infections, 17 leakages, 15 obstructions, 15 outer-cuff extrusions, 5 hemoperltoneum, 6 others) observed during 2687.5 dialysis-months, with an Incidence of one complication every 16.7 dialysis months. Fifty-five catheters (29.2%) were removed; infection (39 cases) was the main cause for removal, followed by obstruction (9 cases), dislocation, and outer-cuff extrusion (2 cases each). Actuarial survival of all catheters was 79.7% at 1 year, 66.6% at 2 years, 42.8% at 3 years, and 39.80/0 at 4 years. No difference In catheter survival was observed according to the entry site. When considering the age of the patients at catheter insertion, a difference close to statistical significance was found (p=0.06).
Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis
Authors: Edefonti Alberto , Picca Marina , Galato Raffaele , Guez Sophie , Giani Marisa , Ghio Luciana , Damiani Beatrice , Dal Col Augusta , Santerarno Carmela
Published: February 2020

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively.

There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05).

In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.
Characteristics of Peripheral and Peritoneal Lymphocytes from Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Lewis Sharon L. , Kutvirt Susan G. , Cooper Christa L. , Bonner Peter N. , Holmes Clifford J.
Published: February 2020

The role of peritoneal lymphocytes in host immunity for continuous ambulatory peritoneal dialysis (CAPD) patients Is just beginning to be understood. CAPD therapy Increases the proportion of peritoneal lymphocytes, most of which demonstrate signs of activation. There are decreased peritoneal T cells and increased peritoneal B cells as compared to the patients’ peripheral blood. When studies examine Immunophenotypes of peripheral and peritoneallymphocytes over time, no significant changes are found. Although changes in peritoneal lymphocyte subsets occur during peritonitis episodes, there are no changes In peripheral blood lymphocytes. The purpose of this article Is to provide a brief review of research that has studied lymphocytes In CAPD patients.
The Modulation of Rifampin Action against Staphylococcus Epidermidis Biofilms by Drug Additives to Peritoneal Dialysis Solutions
Authors: Gagnon Raymonde F. , Richards Geoffrey K. , Obst Gregory
Published: February 2020

Many drugs are added to peritoneal dialysis solutions In continuous ambulatory peritoneal dialysis (CAPD) patients, principally during episodes of peritonitis when antibiotics and nonantiblotic agents are often administered together. To evaluate the Influence of nonantiblotic drug additives on antibiotic action, we determined the effect of ten drug additives on the antimicrobial activity of rifampin against S. epidermiddis biofilms. None of the additives had any direct effect on biofilm bacteria. While five additives did not affect rifampin action, the other five strongly antagonized rifampin. Insulin and heparin were among these five antagonists. This antagonism suggests that a significant degree of Inhibition of antibiotic action may occur by the coadministration of agents In the treatment of peritonitis, particularty in diabetic patients.
Intraperitoneal Vancomycin/Oral Pefloxacin versus Intraperitoneal Vancomycin/Gentamicin in the Treatment of Continuous Ambulatory Peritoneal Dialysis Peritonitis
Authors: Lye Wai-Choong , Lee Evan J.C. , Van Der Straaten Jane
Published: February 2020

Sixty patients were enrolled In a prospective, randomized study to evaluate the efficacy of two different regl mens for the empirical treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. At presentation, Group I received Intraperitoneal vancomycin (1 g) and oral pefioxacin (400 mg b.l.d.), and Group II Intraperitoneal vancomycin (1 g) and gentamicin (80 mg loading dose, followed by 15 mg/2 L). Treatment duration was 14 days. Despite randomization, Group I had significantly more patients with primary Candida peritonitis. When fungal peritonitis was excluded from analysis, there were no significant differences In the treatment success rate (Group I, 73.3% vs Group II, 80.0%, p=NS), number of relapses (Group 1,0 vs Group II, 1), and Tenckhoff catheter removal rates (Group 1,26.6% vs Group 11,16.6%, p=NS) between the two groups. The patients treated with pefioxacin had an increased incidence of nausea and vomiting. In selected situations oral pefioxacin may be a suitable substitute for intraperitoneal gentamicin as outpatient therapy for CAPD peritonitis.
The Use of Fluconazole in the Management of Candida Peritonitis in Patients on Peritoneal Dialysis
Authors: Hoch Brian S. , Namboodiri Neel K. , Banayat Geronimo , Neiderman George , Louis Bertin M. , Manohar Namala L. , Lipner Henry I.
Published: February 2020

In patients receiving peritoneal dialysis, fungal peritonitis is generally impossible to eradicate with previously available therapy in the absence of catheter removal. Corbella et al. described a patient with fungal peritonitis treated with fluconazole without catheter removal. We studied this drug's effectiveness in the treatment of 5 patients with peritonitis secondary to Candida species. Patients received a loading dose of 200–400 mg fluconazole, followed by 50–200 mg fluconazole daily.

Patients Improved initially after therapy with fluconazole. Abdominal pain and fever abated, dialysis returns cleared, cell counts decreased, and, in four cases, cuitures were sterilized. Dialysate fluconazole levels were adequate. However, despite maintenance of fluconazole therapy, all patients had recurrent peritonitis within 1 month. Complete cure did not occur unless the Tenckhoff catheter was removed. When the catheter was removed, tip cuitures grew pure Candida species, and microscopic examination of catheter sections revealed abundant yeast.

Although there may be continued isolated reports of successful eradication of fungal peritonitis without catheter removal, we conclude that in the vast majority of cases catheter removal is required.
Peritoneal Dialysis in the Prune Belly Syndrome
Authors: Crompton Charles H. , Balfe J. Williamson , Khoury Antoine
Published: February 2020

Objectives

To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS).

Design

From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion.

Results

The ages of the 6 boys ranged from 10 months 17 years. The dialysis duration was from 9–22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery.

Conclusion

Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.
Mass Transfer Area Coefficients in Children
Authors: Geary Denis F. , Harvey Elizabeth A. , Balfe J. Williamson
Published: February 2020

Objective

Measurement of mass transfer area coefficients (MTAC) in children of different sizes to determine if solute transport varies with age and to compare with published adult values.

Design

Mass transfer area coefficients calculated from prospectively collected data in 28 selected patients.

Participants

All children starting maintenance peritoneal dialysis at the Hospital for Sick Children. Selected patients were also studied if hospitalized for unrelated reasons.

Results

Mean MTAC values for creatinine and glucose were 4.0 and 4.5 mL/min, respectively, both considerably lower than adult values. When scaled per 70 kg body weight, these results were greater, and when scaled per 1.73 m2 surface area, they were lower than reported adult values. The MTAC/kg body weight was inversely correlated to age.

Conclusions

Solute transport in children is directly related to age and does not approach adult values until later childhood. However, more rapid transport per unit body weight is observed in children and may reflect an increased effective peritoneal surface area.
Continuous Ambulatory Peritoneal Dialysis: An Option in the Developing World?
Authors: Lent Roy , Myers Jonathan E. , Donald Deidre , Rayner Brian L.
Published: February 2020

Objective

To evaluate specified biomedical, socio-economic, and psychosocial criteria as predictors of therapeutic success to optimize patient selection for continuous ambulatory peritoneal dialysis (CAPD) in a developing country.

Design

A restrospective cohort study investigating the relationship between episodes of peritonitis and exitsite infection, and predetermined biomedical, socioeconomic, and psychosocial data.

Setting

A CAPD unit in a large tertiary care teaching hospital.

Patients

AI1132 patients entering the CAPD program between 1987 and 1991.

Results

Overall mean survival time on CAPD was 17.3 months. Peritonitis rates were high, especially among blacks. Multivariate analysis demonstrated that increased peritonitis rates were associated with age, black race, diabetes, and strongly so with several psychosocial factors. Because being black was strongly linked to poor socioeconomic conditions, repeat analysis excluding blacks showed the same associations with the above variables, but, additionally, several socioeconomic factors were associated with high peritonitis rates. No significant explanatory variables were shown for exit-site infections.

Conclusions

The association of biomedical, socio-economic, and psychosocial variables with high peritonitis rates has important implications for the selection of patients for CAPD in this setting.
A Multicenter Study with Once a Week Or Once Every Two Weeks High Dose Subcutaneous Administration of Recombinant Human Erythropoietin in Continuous Ambulatory Peritoneal Dialysis
Authors: Nomoto Yasuo , Kawaguchi Yoshindo , Kubota Minoru , Tagawa Hitoshi , Kubo Kazuo , Ogura Yosuke , Shoji Takao , Kawada Yukimichi , Koshikawa Shozo , Mimura Nobuhide , Maeda Teiryou
Published: February 2020

Objective

To investigate the effectiveness of administering relatively high doses of r-HuEPO subcutaneously once a week or once every 2 weeks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Design

Multicenter prospective analysis. The trial was divided into two phases: an initial 8-week phase (once a week dosing) followed by a 12-week maintenance phase (once every 2 weeks dosing). A response was defined as a change in hematocrit (Ht) of 3% or more. Results were analyzed using Sheffe's test, Mantel-Haenszel's test, and Dunnett's test.

Setting

Eleven renal units in Japan providing a CAPD program.

Patients

Forty-one CAPD patients with a Ht of 28% or less.

Results

After the initial 8 weeks, 13 (81.3%) of 16 patients showed a response to 6000 U (106.9±20.0 U/kg) subcutaneously (sc), once a week. Eleven (84.6%) of 13 in the 9000 U (166.5±27.7 U/kg) group and all 12 (100%) in the 12 000 U (210.7 ±42.1 U/kg) group also showed responses. At the end of both phases, that is, at 20 weeks, 7 (53.8%) of 13 patients in the 6000 U group with once every 2 weeks dosing, 7 (63.6%) of 11 in the 9000 U group, and 10(90.9%) of 11 in the 12 000 U group maintained responses with the same dosing interval. There were no significant changes in mean blood pressure during the study period, and only 2 patients developed treatable hypertension with mild headache.

Conclusion

Administration of relatively high doses of r-HuEPO to CAPD patients once a week or once every 2 weeks is safe and potentially an effective regimen for the correction of renal anemia.
A Comparison of Infection Rates among Older and Younger Patients on Continuous Peritoneal Dialysis
Authors: Holley Jean L. , Bernardini Judith , Perlmutter Jeffrey A. , Piraino Beth
Published: February 2020

Objective

To determine if peritoneal dialysis -related infection rates are higher in older patients compared with younger patients.

Design

A retrospective review of prospectively collected data. Control adult patients were matched with older study patients for race, sex, insulin dependence, connection device, and time on dialysis.

Setting

A university-based peritoneal dialysis program which includes patients from a Veterans Administration Hospital outpatient dialysis program.

Patients

Infection rates of 103 patients 60 years of age (older patients) were compared with 103 matched control patients 18–49 years of age (younger patients).

Main Outcome Measures

Rates of peritonitis, exit site and tunnel infection expressed as episodes/patient/year (episodes/year) and the infecting organisms for each were examined. Outcomes, including catheter removal and the cause for removal, transfer to another dialysis modality and the reason for such, death and transplantation were also assessed.

Results

Mean time on peritoneal dialysis was the same in each group (20±21 months in the older and 18±17 months in the younger patients). The overall peritonitis rates were the same in the two groups (0.95/year in the older and 0.89/year in the younger patients), but the older patients had a higher rate of S. epidermidis peritonitis (0.28/year vs 0. 13/year, p=0.0001). S. aureus peritonitis rates were similar (0.16/year in older and 0.17/year in younger patients). Older patients had fewer exit-site infections (0.80/year versus 1.2/year, p=0.0001) and, specifically, lower rates of S. aureusexit-site infections (0.23/year vs 0.47/year, p=0.0001). Tunnel infections were also less common in older patients (0.15/year vs 0.23/year, p=0.008), but S. aureustunnel infection rates were similar (0.05/year and 0.09/year). Catheter infection was the most common reason for catheter removal in both patient groups (35% of catheters in the older and 44% of catheters in the younger patients, p=NS). More catheters were removed from older patients because of dementia or the loss of mechanical skills required to perform peritoneal dialysis exchanges (15% vs 5%, p=0.04).

Conclusions

Older age per se is not associated with higher peritonitis rates, but the use of disconnect sys tems should be encouraged in older patients and their mental and physical skills monitored to avoid S. epidermidis peritonitis. The lower rates of S. aureus catheter infection in older patients requires further study.
Catheter Configuration and Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Comparison of Two Catheters
Authors: Eklund Björn H. , Honkanen Eero O. , Kala Aino-Riitta , Kyllönen Lauri E.
Published: February 2020

Objective

To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit-site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective randomized trial.

Setting

CAPD unit in one university hospital.

Patients

Forty consecutive patients requiring a dialysis catheter for future CAPD were randomized to receive either a single-cuff straight Tenckhoff catheter or a permanently bent single-cuff Swan neck catheter. The skin exit was upward-directed in the Tenckhoff group and downward-directed in the Swan neck group.

Results

Dialysate leak occurred in one patient and symptomatic catheter tip migration in 3 patients with the Tenckhoff catheter but in none with the single-cuff Swan neckcatheter(p=O.5, p=0.12). No significant differences in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections could be demonstrated.

Conclusion

Catheter configuration did not influence the catheter-related mechanical or infectious complications. We were unable to demonstrate any advantage of the newer, permanently bent single-cuff Swan neck catheter over the conventional straight type.
The Effect of Serum Albumin at the Start of Continuous Ambulatory Peritoneal Dialysis Treatment on Patient Survival
Authors: Struijk Dirk G. , Krediet Raymond T. , Koomen Gerardus C.M. , Boeschoten Elisabeth W. , Arisz Lambertus
Published: February 2020

Objective

To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics.

Setting

University medical center.

Participants

Sixty-one patients, evaluated within 3 months after the start of CAPD.

Main Outcome Measures

Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal body weight, and presence or absence of systemicdisease.

Results

Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1 -43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1).

Conclusions

The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.