bluuebunny/crossref_metadata_2025 huggingface dataset:
Complement in Serum and Dialysate in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Reddingius Roel E. , Schröder Cornelis H. , Daha Mohamed R. , Willems Hans L. , Koster Anja M. , Monnens Leo A.H.
Published: February 2020

Objective

During continuous ambulatory peritoneal dialysis (CAPD), activation of complement in the peritoneal cavity may theoretically occur, with inappropriately high or low levels of certain complement factors in dialysate as a consequence. In a group of children on CAPD, it was tested whether levels of a number of complement factors in dialysate were in the range that was predicted on the basis of their molecular weight.

Design

Serum and dialysate levels of C1 q, C3, C4, C3d, B, D, and P were measured after a night dwell in children on CAPD. Simultaneously, four non-complement proteins (β2-microglobulin, albumin, IgG, and α2macroglobulin) were also measured in dialysate and serum. Assuming a linear relationship between the log base 10 of the dialysate/serum ratio of these non-complement proteins and the log base 10 of their molecular weight, the expected ratios of all complement factors were determined. The differences between actual and predicted ratios were tested using a modified t-test, taking into account the inaccuracy of the estimate.

Setting

University hospital.

Patients

A group of 14 children on CAPD, with a median age of 7.8 years (range 2.1–13.2). These children had been on CAPD for a median period of 42.4 months (range 0.4 89.1).

Results

The ratios of factor D (p < 0.001) and C3d (p = 0.035) were elevated, whereas those of C3 (p < 0.001), C4 (p < 0.001), and factor P (p = 0.012) were decreased.

Conclusions

Relatively low dialysate/serum ratios of C4, C3, and factor P could be caused by intraperitoneal consumption of complement. High levels of C3d are compatible with this. High dialysate/serum ratios of factor D indicate intraperitoneal production of factor D. These results provide evidence for activation of complement in the peritoneal cavity in children on CAPD. A further reduction of already low levels of complement factors in dialysate as a result of this may impair host defense.
Correlations between Plasminogen Activator Inhibitor-1 and Peritoneal Transport in Pediatric CCPD Patients
Authors: Lin Jen-Jar , Singhal Kamal , Parton Lance , Cascio Clair , Patlak Clifford S. , Stewart Charles L.
Published: February 2020

Objective

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

Design

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

Patients

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

Interventions

None.

Results

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

Conclusions

The elevated PAI-1 level during the PET was likely from the local production and release of PAI-1. It had an inverse relationship with the amount of ultrafiltration. Repeated inflammation of the peritoneum was associated with an increased production and release of PAI-1 into the peritoneum.
Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on CAPD: Is There a Synergistic Effect with Insulin?
Authors: Fernandez-Reyes Maria Jose , Selgas Rafael , Bajo Maria Auxiliadora , Jimenez Carlos , Del Peso Gloria , Sanchez Maria-Del-Carmen , Dapena Fabiola , De Alvaro Fernando
Published: February 2020

Objective

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

Design

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

Patients

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

Results

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

Conclusions

According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.
Intraperitoneal Amino Acids: A Therapy Whose Time Has Come?
Authors: Jones Michael R.
Published: February 2020

In regard to the question posed in the title of this review, the answer is mixed. IPN is possible today but only on a limited basis and at high cost with uncertain benefit. A 1.1% amino acid dialysis solution for IPAA therapy is available in several European countries but has not yet been approved for use in the United States. When it becomes more widely available, IP AA should become an important tool, along with other types of therapy, for use in the maintenance of good nutritional status in PDpatients.
Comparison of Three Different Tests for Assessment of Hepatitis C Virus in Dialysis Patients
Authors: Castelnovo Claudia , Lunghi Giovanna , De Vecchi Amedeo , Grancini Anna , Como Giovanna , Graziani Giorgio , Scalamogna Antonio , Ponticelli Claudio
Published: February 2020

Objective

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

Design

Cross-sectional study.

Setting

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

Patients

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

Intervention

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

Results

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

Conclusions

Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.
Continuous Ambulatory Peritoneal Dialysis in End-Stage Renal Disease Due to Multiple Myeloma
Authors: Shetty Anupkumar , Oreopoulos Dimitrios G.
Published: February 2020

Objective

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

Design

Retrospective study.

Setting

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

Patients

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

Results

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

Conclusions

Myeloma patients with ESRO do fairly well on CAPO without deterioration in their quality of life and with an acceptable peritonitis rate.
Chronic Induction of C-Reactive Protein by Hemodialysis, but Not by Peritoneal Dialysis Therapy
Authors: Haubitz Marion , Brunkhorst Reinhard , Wrenger Eike , Froese Peter , Schulze Matthias , Koch Karl-Martin
Published: February 2020

Objective

Evaluation of the inflammatory activity in patients on chronic peritoneal dialysis (PD) and patients on chronic hemodialysis (HD) in comparison to patients with chronic renal insufficiency without dialysis treatment and healthy volunteers.

Design

Open, non randomized prospective study.

Setting

Nephrology Department, including HD and PD therapy in a university hospital.

Patients

Twenty -four patients on chronic PD, 21 patients on chronic HD therapy using a cuprophan dialyzer, 16 patients with chronic renal insufficiency without dialysis treatment, and 33 healthy volunteers; 8 additional patients before and after initiation of chronic HD therapy. All patients and controls were without infection or immunosuppressive therapy.

Main Outcome Measures

As a marker of the inflammatory activity in the different patient groups, C-reactive protein (CAP) was measured serially using a sensitive, enzyme-Iinked, immunosorbent assay in order to detect values below the detection limit of standard assays.

Results

All patient groups had CAP levels higher than the normal controls (p < 0.01). Patients on HD had CAP levels significantly higher than PD patients (p < 0.01) whose levels were comparable to patients without dialysis therapy. Accordingly, longitudinal measurements before and after initiation of chronic HD showed a significant increase in CAP levels after the beginning of HD treatment (p < 0.04).

Conclusions

The results suggest that induction of the inflammatory activity is lower during PD compared to HD, since stimulation by the dialyzer membrane, dialysate buffer, or bacterial fragments in the dialysate is avoided. This observation might indicate a possible lower risk of long-term complications in patients with PD.
Synthesis of Hyaluronic Acid by Human Peritoneal Mesothelial Cells: Effect of Cytokines and Dialysa Te
Authors: Breborowicz Andrzej , Korybalska Katarzyna , Grzybowski Andrzej , Tobis Katarzyna Wieczorowska , Oreopoulos Dimitrios G , Martis Leo
Published: February 2020

Objective

To assess effects of the inflammatory cytokines (IL-1-beta, TNF-alpha, TGF-beta 1) and dialysate effluent on synthesis of hyaluronic acid by human peritoneal mesothelial cells (HMC) in in vitro culture.

Methods

Dialysate effluent was collected after the overnight dwell of DianeaI 1.5% from patients during CAPD training. HMC were obtained from omentum from nonuremic donors or were harvested from the dialysate effluent from CAPD patients. Synthesis of hyaluronic acid was studied on monolayers of HMC, which were deprived of serum 48 hours priortoexperiment. Effects of cytokines were tested in a medium with low serum concentration (0.1%) or in medium mixed (1:1 v/v) with the autologous dialysate. Hyaluronic acid level in medium was measured with radioimmunoassay.

Results

Cytokines enhanced synthesis of hyaluronic acid by HMC, and the strongest effect was induced by IL-1. Effluent dialysate stimulates synthesis of hyaluronic acid stronger than 10% FCS. Effluent dialysate and IL-1 synergistically enhance synthesis of hyaluronic acid by HMC.

Conclusion

Effluent dialysate from CAPD patients stimulates production of hyaluronic acid by HMC and acts synergistically with cytokines.
Differential Glucocorticoid Responsiveness of Dialysis Patients’ Lymphocytes
Authors: Briggs William A. , Gao Zu-Hua , Scheel Paul J. , Burdick James F. , Gimenez Luis F. , Choi Michael J.
Published: February 2020

Objectives

To evaluate in vitro glucocorticoid responsiveness of phytohemagglutinin (PHA)-stimulated lymphocytes from peritoneal dialysis (PO) patients compared to hemodialysis (HO) patients.

Design

Cross-sectional study of prevalent PO and HO patients and concurrent control subjects.

Setting

Urban outpatient dialysis unit.

Patients

20 HO, 14 PO, and 20 control subjects.

Measurements

Using standard lymphocyte culture techniques, the concentration of prednisolone (P) and methylprednisolone (MP) required to cause 50% inhibition (ICso) of the proliferative response to phytohemagglutinin (PHA) was determined from dose-response curves.

Results

There was considerable heterogeneity in the sensitivities of individual patients’ PBMC to glucocorticoid inhibition, especially those of HO patients’ cells to P. The mean: i: SO ICso for MP was significantly (p ≤ 0.001) lower than that for P in each cohort: PO 11 ± 5 vs. 34 ± 18 ng/mL; HO 22 ± 14 vs. 89 ± 43 ng/mL; control subjects 14 ± 11 vs. 55 ± 56 ng/mL. Interestingly, the ICSO for both P and MP was significantly higher in HO than in either PO or controls (ANOVA, P: F = 6.56, p = 0.003; MP: F = 3.77, p = 0.03), indicating decreased sensitivity of HO lymphocytes to both drugs. There were no significant differences in mean ICSO values for either P or MP between PO and controls. No correlations were found between ICSO for either P or MP and patient age, gender, duration of dialysis, serum creatinine, serum albumin, or parathyroid hormone level.

Conclusions

In vitro glucocorticoid responsiveness of dialysis patients’ lymphocytes appears to be influenced by dialysis modality, butthefactor(s) involved remains to be determined. Thegreater sensitivity of PO lymphocytes to both P and MP might result in better immunosuppression and less severe rejection after renal transplantation. MP may be particularly advantageous following renal transplantation for any patient manifesting relative or absolute in vitro resistance to P.
Microcirculation of the Fingernail Fold in Capd Patients: Preliminary Observations
Authors: Schumann Lutz , Korten Gero , Holdt Birgit , Holtz Manfred
Published: February 2020

Objective

To study changes in the peritoneal micro-circulation during continuous ambulatory peritoneal dialysis (CAPD) by studying change in the microcirculation of the fingernails of CAPD patients.

Setting

A university department.

Design

A cross-sectional study of 10 nondiabetic patients on CAPD.

Intervention

Hemorrheological tests of fingernail microcirculation using equipment built at our university.

Main Outcome Measures

Microcirculation was characterized by estimation of capillary density, red blood cell (RBC) column diameter, torque index, and RBC flow velocity semiquantitatively using videocapillaroscopy at the fingernail fold and plasma viscosimetry. Findings were correlated with treatment duration, peritoneal clearance, state of capillary morphology and hemodynamics, and lipid and fibrinogen levels.

Results

Treatment duration was significantly correlated (p ≤ 0.05) with low-density lipoprotein (LDL) (r = 0.776) and clearances of urea (r = -0.583), uric acid (r = -0.666), and potassium (r = -0.764). Changes in capillary morphology were correlated to clearances of urea (r = 0.643) and uric acid (r = 0.701). The fibrinogen concentration increases plasma viscosity (r = 0.799) and deteriorates the capillary state (r = -0.706). In addition, plasma viscosity correlates to cholesterol (r = 0.620, NS) and LDL (r = 0.781), but not to high-density lipoprotein and triglycerides.

Conclusion

CAPD treatment results in lipid abnormalities and high fibrinogen levels that may cause microvascular damage and poor perfusion. These interactions may explain the deterioration of peritoneal transport in some CAPD patients.
Peritoneal Dialysis Kinetic Modeling: Validation in a Multicenter Clinical Study
Authors: Vonesh Edward F. , Burkart John , McMurray Stephen D. , Williams Paul F.
Published: February 2020

Objective

To clinically validate the use of a computer-based kinetic model for peritoneal dialysis (PD) by assessing the level of agreement between measured and modeled values of urea and creatinine clearances and ultrafiltration (UF).

Design

An open multicenter observational study.

Patients

There were 111 adult continuous ambulatory peritoneal dialysis (CAPD) patients (47 female, 64 male) in four centers. All patients underwent a four-hour peritoneal equilibration test (PET) using 2.5% dextrose but with variable fill volumes (range: 1 -3 L). Patients with a residual renal function greater than 10 mL/min were excluded.

Main Outcome Measures

Correlations and limits of agreement between measured and modeled values of total weekly urea KTN, total weekly normalized creatinine clearance (L/week/1.73 m2), daily drain volume (L), net ultrafiltration (L), daily peritoneal urea clearance (L/day), and daily peritoneal creatinine clearance (L/day). Measured values were obtained from 24-hour urine and dialysate collections while modeled values were based on results from the PET in combination with the PD ADEQUEST® kinetic program.

Results

The results show there is excellent agreement between measured and modeled urea KTN and creatinine clearances, with concordance correlations of 0.94 and 0.92, respectively. Given the excessive variation and limited range in ultrafiltration values, the concordance correlation between measured and modeled UF was only 0.50. In terms of daily peritoneal clearances and ultrafiltration, the level of precision (i.e., standard deviation) in the differences between modeled and measured values is ±1.05 L/ day for urea clearance, ±1.03 L/day for creatinine clearance, and ±0.919 L/day for ultrafiltration. By contrast, the level of precision (i.e., standard deviation) in the differences between two measured values is estimated to be ±0.979 L/day for urea clearance, ±0.802 L/day for creatinine clearance, and ±0.707 L/day for ultrafiltration. Defining the limits of clinical agreement to be ±2 standard deviations of the differences between two clinically measured 24-hour clearances (or ultrafiltration), we find that 94% of the modeled urea clearances, 87% of the modeled creatinine clearances, and 86% of the modeled ultrafiltration values fall within the limits of clinical agreement.

Conclusion

Data from a carefully performed PET and overnight exchange can, in combination with a scientifically validated kinetic model, provide clinicians with a powerful mathematical tool for use in CAPD dialysis prescription management. Although not intended to replace actual measurements, kinetic modeling can prove useful as a means for predicting clearances for various alternative prescriptions and perhaps also as a means for checking certain types of noncompliance.
Can Low-Calcium Peritoneal Dialysis Solution Safely Replace the Standard Calcium Solution in the Majority of Chronic Peritoneal Dialysis Patients?
Authors: Buijsen Coby G.M. , Struijk Dirk G. , Huijgen Henk J. , Boeschoten Els W. , Wilmink Joep M.
Published: February 2020

Objective

To evaluate the use of low-calcium solution as the standard solution in chronic peritoneal dialysis patients.

Design

Prospective long-term follow-up study over a one-year period.

Setting

University hospital.

Interventions

The change of the calcium concentration of the dialysate from 1.75 mmollL to 1.25 mmollL.

Main Outcome Measures

Serum calcium and phosphorus concentration and intact parathyroid hormone (iPTH).

Patients

Fifty normo and hypercalcemic patients using the standard 1.75 mmollL calcium solution.

Results

Serum ionized calcium (iCa) decreased significantly during the first six months, resulting in a significant increment of iPTH (baselinevalue: 0.9 79, median 9.4 pmollL; at six months: 1.1 -111, median 20.6 pmollL; p < 0.05). In 28 patients completing the study, iPTH remained significantly elevated, despite high normal iCa. At similar changes of iCa, patients with baseline iPTH > 20 pmollL showed a significantly higher increase in iPTH than patients with low iPTH (24.0 vs 5.0; p < 0.01), despite a more than doubled dose of alfacalcidol and calcium carbonate (mean dose of 1580 increased to 3277 mg/day). During the follow-up, 21 episodes of hypercalcemia were observed. Phosphorus control was adequate.

Conclusions

Low-calcium solution cannot be used as a standard solution, especially in patients with iPTH levels indicating mild or severe hyperparathyroidism, because in these patients iPTH may rise further.
Bicarbonate versus Lactate Buffer in Peritoneal Dialysis Solutions: The Beneficial Effect on Rbc Metabolism
Authors: Buoncristiani Umberto , Galli Francesco , Rovidati Simona , Albertini M. Cristina , Covarelli Carla , Carobi Carmen , Di Paolo Nicola , Canestrari Franco
Published: February 2020

Objective

Using the erythrocyte as a model for other kinds of cells not directly exposed to peritoneal dialysis (PD) solutions, we investigated the tolerance of the cell metabolism to lactate and bicarbonate buffers

Design

We studied, in vivo (in two groups of 5 PD patients each) and in vitro, the Embden-Meyerh of pathway (EMP) because it represents a potential target for the unphysiological effects of lactate or bicarbonate buffers. The EMP is the main glucose-utilizing route in the red blood cell (RBC), producing energy and reducing power.

Methods

The enzymatic activities of the key steps in the glycolytic pathway and the energy charge (EC), determined by the levels of phosphorylated adenine nucleotides, were investigated spectrophotometrically and by high performance liquid chromatography (HPLC) in two groups of patients undergoing lactate (L-group) and bicarbonate (B-group) PD, respectively. The in vitro effects of both bicarbonate and lactate buffers on some EMP enzyme activities and energy production were determined. Cellular pH (pHi) was also investigated.

Results

The B-group showed an EC value near the control levels, while in the L-group a significantly lower EC value was observed (t-test: p < 0.05 vs both B-group and controls). The key enzymes in the EMP, and in particular hexokinase, were higher in the L versus B-group (p < 0.03 for the comparison of the Hk mean values). As demonstrated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, the bound form of glyceraldehyde-3-phosphate dehydrogenase (G-3-PD), an inactive form of this EMP enzyme, was significantly higher in the Lgroup with respect to the B-group (p< 0.004). In thein vitro experiments, high lactate concentrations acutely inhibited the key enzymatic steps of glycolysis, producing a significant decrease in glucose consumption and adenosine triphosphate production. These effects were not observed when bicarbonate was used in the incubations. Bothin vivoandin vitrolactate, but not bicarbonate, induce a significant drop in pHi (p < 0.05). Decreased levels of pHi like those observed in the lactate-incubated RBC were demonstrated to be able to inhibit G-3-PD activity (25±2%) here used as an indicator of the actual decrease in pH.

Conclusion

This study provides evidence for a damaging action of lactate with respect to bicarbonate buffer on the RBC metabolism. This condition was demonstrated observing a cell energy depletion, which coincidesin vitro with an acute EMP impairment; the lactate accumulation together with the consequent lowering of pHi seem to be responsible for this effect, which was not observed when bicarbonate was used instead of lactate.
Body Surface Area Limitations in Achieving Adequate Therapy in Peritoneal Dialysis Patients
Authors: Rocco Michael V.
Published: February 2020

Objective

To estimate the maximal body surface area (BSA) at which an uric chronic peritoneal dialysis patients can achieve adequate peritoneal dialysis using a variety of continuous ambulatory peritoneal dialysis (CAPD) and cycler regimens. Adequate dialysis was defined as a creatinine clearance of either 60 L/week/1.73 m2 or 70 L/ week/1.73 m2.

Design

Calculation of daily peritoneal creatinine clearances using standard formulas. For CAPD patients, creatinine clearance was calculated using published values for dialysate-to-plasma ratios for creatinine (DIP cr) measured over a 24-hour period and assuming a daily ultrafiltration rate of 1.5 to 2.0 L/day. For cycler patients, creatinine clearance was calculated for both one and two-hour dwell volumes, using published values for DIP cr from the peritoneal equilibration test and assuming a daily ultrafiltration rate of 2.0 L/day. All clearances were corrected to a normalized body surface area of 1.73 m2.

Results

For CAPD patients, 2– L dwell volumes can provide a weekly creatinine clearance of 60 L/week/1.73 m2 in patients with BSA < 1.45 m2 in the high transporter group and with BSA < 1.2 m2 in the low-average transporter group. Increasing dwell volume from 2.0 to 2.5 L increases these BSA limits in the four transport groups by 0.2 0.3 m2. Cycler therapy is not a viable option for patients in the low transporter group, and this therapy can achieve adequate creatinine clearances in patients in the low-average transport group only with large dwell volumes and in patients with BSA < 1.55 m2. However, in the high-average and high transporter groups, cycler therapy provides for superior creatinine clearances compared to CAPD patients using similar dwell volumes.

Conclusions

Adequate creatinine clearances in anuric patients are most likely to be achieved in patients with BSA > 2.0 m2 if they have high-average or high transport characteristics and are receiving cycler therapy with large dwell volumes and at least one daytime dwell. However, adequate creatinine clearances may be difficult to achieve in an uric patients who have a large BSA an d a low or low-average transport type, regardless of peritoneal dialysis modality. These patients should be considered for either high-dose peritoneal dialysis (multiple daytime and nighttime exchanges) or hemodialysis therapy.
Paradoxes in Peritoneal Transport of Small Solutes
Authors: Waniewski Jacek , Heimbürger Olof , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Analysis of kinetic studies of peritoneal solute transport involves the need for discrimination between three transport components: diffusion, convective transport, and peritoneal absorption. The description of convective transport in standard clinical conditions of continuous ambulatory peritoneal dialysis (CAPO), as well as in isochratic measurements, has met some problems related to the paradoxical and often anomalous values of sieving coefficient, a parameter that characterizes solute drag with the flow of ultrafiltrate. A possible explanation of some of these results is the time dependence of the transport parameters, which is in contrast to their assumed steadiness. These anomalies as well as the time dependence of the transport parameters are confined more to the standard glucose-based dialysis fluid than to some alternative dialysis fluids. Furthermore, the most striking anomalies have been found for small electrolytes as well as for osmotic agents, which are applied in high, unphysiological concentrations. These solutes may be involved in the transport between intracellular and extracellular compartments within the peritoneal membrane, which phenomena are not included in the current modeling.
Complications Linked to Chronic Peritoneal Dialysis in Children after Kidney Transplantation: Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis
Authors: Andreetta Barbara , Verrina Enrico , Sorino Palma , Edefonti Alberto , Perfumo Francesco , Bassi Sergio , Ghio Luciana , Cattarelli Donatella , Coppo Rosanna , Rinaldi Stefano , Capasso Giovanni , Zanon Giovanni F. , Zacchello Graziella
Published: February 2020

Our objective was to evaluate the infectious complications of the post-transplant period attributable to the persistence of catheter and other complications when chronic peritoneal dialysis (CPD) was performed posttransplantation. The design was a retrospective study, and the setting was an Italian registry of pediatric chronic peritoneal dialysis.

There were 86 pediatric renal transplants (9/86 from living related donors, 2/86 simultaneous liver and kidney transplantation for oxalosis). Six of 86 transplants were lost at follow-up. Mean age of the children (n = 80) at transplantation was 9.3 years (range:1.7–21 years). They had been on CPD for a mean period of 1.7 years (range: 0.2 -4.6 years). During CPD, 67 peritonitis episodes (80% related to exit-site and/or tunnel infections) were observed, with an incidence of peritonitis of one episode per 16 months CPD. The mean safe interval of peritonitis and/ or exit-site or tunnel infection was 208 days (range: 36 1897 days). The mean time of catheter removal was 80.3 days (range: 0 216 days) post-transplantation.

During the first month post-transplantation, one episode of peritonitis secondary to a sepsis occurred in one child. No other episodes of peritonitis or exit-site and/or tunnel infections were observed. Two of 80 children returned to CPD (at four and at 12 months, respectively) because of persistent allograft failure. Furthermore, 12 patients were on CPD because of temporary graft failure. In all these patients the pretransplant peritoneal dialysis (PD) catheter was utilized, with no complications.

These data show that the persistence of the PD catheter after kidney transplantation has produced no infections or other complications. What is more, the catheter was safely utilized during acute rejection or primary allograft nonfunction.
Minoxidil Selectivel Y Improves Peritoneal Ul Trafiltration
Authors: El-Sherif Assem K. , Rizkalla Nader H. , Essawy Mohamed H. , El-Gohary Ahmed M.
Published: February 2020

This cross-over randomized clinical trial was car-ried out to evaluate the effects of intraperitoneal (IP) administration of minoxidil on fluid removal and solute clearance during peritoneal dialysis. Twenty-one patients with endstage renal disease, awaiting enrollment in chronic hemodialysis therapy, were randomly allocated to receive IP minoxidil either in the first or the last nine cycles of a 24-cycle peritoneal dialysis session. Cycle-to-cycle data on fluid balance, blood pressure, and adverse effects of the drug were obtained. The dialysis fluid recovered in cycles 3,6,9, 18,21, and 24 was analyzed, together with plasma, for creatinine, urea nitrogen, and protein content. The mean excess fluid volume collected in minoxidil cycles was 1123.8±1119 mL versus 145.2±743.6 mL in the minoxidil-free cycles (p = 0.004). The mean creatinine clearance, urea nitrogen clearance, and protein losses were comparable in minoxidil cycles and the minoxidilfree cycles. Six patients developed hypotension during the minoxidil cycles, corrected by normal saline, but no other important side effects were noted. It is concluded that IP minoxidil selectively increases ultrafiltration without influencing solute clearance in peritoneal dialysis.
Heat-Sterllized Pd Fluid Blocks Leukocyte Adhesion and Increases Flow Velocity in Rat Peritoneal Venules
Authors: Jonasson Peter , Bagge Ulf , Wieslander Anders , Braide Magnus
Published: February 2020

Data from cell culture experiments indicate that heat sterilization of peritoneal dialysis (PD) fluids produces cytotoxic glucose degradation products.

The present vital microscopic study investigated the effects of different sterilization methods on the biocompatibility of PD fluids. Thus, heat-sterilized (commercially obtained and experimentally produced) and filter-sterilized PD fluids (pH = 5.30 5.40; 1.5% glucose) were compared with Tyrode buffer, with respect to the effects on microvascular blood flow velocity and leukocyte adhesion in the rat mesentery.

Exteriorization of the mesentery produced a mild inflammation, known from the literature and characterized by the adhesive rolling of leukocytes along venular walls. Superfusion of the mesentery with filter-sterilized PD fluid had no significant effects on leukocyte rolling or flow velocity in venules 25 40 μm in diameter compared with buffer superfusion. Heat-sterilized PD fluid decreased the concentration of rolling leukocytes and increased flow velocity significantly, as compared with buffer and filter-sterilized PD fluid.

The results indicate that heat sterilization of PD fluids produces substances that interact with microvascular tone and leukocyte-endothelial adhesion, which hypothetically could impair the acute, granulocyte-mediated defense against bacterial infections.
The Impact of Peritoneal Permeability and Residual Renal Function on Pd Prescription
Authors: Harty John , Gokal Ram
Published: February 2020

Our objective was to evaluate the impact of peritoneal transport characteristics and residual renal function on peritoneal clearance and to determine the dialysis volume required to achieve targets for KT/V and weekly creatinine clearance (WCC) in patients with differing weights, renal function, and transport status.

Retrospective analysis and mathematical model simulation of urea and creatinine clearance were used.

This review demonstrates the important contribution of both residual renal function and peritoneal transport in attaining target values for KT/V and WCC. The limitations of a standard 4 x 2 L dialysis prescription are highlighted in anuric patients and those with low peritoneal transport. In addition, the limitations of short dwell, rapid exchange dialysis modalities are emphasized, especially in patients with low and low average peritoneal transport where daily clearance is demonstrated to be considerably less than conventional continuous ambulatory peritoneal dialysis (CAPD).

Attainment of proposed targets for KT/V (1.7) and WCC (50 L) is greatly dependent on residual renal function. In CAPD, peritoneal transport characteristics determine urea clearance through an effect on ultrafiltrate. Thus low transporters of identical weight will have greater values for peritoneal dialysis KT/V. Creatinine clearance is considerably influenced by transport status. The majority of low and low average groups will need some degree of renal function to achieve currently proposed targets. In these patients, conversion to high volume, short dwell modalities will further compromise small solute clearance unless daytime long dwells or tidal dialysis is instigated.
Survival of Capd Patients in a Center Using Three Two-Liter Exchanges as Standard Regime
Authors: Lo Wai Kei , Jiang Yun , Cheng Suk Wai , Cheng Ignatius Kum Po
Published: February 2020

Our objectives were to study long-term patient survival and dialysis adequacy of continuous ambulatory peritoneal dialysis (CAPD) patients treated with a standard regime of three 2-L daily exchanges. It was a retrospective analysis of patient survival and cross-sectional analysis of adequacy of dialysis. The setting was a dialysis unit in a tertiary referral center of a teaching hospital. All patients (n = 507) accepted into the CAPD program from 1983 to June 1994, were analyzed for survival. Adequacy of dialysis was analyzed in all existing patients in 1993 to 1994. The overall patient survival was 93%, 71%, and 57% at one, three, and five years, respectively. The three-year survival rate was 40% for diabetics and 78% for nondiabetics. It was 86%, 85%, 64%, and 43% for patients aged <35, 35 -50, 50 -65, and over 65 years, respectively. The mean weekly KT/V of 201 existing CAPD patients was 1.76, and creatinine clearance was 57 Uweek/1.73 m2. KT/V by dialysis was only 1.57. The age and disease-adjusted survival in our center was comparable to centers that used standard four 2-L exchange regimes, despite a substantially lower mean KT/V and creatinine clearance (CrCI).
Survival of Diabetic Patients on Peritoneal Dialysis Or Hemodialysis
Authors: Marcelli Daniele , Spotti Donatella , Conte Ferruccio , Tagliaferro Alfonso , Limido Aurelio , Lonati Fulvio , Malberti Fabio , Locatelli Francesco
Published: February 2020

Our objective was to analyze the survival of diabetic patients on renal replacement therapy and to compare their survival on extracorporeal and on peritoneal dialysis. All data regarding diabetic patients admitted to dialysis between 1 January 1983 and 31 December 1993 were collected by means of individual patient questionnaires sent to all of the 44 regional Renal Units (100% answers) of Lombardy, Italy. Cox proportional hazards model, stepwise procedure, was applied in order to select the covariates significantly associated with survival. Age (at baseline), sex, type of diabetes, initial modality of treatment (hemodialysis or peritoneal dialysis), and initial clinical risk factors (malignancies, serious heart disease, vascular disease, cirrhosis of the liver, cachexia) were considered. Descriptive analysis of survival was performed using the Kaplan-Meier technique. The survival of all diabetic patients (895) was 86.5% at one year, 52% at three years, an d 34% at five years. The main causes of the 488 deaths of diabetic patients were cardiovascular diseases (56%), cachexia (18%), and infections (11%). The relative death risk of patients on peritoneal dialysis versus those on hemodialysis, after taking into account the main comorbid conditions, did not significantly differ from 1, as estimated by the Cox proportional hazards regression model. Five-year survival of diabetic patients was 34%, and no differences were found between peritoneal dialysis and hemodialysis as far as mortality is concerned.
Prescription of Calcium Concentration and Pth Control
Authors: Ritz Eberhard , Passlick-Deetjen Jutta , Zeier Martin , Stefanski Adam
Published: February 2020

The use of calcium-containing oral phosphate binders, introduced in an effort to avoid aluminum-containing compounds, has led to more frequent episodes of hypercalcemia. This prompted the introduction of continuous ambulatory peritoneal dialysis (CAPD) solutions with diminished calcium content. The problems raised by such solutions included stimulation of parathyroid hormone (PTH) secretion and long-term maintenance of calcium balance. Some of these issues can today be answered on the basis of controlled prospective trials. Variability of the rate of intestinal calcium uptake of bone turnover, of baseline parathyroid activity, and other factors make it necessary to individualize the indication for the use of CAPD solutions with low calcium content.
A Prospective Randomized Comparison of the Swan Neck, Coiled, and Straight Tenckhoff Catheters in Patients on Capd
Authors: Lye Wai-Choong , Kour Nam-Wee , Van Der Straaten Jane C. , Leong See-Odd , Lee Evan J.C.
Published: February 2020

Our objective was to study the impact of peritoneal catheter configuration on continuous ambulatory peritoneal dialysis (CAPO)-related infections, mechanical complications, and patient dropout in a prospective randomized trial. Forty consecutive patients who were commencing CAPO were randomized to receive either a double-cuff, Swan neck coiled catheter or a double-cuff, straight Tenckhoff catheter, implanted by surgical technique.

There was no significant difference in the peritonitis rate between the two groups. There was a lower rate of exit-site infection in the Swan neck group compared to the straight catheter group (0.29 vs 0.60 eplsodes/patientyear, p < 0.05). Catheter-tip migration occurred in 3 patients with the straight catheters compared to one patient with the Swan neck catheter. No patient had to discontinue CAPO because of mechanical complications. The number of CAPO patient dropouts was not significantly different between the two groups.

The Swan neck configuration resulted in a significant reduction in the rate of exit-site infections. The coiled component of the catheter may lead to fewer episodes of catheter-tip migration. However, catheter configuration did not influence the number of technique failures.
Peritoneal Dialysis in the Pacific
Authors: King Margaret J.
Published: February 2020

Peritoneal dialysis (PD) in the Pacific is the predominant dialysis modality for home dialysis patients. Patient location, age, personal preference, and medical condition are all taken into consideration. However, with the steadily increasing number of patients on PD, financial constraints are now affecting the nurse-patient ratios.

As a consequence, PD nurses are constantly seeking new and improved clinical practice regimes with which they can provide and maintain quality, cost-effective nursing care. To enable PD nurses to provide such care, they are now, more than ever, Involved in patient, professional, and management issues. These patient issues include, but are not limited to: the elderly, the diabetic, the indigenous patient, and their carers, peritonitis, exit-site infection, and adequate dialysis. Professional issues include the development of standards of clinical practice, nursing research, quality improvement, and tertiary education. Management issues are constantly encroaching into the clinical practice setting, therefore the PD nurse must now justify spending, develop strategic plans, and meet annual budgets.

In conclusion, it can be seen that PD nurses in the Pacific are faced with similar patient-care, professional, and management issues as their counterparts throughout the world.
Icodextrin: Overview of Clinical Experience
Authors: Peers Elizabeth , Gokal Ram
Published: February 2020

Objective

To review all clinical studies and experience gained with icodextrin to date; primarily its use in peritoneal dialysis in patients with end-stage renal failure, but also its use as an intraperitoneal vehicle.

Data sources

Peer-reviewed original research articles in the literature; abstracts from international scientific meetings; data generated from the compassionate use programme.

Study selection

All published studies to date are included, some 10–20 studies being included in this review.

Data extraction

Data have not been specifically extracted from studies; results have been described in the context of overall experience.

Results

Over ten years of clinical experience with icodextrin have now been accumulated, in both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). A small number of patients have received icodextrin for over five years, with no loss of effect. Icodextrin produces sustained ultrafiltration over long dwells while being iso-osmolar, by the process of colloid osmosis.

Conclusion

Icodextrin represents the first viable alternative osmotic agent to glucose, for use in solutions for peritoneal dialysis. It also has a potential use as a vehicle solution for intraperitoneal drug delivery.
Six-Month Prospective Cross-Over Study to Determine the Effects of 1.1% Amino Acid Dialysate on Lipid Metabolism in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Misra Madhukar , Reaveley David A. , Ashworth Jacqueline , Muller Bruce , Seed Mary , Brown Edwina A.
Published: February 2020

Objective

To evaluate the effect of 1.1% amino acid dialysate (A AD) (Nutrineal, Baxter, Castlebar, Ireland) on lipid metabolism in hyperlipidemic patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

Patients were alternately assigned to receive AAD in the first (group A), or the second (group B), 6 months of a prospective cross-over study.

Setting

University teaching hospital.

Patients

Eighteen stable CAPD patients with a serum cholesterol 5.5 mmol/L or greater.

Interventions

One post prandial exchange of AAD during a 24-hour period for 6 months.

Main Outcome Measures

A significant change in serum lipid levels.

Results

Patients in group A (n = 10) received a single daily exchange of AAD in place of their post prandial dextrose exchange for the first 6 months, and then crossed over to the dextrose phase. Patients in group B (n = 8) continued their usual dextrose dialysis for the first 6 months and then crossed over to receive AAD in the latter 6 months. Measurements of serum lipids and lipoproteins along with other biochemical parameters were made at regular intervals. Although a downward trend in mean serum total cholesterol was seen on AAD in group A, no significant change in total cholesterol, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol was observed in any group. Mean serum triglycerides fell on AAD in both groups, but were not statistically significant. Serum lipoprotein(a) [Lp(a)] and apolipoprotein B were elevated in both groups but did not change on AAD or with time. No change was observed in serum apoprotein A1 levels. Serum Lp(a) was not correlated to dialysate protein excretion. No change in mean serum albumin was observed, in either group, on AAD. KT/V urea, total weekly creatinine clearance, net ultrafiltration, and dialysate protein excretion remained unchanged on AAD.

Conclusions

The use of A AD, although clinically safe and without side effects, had no effect on the dyslipidem ia in our group of CAPD patients.
Compliance with Capd Prescription is Good
Authors: Fine Adrian
Published: February 2020

Objective

To determine compliance with continuous ambulatory peritoneal dialysis (CAPO) prescription.

Design

In the first part of the study, we examined the deliveries of dialysate to our CAPO patients (n = 67) between 1992 and 1995 and compared these to the CAPO prescription. In the second part of the study, we performed two inventory checks in a cohort of patients (n = 26) in one urban Canadian center. Compliance was defined as using more than 90% of prescribed dialysate.

Results

Based on dialysate deliveries, 95% of our CAPO patients were compliant. Based on home inventory checks, 12% of patients were noncompliant.

Conclusions

Compliance with CAPO prescription is remarkably good in our patient population. These data contrast with American data and could partially explain differences in mortality rates for CAPO patients between the two countries.