bluuebunny/crossref_metadata_2025 huggingface dataset:
Infected Intra-Abdominal Hematoma Associated with an Indwelling Tenckhoff Catheter
Authors: Braden Gregory L. , Germain Michael J. , Guardione Vincent A. , Fitzgibbons John P.
Published: February 2020

Two months after cessation of continous cycling peritoneal dialysis a pa tient developed an infected intra abdominal hematoma while a Tenck hoff catheter was still present in the abdomen. The hematoma required surgical evacuation. This complication suggests that we should consider early removal of Tenckhot T catheters after successful renal transplanta tion or after switching to hemo dialysis.

The chronic peritoneal catheter pioneered by Tenckhoff has made it possible to treat thousands of patients with end stage renal failure by chronic peritoneal dialysis. The complications of Tenckhoff catheters include dialysate leakage, outflow obstruction, pelvic pam, hydrothorax, dacron cuff extrusion, tract infections, combined inflow outflow obstruction, abdominal or in guinal hernias, and hydroceles (1–6). This paper describes a patient who developed abdominal pain and an in fected intra-abdominal hematoma two months after being transferred from continuous cycling peritoneal dialysis (CCPD) to hemodialysis. The appear ance of this complication two months after discontinuing peritoneal dialysis raises the question: When should one remove a Tenckhoff catheter after transfer to hemodialysis or successful renal transplantation?
Genital Edema in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Orfei Reto , Seybold Klaus , Blumberg Alfred
Published: February 2020

Two patients who developed massive genital edema while on CAPD were investigated by peritoneal scintigraphy with Tc99m-glucoheptonate. In one the genital swelling was due to an umbilical hernia and in the other it was due to an abdominal-wall hernia. After the hernia was repaired CAPD could be continued. We recommend peritoneal scintigraphy as a technique for the investigaiton of leakage of peritoneal fluid in patients undergoing CAPD.

Recently genital swelling has been described as a complication of CAPD (I, 2). In one patient an isotope technique demonstrated an open processus vaginalis (1), and in four patients (2) scrotal or labial edema was due to an inguinal hernia. This communication describes two patients with genital edema which was due to an umbilical hernia in one, and to an abdominal wall hernia in the other.
A Quantitative Approach to the CAPD Prescription
Authors: Teehan Brendan P. , Schleifer Charles R. , Sigler Miles H. , Gilgore Gary S.
Published: February 2020

The CAPD prescription, expressed as daily drainage volume, can be formulated as a function of the recommended dietary protein intake and the average BUN level. This process is greatly simplified because urea nitrogen reaches a state of equilibrium on CAPD. The ratio of the actual drainage volume to this prescribed drainage volume -a dialysis index (Dl), reflects the fraction of urea nitrogen clearance achieved. Used with the average BUN level, the dialysis index provides an estimate of the protein catabolic rate (PCR), in gm/kg/day. When integrated these three factors -BUN, Dl and PCR, can be applied to optimize diet and dialysis and may provide a basis for comparing treatment results between patients and between centers.

As continuous ambulatory peritoneal dialysis (CAPD) approaches its ninth anniversary, it continues to grow and to enjoy wide acceptance. Only a small minority continue to question its role in the care of end-stage renal disease patients. However, they ask fundamental questions which deserve our attention. Why is rate of hospitalization higher -peritonitis and access-related difficulties are only partially responsible (I). Does this technique's low urea nitrogen clearance provide adequate dialysis? Why do nearly 30% of patients leave CAPD programs within one year (2)? Are some CAPD patients under-dialyzed or malnourished? After nearly a decade of experience we have not answered these nagging questions and perhaps they cannot be answered. However, it is clear that they cannot be avoided. As Huxley cautioned, “Facts do not cease to exist because they are ignored.” An objective analysis of these issues raises the fundamental question, namely, the adequacy of dialysis -and adequacy compared to what?
Transplantation in Patients Undergoing CAPD
Authors: Tsakiris Dimitrios , Bramwell Stephen P. , Briggs J. Douglas , Junor Brian J.R.
Published: February 2020

Between May 1980 and December 1983, 39 patients on continuous ambulatory peritoneal dialysis (CAPD) received renal allografts, which represents 18% of the 212 transplants done during this period. The remaining 173 allografts were transplanted into 162 patients who to the time of operation had been maintained on hemodialysis. For the CAPD and hemodialysis patients respectively, the one-year graft survival for first cadaveric transplants was 61% and 59%, while, for the two groups, the one-year patient survival was identical-95%. In five of the 14 patients (36%) in whom CAPD was used immediately after the transplant peritonitis developed, but in none of the 25 patients who did not have CAPD at this time. The Tenckhoff catheters were left in situ for a mean period of 12.7 weeks after the transplant without leading directly to any complications. However, at catheter removal, organisms grew on cultures from 11 of 25 catheter tips (44%). In conclusion, graft and patient survival is as high in CAPD patients as in those maintained by hemodialysis. In patients in whom the transplant does not function immediately we now use hemodialysis because CAPD at this time is associated with peritonitis and wound infection in some of the patients.

Only a few centres have described their experience with renal transplantation in CAPD patients and most have not considered CAPD to be a contraindica tion to transplantation (1–5). However, based on one case report Cramer et al (6) suggested that CAPD provides a suboptimal preparation for transplantation, and Gelfand et al (7) reported that compared with hemodialysis, patients on CAPD had inferior transplant results. The small numbers of patients and varying selection criteria in most of these studies may explain the differences of opinion. This paper describes our experience with 39 CAPD patients who received renal allografts between May 1980 and Dec. 1983.
Procedures Used to Demonstrate a Pleuroperitoneal Communication: A Review
Authors: Kennedy Juanita M.
Published: February 2020

A variety of procedures are used to demonstrate transdiaphragmatic transport of peritoneal fluid. Ideally, the procedure should be safe, reliable and generally available. At present, three procedures are used for this purpose: I) The study of dialysate, serum and pleural fluid for glucose, protein and LDH compoDents, 2) the intraperitoneal instillation of methylene blue dye, and 3) radionuclide scanning. Our study of five patients with hydrothorax suggests that these three procedures differ in risk factors, availability and reliability. Radionuclide scanning made the correct diagnosis in three of three cases where it was performed; the other two procedures were associated with false negative and positive results and a high incidence of side effects.

We have concluded that radionuclide scanning is a safe and reliable procedure by which to demonstrate a pleuroperitoneal communication. Methylene blue test should be abandoned because of its toxic side effects and inconclusive results.
Effect of the Peritoneal Dialysate Buffer on UL TRafil Tration: Studies in Normal Rabbits
Authors: Kwong Mary B.L. , Wu George G. , Rodella Helen , Brandes Lidia , Oreopoulos Dimitrios G.
Published: February 2020

We studied an animal model to test the ultrafiltration capability of three different peritoneal dialysis solutions: Brand A, containing lactate and manufactured in Canada, Brand B, containing acetate and manufactured in U.S.A. and Brand C also containing acetate and manufactured in France. Solutions with 1.5 g0/o and 4.25 g0/o glucose concentrations were tested. We found no significant difference in the amount of ultrafiltration produced with the three brands when glucose concentration was 1.5 g0/o. However with glucose concentration of 4.25 g 0/o ultrafiltration was significantly lower with the Brand C-French acetate solution comparing to Brand A-Iactate solution. Brand B (acetate U.S.A.) solution produced ultrafiltration volumes that were between the other two and were not statistically significantly different from either Brand A (acetate) nor from Brand C (acetate).

We concluded that the lower ultra-filtration produced by Brand C is not due to the presence of acetate buffer but to other factors operating alone or in combination with acetate.

Adequate peritoneal ultrafiltration for fluid balance is one of the main factors in the success of continuous ambulatory peritoneal dialysis (CAPD). Ultrafiltration failure associated with the use of acetate buffered dialysis solution has been described frequently in France (I, 2, 3), but only occasionally in North American centres (4,5,6).

It is still controversial whether acetate or some other element(s) is the factor responsible for the ultrafiltration failure observed in French patients. The first report of an international co-operative study revealed that ultrafiltration is significantly lower in patients using acetate, compared to those using lactate dialysis solutions (7). However, the second report of this study, which contained results from patients using a larger number of brands, showed that acetate may not be a responsible factor because there were patients using acetate-solutions manufactured outside France who had an ultrafiltration similar to that produced with lactate brands (8). Because of this, we chose to study in an animal model the ultrafiltration produced with solutions containing different buffers during acute experiments. This paper reports our findings.
Coronary Artery Bypass Surgery in Peritoneal Dialysis Patients
Authors: McNamee Peter T. , Sombolos Kostas I. , David Tyrone E. , Oreopoulos Dimitrios G.
Published: February 2020

Over the last two years, in the Toronto Western Hospital, five chronic renal failure patients suffering from severe symptomatic ischemic heart disease, who had been maintained on peritoneal dialysis underwent coronary artery bypass surgery. One of the five had simultaneous mitral valve replacement. Of the five, four survived with substantial improvement in symptoms, the fifth died soon after the operation. This paper describes the management of these patients and the dialysis technique used in the preand postoperative periods.

Coronary artery bypass surgery (CABG) is effective in the treatment of symptoms of ischemic heart disease and under some circumstances it seems to improve life expectancy (1–4). Cardiovascular disease, which frequently is associated with chronic renal failure (CRF) remains the most common cause of death in dialysis patients (5, 6). Several workers have reported successful cardiac surgery in hemodialysis patients (7–10); however, we know of no relevant literature on similar operations in those maintained on peritoneal dialysis. During the last 5 years there has been a considerable increase in the number of CRF patients receiving peritoneal dialysis (11), and this paper describes five of our patients who underwent bypass operations while maintained on this fonn of therapy.
Closter: A New Connection for a Double-Bag System to Prevent Exogenous Peritonitis
Authors: Coli Giorgio Bazzato Ugo , Landini Silvano , Fracasso Agostino , Morachiello Paolo , Righetto Flavio , Scanferla Flavio , Genchi Rosangela
Published: February 2020

Although CAPD has been widely accepted as routine treatment for uremic patients, recurrent peritonitis still remains a limiting factor. Since 1978 to reduce the incidence of the peritonitis mainly due to exogenous origin, we have used a doublebag system with satisfactory results. To make easier the connection and to reduce the chances of contamination during the bag-exchange manoeuvre, we designed “Closter”, a new closed sterile connection.

This device consists of a needle mounted on a Luer cap, and protected by a folding plastic cover. A thin diaphragm at the end of the needle closes the entire system. During the connecting manoeuvre, the cap is first locked to a branch of the Y adaptor connected to the Tenckhoff catheter, then the needle, driven with a slight pressure through the diaphragm and the antiseptic chamber, puts the system in line.
Drug-Protein Binding during Continuous Ambulatory Peritoneal Dialysis
Authors: Morse Gene D. , Rowinski Carolyn , Lieveld Patricia E. , Walshe J. Joseph
Published: February 2020

This study of drug-protein binding in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) measured the serum and dialysate binding of cefamandole -an acidic, cephalosporin antibiotic. Ten CAPD patients, five with and five without peritonitis received a 1.0 g intraperitoneal dose of cefamandole; serum and dialysate was sampled at 4, 10, and 24 h after drug administration. Binding also was studied in serum obtained from five chronic hemodialysis patients and five normal volunteers. Equilibrium dialysis was used to determine protein binding and high performance liquid chromatography to measure cefamandole. Mean fraction unbound (fu) serum values for CAPD patients were 0.35 ± 0.04 (noninfected) and 0.37 ± 0.14 (peritonitis). In comparison, the fu values in hemodialysis patients were 0.41 ± 0.19 and 0.15 ± 0.02 in normal volunteers. Greater than 90% of cefamandole in dialysate was unbound suggesting that antibiotics, which cross the peritoneal membrane, are present in the free, microbiologically active form.
Effectiveness of Single Daily Intraperitoneal Administration of Aztreonam and Cefuroxime in the Treatment of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Fuiano G. , Sepe V. , Viscione M. , Nani E. , Conte G.
Published: February 2020

To discover if the management of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) may be effectively simplified by single daily i.p. administration of aztreonam (A) and cefuroxime (C), 10 adult CAPD patients (pts) with peritonitis were trained to start the following treatment procedure: a) sterile collection of dialysate effluent for cultures; b) 4 rapid in-and-out exchanges with antibiotic free dialysate; c) addition of 2 g C and 2 g A to a 2-L exchange for 6-h dwell time (the same dosage was repeated once a day in the overnight exchange); d) routine CAPD exchanges. Concentrations of C and A were measured in dialysate and serum of the patients 2, 12, 18, and 21–23 h after the i.p. administration: C remained within therapeutic range in all samples, while serum and dialysate A levels fell below such range 16 h after the i.p. administration. Seventeen peritonitis episodes occurred during the observation period (12 months): initial dialysate cultures grew Staph. aureus in 6 episodes, Staph epidermidis in 6, Pseudomonas aer. in 2, Streptococcus faecalis in 1, Citrobacter in 1, and Candida in 1. All patients but 1 (with Candida-positive culture) responded to this treatment with no relapse in 2 months.

We conclude that once a day i.p. administration of 2 g aztreonam plus 2 g of cefuroxime is an effective and simple way of treating CAPD pts with gram-positive and gram-negative peritonitis.
Losses of Calcitriol to Peritoneal Dialysis Bags and Tubing
Authors: Vieth Reinhold , Ledermann Sarah E. , Kooh Sang Whay , Balfe J. Williamson
Published: February 2020

Peritoneal dialysis provides a convenient means of administering calcitriol. We investigated in vitro the efficiency with which this approach would deliver the drug to patients. We used an injectable preparation of calcitriol, Calcijex® (Abbott Laboratories, Montreal, Quebec, Canada), which we radiolabelled by adding radioactive 1,25 dihydroxyvitamin D3 to it. The preparation was injected into dialysis bags and drained through appropriate tubing to monitor delivery of the radiolabelled calcitriol. By 2 h after injecting calcitriol into dialysis bags, 50% of the dose was left in the fluid, by 20 h only 26% was left. The delivered drug was pure 1,25-dihydroxyvitamin D3 based on chromatographic analysis of the recovered radiochemical. To study what would happen if the drug was in the bag for a minimal length of time the calcitriol was injected immediately prior to draining the fluid. We recovered 62.9% ± 5.2% SD of the dose from the tubing which would theoretically have entered a patient. There was no significant change in calcitriol dose delivered if the fluid was warmed to 37°C prior to injecting the drug and immediate drainage of the bag.
Vitamin D and Vitamin-D-Binding Protein Kinetics in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Joffe Preben , Heat James G.
Published: February 2020

Serum and dialysate levels of 25-hydroxycholecalciferol (25-0HD3), 1,25 dihydrox ycholecalciferol (1,25(0H)2D3), and vitamin-D-binding protein (DBP) were measured in 14 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Serum levels of 25-0HD3 and DBP were within normal range (29.1 ± 22.9 nmollL and 5.9 ± 1.1 μmol/L, respectively). Serum levels of 1,25-(0H)2D3 were subnormal in all «16 pmol/L) but one. In 5 patients, dialysate concentrations of 25-0HD3 were 2.3 ± 0.9 nmol/L, the rest had levels <1.0 nmol/L. Small quantities of 1,25-(0H)2D3 were found in the dialysate effluents.

DBP could be detected in the dialysate in all patients (0.24 ± 0.06 μmol/L). Mass transfer (MT) of 25-0HD3 and DBP were respectively -10.4 ± 8.3 nmol/24 h and -1.46 ± 0.46 μmol/24 h. Peritoneal clearances of 25-0HD3 and DBP were low (0.40 ± 0.37 mL/min and 0.18 ± 0.06 mL/ min, respectively.

We conclude that CAPD leads to losses of 25-0HD3 and DBP. However, the peritoneal loss of DBP is well compensated and does not result in serum deficiency. Serum 25-0HD3 levels did not correlate with time on CAPD.
Evaluation of Nutritional Status in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Buchwald Raquel , Peña Jose Carlos
Published: February 2020

We designed this study to evaluate the nutritional conditions of 16 continuous ambulatory peritoneal dialysis (CAPD) patients. In all these patients we did a monthly 1-day clinical, anthropometrical, biochemical, and nitrogen balance evaluation: a minimum of 3 and a maximum of 9 monthly evaluations in all patients. The results were analyzed in two groups: Group I (N = 8) with neutral or positive nitrogen balances, and Group II (N = 8) with one or more negative nitrogen balances. The sex distribution, mean age in years, time on CAPD, and period of study in this protocol were similar in both groups. Group I maintained a positive nitrogen balance and steady values in the anthropometric measurements (triceps fat fold, upper-arm circumference, body weight). Group II showed a significant decrease in both the anthropometric values and the nitrogen balance during the episodes of peritonitis. In this same group, when peritonitis subsided, the protein intake increased, nitrogen balance became positive, and the anthropometric values improved. When all the nutritional evaluations were analyzed we found a significant and direct linear correlation between nitrogen intake and nitrogen balance in g/kg/day (N = 60; nitrogen balance = nitrogen intake X 0.75 -0.101; r = 0.71; p < 0.001). We also contrasted the presence of peritonitis with the nitrogen balance and the anthropometric values using Spearman rank correlation coefficient and obtained a very high correlation (0.997 to 0.999).

Blood values (blood urea, serum creatinine, serum phosphate, serum potassium, and hemoglobin) were not very sensitive to detect differences within or between groups along the study. The serum proteins and the serum albumin were good markers of the changes in the nutritional conditions of our patients. With the use of the monthly 1-day evaluation, we were able to estimate the initial nutritional conditions at the time of the first assessment and the clinical and nutritional course with the monthly evaluations. The low caloric and proteic intake, during the episodes of peritonitis, were the main cause of malnutrition in this group of CAPD patients and not the peritoneal membrane protein losses as reported in the literature.
Air under the Diaphragm in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Suresh Keelapandal R. , Port Friedrich K.
Published: February 2020

To understand the significance of pneumoperitoneum in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we reviewed 110 upright x-rays of 33 patients. Only 3 x-rays belonging to 2 patients displayed large amounts of air under the diaphragm. One patient had documented colonic perforation and the other patient used a faulty technique that introduced air into the abdomen. Five additional asymptomatic patients showed minute amounts of air. We conclude that large amounts of air, as defined radiographically by an air shadow of more than 5 mm in height, is unusual in CAPD patients and should be taken seriously as suggestive of bowel perforation until proven otherwise.
Changes in Activity of Selected Lysosomal Enzymes in Peritoneal Macrophages of Renal Failure Patients on Peritoneal Dialysis
Authors: Sulowicz Wladyslaw , Cichocki Tadeusz , Hanicki Zygmunt
Published: February 2020

Activity of acid phosphatase (AP), beta-glucuronidase (GR), N-acetyl-beta-D-glucosaminidase (GZ), and peroxidase (P) was assessed using a semiquantitative cytochemical method in peritoneal macro phages of 30 patients with end-stage renal failure treated by intermittent peritoneal dialysis and of 30 control patients with normal renal function.

The dialysed patients showed a significantly higher activity of GR and P at the beginning of the treatment as compared with the respective activities observed in the control group and a further significant rise of these activities after 4 months of dialysis. Activity of AP at the beginning of the treatment was insignificantly lower than in the control group and the difference became significant at the end of the investigated period. There was no significant difference between the dialysed patients and the control group in the activity of GZ assessed at the beginning of the dialytic treatment and after 4 months of dialysis. A significant decrease in that activity was, however, observed in the course of dialysis.
Strain Differences in the Opsonisation of Staphylococcus Epidermidis
Authors: Bennett-Jones David N. , Yewdall Virginia M. A. , Gillespie Cecilia M. E. , Ogg Chisholm S. , Cameron J. Stewart
Published: February 2020

Ten isolates of coagulase-negative staphylococci, collected from patients receiving treatment with continuous ambulatory peritoneal dialysis (CAPD), exhibited marked differences in the degree of opsonisation when incubated in 10% and 1% pooled human serum, 10% and 1% heat-treated serum, Hanks’ Balanced Salt Solution, and timed peritoneal dialysis (PD) effluent. The addition of exogenous IgG to PD effluent results in a greater increase in opsonisation in those fluids with the weakest inherent opsonic activity, but is ineffective against the majority of isolates in the absence of heat-Iabile opsonic activity. The results of this in vitro study suggest that host resistance to CAPD peritonitis due to coagulasenegative staphylococci may be determined as much by the characteristics of the contaminating strain, as by the opsonising activity of PD effluent.
Isolation and Propagation in Vitro of Peritoneal Mesothelial Cells
Authors: Hjelle J. Thomas , Golinska Barbara T. , Waters Diane C. , Steidley Kevin R. , McCarroll David R. , Dobbie James W.
Published: February 2020

Mesothelial cells lining the peritoneal cavity are the primary site of molecular exchange during peritoneal dialysis, a life support system for over 50 000 patients worldwide. In this study, techniques are described for the isolation and propagation in culture of peritoneal mesothelial cells from rats and rabbits. For comparison, mesothelial cells were also obtained from the serosal surface of human colonic tissue. By electron microscopy the cultured cells were found to exhibit microvilli, a well developed endoplasmic reticulum and golgi apparatus, micropinocytotic vesicles, and lipid-filled intracellular vesicles. Immunochemical probes revealed the expression by these cells in vitro of cytokeratin, fibronectin, vimentin, and keratin, but not von Willebrand factor. Mesothelial cells from rat, rabbit, and human exhibited contact inhibition, but differences in growth rates and dependence on supplements to the growth media. This work provides a multispecies comparison of the behavior of mesothelial cells in vitro for the purpose of developing an experimental system for the study of mesothelial cell biology and the role of these cells in peritoneal dialysis.
Treatment Recommendations 1993 Update
Authors: Keane William F. , Everett E.D. , Golper Thomas A. , Gokal Raman , Halstenson Charles , Kawaguchi Yoshindo , Riella Miguel , Vas Stephen , Verbrugh Henri A.
Published: February 2020

In conclusion, the recommendations provided in this document represent a distillation of various experiences, as well as data obtained from published studies. It is hoped that this compilation will provide a basis upon which future developments and advances can be made in the therapeutic approach to infectious complications of peritoneal dialysis.
A Comparison of Peritoneal Dialysis-Related Infections in Black and White Patients
Authors: Holley Jean L. , Bernardini Judith , Piraino Beth
Published: February 2020

Objective

To determine if black patients in our peritoneal dialysis (PD) program had higher rates of PD-related infections. The outcomes of black patients versus white patients were also reviewed.

Design

A review of prospectively collected patient demographic and PD-related infection data and out comes, from 1979 to 1991.

Patients

The 68 black patients in our PD program were matched with white control patients for age, sex, insulin dependence, time on dialysis, and mode of dialysis (CAPD or CCPD). The infection, demographic, and outcome data from the two groups were compared.

Results

Black patients had higher peritonitis rates (1.10 vs 0.82 episodeslyear, p=0.001) and exit-site infection rates (1.13 vs 0.95 episodeslyear, p=0.02) than the white control patients. Tunnel infection rates were 0.21 episodeslyear in both groups. S. epidermidis peritonitis was more common in black patients (48% of episodes vs 21% of episodes in whites, p=0.005), and S. aureus peritonitis was more common in white patients (29% vs 11% in blacks, p=0.005). The subset of black patients (n=13) on a disconnect system (Y-set) had a peritonitis rate similar to their white controls on the Y-set (0.41 vs 0.74 episodes/year, p=0.27). There were no episodes of S. epidermidis peritonitis in this subset of black patients. Black patients had fewer S. aureus exit-site infections than white patients (21% vs 41%, p=0.005). Peritonitis was the leading cause of transfer to hemodialysis in the black patients but not in the white patients.

Conclusion

The susceptibility to S. aureus and S. epidermidis infections differs in black and white patients on peritoneal dialysis for unclear reasons. Peritonitis rates in black patients can be reduced to that of white patients if a disconnect system is used.
Poor Response to Oral Ciprofloxacin in the Treatment of Peritonitis in Patients on Intermittent Peritoneal Dialysis
Authors: Waite Nancy M. , Johnson Michael D. , Webster Nancy R. , Fong Ignatius W.
Published: February 2020

Objectives

To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population.

Design

Open nonrandomized prospective study.

Setting

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

Patients

Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following: 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of >100!IJl, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria.

Interventions

Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days.

Main Outcome Measures

Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration.

Results

Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured.

Conclusions

Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis related Gram-positive bacterial peritonitis.
Evaluation of Short-Chain Polypeptides as An Osmotic Agent in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Imholz Alexander L.T. , Lameire Norbert , Faict Dirk , Koomen Gerardus C.M. , Krediet Raymond T. , Martis Leo
Published: February 2020

Objectives

To assess whether dialysate containing short-chain polypeptides is well tolerated in continuous ambulatory peritoneal dialysis (CAPD) patients and to determine its effect on fluid and solute transport, plasma amino acid levels, and biochemical parameters.

Design

Two -treatment, two-period cross -over design.

Setting

Renal Unit, Academic Medical Center, Amsterdam and Renal Unit, University Hospital, Gent.

Patients

Two groups of 10 stable CAPD patients.

Intervention

All patients received a trial solution (1.36% glucose and 1% peptides, 381 mOsm/kg) and a control solution (2.27% glucose, 404 mOsm/kg) in randomized order. The patients were examined on four consecutive days in which two dwell periods on days 1 and 3 of either 4 (Group I) or 8 hours (Group II) were performed.

Results

The peptide solution was well tolerated in all patients. In addition, no differences were found in the parameters for the effective peritoneal surface area and the intrinsic permeability, implying that no irritating effect of the peptide solution was present. Net ultrafiltration was not different in Group I: -43±125 versus 86±125 mL (mean±SEM) and marginally lower in Group II: -94±64 versus 51±64 mL, despite the lower osmolality of the trial solution compared to the control solution. Glucose absorption was higher than the peptide absorption in all patients: Group I: 66±10% versus 57±13% (p = 0.0003); Group II: 80±5% versus 72±11% (p = 0.006). No differences in plasma amino acid profiles could be detected.

Conclusion

Short-chain polypeptides are absorbed less than glucose and can be used as an osmotic agent in CAPD patients. However, longer-term studies are needed to evaluate possible additional effects of peptides on the nutritional status of CAPD patients.
Positive Nitrogen Balance after Intraperitoneal Administration of Amino Acids in 3 Patients
Authors: Rubin Jack , Garner Tina
Published: February 2020

Objective

To determine whether intraperitoneal (IP) administration of amino acids improves nitrogen balance during continuous ambulatory peritoneal dialysis (CAPD).

Design

Nitrogen balance studies of CAPD patients comparing periods of peritoneal dialysis using dialysate with nitrogen added from a commercial amino acid solution, versus standard dialysate.

Setting

Clinical research center in a tertiary facility.

Patients

Patients on CAPD who volunteered.

Interventions

One 4-day balance period was carried out with conventional dialysate and one 4-day period with conventional dialysate to which amino acids were added. The study periods were separated by a 3-day washout period.

Main Outcome Measures

Nitrogen accumulation or loss during each period.

Results

The mean (SD) daily control period balances (grams per day) were 0.2, 1.9, and -3.4; during the amino acid period the balances were 5.4, 2.7, -0.7. The mean daily control effluent dialysate volumes (milliliters) were 11 350±443, 10 052±449, and 10 165±154; during the amino acid period the volumes were 10345±50, 12325±1021, and 10 220±655.

Conclusions

The IP addition of amino acids diminishes the amount of nitrogen lost from dialysate while maintaining effluent dialysate volume. Nitrogen balances improved in al13 patients during the period with IP amino acids, compared to control.
Higher Incidence of Peritonitis in Native Canadians on Continuous Ambulatory Peritoneal Dialysis
Authors: Fine Adrian , Cox Darlyne , Bouw Maria
Published: February 2020

Objective

To determine if the rate of peritoneal dialysis (PD)-related infections in our large Native population was higher than in non-Natives.

Design

Prospective study of PD-related infections, 1987 to 1993.

Patients

Forty-eight Natives and 136 non-Natives were studied. Comparisons of infection rates were made as well as determinations of the effect of diabetes and of dialysis techniques on infection rate.

Results

The chance of remaining free of peritonitis was far lower at 6 and 12 months in Natives versus nonNatives, 40% versus 76% at 6 months, and 24% versus 54% at 12 months (p < 0.01). Having diabetes or adding intraperitoneal insulin did not confer additional risk of peritonitis. The Y-Iine reduced the risk of peritonitis in non-Natives only. Exit-site infection (ESI) was significantly higher in Natives versus non-Natives, 0.42 versus 0.19 episodes per patient year (p < 0.01) mainly due to Staph. aureus. However, less than 30% of episodes of peritonitis were due to that organism. Staph. epidermidis peritonitis episodes were not more common in Native patients, whereas infections due to most other organisms were.

Conclusion

The susceptibility to both peritonitis and exit-site infection is increased in Native Canadians compared to non-Natives. The non protective effect of the Yline combined with increased peritonitis due to most organisms except Staph. epidermidis in Natives suggests that host factors could be important in these patients.
The Peritoneal Permeability and Surface Area Index
Authors: Sherman Richard A.
Published: February 2020

The value of the peritoneal equilibration test (PET) derived dialysate-to-plasma creatinine ratio (D/Pcr) as a measure of the peritoneal membrane's diffusive characteristics is obscured by the major role of convection in determining this value, particularly for low transporters. A simple index, derived from PET data, may permit a more accurate clinical measure of peritoneal diffusion.
Urea Peritoneal Transfer Evaluated Using Plasma Water Urea Concentrations
Authors: Grzegorzewska Alicja E.
Published: February 2020

Objective

To quantify differences in evaluation of urea peritoneal transport parameters according to the expression of urea concentration in whole plasma and plasma water.

Design

Prospective study in which the dialysate samples for urea determinations were taken at short dwell times (2.5 45 minutes) during three consecutive exchanges of intermittent peritoneal dialysis (IPD). Blood samples were drawn at the beginning and at the end of the study period. Urea peritoneal transport parameters were calculated using urea concentration in whole plasma and plasma water. The results were then compared.

Setting

Peritoneal dialysis unit of a nephrology de partment.

Patients

Ten stable patients on IPD.

Interventions

Dialysateand blood sample collections.. Main Outcome Measures: Dialysate-to-plasma ratios (DIP), peritoneal clearances (Cp)’ and diffusive mass transport coefficients (KBD) of urea.

Results

At short dwell times, uncorrected (whole plasma) DIP and Cp of urea values were higher than the corrected (plasma water) values by 5.7% -5.9%. Uncorrected urea KBD’ calculated using the simplified two sample model of Garred et al., yielded an overestimation that significantly increased with prolongation of dwell (8.5±0.5% at 2.5 minutes vs 13.0±0.8% at 45 minutes). Urea KBD’ assessed by the linear regression model of Garred and Spencer, was 9.4±0.3% higher for uncorrected values.

Conclusions

The expression of urea concentration in whole plasma instead of plasma water overestimates urea peritoneal transfer parameters. The percent overestimation (y) of urea KBD’ calculated using the simplified model of Garred et al., can be predicted with the equation y = 0.131x+ 7.563, wherex is the dwell time (in minutes).
Weight Limitations for Weekly Urea Clearances Using Various Exchange Volumes in Continuous Ambulatory Peritoneal Dialysis
Authors: Nolph Karl D. , Jensen Richard A. , Khanna Ramesh , Twardowski Zbylut J.
Published: February 2020

Objective

To calculate the relationships of weekly KT/V urea to standard body weight with different exchange volumes (2, 2.5, or 3 L) for continuous ambulatory peritoneal dialysis (CAPD) in functionally a nephric patients and to display the results in graphic form.

Design

Theoretical calculations using previously measured 24-hour dialysate/plasma urea values in 77 CAPD patients and other defined components of weekly KT/V urea.

Setting

Measurements and calculations in theoretical patients doing standard CAPD with four daily exchanges.

Patients

Theoretical functionally anephric patients on standard CAPD as above.

Interventions

Theoretical calculations based on instillation of 2-, 2.5-, and 3-L exchange volumes.

Main Outcome Measures

Weekly urea clearances normalized to total body water (weekly KT/V urea). The values using different exchange volumes were related to standard body weight.

Results

Although a minimum recommended weekly KT/V urea target is arbitrary, the results illustrate the range of flexibility of CAPD relative to KT/V urea values with variations in exchange volume. The standard weights above which anephric patients on CAPD using four exchanges per day with 2-, 2.5-, and 3-L exchanges cannot reach a weekly KT/V urea target of 1.7, have been identified. The range of weekly KT/V urea levels possible with different exchange-volume programs has been graphically illustrated.

Conclusions

Weights above which a weekly KT/V urea of 1.7 cannot be reached in functionally anephric patients are 64, 77.6, and 91 kg for CAPD using 2-, 2.5-, and 3- L exchanges, respectively.
Icodextrin in Peritoneal Dialysis: Early Development and Clinical Use
Authors: Mistry Chandra D. , Gokal Ram
Published: February 2020

Over the past decade we have explored the potential of a starch-derived glucose polymer (icodextrin) as a “colloid” osmotic agent and clinically adapted it to produce sustained ultrafiltration over long dwell exchanges. An optimal osmotic profile was defined using a series of glucose polymer formulations of varying molecular distribution.

Initially, a readily available dextrin formulation (Caloreen) with a bimodal molecular weight profile was used. Five and 10% solutions containing this formulation [weight average MW (Mw) of 7000 dalton and number average MW (Mn) of 960 dalton were nearly twice as effective as 1.36% and 3.86% glucose solutions, but their effectiveness was limited by rapid absorption of fractions less than 12 glucose units.

Further modification isolated a purified “high” MW fraction containing chain length greater than 12 glucose units with Mw of 16 823 dalton and Mn of 5304 dalton. A 5% solution containing this fraction, iso-osmolar to uremic plasma, provided calorie load half that of a 1.36% glucose, yet produced increased and sustained ultrafiltration for up to 12 hours by a mechanism resembling “colloid” osmosis. Only a fraction of glucose polymer load was absorbed via the lymphatic pathway, but its metabolism was incomplete, resulting in the accumulation of maltose. Although it was devoid of any detectable adverse effect in the short term, long-term concerns remained.

In studies using a single daily overnight exchange of glucose polymer combined with three daytime exchanges of glucose over 5 days, 10 days, and 3 months, we have shown that a constant peritoneal clearance (3 mL/minute) ensures a steady-state level of maltose in the serum within 10 days, and this remains stable for up to 3 months without any adverse effects.

The relative inertness of icodextrin has been the key factor in its success as the first “colloid” osmotic agent in clinical use. It is safe and effective, and the demonstration of steady-state levels of accumulated maltose and oligosaccharides without any adverse effects has been encouraging and provided further impetus to proceed with longer-term studies.
Cell Function, Viability, and Icodextrin
Authors: Topley Nicholas , Liberek Tomasz , Mistry Chandra , Coles Gerald A. , Williams John D.
Published: February 2020

The bioincompatibility of conventional dialysis fluids is related primarily to the combination of low pH and high lactate concentrations. This results in the reduction of intracellular pH and a consequent inhibition of cell function. The use of high glucose concentrations to increase fluid osmolality adds to the cytotoxicity and has a further inhibitory effect on peritoneal cells.

The clinical need for fluids that provide sustained ultrafiltration has led to a novel approach using a high molecular weight glucose polymer (icodextrin) to generate an ultrafiltration gradient in an iso-osmolar fluid. In the studies presented we have had the opportunity of examining, in the laboratory setting, the biocompatibility of such a fluid.

As in previous studies with conventional fluids, pH per se has a profound effect on most modalities of cell function. In addition, there appearto be a few areas where problems can be ascribed to icodextrin itself. Furthermore, it is possible that Staph. epidermidis survives better in icodextrin than in conventional dialysate. Whether the benefits of sustained ultrafiltration outweigh the possible disadvantages outlined can only be judged when the results from ongoing clinical trials are available.
Peritoneal Fluid and Tracer Albumin Kinetics in the Rat. Effects of Increases in Intraperitoneal Hydrostatic Pressure
Authors: Zakaria EL Rasheid , Rippe Bengt
Published: February 2020

Objectives

To study the peritoneal fluid loss rate, the clearance (CI) of radioactive tracer albumin (RISA) eliminated from the peritoneal cavity (PC), as well as the peritoneal-to-plasma RISA clearance (CI -+ P) during acute peritoneal dialysis (PD) at large elevations in intraperitoneal hydrostatic pressure (IPP).

Design

Experimental study in anesthetized Wistar rats.

Methods

The intraperitoneal volume (IPV) was assessed using RISA dilution, correcting for the RISA CI from the PC. Volume recovery at termination of the dwells was obtained using graduated cylinders and preweighed gauze tissues. Measurements of CI and CI -+ P were obtained by repeated micro-sampling of dialysate and plasma, respectively. The IPP was continuously measured, and could be varied by external concentric abdominal compression using an inflatable cuff. On termination of the experiments, samples from tissues lining the PC were analyzed with respect to their content of RISA and edema, the latter being assessed from wet/dry weight ratios.

Results

At 2 mm Hg of IPP (control) the RISA CI was 27.1:1:2.0(:1:SE)μL.min-l, whereas CI→ Pwasonly 8.07:1:0.67 μL.min-l, at a total fluid loss rate of 10.1:1:5.4μL.min-1 for 1.36% Dianeal. At an IPP of 14 mm Hg, the CI increased to 55.3±4.1 μL.min -1 and the peritoneal fluid absorption rate was 34.4±5.6 μL.min -l, whereas CI -+ P was just moderately increased as compared to control (11.2:1:1.4 μL. min -I). Furthermore, a pleural effusion of 1.16:1:0.08 mL was detectable at elevated IPPs. The degree of edema formation in the anterior abdominal muscles (AAM) and the diaphragm (DIA) was largely insignificant during 150 min at 2 mm Hg of IPP, but increased markedly at 14 mm Hg, as did the RISA uptake to the AAM and DIA. The discrepancy between CI and CI -+ P was largely accounted for by tracer entrance into tissues lining the peritoneal cavity, mainly the AAM.

Conclusions

At a nearly unchanging capillary Starling equilibrium, the losses of fluid and of RISA from the PC were markedly elevated at increased IPPs. However, the RISA clearance to the plasma appeared to be only moderately altered at elevated IPP and represented only a minor fraction of the RISA clearance out of the PC. Tissues lining the PC apparently act as a variable ‘sink’ for intraperitoneal proteins and fluid during peritoneal dialysis (PD).
Analysis of Inflammatory Mediators and Peritoneal Permeability to Macromolecules Shortly before the Onset of Overt Peritonitis in Patients Treated with CAPD
Authors: Zemel Désirée , Betjes Michiel G.H. , Dinkla Chris , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Objective

To investigate whether changes in peritoneal membrane characteristics and inflammatory mediators in dialysate precede the onset of overt infection during continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis.

Design

CAPD patients with a high peritonitis incidence stored every night bag at 4°C. Routinely, each bag was thrown away after two days. Only if patients developed peritonitis, all bags were delivered for study. Thus, two night bags immediately prior to the first peritonitis bag were available for analysis. A control study was done 14 days after recovery. Dialysate samples were measured for TNFα, IL-6, PGE2, 6-keto-PGF lα’ TxB2, and serum proteins. The clearance of β2-microglobulin was used as an indicator of the effective peritoneal surface area. The intrinsic peritoneal permeability was characterized by the restriction coefficient.

Results

Eight episodes occurred in 5 patients. The night dwells available prior to the first peritonitis effluent were drained maximally nine dwells and minimally one dwell before the first peritonitis bag. Dialysate leukocyte counts exceeded 100 × 106/L only on the day of manifest infection. However, bacterial cultures were already positive at least one day before overt infection in four episodes and in three of these cases two days before. No changes were observed prior to peritonitis for the clearance of β2-microglobulin or the restriction coefficient. In contrast to these permeability characteristics, the cytokines, TNFα and, though less significant, also IL-6, were increased in dialysate one day prior to overt infection, when compared to the values obtained at the control investigation. This was especially evident in effluents drained no longer than two dwells before the first peritonitis bag. Prostaglandin concentrations in dialysate were not different before the onset of manifest peritonitis from the values measured after recovery.

Conclusion

In this study, the increased effective peritoneal surface area and intrinsic peritoneal permeability during acute infection appeared to be preceded by elevations in the cytokines TNFα and, to a lesser extent, IL-6. These increments occurred only very shortly before the onset of clinical symptoms.