bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of Defensin Antimicrobial Peptides in the Peritoneal Cavity of Patients on Peritoneal Dialysis
Authors: Zarrinkalam Krystyna H. , Leavesley David I. , Stanley Jodie M. , Atkins Gerald J. , Faull Randall J.
Published: February 2020

Objective

To investigate the expression and regulation of defensins in the peritoneal cavity of peritoneal dialysis (PD) patients.

Design

The presence of defensins in the peritoneal cavity was assessed using reverse transcription polymerase chain reaction (RT-PCR). In vivo defensin expression was analyzed in human peritoneal membrane biopsies and in peritoneal cavity leukocytes isolated from spent dialysate. Defensin expression in vitro was assessed in cultured human peritoneal mesothelial cells (HPMC) and confirmed with PCR Southern blot and DNA sequencing. The effect of tumor necrosis factor alpha (TNFa) and epidermal growth factor (EGF) on b2 defensin expression in HPMC was analyzed by Northern blot analysis and RT-PCR respectively.

Results

Both a and b classes of defensins are expressed in the peritoneal cavity of PD patients. Messenger RNA for the a-defensin human neutrophil peptide 3 and for b-defensin-1 (hbD-1) were found in preparations containing predominantly peritoneal leukocytes, whereas b-defensin-2 (hbD-2) is expressed by HPMC. HPMC isolated from different individuals displayed variability in both basal hbD-2 expression and in response to stimulation by TNFa. Conversely, EGF consistently downregulated the level of hbD-2 message in HPMC.

Conclusion

a- and b-defensins are expressed in the peritoneal cavity, and hbD-2 is the main defensin present in the peritoneal membrane. Variable levels of expression of hbD-2 by mesothelial cells were seen, with evidence of regulation by cytokines and growth factors. This provides evidence for a previously unknown mechanism of innate immunity at that site.
Ten Years’ Experience with Chronic Peritoneal Dialysis at a Community Hospital
Authors: Handa S. Paul , Greer Sheila
Published: February 2020

This paper describes the experience of a community hospital in the treatment of chronic renal failure with intermittent (IPD) and continuous ambulatory peritoneal dialysis (CAPD) in 61 adult patients over a 10 year period. In the earlier years of this decade, 14 patients, dialysed through temporary catheters, were transferred to hemodialysis or received a kidney transplant. Later, a long-term IPD and CAPD treatment through permanent peritoneal catheters was instituted in 25 and 22 patients respectively. Over a similar but not simultaneous follow-up period, the patient survival with CAPD was better than with IPD.
Pharmacokinetics of Netilmicin in CAPO Patients
Authors: Keogh J.A. Brian , Carr M.E. , Falkiner F.R. , Martin P. , Grant G. , Keane C.T.
Published: February 2020

The pharmacokinetics of netilmicin were studied during 16 episodes of peritonitis in CAPD patients. An initial intraperitoneal dose of 10 mg of netilmicin per litre of dialysate gives a concentration adequate for most cases. This dose may have to be increased according to the respective minimal inhibitory concentrations (MICs) of the infecting organisms.
Is Extensive Diverticulosis of the Colon a Contraindication to CAPD?
Authors: Wu George , Khanna Ramesh , Vas Stephen , Oreopoulos Dimitrios G.
Published: February 2020

Fecal peritonitis (mixed fecal flora) is a severe complication of CAPD treatment. This prospective study of the relationship between colonic diverticulosis and fecal peritonitis, involved 72 CAPD patients, who had barium enemas and were divided into three groups. Group I (45) had no evidence of colonic diverticuli. Group II (12) had one to five colonic diverticuli, whereas, Group III patients (15) had >5 colonic diverticula. Patients with colonic diverticula were older than those without. The mean follow-up period on CAPD was similar in the three groups. All nine poly-cystic kidney patients had colonic diverticuli. There were four episodes of fecal peritonitis: three in group III and one in group I. All three patients in Group III were treated successfully with appropriate antibiotics without the removal of the peritoneal catheter. Three of the patients who had fecal peritonitis returned to CAPD and the fourth on chronic IPD. In conclusion, we have concluded that fecal peritonitis is highly correlated with colonic diverticular disease but that extensive colonic diverticulosis is not an absolute contraindication to CAPD.
Tuberculous Peritonitis in a Patient Undergoing Chronic Ambulatory Peritoneal Dialysis (CAPD)
Authors: Kluge Glenn H.
Published: February 2020

This report of tuberculous peritonitis in a CAPD patient is the eighth in the world's literature. A 54-year-old black woman presented with fever of recent onset and signs of an acute abdomen after 13 months of uncomplicated CAPD. After three weeks of investigation, supportive therapy, antibiotics and hemodialysis, a laparotomy established the diagnosis of tuberculous peritonitis. She responded promptly to antituberculous therapy.
Some Aspects of Peritoneal Dialysis and Nephrology in the People's Republic of China
Authors: Price John D.E.
Published: February 2020

In April, 1983 I was invited to visit four medical schools in the People's Republic of China in order to demonstrate the Betacap technique of CAPD. This paper will describe some aspects of peritoneal dialysis in these four medical schools.
An Evaluation of Monthly versus BI-Monthl Y CAPO Solution Transfer Set Changes
Authors: Jensen Susan , Davidson Molly , Durnell Theresa , Poling Debbie , McMurray Stephen
Published: February 2020

We compared the safety of monthly and bimonthly solution transfer set tubing changes by following 40 patients for one year. In 20 the solutiontransfer-set tubing was changed monthly and in 20 the tubing was changed every two months. In the monthly group, there were 10 episodes of peritonitis per 192 patient months and, in the bi-monthly group, 10 episodes of peritonitis per 207 patient months. Spike durability was assessed in both groups over a six-month period. Of the tubings that were changed monthly, 23% had spikes with curled edges or chips, compared to 25% in the bi-monthly group. The tubing material proved durable over a two month period when the two groups were compared. There was no statistically significant difference in peritonitis rates or spike failure rates. Changing the solution transfer set every two months offers a practical and safe alternative to the customary monthly change.
Local Anesthetic -Bupiv Acaine Increases the Transperitoneal Transport of Solutes. Part II: In Vitro Study
Authors: Breborowicz Andrzej , Knapowski Jall
Published: February 2020

The local anesthetic, bupivacaine, alters the mesothelial permeability to urea and inulin. The effect is biphasic; an initial transient decrease is followed by an increase in permeability of the membrane to both solutes. Cytochalasill B and colchicine can mimic partially the action of bupivacaine, but without the initial decrease in the mesothelilal permeability. Similar to bupivacaine, verapamil also evokes a biphasic effect on the trallsmesothelial nux of urea and inulin. In conclusion bupivacaine induces changes both in trallscellular and intercellular pathways, due to its interaction with calcium ions and the cytoskeleton of the mesothelial cells.

Mesothelium is one of the barriers detennining transfer of solutes from blood to the peritoneal cavity during peritoneal dialysis (1). It has been demonstrated that the function of the mesothelial cells may influence the efficiency of the peritoneal dialysis (2–4). Earlier we showed that bupivacaine added to the dialysis fluid in a concentration of 0.25 mmol/l increased the removal of urea and inulin via the peritoneum (5). Our findings suggest that the effect of bupivacaine depended primarily on its action on the mesothelium.

We perfonned a series of in vitra experiments on the monolayer mesothelium taken from the ileal rabbit's mesentery in order to define the character of changes induced in this structure by bupivacaine. This paper describes our findings.
Augmentation of Peritoneal Hydraulic Permeability by Amphotericin B: Locus of Action
Authors: Maher John F. , Hirszel Przemyslaw , Bennett Robin R. , Chakrabarti Eva
Published: February 2020

In normal rabbits, intraperitoneal instillation of amphotericin B increased peritoneal ultrafiltration rates without changing the osmotic gradient. Solute clearances were unaffected. When given intravenously the drug was ineffective, suggesting that amphotericin B acts on the serosal side of the vasculature or mesothelium, presumably creating channels through the membrane, thereby increasing hydraulic permeability.

Peritoneal transport rates are much lower than those of hemodialysis (I). To circumvent this deficiency, continuous peritoneal dialysis is now employed in many patients (2). Nevertheless. a segment of patients undergoing continuous ambulatory peritoneal dialysis have, or develop, inadequate transport rates for solutes, or more often for water (3). Hence, their dialyses are not efficient enough for maintenance therapy.

It is naive to consider that the peritoileum is inert like hemodialysis membranes. Accordingly, it has been observed that transport rates decrease with systemic vascular disease, or after vasoconstrictor drugs (4, 5) and increase when vasodilators are administered locally or have selective effects on the splanchnic vasculature (5 7). Also small number of studies have demonstrated that drugs, which affect membranes directly modulate peritoneal transport rates (8–10).

A preliminary evaluation of the effects of amphotericin B on peritoneal transport rates showed that osmotically induced water flux increases when the drug was given intraperitoneally (11). No direct effect on solute transport was detected and, over the range of 0.5 to 25 mg/kg, we noted no dose effect. Although amphotericin B is so large a solute that its own transmembrane transport would be slow, the site of action could not be determined with confidence from these studies. Accordingly, we undertook to compare the effects of intraperitoneal instillation with those of intravenous administration of amphotericin B in the same experimental animals.
Does Hypercoagulability Exist in CAPD Patients?
Authors: Bertoli Massimo , Gasparotto Maria L. , Vertolli Ugo , Ruffatti Annamaria , Di Landro Domenico , Romagnoli Gian Franco
Published: February 2020

Blood levels of fibrinogen degradation products (FDP), factor VIII (antigen and coagulant), plasminogen and antithrombin III, as well as fibrinogen half-life were studied in 15 patients on CAPD from 3–24 months; the daily loss of these factors in the dialysate was also determined.

Fibrinogen and factor VIII levels were above (p < 0.05), fibrinogen half-life was below (p < 0.05) and AT III was within the normal range. The average daily protein loss in the dialysate was 7.74: t 2.42 g; fibrinogen loss was 48.14:t 41.66 mg;FDP241.37 :t 185.19 mg; plasminogen 11.16 :t 6.94, and AT IIl64.96 :t 37.67 mg.

These findings suggest that patients on CAPD have a state of hypercoagulability similar to that observed in patients with the nephrotic syndrome.

Continuous ambulatory peritoneal dialysis (CAPD) is accompanied by protein losses, which may lead to protein depletion (1). The situation is similar in the nephrotic syndrome (NS), which, in addition, has the features of a hypercoagulability state (2, 3). After observing the appearance of thrombotic events in some CAPD patients, we set out to determine whether patients undergoing continuous ambulatory peritoneal dialysis also have a hypercoagulability state and this paper presents our findings.
Renal Transplantation in Patients on Peritoneal Dialysis
Authors: Glass Neal R. , Miller Douglas T. , Sollinger Hans W. , Zimmerman Stephen W. , Simpson David , Belzer Folkert O.
Published: February 2020

The authors reviewed the course of 56 peritoneal dialysis patients after renal transplantation to determine the influence of this mode of dialysis on the results of transplantation.

Three subgroups were analyzed separately because of marked differences in results. Group 1 was a historical group of 13 diabetic and two nondiabetic recipients of cadaveric grafts transplanted before 1982 who received standard immunosuppression with steroids and azathioprine only, and antirejection therapy with steroids and/or antithymocytic globulin (ATG). In this group results were poor: only 100/o of grafts and 670/o of patients survived two years or more. Group 2, the current group of cadaveric recipients, consists of 11 diabetic and nine nondiabetic patients transplanted since 1982; these patients received standard immunosuppression with low-dose steroids, azathioprine, and a two-week course of prophylactic ATG beginning within one day of transplantation; rejection was treated with high doses of oral steroids. In this second group, results were good: 630/o of the grafts are functioning and 100% of patients have survived for up to two years. Group 3, consisting of 21 recipients of living donor kidneys, had excellent results with 1000/o graft and patient survival up to five years.

Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused the 19 graft losses. In most patients the dialysis catheters were removed three weeks to three months after transplantation when renal function was stable. There were two minor complications and no infections related to the catheters.

We conclude that: a) excellent transplant results can be achieved in peritoneal dialysis patients, most of whom are diabetic and receive cadaveric grafts, b) the peritoneal dialysis catheter is not a significant source of peritransplant morbidity and therefore c) peritoneal dialysis is appropriate for patients awaiting renal transplantation and should not bias against their selection for transplantation.

The published literature on kidney transplantation in patients on peritoneal dialysis is sparse, suggesting that it is not, and perhaps should not be common practice to transplant these patients. This study and review of the literature was undertaken 1) to characterize peritoneal dialysis patients undergoing renal transplantation at our center, 2) to determine the results of transplantation in this group, 3) to evaluate the risk to these patients from the peritoneal dialysis catheter itself and 4) to compare our experience with the literature concerning renal transplantation of peritoneal dialysis patients.
Is Fat Absorbed through the Peritoneum?
Authors: Helen Ahmed Mitwalli , Brandes Rodella Lidia , Wu George Ian Wanless , Ogilvie Raymond , Schilling James Holger , Dobbie W. , Wilson Lionel S. , Oreopoulos Dimitrios G.
Published: February 2020

A 10% fat solution (Liposyn) was infused (50 mi/kg) into the peritoneal cavity of four normal rabbits and left for five hours. Changes in the intraperitoneal volume were measured by using the radioactive albumin dilution technique. After an initial ultrafiltration, which peaked at one hour, the solution began to be absorbed and approximately 30% of the initial volume was removed at five hours. At the end of the infusion, dialysate fat concentration decreased to 85% of the initial value but the absolute amount absorbed was approximately 40% of the infused amount. Plasma total fat increased from 0.16 ± 0.03 to 1.35 ± 0.49 g/100 ml and plasma triglycerides increased from 94.7 ± 57.5 to 1247.8 ± 6.46 mg/100 ml. We observed no histological changes in the liver of the rabbits and the transmission electron microscopy demonstrated passage of lipid droplets into the mesenteric interstitium. The presence of droplets in micropinocytotic vesicles indicates that at least some of the lipid is transported through the cell by vesicular diacytosis. Our data indicate that fat emulsion is absorbed through the peritoneum slowly as the infused volume is absorbed. Under these conditions the solution cannot be used as a dialysis solution, but may be used for total parenteral nutrition in patients with normal kidney function who have no vascular access.
Abdominal Hernias in Chronic Peritoneal Dialysis Patients: A Review
Authors: Rocco Michael V. , Stone William J.
Published: February 2020

Of 1365 patients on continuous ambulatory peritoneal dialysis (CAPD) identified by a literature review, 174 (12.7%) developed one or more abdominal hernias. Twenty-three per cent of these hernias were inguinal, 19.1% developed at the site of catheter insertion, 18.6% were umbilical, 8.3% were ventral, 9.8% were at other incisional sites, 7.4% were at other sites, and 13.7% were unclassified. Twenty-seven (13.2%) of the hernias were strangulated or incarcerated. The incidence of abdominal hernias in 827 CAPD patients was one per 104.2 cathetermonths, with a range among dialysis centers of one hernia per 47.4 to 779.0 catheter-months. Among 436 patients on intermittent peritoneal dialysis, 12 (2.8%) developed an abdominal hernia, four times less frequently than in CAPD patients (P < 0.001).
Elevated Plasma Carnitine Levels in Patients on CAPD
Authors: Moorthy A. Vishnu , Shug Austin L.
Published: February 2020

Carnitine, a small-molecular-weight quarternary amine, is lost from the plasma during hemodialysis in patients with chronic renal failure. Reports are conflicting concerning plasma carnitine levels in patients on continuous ambulatory peritoneal dialysis (CAPD). We studied 35 patients on CAPD for varying durations (up to 70 months) and noted a significant elevation in plasma levels of total carnitine, 62.98 ± 19.76 Uμmol/l; M ± SD) when compared to levels in healthy controls, 50.45 ± 8.7 (p < .005). This elevation in total carnitine level was due entirely to increases in esterified carnitine fractions in the patients 27.05 ± 11.8 when compared to control values, 7.93 ± 3.3 (p < .001). Plasma levels of free carnitine were similar in patients, 38.05 ± 13.7 and controls, 42.5 ± 8.14. In nine patients repeat plasma carnitine determinations 29 months after the initial studies showed no significant changes. Despite loss of carnitine in the peritoneal dialysate, plasma carnitine levels do not fall in patients on CAPD. At present, no one knows why plasma levels of esterified car nitine are elevated in patients on CAPD; this requires further study.
A New Treatment for Unilateral Recurrent Hydrothorax during CAPD
Authors: Vlachojannis Jannis , Boettcher Ivar , Brandt Lothar , Schoeppe Wilhelm
Published: February 2020

A 46-year-old woman undergoing CAPD developed a recurring right sided hydrothorax. Instillation of tetracycline HCI and triamcinolone acetonide did not correct the condition. However application of a fibrin adhesive (Tissucol) made it possible to achieve permanent adhesion of the pleural layers. This paper descrubes the method in detail.

The development of pleural effusions in patients undergoing peritoneal dialysis, although a rare complication, can lead to the interruption of CAPD (2,3). As treatment, several workers have provoked the adhesion of parietal and visceral pleura by instillation tetracycline HCI or triamcinolone acetonide into the pleural space (6). As this report shows, these approaches failed in one patient and we achieved pennanent correction of this hydrothorax by employing a non-invasive, fibrin-adhesion technique.
Transmesothelial Ultrafiltration IN VITRO
Authors: Breborowicz Andrzej , Knapowski Jan
Published: February 2020

The authors created transmesothelial ultrafiltration in vitro by inducing an osmotic gradient (vasc-300 mOsm: meso-400 mOsm) across the membrane. Calculated value of hydraulic conductivity of the mesothelium is comparable with analogous value for endothelium of the microvessels.

They propose that transperitoneal ultrafiltration develops in two phases: Transmesothelial ultrafiltration, which augments tonicity of the interstitial tissue which is followed by transendothelial ultrafiltration due to the osmotic gradient between the dehydrated interstitium and the vascular space. Hypertonic medium on the mesothelial side of the membrane modified its permeability to various solutes: transport rate of urea and inulin was increased whereas transport rate of albumin decreased.

Transperitoneal ultrafiltration of fluid during peritoneal dialysis conditions the removal of water from the organism. According to Nolph et al, the endothelium of the peritoneal microvessels plays a crucial role in this process (I). Little is known about the role of the mesothelium in transperitoneal ultrafiltration but patients with damaged mesothelium show decreased removal of water across the peritoneal membrane (2).

This paper describes the results of an in vitro study on the transmesothelial, osmotically induced ultrafiltration.
Autopsy Findings in Patients Treated by Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Sombolos Kostas , McNamee Peter , Mitwalli Ahmed , Rabinovich Sol , Oreopoulos Dimitrios G.
Published: February 2020

From October 1977 to October 1985, our pathology department did autopsies on 19 patients (14 men, five women) treated by CAPD for four to 55 (mean 29.3) months. Their mean age was 60.2 (range 28–79) years and the primary renal diseases were diabetes mellitus (eight), nephrosclerosis (five), polycystic kidneys (three), chronic glomerulonephritis (one) and chronic renal failure associated with sarcoidosis and congestive cardiomyopathy in two. During the same period, the authors selected as controls 18 autopsied patients (14 men, four women), who had not had chronic renal failure, and these were matched with the CAPD patients for age, sex, longstanding hypertension and insulin-dependent diabetes.

Direct causes of death for CAPD patients were cardiovascular incidents (12) infection (5), pancreatitis (1) and lung cancer (1); in controls, the causes were cardiovascular in 11 and infection in two. Thirteen of the CAPD and 12 autopsied controls had coronary artery stenosis equal to or greater than 70%, and affecting one or more arteries.

The mean weight of organs in CAPD patients and controls were similar except for kidneys and the spleen; we found the latter weighed more in those on CAPD (p = 0.002).

In CAPD patients the most important organ changes were: evidence of myocardial infarction, old or acute, in nine, acquired cystic disease of the kidney in five, and thickening and adhesions of peritoneum in nine and five respectively.
Exaggerated Protein Loss Complicating Sterile Peritonitis Results from Increased Diffusion
Authors: Hirszel Przemyslaw , Chakrabarti Eva , Maher John F.
Published: February 2020

To assess the mechanism of protein loss during chemical peritonitis, dialyses with sodium desoxycholate added to the instilled solution were compared to controls in rabbits. Sodium desoxycholate caused an inflammatory reaction characterized by increased protein loss, leukocyte exudation, decreased ultrafiltration and increased clearance of solutes including neutral dextrans. It is suggested that increased protein loss accompanying peritonitis which is due to increased diffusion through capillaries unrelated to effects of membrane anionic charge.

Exaggerated protein loss is a recognized sequel of the peritonitis that complicates peritoneal dialysis (I, 2). Such excessive protein loss can contribute to malnutrition, impeding recovery from infection.

It has been assumed that the augmented protein loss is due to increased diffusion but this has not been verified. Secretion from inflammed cells adjacent to the peritoneum could account for increased protein loss. Enhanced transfer of plasma proteins across the capillary wall may be due to an overall increase in permeability following capillary dilation which stretches pores, or alternatively it might represent a loss of the anionic charges, which line the pores and retard transport of anionic macromolecules.

Previously the transfer rate of polydispersed dextrans from plasma to peritoneal dialysate has been used to assess peritoneal porosity, presumably reflecting capillary-wall permeability (3). The transfer of neutral dextrans should not be inhibited by the fixed anionic charges of the capillary wall interstices.

Moreover, these carbohydrates would not be secreted by injured cells; their distribution is extracellular. An increased rate of transfer from plasma to peritoneal dialysate should indicate enhanced diffusion, when there is no increase in convective transport accompanying ultrafiltration.

Sodium desoxycholate, the solvent used with amphotericin B, is an irritant that has been shown to induce a sterile peritonitis characterized by dialysate leukocytosis, increased diffusion of small solutes such as urea, and decreased ultrafiltration, owing to the loss of the glucose-induced osmotic gradient (4).

These studies were designed to determine whether sodium desoxycholate would increase the peritoneal transfer rate of neutral dextrans from plasma to dialysate. The higher rate of dextran transfer observed with this agent is interpreted to support the hypothesis that proteins, lost excessively during peritonitis, derive from plasma.
Improvement of Iron Utilization and Anemia in Uremic Patients Switched from Hemodialysis to Continuous Ambulatory Peritoneal Dialysis
Authors: Movilli Ezio , Natale Carlo , Cancarini Giovanni Carlo , Maiorca Rosario
Published: February 2020

Serum ferritin, hematocrit (Ht) and hemoglobin (Hb) were studied in seven patients treated with hemodialysis (HD) who later switched to continuous ambulatory peritoneal dialysis (CAPD). No iron supplements were given during the study. During the whole observation period (12 months on HD and 12 months on CAPD), there was a progressive decrease in serum ferritin during HD, accompanied by a progressive drop in Hb and Ht; on the contrary, on CAPD, Hb and Ht showed a sharp increase despite further ferritin reduction. The CAPD ferritin drop was not due to peritoneal loss of iron or ferritin, which appeared negligible. We propose that the increase in both Ht and Hb in CAPD is due to the removal of toxic factor(s) inhibiting erythropoiesis, which allow(s) increased iron utilization, and consequently a reduction in serum-ferritin levels.

Anemia of chronic renal failure is a complex event to which many factors may contribute -reduced erythrocyte survival, hemolysis, iron losses from gastrointestinal leakage, reduced erythropoiesis, presence of inhibitors of erythropoiesis (1).
The Peak Concentration Hypothesis: A Urea Kinetic Approach to Comparing the Adequacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis
Authors: Keshaviah Prakash R. , Nolph Karl D. , Van Stone John C.
Published: February 2020

The KTIV urea index ( K, clearance; T, treatment time; V, volume of urea distribution) has become an established index of hemodialysis (HD) adequacy, values of KTIV < 0.8 being associated with overt uremic toxicity. For the typical continuous ambulatory peritoneal dialysis (CAPD) regimen of 4 X 2 L exchanges/day, the equivalent KT/V -0.6. Paradoxically, overt uremic toxicity is not commonly observed in CAPD patients with this typical therapy prescription. Application of the urea kinetic model demonstrates that HD and CAPD have the same time-averaged urea concentration at the same KTIV. However, as HD is an intermittent therapy, the urea concentration in HD exceeds the time-averaged concentration for about half the hours in the week. If uremic toxicity is related to the peak rather than the time-averaged urea concentration, a higher KT/V would be required in HD to achieve a peak concentration at or below the steady state CAPD concentration. This peak concent ration hypothesis predicts, based on the results of the National Cooperative Dialysis Study, that underdialysis with CAPD would occur at KT/V < 0.4 for a protein intake of 1.1 gmlkglday.
Single and Multiple-Dose Kinetics of Ofloxacin in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Passlick J. , Wonner R. , Keller E. , Essers L. , Grabensee B.
Published: February 2020

To evaluate the pharmacokinetics of ofloxacin, a novel quinolon antibiotic, in patients with end-stage renal disease (ESRO) on continuous ambulatory peritoneal dialysis (CAPO), we investigated 6 patients in a single-dose study and 9 patients in a multiple-dose study, all without peritonitis. In the single-dose study, patients received 200 mg ofloxacin orally. Serum concentrations (Cmax) peaked at 3.1 ± 0.3 mg/L (x ± SEM), 1.6 ± 0.5 h after p. 0. administration of the drug. Elimination half-life ( t112) was 26.8 ± 2.5 h. Peritoneal clearance accounted for 10% of the total body clearance. After 5- h dwell time, ofloxacin concentrations in the dialysate were 1.5 ± 0.2 mg/L, which is above the MIC90 for most bacteria responsible for peritonitis in patients on CAPO. In the multiple dose study, 200 mg ofloxacin were administered twice, with a time interval of 12 h, followed by 200 mg for 9 days every morning. Mean trough serum levels were 2.6 ± 1.0 mg/L, mean peak concentrations were 4.1 ± 1.7 mg/L. Mean ofloxacin concentrations in the peritoneal effluent were 1.9 ± 0.9 mg/L. It is concluded that an oral loading dose of 400 mg on the first day and a maintenance dose of 200 mg ofloxacin/day does not lead to significant accumulation, even though the elimination by the peritoneal route is only small. The proposed dosing regimen could be an adequate therapy of peritonitis and exit-site infections in patients on CAPO since levels reached in the dialysate effluent are bactericidal. The clinical usefulness in the treatment of peritonitis has to be proven in further studies.
Successful Treatment of Postparathyroidectomy Hypocalcemia Using Continuous Ambulatory Intraperitoneal Calcium (CAIC) Therapy
Authors: Benz Robert L. , Schleifer Charles R. , Teehan Brendan P. , Sigler Miles H. , Gilgore Gary S.
Published: February 2020

Severe, recalcitrant hypocalcemia and hungry bone syndrome can complicate parathyroidectomy in endstage renal disease patients. Treatment with prolonged and massive doses of intravenous calcium, with calcitriol supplementation, is often necessary, but potentially dangerous and may prolong hospitalization. Three CAPD patients (including 1 with malabsorption) were safely treated by adding 1 to 3 ampules (10–30 mL) of 10% calcium gluconate solution to each bag of dialysate for up to 29 months. Continuous ambulatory intraperitoneal calcium (CAIC) therapy was initiated postoperatively and continued on an outpatient basis until the patients’ hungry bone syndrome resolved and serum calcium normalized. Complications such as visible dialysate precipitation or an increased rate of peritonitis were not observed. Mean total calcium uptake was approximately 137 to 226 mg/exchange. We conclude that CAIC therapy is a safe, effective treatment both for CAPD patients with postparathyroidectomy hypocalcemia with hungry bone syndrome, as well as in patients with hypocalcemia secondary to malabsorption.
Clinical Aspects of Continuous Ambulatory and Continuous Cyclic Peritoneal Dialysis in Diabetic Patients
Authors: Rottembourg Jacques , Issad Belkacern , Allouache Mahmoud , Baumelou Alain , Deray Gilbert , Jacobs Claude
Published: February 2020

The treatment of end-stage renal diabetic nephropathy, remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPO) and continuous cyclic peritoneal dialysis (CCPO). Eighty-one patients, mean age 51.3 years, were treated over the last 9 years by CAPO-CCPO. Extrarenal complications, mainly vascular lesions, were present in this high-risk group of patients. The technique was modified in order to inject intraperitoneally, 4 times per day, insulin to control blood glucose level in CAPO patients. Actuarial survival was 92% at 1 year, 50% at 4 years mainly influenced by age: 85% survival at 2 years in 35 patients aged less than 50 years old and 62% at 2 years in 46 patients aged more than 50 years old. The main causes of death were of cardiovascular origin: myocardial infarction, stroke, atherosclerotic vasculopathy. The main causes of transfer to hemodialysis were due to technical complications. Peritonitis rate was one episode every 14 patientmonths. Control of blood pressure, blood glucose levels, main biological parameters, and visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPO-CCPO is the technique of first choice in young diabetics and the preferential technique for home dialysis.
Combined Abdominal Hernia Repair and Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheter Insertion
Authors: Nicholson Michael L. , Madden Annabel M. , Veitch Peter S. , Donnelly Peter K.
Published: February 2020

Out of a series of 290 surgically inserted continuous ambulatory peritoneal dialysis (CAPD) catheters, 19 patients had 24 abdominal hernias repaired at the same time as CAPD catheter insertion. All catheters were used immediately after our normal postoperative break in protocol. There were no fluid leaks from the hernia repair site but 3 catheters failed due to complications unrelated to the hernia repair. CAPD technique survival was not adversely affected in the hernia repair group.
Beta-2 Microglobulin Amyloidosis in a Patient on LongTerm Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Colombi A. , Wegmann W.
Published: February 2020

A 61-year-old female patient with ESRD due to analge sic nephropathy and treated solely with CAPD for 81 months is described. During this period she developed peritonitis 4 times. She eventually died of acute pulmonary edema due to coronary heart disease. The autopsy showed an analgesic nephropathy with contracted kidneys, diffuse peritoneal fibrosis, and articular and periarticular amyloidosis of AB2m-type. This form of amyloidosis is well known after hemodialysis; it was, however, not observed heretofore after sole long-term CAPD.
Calcium Carbonate as a Phosphate Binder: Is There a Need to Adjust Peritoneal Dialysate Calcium Concentrations for Patients Using CaCO3?
Authors: Martis Leo , Serkes Kenneth D. , Nolph Karl D.
Published: February 2020

The widespread use of calcium carbonate as a phosphate binder is limited by its tendency to develop hypercalcemia in some patients using effective dosages needed to control hyperphosphatemia. Most common continuous ambulatory peritoneal dialysis (CAPD) regimens using dialysis solutions containing 3.5 mEqlL of calcium result in net absorption of calcium from the dialysis solution and, hence limit the amount of oral calcium that can be administered. Peritoneal dialysis solutions with reduced calcium levels are needed for effective use of CaCO3 to control hyperphosphatemia in some dialysis patients.
Renaissance of Tuberculosis in the 19905: Lessons for the Nephrologist
Authors: Vas Stephen I.
Published: February 2020

Objective

To call attention to the worldwide increase in tuberculosis and to review the disease in peritoneal dialysis patients.

Data Sources

Recent epidemiological publications.

Data Extraction

Epidemiological data summarized in tables and diagnostic and therapeutic recommendations reviewed.

Conclusions

Tuberculosis is on the rise worldwide. Multiple drug-resistant strains are emerging, causing therapeutic problems. The role of atypical mycobacterial infections in continuous ambulatory peritoneal dialysis (CAPD) is reviewed. Early diagnosis of cases and thorough chemotherapy are advocated.
A Randomized Prospective Study of the Cost -Effectiveness of the Conventional Spike, O-Set, and Uvxd Techniques in Continuous Ambulatory Peritoneal Dialysis
Authors: Cheng Ignatius K.P. , Chan Ching-Ying , Cheng Suk-Wai , Poon Joana F.M. , Ji Yu-Lian , Lo Wai-Kei , Chan Daniel T.M.
Published: February 2020

Objective

To compare the clinical outcome and cost-effectiveness of three techniques for continuous ambulatory peritoneal dialysis (CAPD): the conventional spike technique (C), the O-set (0), and UVXD (U, ultraviolet irradiation connection box).

Design

A randomized and prospective comparison of three CAPD techniques.

Setting

A tertiary referral and a satellite dialysis center.. Patients: One hundred patients with end-stage renal failure between 10 and 70 years of age, with good handeye coordination and not anticipated to receive a living related transplant within 6 months.

Interventions

Patients were randomized by referral to a table of random numbers to perform one of the three CAPD techniques.

Main Outcome Measures

Training time, details of peritonitis and exit-site infection (ESI) including the costs of antibiotic treatment, outpatient visits, hospital stays, technique, and patient survival were analyzed after a minimum follow-up period of one year.

Results

There were 38, 31, and 31 patients in groups C, 0, and U, respectively, and the total observation periods were 838,802, and 745 patient-months, respectively. The peritonitis rates for C, 0, and U were 21.5, 30.8, and 29.8 patient-months/episode, respectively. The corresponding ESI rates were 16.4,14.9, and 24 patient-months/ episode, respectively. When the time from the commencement of CAPD to the first infection was expressed using the Kaplan-Meier life table analysis, 39.5%, 67.7%, and 61.3% of patients in Groups C, 0, and U were free from peritonitis at one year (p = 0.088). The corresponding figures for ESI were 52.6%, 48.4%, and 61.3% (p = 0.35). There was no significant difference in technique survival in the three treatment groups. An analysis of the costs related to the use of antibiotics, outpatient visits, and hospital stays necessary for the treatment of peritonitis and ESI and those related to training time, additional equipment, and consumables required for the three CAPD techniques showed that, overall, the cost in 0 was the lowest, followed by U and C (U.S. $158, $170, and $179 per patient-month, respectively).

Conclusion

It was concluded that the O-set is a more cost-effective CAPD technique than UVXD, while both are more cost-effective than the conventional spike technique.
Cell Populations Present in the Nocturnal Peritoneal Effluent of Patients on Continuous Ambulatory Peritoneal Dialysis and Their Relationship with Peritoneal Function and Incidence of Peritonitis
Authors: De Castro Mercedes Fernandez , Selgas Rafael , Jimenez Carlos , Baja Maria Auxiliadora , Martinez Victoria , Romero Jose Ramon , De Alvaro Fernando , Vara Francisco
Published: February 2020

Objective

To study the relationship between peritoneal effluent cells and infection rate and to relate this population with functional characteristics.

Design

Prospective, longitudinal, and comparative study.

Setting

Outpatient continuous ambulatory peritoneal dialysis (CAPD) unit of a university medical center.

Participants

Seventy-one uninfected patients, treated for 0-156 months on CAPD, in stable condition were studied (33 female, 38 male).

Interventions

Nocturnal peritoneal effluent (NPE) was drained with EDT A (2.5 mmol/L) at 37°C and centrifuged at 2500 rpm for 9 minutes.

Measurements

Accumulated peritoneal inflammation days/year and ultrafiltration/diffusion (mass transfer coefficients (MTCs) for small molecules) capacities were recorded. Cellular count (cells/night) was performed using a Neubauer chamber. Macrophage function was assessed by cytochemical (lysosomal enzyme content: ANAE, beta-glucuronidase, acid phosphatase) and immunohistochemical procedures (expression of membrane antigens, CD4, 11b, 11c, 14,16,25,35, and 71).

Results

The macrophage is the most frequently appearing cell in the NPE. Cell count decreases over time on CAPD (from 20 x 106 to 5 x 106 after the first year). Intrapatient variability was low, but interpatient differences were marked. Mesothelial cell count remained stable over time (0.25 0.5 x 106). Four of our patients showed a “transforming” change in these cells. Previous incidence of peritonitis and values of functional measurements did not correlate with cell count or expressions of macrophage function (lysosome enzyme content and percentage of cells expressing different membrane antigens).

Conclusion

There is difficulty interpreting the results on peritoneal effluent cells and their relationship with the incidence of peritonitis and functional characteristics of the peritoneum. No definite conclusions can be drawn other than the great interpatient and intrapatient variability. The presence of abnormal peritoneal cells with undetermined origin and function suggests the need for periodic studies of peritoneal effluent cells on long-term CAPD patients.
Case Forum
Authors: Twardowski Zbylut J. , Schreiber Martin J. , Burkart John M.
Published: February 2020

A 62-year-old Man with Numbness, Tingling, Weakness in the Lower Extremities and Difficulty in Walking
History, Chemical, and Pharmaceutical Development of Icodextrin
Authors: Alsop R. Michael
Published: February 2020

Pharmaceutical formulations employing glucose as the osmotic agent in continuous ambulatory peritoneal dialysis (CAPD) have been available in the United Kingdom for some 15 years. They do, however, exhibit certain disadvantages related to the absorption of glucose through the peritoneum which have been well characterized.

The development of possible alternatives such as dextran, amino acids, and glycerol is briefly reviewed. No commercially available products have emerged from this work.

The use of a starch-based polyglucose as an alternative osmotic agent has also been the subject of clinical trials both in the United States and the United Kingdom. In the United States a narrow fraction low molecular weight product [molecular weight (MW) 1000 dalton] was extensively examined in dogs and patients. Disadvantages with high carbohydrate transference to the serum appear to have precluded its further development.

In the United Kingdom a wider fraction based on an existing oral product, Caloreen, was first examined. This product had a bimodal MW distribution containing a fraction of MW 1000 dalton and another of MW 20000 dalton. These overlapping fractions were separated and the two component parts examined clinically. Surprisingly, the higher MW fraction showed most promise. The low MW fraction, virtually identical to the U.S. material, was rejected for the same reasons.

The high MW material was purified, the critical aspects of its molecular size defined by the development of improved size exclusion chromatography techniques, and a new membrane manufacturing process established. The products made were extensively tested for toxicity and further examined clinically. A final product was selected and its specification defined.

A multicenter clinical trial of the product, icodextrin, was conducted with excellent results.

The importance of product control, especially with respect to MW, and the mode in which the osmotic effect occurs between virtually iso-osmolar solutions (colloidal osmosis) is emphasized.

The development pharmacy and chemistry necessary to obtain a U.K. product license, now granted, is described.
Protein Clearance and Icodextrin
Authors: Krediet Raymond T. , Brown Colin B. , Imholz Alexander L.T. , Koomen Gerardus C.M.
Published: February 2020

Objective

To analyze the peritoneal transport of serum proteins during continuous ambulatory peritoneal dialysis (CAPD) with icodextrin.

Design

A comparison was made between CAPD with glucose-based dialysate and, in the same patients, 4 weeks after the instillation of icodextrin for the long night dwell, with icodextrin-based dialysate.

Patients

Ten stable CAPD patients, who participated in a large randomized multicenter study comparing icodextrin with glucose-based dialysate. Five patients used glucose 1.5% dialysate for the night dwell before its replacement by icodextrin (good ultrafiltration group), and 5 used glucose 4.25% (poor ultrafiltration group).

Results

The clearance of β2-microglobulin increased by 28% on icodextrin, due to increased convective transport. The clearances of the larger proteins -albumin, IgG, fibronectin, and α2-macroglobulin -remained unaltered, indicating transport of these proteins across the large pore system. The patients with poor ultrafiltration had a higher β2-microglobulin clearance on glucosebased dialysate than the high ultrafiltration group. This indicates that the ultrafiltration failure was caused by a large effective peritoneal surface area, leading to a rapid absorption of glucose. Icodextrin produced significantly more ultrafiltration in the poor ultrafiltration patients than in the high ultrafiltration group. A correlation was found for the β2-microglobulin clearance on glucose-based dialysate and the ultrafiltration produced by icodextrin.

Conclusions

Icodextrin causes ultrafiltration through the small pore system, whereas glucose-based dialysate has its effect on transcellular water transport. Therefore, the use of icodextrin causes an increased clearance of β2 microglobulin, but not of larger proteins. Icodextrin was especially useful in patients with a large effective surface area leading to ultrafiltration failure during treatment with glucose-based dialysate.
Clinical Experience with Icodextrin in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Stein Andrew , Peers Elizabeth , Hattersley Jane , Harris Kevin , Feehally John , Walls John ,   The MIDAS Study Group, Brown C.B. , Nichols N. , Mistry C.D. , Ashman R. , Raftery M. , Peters J. , Gokal R.
Published: February 2020

Objectives

To review the clinical experience in the United Kingdom with icodextrin (Ic).

Design

A retrospective multicenter study.

Patients

(1) the MICAS 1 patients who received Ic and elected to continue using it (called MICAS 2 patients), and (2) patients started on Ic on a named-patient basis (called compassionate use patients). Nearly all this latter group had ultrafiltration (UF) failure and were approaching hemodialysis (HC).

Interventions

The institution of one Ic bag, as the overnight exchange, usually in addition to three glucose bags.

Results

(1) MICAS 2: Of the 67 patients who received Ic and completed MICAS 1, 48 (72%) patients from eight units in the United Kingdom wished to continue Ic. Forty two percent of MICAS 2 patients were well on Ic after approximately 30 months of study (including the 6 months on MICAS 1). The main reasons for withdrawal were transplantation (21 %), death (17%), or transfer to HC for reasons other than UF failure (10%). There were no significant changes in laboratory data, including hematology, simple biochemistry, bone biochemistry, liver function tests, serum osmolality, and maltose levels. The adverse events reported were incidental to Ic. (2) Compassionate use: 30/63 (48%) patients remain well on Ic after 10 months of study. Eight patients (12%) went on to experience UF failure (again) after 13 months on Ic, requiring transfer to HC. The other main outcomes were death (11 %), transplantation (11 %), or transfer to HC for reasons unrelated to Ic (16%), usually intractable peritonitis. The serum sodium concentration decreased from 136.6±3.8 to 134.4±4.2 mmol/L (p < 0.05). There were no other significant changes in hematology or biochemistry measurements.

Conclusion

In MICAS 2 Ic probably maintained its effects, since there were no withdrawals due to UF failure. The compassionate use program has shown that a single Ic exchange is useful in UF failure, being able to prevent or delay transfer to hemodialysis. In both studies the safety and efficacy of Ic has been demonstrated in a large group of patients. A total of 192 patient-years of experience (including MICAS 1) has been accumulated to date. Properly controlled studies are needed to determine whether Ic, in its present form, should remain a “special needs” product (for UF failure) or whether it could replace glucose as the treatment of choice for CAPC patients.