bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Artifact Mimic the Pathology of the Peritoneal Mesothelium?
Authors: Von Ruhland Christopher J. , Newman Geoffrey R. , Topley Nicholas , Williams John D.
Published: February 2020

Objective

A peritoneal biopsy registry was established to examine morphological and functional changes to the peritoneum during peritoneal dialysis (PD). During the early stages of this study, it became clear that surgical trauma to the peritoneum at the time of biopsy could cause a variety of changes to the surface. We examined the effects of surgical trauma in a rat biopsy model.

Design

Rat peritoneum was subjected to a variety of traumas that might occur at biopsy and compared with peritoneal biopsies that had been collected, using the suture method described here, from PD patients. Changes in the quality of non-PD biopsies taken before and after the development of the suture technique were evaluated.

Results

In the rat model, external massaging of the peritoneum induced moderate loss of microvilli. Brief light touching caused distortion of the mesothelial surface. Pressing resulted in mesothelial denudation and thin strands of presumed cellular remains. Rubbing caused complete loss of mesothelial cells and their basement membrane. Air drying caused progressive loss of microvilli and eventual cellular distortion. Comparison with peritoneal biopsies from PD patients revealed similarities with certain types of trauma, namely, air drying and pressing. Collection of peritoneal biopsies using the suture method significantly improved specimen quality compared with specimens taken before its introduction ( p < 0.025%).

Conclusion

These results illustrate the sensitivity of the mesothelium to mechanical trauma, the possibility of confusing trauma with genuine pathology, and, hence, the necessity of employing a trauma-free method of biopsy collection, such as the technique described here.
Peritoneal Function and Assessment of Reference Values Using a 3.86% Glucose Solution
Authors: Smit Watske , Van Dijk Paul , Langedijk Monique J. , Schouten Natalie , Van Den Berg Nicole , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Background

The most widely used peritoneal function test, the peritoneal equilibration test (PET), is performed with a 2.27% glucose solution. Recently, the International Society for Peritoneal Dialysis committee on ultrafiltration failure (UFF) advised performing the test with 3.86% glucose solution because it is more sensitive for detecting clinically significant UFF. Because no reference values for this test were available, we analyzed the results of standard peritoneal permeability analyses (SPAs) using 3.86% glucose.

Methods

The tests were performed in our center on 154 clinically stable peritoneal dialysis (PD) patients that were free of peritonitis for at least 4 weeks. For the assessment of reference values, we used two approaches. In approach A, patients with UFF, defined as net ultrafiltration (UF)< 400 mL/4 hours, were excluded. In approach B, only patients within their first 2 years of PD treatment were included, regardless of net UF. Means and 95% confidence intervals (95% CI) were calculated for the transport parameters of the PET and SPA.

Results

Means of normal distribution with 95% CI in approach A were as follows: for 2.0-L exchanges, mass transfer area coefficient (MTAC) for creatinine 8.8 mL/minute (4.7 – 12.7 mL/min), dialysate/plasma ratio (D/P) creatinine 0.70 (0.52 – 0.88), glucose absorption 58% (44% – 72%), dialysate240/initial dialysate ratio of glucose (D t/D0) 0.28 (0.18 – 0.38), net UF 675 mL (375 – 975 mL), and maximal dip in D/P sodium after correction for diffusion from the circulation 0.110 (0.050 – 0.164); for 1.5-L exchanges, MTAC creatinine 7.4 mL/min (3.8 – 11.0 mL/min), D/P creatinine 0.69 (0.52 – 0.86), glucose absorption 62% (52% – 72%), D t/D0 glucose 0.25 (0.17 – 0.32), net UF 551 mL (430 – 670 mL), and maximal dip D/P sodium 0.120 (0.048 – 0.166). In approach B, most of the transport values were similar; however, values for lymphatic absorption were significantly higher [1.52 mL/min (2-L) and 1.40 mL/min (1.5-L), p < 0.01] and values for the maximum dip in D/P sodium were lower [0.101 (2-L) and 0.112 (1.5-L), p > 0.05]. This was probably the result of including patients with UFF in approach B, since these parameters can be causative factors of UFF.

Conclusions

A peritoneal transport function test using 3.86% glucose provides data on various aspects of transport. This study gives normal reference values that can be used for analysis of causes of UFF.
A 12-Month Review of Peritoneal Dialysis-Related Peritonitis in Western Australia: Is Empiric Vancomycin Still Indicated for Some Patients?
Authors: Kan George W. , Thomas Mark A.B. , Heath Christopher H.
Published: February 2020

Background

The International Society for Peritoneal Dialysis (ISPD) guidelines recommend empiric therapy with cefazolin and ceftazidime for peritoneal dialysis (PD)-related peritonitis. Empiric cefazolin therapy may have diminishing efficacy because of emerging methicillin resistance in gram-positive bacteria (GPB). Western Australia also has large numbers of Aboriginal and isolated regional patients, where giving these antimicrobials can be impractical.

Objectives

To evaluate, based on local antimicrobial resistance patterns, the feasibility of following ISPD guidelines in Western Australia and to identify any subgroups of PD peritonitis patients that may benefit from alternative empiric intraperitoneal antibiotics ( e.g., vancomycin).

Study Design

Retrospective study of all PD peritonitis episodes in Western Australia from 1 February 2000 to 31 January 2001.

Setting

Three adult tertiary referral university hospitals and their PD patients in metropolitan Perth and regional Western Australia.

Patients

All adults on PD in Western Australia.

Main Outcome Measure

Isolates and antibiograms were analyzed versus patient characteristics, including race and patient demographics.

Results

293 patients (28% Aborigines, 32% regional patients) received PD. 145 episodes of PD peritonitis occurred during the study. The overall PD peritonitis rate was 1 episode/16 patient months, with Aborigines having 1 episode/10.5 patient months versus non-Aborigines having 1 episode/17 patient months p (< 0.001). 36% of isolates from PD peritonitis episodes were resistant to cefazolin or ceftazidime. 22% were methicillin-resistant GPB (MR-GPB) [18% coagulase-negative staphylococci (CoNS), 1.6% MR Staphylococcus aureus]; 2.5% were multidrug-resistant gram-negative bacteria (MDR-GNB); 5.7% were polymicrobial (MR-GPB and/or MDR-GNB); and 5.7% were fungal. 63% of CoNS were methicillin resistant. Non-Aboriginal patients yielded MR-GPB in 22% of isolates versus 23% in Aborigines ( p = 0.9). Six of seven cases of fungal peritonitis occurred inAboriginal patients ( p < 0.001).

Conclusions

In our study population the ISPD guidelines were appropriate for 64% of patients with PD peritonitis. We could not identify specific patient subgroups where empiric cefazolin use could be more effective. High proportions of MR-GPB PD peritonitis episodes, along with local factors, make empiric cefazolin unsuitable for many regional PD patients in Western Australia.
Bone Metabolism and Peritoneal Membrane Transport in Children on Chronic Peritoneal Dialysis
Authors: Ziólkowska Helena , Pańczyk-Tomaszewska Malgorzata , Debiński Andrzej , Sawicki Andrzej , Roszkowska-Blaim Maria
Published: February 2020

Objective

The aim of the study was to assess the influence of peritoneal membrane permeability on bone metabolism in dialyzed children.

Patients and Methods

24 children with end-stage renal failure and being treated with peritoneal dialysis (PD) were studied. The children were divided into two groups based on the results of a standard peritoneal equilibration test: group I, high peritoneal transport [ratio of dialysate glucose concentration at 4 hours to dialysate glucose concentration at 0 hours (D/D0) < 0.26, dialysate-to-serum ratio of creatinine concentration at 4 hours (D/P) > 0.81], 10 children aged 9.9 ± 2.9 years; group II, other peritoneal transport types (D/D0 > 0.26, D/P < 0.81), 14 children aged 11.4± 2.7 years. Serum levels of calcium (sCa), phosphorus (sP), protein, albumin, alkaline phosphatase (AP), and parathormone (PTH) were measured, and bone biopsies were performed in all children. Alfacalcidol and calcium carbonate doses were adjusted to sCa, sP, and PTH levels in all patients.

Results

No statistically significant differences (NS) between the two groups were found in age, duration of PD, sCa, sP, AP, PTH, protein, or albumin levels. The mean alfacalcidol dose was 0.055 ± 0.057 μg/kg body weight/week in group I and 0.099 ± 0.065 μg/kg/week in group II ( p = NS). In group I, the high peritoneal transport group, significantly lower osteoclast surface (OcS/BS) and bone formation rate (BFR/TV) were found compared with group II (3.1% ± 1.7% vs 4.6% ± 2.0%, and 483.5 ± 329.2 μm3/mm2/day vs 913.9 ± 558.3 μm3/mm2/day, respectively, p < 0.05). We also found significant positive correlation between D/D0 and BFR/TV and OcS/BS ( r = 0.45, p < 0.05).

Conclusion

Bone turnover in children treated with PD may depend on peritoneal permeability.
Feasibility of Reinstitution of CAPD after Partial Hepatectomy in Patients with Malignant Hepatic Tumors
Authors: Lui Sing Leung , Yip Pok Siu , Lam Man Fei , Lo Wai Kei
Published: February 2020

Objective

To determine the feasibility of reinstitution of continuous ambulatory peritoneal dialysis (CAPD) in patients with malignant hepatic tumors after partial hepatectomy.

Design

Retrospective analysis of 2 CAPD patients.

Setting

Dialysis unit of a university teaching hospital.

Patients

Two CAPD patients with malignant hepatic tumors who had undergone partial hepatectomy.

Main Outcome Measures

Serum biochemistry, Kt/V, peritoneal equilibration test (PET) results before and after hepatectomy.

Results

One patient was able to resume CAPD 4 weeks after partial hepatectomy. The other patient was successfully resumed on CAPD after resting the peritoneum for 3 months following partial hepatectomy. The serum biochemistry, Kt/V, and PET results of the 2 patients did not change significantly before and after partial hepatectomy.

Conclusions

Reinstitution of CAPD after partial hepatectomy in patients with malignant hepatic tumors is feasible.
Blood Pressure Control and Left Ventricular Hypertrophy in Long-Term Capd and Hemodialysis Patients: A Cross-Sectional Study
Authors: Günal Ali Ihsan , Ilkay Erdogan , Kirciman Ercan , Karaca Ilgin , Dogukan Ayhan , Celiker Huseyin
Published: February 2020

Background

It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients.

Methods

To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration).

Results

The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT.

Conclusion

If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.
Comparison of the Charlson Comorbidity Index and the Davies Score as a Predictor of Outcomes in PD Patients
Authors: Fried Linda , Bernardini Judith , Piraino Beth
Published: February 2020

Background

Comorbidity is a strong predictor and confounds many studies of outcomes. Previous studies have shown that the Charlson Comorbidity Index (CCI) and the Davies score predict mortality in peritoneal dialysis (PD) patients. However, there are few data on the comparison of comorbidity scores.

Objective

To compare the CCI (combines comorbidity and age) and Davies score (comorbidity score without age) to see if one score was superior to the other in predicting outcomes.

Design

Prospective database study.

Setting

Seven dialysis centers in Western Pennsylvania.

Participants

415 incident PD patients, starting PD from 1/1/90 to 2/1/00.

Measurements

The CCI and Davies score calculated at the start of PD; serum albumin levels and demographics at the start of PD; total hospitalizations and mortality, collected prospectively.

Results

The correlation between CCI and Davies was 0.80, p < 0.0001. The CCI was inversely correlated with serum albumin (–0.31, p < 0.0001). Davies was significantly correlated with age (0.32, p < 0.0001) and inversely correlated with albumin (–0.27, p < 0.0001). The CCI alone was a stronger predictor than Davies alone (score by best subsets regression 49.6 vs 42.0, p = 0.0058). The CCI and Davies with age appeared to be equivalent models of survival (49.61 vs 49.64). The best predictive models were CCI and initial albumin, or Davies, age, and initial albumin. Both CCI and Davies were predictors of hospitalization rates, but the model with the Davies score was better (Akaike information criterion 799.2 vs 850.2). The best predictive model was Davies, albumin, age, and race.

Conclusions

Both comorbidity scores were significant predictors of outcomes, with CCI the stronger predictor for mortality, but the Davies was a stronger predictor of hospitalizations. One or both should be done at the start of dialysis to predict outcome.
What Can We Do to Preserve the Peritoneum?
Authors: Krediet Raymond T. , Zweers Machteld M. , Van Westrhenen Roos , Ho-dac-Pannekeet Marja M. , Struijk Dirk G.
Published: February 2020

Background

Long-term peritoneal dialysis may lead to peritoneal membrane failure. Loss of ultrafiltration is the most important clinical abnormality. Loss of ultrafiltration is associated with an increased number of peritoneal blood vessels, with fibrotic alterations, and with loss of mesothelium. Continuous exposure to bioincompatible dialysis solutions is likely to be important in the pathogenesis of these alterations.

Methods

This article reviews the toxicity of various constituents of dialysate, current assessments of interventions, and the results of interventions aimed at preserving the peritoneum.

Results

Glucose, possibly in combination with lactate, and glucose degradation products (GDPs) are likely to be the most toxic constituents of dialysate. Diabetiform peritoneal neoangiogenesis is likely to be mediated by vascular endothelial growth factor (VEGF). Release of VEGF might be influenced by glucose-induced cellular pseudohypoxia, which is likely to be increased by exposure to lactate. Glucose and GDPs are both toxic to peritoneal cells. Glucose degradation products induce the formation of advanced glycosylation end-products at a much faster rate than does glucose itself, but the relative importance of GDPs and glucose in clinical PD has not been clarified. The effects of interventions should first be assessed in long-term animal models, followed by clinical studies on peritoneal transport and on effluent markers that may reflect the status of the peritoneum. Possible interventions aim at reducing peritoneal exposure to glucose, GDPs, and lactate. Techniques include peritoneal resting, replacing some glucose-based exchanges with amino acid–based and icodextrin-based dialysate, using bicarbonate as a buffer, and administering solutions that have a low GDP content. Exposure to various dialysis solutions with a reduced GDP content has resulted in an increase in the effluent concentration of the mesothelial cell marker CA125, irrespective of the buffer used. Experimental studies in a long-term peritoneal exposure model in rats showed that the combination of a reduction in the concentration of lactate and replacement of lactate with pyruvate resulted in a reduction of the number of peritoneal blood vessels. Results of drug therapy have been studied in various animal models. Their use in patients is still experimental.

Conclusions

Strategies to preserve the peritoneum aim at reducing membrane exposure to bioincompatible solutions. Currently available dialysis fluids that are more biocompatible are likely to have some beneficial effects. Further research on the development of dialysis solutions that use combinations of osmotic agents and alternative buffers is necessary.
Peritoneal Function: The Role of Aquaporins
Authors: Lai Kar Neng , Lam Man Fai , Leung Joseph C.
Published: February 2020

The aquaporins (AQPs) constitute a large family of water channels that play a part in transcellular water movement in many tissues. They are particularly abundant and important in the kidney and the lung. Derangement of AQP structure or function leads to a variety of water-balance disorders. Aquaporin-1 (AQP1) is constitutively expressed in the endothelial cells of the capillaries and venules that provide the ultrasmall pores predicted by the three-pore model of water movement during peritoneal dialysis. The ultrasmall pores are critical for ultrafiltration. In addition, AQP1 and AQP3 are constitutively expressed in peritoneal mesothelial cells. The expression of those AQPs is upregulated by hyperosmolality. Reduced expression or function of AQP1 may be responsible for some cases of ultrafiltration failure, but further evidence is required to establish that link.
Are Three Exchanges Suitable for Asian Patients on Peritoneal Dialysis?
Authors: Abraham Georgi , Mathew Milly , Gopalakrishnan Padma , Sankarasubbaiyan Suresh , Shroff Sunil
Published: February 2020

Phenomenal growth in continuous ambulatory peritoneal dialysis (CAPD) has occurred in the developing countries of Asia. In many regions in Asia, neither governments nor insurance companies fully cover treatment expenses for dialysis. Hence, patients in developing countries such as India, Bangladesh, Pakistan, and Nepal use just three 2-L exchanges daily. Typical practice in many centers is to do daytime CAPD with a dry night. Most of our Indian patients who are on three exchanges per day showed a Kt/V of 1.67 and 2-year survival rate of 60% with a normalized protein equivalent of nitrogen appearance of 0.73 – 0.80 g/kg daily. Vegetarians had a lower protein consumption rate and lower serum albumin levels. Peritoneal membrane characteristics vary among high, high average, and low average in various regions of Asia. The prevalence of diabetic nephropathy, with its associated comorbid conditions, as a major cause of end-stage renal disease in the Indian subcontinent explains the differences in the CAPD mortality rates between India and various Asian countries. Given the financial constraints in countries in Asia, small-volume dialysis of 6 L daily may be an acceptable compromise in some patient populations with a smaller body size and significant residual renal function; however, dialysis dose should be individualized according to the needs of each patient.
Does Amino Acid–Based Peritoneal Dialysate Change Homocysteine Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients?
Authors: Chang Jer-Ming , Chen Hung-Chun , Hwang Shang-Jyh , Tsai Jer-Chia , Lai Yung-Hsiung
Published: February 2020

Objective

We examined whether amino acid–based peritoneal dialysate that contains 85 mg/dL L-methionine affects homocysteine (Hcy) metabolism.

Design

The study enrolled 17 adult CAPD patients (11 men, 6 women) who had been receiving CAPD for at least 6 months and who had low serum albumin levels (<3.7 g/dL). Diet was not specifically changed. All of the study patients received daily 4-exchange CAPD treatment, and they used Nutrineal (Baxter Healthcare, Deerfield, IL, U.S.A.) as one of their daily exchanges (first or second exchange). Blood samples were collected every 2 weeks, and Hcy was measured.

Results

After use of Nutrineal, serum albumin was unchanged, but blood urea nitrogen (BUN) and total protein were increased. Before the study began, 1 patient had a very high Hcy level (256 μmol/L); his data were excluded from the analysis. In the remaining 16 patients, baseline Hcy was 24.4 ± 7.0 μmol/L. Levels of Hcy progressively increased with the use of Nutrineal: 28.1 ± 6.2 μmol/L in week 2, 28.4 ± 7.1 μmol/L in week 4, 29.1 ± 7.6 μmol/L in week 6, 29.3 ± 9.0 μmol/L in week 8, 27.5±9.7 μmol/L in week 10, and 30.3 ± 8.2 μmol/L in week 12.

Conclusions

Nutrineal might help to replenish daily protein loss, but it also increased formation of Hcy and, therefore, the potential risk of cardiovascular illness. Further studies will be needed to examine the effect of folic acid and vitamin B12 supplementation in the rescue of that Hcy increase, and also a possible correlation with methylenetetrahydrofolate reductase gene polymorphism.
Nutritional Requirements and Actual Dietary Intake of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Chow Vincent C. , Yong Rose M. , Li Alice L. , Lee Chi-wai , Ho Eva H. , Chan Ching-kit , Lo Stanley H. , Mo Stephen K. , Wong Kin-shing
Published: February 2020

Objective

Nutritional status is related to morbidity and mortality in the continuous ambulatory peritoneal dialysis (CAPD) population. In the present study, we compared the dietary intake of CAPD patients with their requirements for calorie and protein nutrition and with the recommended intakes of potassium and phosphate.

Design

Patients were recruited from the CAPD clinic. Desirable body weight was derived from the height of the individual patients and the desirable body mass index (BMI) for adult Asians. The calorie requirement was calculated by multiplying desirable body weight by 30 kcal. The protein requirement was calculated by multiplying desirable body weight by 1.2 – 1.5, according to serum albumin level. The K requirement was set at 3500 mg daily, and the PO4 requirement, at 1000 mg daily. The actual dietary intake of individual patients was estimated from dietary history by a computer software program.

Results

The study included 57 patients who had been on CAPD for 22.1 ± 23.5 months. Of the 57 patients, 8 patients (14.0%) were below the desirable BMI range, 20 (35.1%) were within the range, and 29 (50.9%) were above the range. By subjective global assessment (SGA), 45 patients (78.9%) were mildly-to-moderately malnourished, and 12 (21.1%) well nourished. Serum albumin was 32.1 ± 4.7 g/L. Patients met 98% ± 35.7% (range: 33% – 224%) of their nutritional requirement for calories and 92.1% ± 37.7% (range: 22% – 202%) of their nutritional requirement for protein. Only 23 patients (40.4%) reached the target for calorie intake, and only 22 (38.6%) reached the target for protein intake. Excess K intake was seen in 1 patient (1.8%), and excess PO4 intake, in 6 patients (10.5%). Actual dietary intake was not related to BMI or SGA score.

Conclusion

Most CAPD patients had inadequate calorie and protein intakes. Calorie and protein intakes were not related to BMI and SGA scores. Compliance with recommended K and PO4 intakes was good.
Nutritional Assessment of Continuous Ambulatory Peritoneal Dialysis Patients by Bioelectrical Impedance
Authors: Chow Vincent C. , Lee Chi-wai , Ho Eva H. , Chan Ching-kit , Yong Rose M. , Li Alice L. , Lo Stanley H. , Mo Stephen K. , Wong Kin-shing
Published: February 2020

Objective

The Dialysis Outcomes Quality Initiative (DOQI) guidelines suggest that anthropometric measurements are useful in assessment of nutrition. However, the technique is operator-dependent and time consuming. To estimate fat-free mass and fat mass, bioelectrical impedance analysis (BIA) measures the impedance of an electrical current passing through the body. Our aim in the present study was to validate the use of BIA in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

We recruited patients from the CAPD clinic. The biceps, triceps, subscapular, and suprailiac skinfold thickness were measured by Harpenden skinfold calipers (British Indicators, Burgess Hill, West Sussex, U.K.). Using a linear regression equation (Durin and Womersley) and the Siri equation, we calculated percentage body fat composition from the anthropometric measurements. For BIA assessment, fat composition was measured using the Body Composition Analyzer (TBF-300GS: Tanita Corporation of America, Arlington Heights, IL, U.S.A.).

Results

We recruited a total of 60 patients who had been on CAPD for 21.8 ± 23 months. The percentage of body fat in the study group as estimated by anthropometry was 27.5% ± 8.6% (range: 5.78% – 40.4%). By BIA, the percentage of body fat was 17.6% ± 8.9% (range: 2.4% – 42.3%). The results by the two methods were highly correlated ( r = 0.712, p < 0.001). By paired t-test, the mean difference in body fat composition using the two different methods was 9.9% ± 6.6% ( p < 0.001).

Conclusions

Measurement of body fat composition in CAPD patients by BIA and by anthropometry were highly correlated. The body fat composition measured by BIA was lower than that measured by anthropometry. The BIA method is simple and noninvasive. It may play a role in monitoring trend of body composition in CAPD patients in an outpatient setting.
Hypoproteinemia in Patients with Diabetes Undergoing Continuous Ambulatory Peritoneal Dialysis is Attributable to High Permeability of Peritoneal Membrane
Authors:   for the Japan PDC Study Group, Nakamoto Hidetomo , Suzuki Hiromichi
Published: February 2020

Background

The present study used the newly developed personal dialysis capacity (PDC) peritoneal function test to investigate differences in individual peritoneal membrane transport function and nutritional status in non diabetic (non DM) and diabetic (DM) patients on continuous ambulatory peritoneal dialysis (CAPD).

Patients and Methods

To clarify the differences in peritoneal function that determine plasma protein levels, we carried out PDC tests in non DM and DM patients. Between May 1995 and May 1999, in multicenter study in Japan, we carried out 232 PDC tests on 232 non DM patients and 47 PDC tests on 47 DM patients who had been on CAPD for 1 – 210 months.

Results

Plasma levels of total protein and albumin in DM patients were significantly lower than those in non DM patients (total protein: 6.5 ± 0.1 g/dL non DM vs. 5.9 ± 0.1 g/dL DM, p < 0.0001; albumin: 3.5 ± 0.1 g/dL non DM vs. 2.9 ± 0.1 g/dL DM, p < 0.0001). The mean membrane area in the DM group was significantly larger than that in the non DM group (21943 ± 608 cm/1.73 m2 non DM vs. 26 304 ± 1699 cm/1.73 m2 DM, p = 0.0076). The mean plasma loss through the large pores in the DM group was significantly greater than that in the non DM group (0.095 ± 0.004 mL/min/1.73 m2 non DM vs. 0.119 ± 0.008 mL/min/1.73 m2 DM, p = 0.0113). Protein loss into dialysate in DM patients was significantly greater than that in non DM patients. We observed a significant correlation between total protein or albumin and plasma loss from dialysis solution in non DM and DM patients on CAPD.

Conclusions

The study demonstrated that peritoneal function, including peritoneal membrane transport and peritoneal permeability to protein was significantly higher in DM patients than in non DM patients. Hypoproteinemia in DM patients might be associated with high permeability of peritoneal membrane in CAPD.
Rehabilitating a Dialysis Patient
Authors: Cheng Yuk-Yee , Wong Ying-Fan , Chu Bonnie Y.C. , Lam Woon-Or , Ho Yiu-Wing
Published: February 2020

End-stage renal disease (ESRD) patients undergoing dialysis face much stress and have to make adjustments in their lives. To optimize health and improve quality of life, rehabilitation of renal patients is a necessity. Renal rehabilitation includes physical, social, psychological, and vocational elements. We established a renal rehabilitation program—including predialysis education, in-center training, and community rehabilitation—in our regional dialysis unit. The program is organized by a multidisciplinary team of health professionals with the help of a renal-patient support group. A patient who joined the rehabilitation program showed significant lifestyle change.
Improving Outcome in Geriatric Peritoneal Dialysis Patients
Authors: Hiramatsu Makoto
Published: February 2020

Objective

Few data are available about elderly patients on peritoneal dialysis (PD). In the present study, we reviewed our experience with patients aged 70 years or more at the start of peritoneal dialysis (PD).

Design

This retrospective study was conducted at a single center in Japan.

Patients and Methods

Of 222 patients managed using PD at our hospital between 1991 and 2001 (including 219 cases of PD first), 150 patients were aged under 70 years and 72 patients were 70 years of age or older. For the two groups of patients, we determined clinical data, erythropoietin and PD prescriptions, reasons for selecting PD (elderly patients only), urine and ultrafiltration volumes, comprehensive functional assessment, quality of life (QOL), comorbidity, technique survival rate, and causes of death.

Results

Serum creatinine, serum β2-microglobulin, total dose of erythropoietin (EPO) needed to maintain hematocrit at 30%, number of continuous ambulatory peritoneal dialysis (CAPD) exchanges, and total volume of dialysis solution prescribed were significantly lower in the elderly patients as compared with patients aged under 70 years. The main reasons for starting PD in elderly patients at our hospital were advanced age (57%), patient's choice (25%), and cardiovascular complications (9%). Residual renal function was well maintained in CAPD patients aged 70 years or more as compared with patients aged under 70 years. Ultrafiltration volume was lower in the elderly CAPD patients. Scores on the Revised Hasegawa Dementia Scale, the Physical Self-Maintenance Scale, and the Instrumental Activities of Daily Living scale were significantly higher in CAPD patients than in hemodialysis patients. Subjective assessment using a linear analog scale showed a high QOL score in the elderly patients for overall feelings of well-being, mood, and anxiety. At the time of dialysis introduction, the major existing disorders in patients over 80 years of age were mostly cardiovascular disorders such as heart failure, myocardial infarction, serious arrhythmia, and cerebrovascular disease. The median technique survival in patients aged 70 years or more was 31.5 months. The main causes of death in elderly PD patients were heart failure (35.7%), peritonitis (14.3%), and cerebrovascular disease (11.9%).

Conclusion

Peritoneal dialysis should be considered the treatment method of choice when introducing dialysis in elderly patients.
Psychosocial Aspects in Renal Patients
Authors: Leung Dora K.C.
Published: February 2020

It is not uncommon for renal patients to present with psychosocial problems and behavioral problems. This paper briefly discusses some of the psychosocial factors associated with renal disease and peritoneal dialysis, considers the role that those factors play in relation to clinical treatment, and suggests nursing interventions that involve problem-solving with patients and providing support to caregivers. Because nurses are on the front line in encounters with patients, their contribution can facilitate support for the psychosocial situations of their patients through effective communication within a committed multidisciplinary team that share a vision of the significance of psychosocial intervention.
Effect of a Home Exercise Program Based on Tai Chi in Patients with End-Stage Renal Disease
Authors: Ling Kin-wa , Wong Flora S.Y. , Chan Wing-ki , Chan Shuk-yin , Chan Eric P. Y. , Cheng Yuk-lun , Yu Wai-yin
Published: February 2020

Objective

Previous reports have documented the benefits of exercise on the well-being of renal patients. However, fewer than 50% of our end-stage renal disease (ESRD) patients engage in regular exercise. To promote exercise, we implemented a home-based exercise program. The aim of the program was to reduce barriers to exercise by helping patients to exercise at their convenience and without the need to travel. The effect of the program was evaluated 3 months after implementation.

Patients and Methods

Each study participant received a videotape that demonstrated 30 minutes of low-capacity aerobic exercise. Participants were advised to exercise by following the demonstration on the videotape. Encouragement was given over the telephone. Self-reports on practice were recorded in a log book that was also provided. The effect of the program was evaluated by comparing outcomes data before, and 3 months after, implementation of the program. Outcomes assessment included functional mobility (timed “Up & Go” test), muscle flexibility (“Sit & Reach” test), physical capacity (“Six-Minute Walk”), and quality of life [Kidney Disease Quality of Life Short Form (KDQOL-SF)].

Results

The program began with 72 participants. Over time, 39 dropped out. The remaining 33 participants included 11 men and 22 women with a mean age of 52.8 ± 9.8 years. They exercised 3 – 7 times weekly. Significant improvements were observed in the timed “Up & Go” ( p = 0.003) and “Sit & Reach” ( p < 0.001) tests. Improvements in the “Six-Minute Walk” ( p = 0.130) and in KDQOL-SF scores for emotional well-being ( p = 0.456), pain ( p = 0.100), burden of kidney disease ( p = 0.061), and general health ( p = 0.085) were statistically insignificant.

Conclusions

Physically, patients with ESRD benefit from home-based low-capacity aerobic exercise. A home-based program provides an alternative to outdoor and group exercise. In view of a high drop-out rate, intensive promotion and encouragement should be considered to achieve a positive outcome.
A Prospective Randomized Study on Three Different Peritoneal Dialysis Catheters
Authors: Lo Wai-Kei , Lui Sing-Leung , Li Fu-Keung , Choy Bo-Ying , Lam Man-Fai , Tse Kai-Chung , Yip Terence P.S. , Ng Flora S.K. , Lam Suk-Ching , Chu Wai-Ling , Cheng Suk-Wai
Published: February 2020

Objective

We compared outcomes for catheters with different configurations: conventional straight, swan-neck straight tip, and swan-neck curled tip.

Design

The study was conducted as a prospective randomized controlled trial in the continuous ambulatory peritoneal dialysis (CAPD) unit of a university center.

Patients and Methods

We randomized 93 new regular CAPD patients without prior peritoneal dialysis (PD) catheter insertion to receive a conventional straight, double-cuffed catheter (CS), a swan-neck straight catheter (SNC), or a swan-neck curled tip catheter (SNC) in 2:1:1 ratio.

Results

The exit-site infection (ESI) rate was slightly lower with swan-neck catheters as compared with straight catheters, but the difference was not statistically significant. The peritonitis rate and overall catheter survival were similar. In Staphylococcus aureus nasal non carriers as compared with carriers, ESI-free catheter survival was significantly better with swan-neck catheters ( p = 0.0302 and p = 0.82 respectively). As compared with SC catheters, SNC catheters had a significantly higher migration rate ( p = 0.022).

Conclusions

Swan-neck catheters were associated with a slightly better ESI rate, but SNC catheters are not routinely recommended because of a high migration rate. The SNS catheter is therefore recommended as the first-line catheter of choice, particularly in populations with a low rate of S. aureus nasal carriage.
Medico-Social Problems in Bruneian Dialysis Patients
Authors: Dwarakanathan Ranganathan , Yaakob Hjz Zarah , Hadi Hasanani , Asing Anthony
Published: February 2020

Objective

Our objective in the present study was to identify the medico-social problems in dialysis patients at the Department of Renal Medicine, RIPAS Hospital, Brunei Darussalam.

Patients and Methods

We retrospectively analyzed the social problems encountered by the patients in our dialysis program during the period January 2001 to June 2002. During that period, 285 patients were on hemodialysis (HD), and 65 patients were on continuous ambulatory peritoneal dialysis (CAPD). We made 302 referrals to the medical social unit.

Results

Of the 302 cases referred to the medical social unit, 35 (11.59%) were referred for welfare assistance from government or service clubs. Home assessments were conducted on 85 occasions (28.15%) during the study period. The HD section referred 18 (5.96%) patients to the medical social unit for assistance with employment- or work-related problems. The medical social unit also helped patients to settle medical bills (2 cases), acquire prosthetic equipment (9 cases), and obtain approval for housekeeping services applications (6 cases). Our medical social workers (MSWs) solved all 18 employment-related problems referred in HD cases. No cases were referred to the MSWs from the CAPD section for similar problems. It seems that employment-related problems are fewer in CAPD patients than in HD patients. However, long-term studies are required to confirm our findings.

Conclusion

The MSWs helped to improve the quality of life in patients undergoing dialysis in Brunei.
How to Have a Successful Peritoneal Dialysis Program
Authors: Li Philip K.T. , Chow Kai Ming
Published: February 2020

The proportion of end-stage renal disease patients on continuous ambulatory peritoneal dialysis (CAPD) has increased by twofold in Hong Kong over last two decades, accounting for 80% of the entire dialysis population. Our encouraging outcome results—a 2-year actuarial patient survival of 83%, and a 2-year technique survival of 72.8%—further testify to the success of CAPD in our territory. A relatively constant successful outcome has been achieved despite an increasing prevalence of diabetes mellitus and an aging population. The present review postulates the reasons behind our success. Apart from reimbursement policy, technique-related factors, and center effects, inherent patient factors—including baseline survival advantage of Chinese patients, genetic difference, cardiovascular risk factors, and possibly lower dialysis volume requirement and compliance—are thought to be contributory. As for the future, more efforts are needed to further improve the technique survival rate and the nutritional status, psychosocial well-being, and rehabilitation of CAPD patients. Judicious assessment of peritoneal dialysis adequacy and preservation of residual renal function should be constantly exercised to tailor treatment to the needs of Chinese CAPD patients.
Health-Related Quality of Life and Caregiver Burden among Peritoneal Dialysis Patients and Their Family Caregivers in Japan
Authors: Shimoyama Setsuko , Hirakawa Orie , Yahiro Keiko , Mizumachi Toshimi , Schreiner Andrea , Kakuma Tatsuyuki
Published: February 2020

Objective

Recent studies have found that patients with chronic renal failure suffer from depression and other symptoms of decreased mental health. However, little is know about caregiver burden and mental health among patients’ families. In the present study, we examined the relationship in Japan between peritoneal dialysis (PD) patients and caregivers with regard to health-related quality of life (HRQOL) and caregiver burden.

Method

In March of 2002, we recruited 60 subjects—26 patients on continuous ambulatory peritoneal dialysis (CAPD), and 34 caregivers—from a PD patient support group in southern Japan. We used the Kidney Disease Quality of Life Short Form (KDQOL-SF) and the Medical Outcomes Study Short Form 36 (SF-36) to measure HRQOL. We used the Zarit Burden Interview (ZBI) to measure caregiver burden. Data was also collected on each patient's duration of illness, treatment modality, age, sex, and medical history. All data were collected by mail surveys.

Results

Mean age of the PD patients was 48.2; mean age of the caregivers was 46.6. Mean caregiver burden on the ZBI was 14.1, which is considerably lower than that reported among caregivers for patients with dementia or stroke. Caregivers and patients both rated their general health and vitality among the lowest of the eight dimensions on the KDQOL-SF. In addition, patients scored lower than a normative population in all dimensions and significantly lower than caregivers in the dimensions of role physical functioning, role emotional functioning, and social functioning. Compared to national normative data for their age group, caregivers scored substantially lower in general health, vitality, and mental health.

Conclusions

Patients on CAPD are at risk for social role dysfunction, and their caregivers are at risk for decreased mental health. Further research is needed to identify interventions that can improve the HRQOL of CAPD patients and their family caregivers.
Diagnosis of Primary Hyperoxaluria Type 1 by Determination of Peritoneal Dialysate Glycolic Acid Using Standard Organic-Acids Analysis Method
Authors: Wong Ping-Nam , Law Eric L.K. , Tong Gensy M.W. , Mak Siu-Ka , Lo Kin-Yee , Wong Andrew K.M.
Published: February 2020

Objective

Hyperglycolic hyperoxaluria is an important biochemical diagnostic hallmark for primary hyperoxaluria type 1 (PH1). Biochemical work-up on urinary specimens becomes impossible after the development end-stage renal failure and anuria. We studied the diagnostic value of determining glycolic acid content in peritoneal dialysate effluent in PH1.

Patients and Methods

We performed a comparative study on an anuric continuous ambulatory peritoneal dialysis (CAPD) patient whose PH1 was confirmed by genetic study and on 5 anuric CAPD controls. Specimens were taken from each bag of peritoneal dialysate effluent over a 24-hour period, and the corresponding drainage volume was noted. The specimens were then processed using standard procedures for organic-acid analysis. They underwent ethyl acetate extraction, followed by semiquantitative analysis of organic acids by gas chromatography mass spectrometry (GCMS). The daily output of glycolic acid in peritoneal dialysate for each individual was then estimated.

Results

All 6 patients were receiving four 2-L CAPD exchanges daily. The estimated daily glycolic acid output for the PH1 patient was 48.3 μmol daily. The mean glycolic acid output for the 5 controls was estimated to be much lower at 19.6 μmol daily (range: 15.1 – 27.5 μmol daily).

Conclusion

Standard organic-acid analysis for glycolic acid in peritoneal dialysate could be a useful initial screening tool before invasive or sophisticated testing is done in CAPD patients with suspected PH1.
Fluid and Electrolyte Transport across the Peritoneal Membrane during CAPD According to the Three-pore Model
Authors: Rippe Bengt , Venturoli Daniele , Simonsen Ole , De Arteaga Javier
Published: February 2020

In the present review, we summarize the principles governing the transport of fluid and electrolytes across the peritoneum during continuous ambulatory peritoneal dialysis (CAPD) in “average” patients and during ultrafiltration failure (UFF), according to the three-pore model of peritoneal transport. The UF volume curves as a function of dwell time [V( t)] are determined in their early phase by the glucose osmotic conductance [product of the UF coefficient (LpS) and the glucose reflection coefficient (σg)] of the peritoneum; in their middle portion by intraperitoneal volume and glucose diffusivity; and in their late portion by the LpS, Starling forces, and lymph flow. The most common cause of UFF is increased transport of small solutes (glucose) across the peritoneum, whereas the LpS is only moderately affected. Concerning peritoneal ion transport, ions that are already more or less fully equilibrated across the membrane at the start of the dwell, such as Na+ (Cl–), Ca2+, and Mg2+, have a convection-dominated transport. The removal of these ions is proportional to UF volume (approximately 10 mmol/L Na+ and 0.12 mmol/L Ca2+ removed per deciliter UF in 4 hours).

The present article examines the impact on fluid and solute transport of varying concentrations of Ca2+ and Na+ in peritoneal dialysis solutions. Particularly, the effect of “ultralow” sodium solutions on transport and UF is simulated and discussed. Ions with high initial concentration gradients across the peritoneum, such as K+, phosphate, and bicarbonate, display a diffusion-dominated transport. The transport of these ions can be adequately described by non-electrolyte equations. However, for ions that are in (or near) their diffusion equilibrium over the peritoneum (Na+, Ca2+, Mg2+), more complex ion transport equations need to be used. Due to the complexity of these equations, however, non-electrolyte transport formalism is commonly employed, which leads to a marked underestimation of mass transfer area coefficients (PS). This can be avoided by determining the PS when transperitoneal ion concentration gradients are steep.
Leukocyte CD11b and CD62L Expression in Response to Interstitial Inflammation in CAPD Patients
Authors: Dadfar Elham , Lundahl Joachim , Fernvik Eva , Nopp Anna , Hylander Britta , Jacobson Stefan H.
Published: February 2020

Objective

Very little is known about the kinetics of leukocyte recruitment and the modulation of adhesion molecules on leukocytes in the interstitium at the site of inflammation outside the peritoneal cavity in patients on peritoneal dialysis. These issues were addressed in the present study.

Patients and Methods

Two skin blisters were raised in 10 patients on peritoneal dialysis and in 19 healthy subjects. After 12 hours, blister exudates were collected and the blisters were thereafter challenged with buffer or autologous serum in order to establish an intermediate and an intense cutaneous inflammation. Leukocyte count, leukocyte CD11b/CD62L expression, monocyte chemotactic protein-1 (MCP-1), and interleukin-8 (IL-8) were determined in blood and at the three sites of interstitial inflammation by immunostaining, flow cytometry, and ELISA.

Results

In monocytes and granulocytes, expression of CD11b increased and CD62L decreased significantly during the transmigration process from the peripheral blood into the three sites of interstitial inflammation. In the nonstimulated blister, expression of CD11b on both monocytes and granulocytes was similar in patients and healthy subjects. At the site of intermediate inflammation, expression of CD11b on both monocytes and granulocytes was significantly higher in healthy subjects compared to patients ( p < 0.05 and p < 0.001 respectively). At the site of intense inflammation, expression of CD11b on granulocytes was significantly lower ( p < 0.001), and CD62L significantly higher ( p < 0.001) in patients. Interstitial concentrations of MCP-1 and IL-8 at the sites of intermediate inflammation were significantly higher in healthy subjects compared to patients ( p < 0.05 and p < 0.05 respectively). However, at the site of intense inflammation, similar concentrations of MCP-1 and IL-8 were observed. Furthermore, there were no significant correlations between concentrations of MCP-1 and IL-8 in blister exudates and expression of CD11b on monocytes and granulocytes at the sites of interstitial inflammation.

Conclusion

The ability of monocytes and granulocytes to modulate the expression of adhesion molecule in response to interstitial inflammation was significantly impaired in patients on peritoneal dialysis. Furthermore, these data suggest that the expression of CD11b on leukocytes is not dependent on concentrations of IL-8 and MCP-1 in interstitium in this patient group.