bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Gastric Emptying Rate and Nutritional Status in Patients Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Stompór Tomasz , Hubalewska–Hola Alicja , Staszczak Anna , Sulowicz Wladyslaw , Huszno Bogdan , Szybinski Zbigniew
Published: February 2020

♦ Objective

To estimate gastric emptying rate in continuous ambulatory peritoneal dialysis (CAPD) patients, with or without indwelling dialysate, and to evaluate if there is an association between gastric motility and nutritional status.

♦ Design

Single-center cross-sectional study.

♦ Setting

Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Krakow, Poland.

♦ Patients and Methods

20 end-stage renal disease patients [11 F, 9 M; mean age 50.1 ± 11 years; treated with CAPD for median 13.5 (2 – 61) months] were studied. All patients were nondiabetic and had no comorbidity that might influence gastric motility; nor were they receiving any prokinetic drugs. Gastric emptying rate was estimated with dynamic abdominal scintigraphy, started immediately after complete ingestion of a standard 200-kcal solid meal injected with 99mTc-labeled colloid, activity 40 MBq. Scintigraphy was performed at the rate of 23 images in 4-minute intervals for 92 minutes. Two consecutive procedures — with and without PD fluid — were performed at weekly intervals. As nutritional parameters, protein catabolic rate (PCR) and lean body mass (LBM) (based on urea and creatinine kinetics, respectively), body mass index (BMI), and serum albumin were measured.

♦ Results

All analyzed gastric emptying parameters, measured with or without dialysis fluid, were markedly prolonged in patients compared to values accepted as normal in the local scintigraphy unit. Gastric emptying half-time (T1/2) and percent of initial activity in minute 46 and in minute 92 were 60.5 ± 25.0 minutes, 57.19% ± 17.5%, and 33.8% ± 20.9% with a full peritoneal cavity, and 63.9 ± 28.2 minutes, 59.1% ± 23.9%, and 33.9% ± 24.3% with an empty peritoneal cavity. The T1/2 and percent of initial activity after 46 and 92 minutes for healthy subjects were 39 ± 9 minutes, 45% ± 11%, and 15% ± 6%, respectively. T1/2 without dialysis fluid revealed a negative correlation with LBM and BMI values ( r = –0.5, p < 0.05, and r = –0.56, p < 0.01; respectively). Patients with dialysate-free T1/2 > 40 minutes were characterized by significantly lower serum albumin level compared to subjects with T1/2 < 40 minutes (39.2 ± 2.9 vs 42.9 ± 3.6 g/L, p < 0.05). The values of all gastric emptying parameters measured for an empty abdomen were prolonged in subjects with BMI < 25 kg/m2. No difference was found between patients with and without PD fluid.

♦ Conclusions

Gastric emptying is markedly impaired in CAPD patients compared to healthy subjects. However, the presence of dialysate does not influence it significantly. Gastric emptying rate was negatively associated with the nutritional status of treated subjects. This association can be demonstrated when gastric motility is measured with an empty peritoneal cavity.
Generalized Dilation of the Visceral Microvasculature by Peritoneal Dialysis Solutions
Authors: Zakaria El Rasheid , Spain David A. , Harris Patrick D. , Garrison R. Neal
Published: February 2020

Objectives

Conventional peritoneal dialysis solutions are vasoactive. This vasoactivity is attributed to hyperosmolality and lactate buffer system. This study was conducted to determine if the vasodilator property of commercial peritoneal dialysis solutions is a global phenomenon across microvascular levels, or if this vasodilation property is localized to certain vessel types in the small intestine.

Design

Experimental study in a standard laboratory facility.

Interventions

Hemodynamics of anesthetized rats were monitored while the terminal ileum was prepared for in vivo intravital microscopy. Vascular reactivity of inflow arterioles (A1), branching (A2), and arcade, as well as pre-mucosal (A3) arterioles was assessed after suffusion of the terminal ileum with a non-vasoactive solution or a commercial 4.25% glucose-based solution (Delflex; Fresenius USA, Ogden, Utah, USA). Vascular reactivity of three different level venules was also assessed. Maximum dilation response was obtained from sequential applications of the endothelial-dependent dilator, acetylcholine (10–5 mol/L), and the endothelial-independent nitric oxide donor, sodium nitroprusside (NTP; 10–4mol/L).

Results

Delflex induced an instant and sustained vasodilation that averaged 28.2% ± 2.4% of baseline diameter in five different-level arterioles, ranging in size between 7 μ and 100 μ. No significant vascular reactivity was observed in three different-level venules. Delflex increased intestinal A1 blood flow from baseline 568 ± 31 nL/second to 1049 ± 46 nL/sec ( F = 24.7, p < 0.001). Similarly, intestinal venous outflow increased to 435 ± 17 nL/sec from a baseline outflow of 253 ± 59 nL/sec ( F = 4.7, p < 0.05). Adjustment of the initial pH of Delflex from 5.5 to 7.4 resulted in similar microvascular responses before pH adjustment.

Conclusions

Ex vivo exposure of intestinal arterioles to conventional peritoneal dialysis solutions produces a sustained and generalized vasodilation. This vasoactivity is independent of arteriolar level and the pH of the solution. Dialysis solution-mediated vasodilation is associated with doubling of A1 intestinal arteriolar blood flow. Addition of NTP at an apparent clinical dose does not appear to produce any further significant arteriolar dilation than that induced by dialysis solution alone. Experimental data that estimate the exchange vessel surface area per unit volume of tissue will be required to make a correlation with permeability in order to extrapolate our findings to clinical in vivo conditions.
Association between an Increased Surface Area of Peritoneal Microvessels and a High Peritoneal Solute Transport Rate
Authors: Numata Miwako , Nakayama Masaaki , Nimura Satoshi , Kawakami Makio , Lindholm Bengt , Kawaguchi Yoshindo
Published: February 2020

Objective

The peritoneal solute transport rate (PSTR) often increases, especially for small solutes, during long-term peritoneal dialysis (PD) treatment. Although the mechanism by which PSTR increases in PD patients is not known, it is likely that an increased PSTR reflects an increased surface area of the peritoneal capillary and postcapillary venules (microvessels), but this has not previously been investigated. The aim of this study was to clarify the relationship between PSTR and peritoneal microvessel alterations in biopsy specimens of peritoneum obtained from PD patients after various times on PD, and the possible contribution of the duration of PD in relation to these alterations.

Design

Tissue from the parietal peritoneum was obtained from 22 PD patients (age 48.5± 9.0 years, duration of PD 66.3 ± 46.6 months, incidence of peritonitis 0.3/patient-year). The patients were subdivided into three groups according to duration of PD: zero months (group 0, n = 4), less than 60 months (group I, n = 7), and more than 60 months (group II, n = 11).

Methods

For each specimen, the relative microvessel area (RVA) calculated as total area of microvessels/total area of peritoneal field, and the relative microvessel number (RVN), calculated as number of microvessels/total area of peritoneal field, were determined. The ratio RVA/RVN was used to assess the average area of microvessels. The PSTR was evaluated for creatinine, glucose, β2-microglobulin, and albumin using the peritoneal equilibration test.

Results

The dialysate-to-plasma concentration ratio (D/P) for creatinine showed a significant positive correlation with both RVA (rho = 0.77, p < 0.001) and RVA/RVN (rho = 0.51, p = 0.01), but not with RVN. The D/P for β2-microglobulin correlated with RVA (rho = 0.51 p = 0.015) but not with RVN or RVA/RVN. No differences were found between the three groups in the values for RVN, whereas there was an apparent significant increase in RVA with time on PD ( p < 0.001 for group 0 vs both groups I and Furthermore, in high transporters, RVA tended to be higher in group II than in group I.

Conclusions

The present study demonstrates for the first time that an increased peritoneal solute transport rate (for both creatinine and β2-microglobulin) is associated with an increased surface area of peritoneal microvessels, especially in patients on long-term PD treatment. This indicates that increased vascularization and/or dilatation of peritoneal microvessels may play a key role in the development of a high PSTR.
Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others
Authors: Agarwal Mamta , Clinard Patricia , Burkart John M.
Published: February 2020

Objective

To determine the clinical experience of using combined-modality [simultaneous hemodialysis (HD) and peritoneal dialysis (PD)] treatment in patients with end-stage renal disease.

Design

We reviewed data on 4 patients from our center that were treated with “combined-mode therapy.” We then conducted a retrospective survey by sending questionnaires to nephrologists in the US and Canada by mail and by posting the survey on the Internet. Data queried included number of patients on combined modality, solute clearances, albumin levels pre and post combined therapy, reasons for using combined therapy, duration and success of combined therapy, and reimbursement issues.

Setting and Participants

Ours is a tertiary-care center. Patients that were not doing well on PD alone were put on combined modality of treatment between 1992 and 1998.

Main Outcome Measures

Clinical improvement in the indication for which the participant was started on combined modality.

Results

In response to the survey, data on 27 patients were collected. These data were combined with data on 4 patients from our unit that had previously been treated with combined HD and PD. Most patients were reported to have more than one clinical reason for changing from PD to combined therapy. The main clinical reason for offering combined treatments was inadequate solute clearance (34%), followed by ultrafiltration problems (16%) and neuropathy (11%). Mean duration of time followed on combined treatment was 8.5 ± 0.12 months. Most patients tolerated combined treatment well and were reported to show improvement in the clinical reasons for which they needed the combined modality. Dual access and reimbursement issues were not a problem. There was no single method used for calculating total (HD, PD, and residual renal) solute clearance. No universal total solute clearance goal was reported.

Conclusion

Hemodialysis and PD are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of patients. Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.
Experience using Presternal Catheter for Peritoneal Dialysis in Poland: A Multicenter Pediatric Survey
Authors: Warchol Stanislaw , Roszkowska–Blaim Maria , Latoszynska Joanna , Jarmolinski Tomasz , Zachwieja Jacek
Published: February 2020

← Objectives

Permanent and adequate access to the peritoneal cavity is the key to successful chronic peritoneal dialysis (PD). A variety of catheter designs and implantation techniques have been developed to achieve optimal peritoneal access. One such new and modified PD catheter is the presternal catheter [swan neck presternal catheter (SNPC)], with the exit site located on the chest wall.

← Design

A multicenter survey was undertaken to summarize 10 years of experience with the presternal catheter in children in Poland.

← Setting

Four pediatric institutions using the SNPC in children: ( 1 ) Medical University of Warsaw, Warsaw; ( 2 ) Childrens’ Memorial Health Institute, Warsaw; ( 3 ) District Children's Hospital, Szczecin; ( 4 ) University of Medical Sciences, Poznan.

← Patients

During the past 10 years, 20 presternal catheters were implanted in 19 children, aged 0.2 – 17.7 years (mean 8 ± 5.8 years), with end-stage renal failure. The main indications for the SNPC include urinary diversion (ureterocutaneostomy or vesicostomy), use of diapers, young age, obesity, abdominal wall weakness, and recurrent exit-site infections (ESI) with previous abdominal PD catheters.

← Intervention

In all children the presternal catheter was implanted surgically under general anesthesia by one surgeon. Uniform operative technique and uniform perioperative management were used.

← Results

The mean observation time for the 20 presternal catheters was 24.8 ± 25 months (range 1 – 83 months). The ESI rate was 1/70.9 patient-months (0.17 episodes per year), tunnel infection rate was 1/248 patient-months (0.05 episodes per year), and the overall peritonitis rate was 1/26.6 patient-months (0.51 episodes per year). Noninfectious complications associated with the SNPC included disconnection of both sections (2 children) and trauma to the exit site located on the chest wall (4 children). Mean survival time of the presternal catheter, as calculated by the Kaplan–Meier method, was 57.5 ± 8.5 months; 50% catheter survival reached 72 months.

← Conclusions

The good outcome in patients with a SNPC validates the rationale for the presternal catheter design and should encourage its more widespread use. The SNPC seems to be suitable for any patient on PD; however, this catheter is particularly useful in patients with specific indications ( i.e., higher tendency to ESI). The SNPC allows safe and long-term chronic PD in very young children using diapers and in patients with urinary diversion.
Effect of Polymeric Diets in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Galindo Beatriz A. Aguirre , Fierro Jorge G. Prieto , Cano Pedro , Abularach Leonor , Rentería Armando Nieves , Navarro Maricela , Del Río Jesús
Published: February 2020

Objective

To determine if a diet complemented with calcium caseinate is better than a natural high protein diet for increasing serum albumin levels in patients on continuous ambulatory peritoneal dialysis (CAPD).

Patients and Methods

A 4-month clinical trial involving 100 patients older than 18 years was performed. Patients were randomized into two groups: group A, high protein diet (1.4 g natural protein/kg target weight/day and 35 kcal/kg target weight/day); and group B, calcium caseinate (0.7 g calcium caseinate plus 0.7 g natural protein diet/kg target weight/day and 35 kcal/kg target weight/day). Serum levels of albumin, total proteins (TP), BUN, creatinine, glucose, urea, sodium, and potassium, and hematocrit, leukocytes, erythrocytes, and hemoglobin were analyzed at baseline and every 30 days.

Results

The final mean albumin value was, for group A, 3.04 ± 0.39 g/dL, and for group B, 3.1±2 0.41 g/dL ( p < 0.05); TP for group A, 6.29 ± 0.47 g/dL, and for group B, 6.49 ± 0.51 g/dL ( p < 0.05); leukocytes for group A, 688 ± 8 1282/mm3, for group B, 7288 ± 1878/mm3 ( p = 0.05); BUN for group A, 47 ± 11 mg/dL, for group B, 50 ± 16 mg/dL ( p = 0.05). Regression analysis showed a treatment effect in serum albumin and TP levels from the third month in both groups. In group B, a constant elevation of serum albumin of 0.19 mg/dL and TP of 0.27 mg/dL was observed in every month of treatment with calcium caseinate. In the regression analysis of group A we observed a smaller increase in serum albumin, 0.06 mg/dL, and in TP, 0.11 mg/dL, in each month of treatment with the high protein diet. Both differences are significant ( p < 0.05).

Conclusion

Calcium caseinate used in CAPD patients suffering from malnutrition increases serum albumin levels.
Incidence and Significance of Peritoneal Eosinophilia during Peritoneal Dialysis-Related Peritonitis
Authors: Fontán Miguel Pérez , Rodríguez-Carmona Ana , Galed Ignacio , Iglesias Pilar , Villaverde Pedro , García-Ureta Ernesto
Published: February 2020

Objective

To determine the incidence and significance of peritoneal eosinophilia (PEo) during peritoneal dialysis (PD)-related peritonitis.

Design

Retrospective observational study.

Setting

Tertiary-care public hospital.

Patients and Method

We performed a cytological study of dialysate at the start of 465 cases of peritonitis diagnosed between January 1987 and May 2002. Cases associated with PEo (> 10% eosinophils) were classified according to their infectious or seemingly noninfectious origin. We compared the two groups, trying to disclose differentiating patterns of presentation.

Results

We found PEo in 42 cases. Infectious peritonitis was the final diagnosis in 22 of the 42 cases; a diagnosis of idiopathic eosinophilic peritonitis was finally established in 20 cases. The etiologic spectrum of infectious peritonitis with PEo did not differ markedly from the global spectrum of peritonitis in our unit. Infectious peritonitis with PEo tended to appear later in the course of PD therapy, presented with more severe clinical symptoms, displayed higher total peritoneal leukocyte and neutrophil counts, and showed lower degrees of PEo than idiopathic eosinophilic peritonitis, but overlap between the groups was significant.

Conclusions

Peritoneal eosinophilia is infrequent but not rare during infectious PD-related peritonitis. Our findings agree with established concepts on idiopathic eosinophilic peritonitis, but overlap in presentation with infectious eosinophilic peritonitis is significant, which should be taken into consideration at the time of planning therapy for this condition.
An Exploratory Study of a Novel Peritoneal Combination Dialysate (1.36% Glucose/7.5% Icodextrin), Demonstrating Improved Ultrafiltration Compared to Either Component Studied Alone
Authors: Jenkins Sarah B. , Wilkie Martin E.
Published: February 2020

Objective

Concerns regarding the impact of ultrafiltration failure on peritoneal dialysis and the effect of hypertonic glucose on the peritoneal membrane have lead to a search for alternative dialysates. Computer simulations based on the three-pore theory suggest that a combination of 1.36% glucose and 7.5% icodextrin (glucose polymer) offers an improved ultrafiltration profile. The aim of the present study was to investigate the ultrafiltration profile of this combination fluid.

Design

Prospective open study comparing 1.36% glucose, 3.86% glucose, 7.5% icodextrin, and the combination fluid (1.36% glucose/7.5% icodextrin).

Setting

Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK.

Patients

11 patients currently using peritoneal dialysis not previously exposed to icodextrin.

Main Outcome Measure

Intraperitoneal volume was measured using a radioisotope dilution method.

Results

The combination fluid showed a biphasic ultrafiltration profile, with a steep initial increase in intraperitoneal volume, then a maintained plateau phase for the duration of the study dwell (7 hours). The final volume was greater than that with the 1.36% glucose dwell and the 7.5% icodextrin dwell. The fluid was well tolerated by the patients.

Conclusions

These findings are in keeping with computer simulations using the three-pore model. The combination fluid offers an improved ultrafiltration profile, with a final volume similar to 3.86% glucose, while avoiding exposing the peritoneal membrane to high glucose concentrations. It may have a role as a long dwell to optimize ultrafiltration and possibly prolong peritoneal dialysis technique survival.
Influence of Climate on the Incidence of Peritoneal Dialysis-Related Peritonitis
Authors: Szeto Cheuk-Chun , Chow Kai-Ming , Wong Teresa Yuk-Hwa , Leung Chi-Bon , Li Philip Kam-Tao
Published: February 2020

Objective

The use of peritoneal dialysis has expanded in many developing subtropical countries; however, the role of climatic factors in dialysis-related peritonitis has not been studied in detail.

Design

Retrospective study.

Setting

A single regional dialysis unit in a university teaching hospital.

Patients

We reviewed all cases of dialysis-related peritonitis treated in our dialysis unit from January 1995 to December 2001. Information was collected on demographic data, microbiologic etiology, associated catheter exit-site infection, and clinical response.

Results

In 24 059 patient-months of follow-up, 1344 episodes of peritonitis were recorded. There were significantly more peritonitis episodes in July and August [odds ratio 1.17, 95% confidence interval (CI) 1.03 – 1.32], and fewer peritonitis episodes in December (odds ratio 0.79, 95% CI 0.61 – 0.98). There was also a trend of more peritonitis in March (odds ratio 1.18, 95% CI 0.97 – 1.41), but the difference was not statistically significant. When the incidence of peritonitis caused by individual bacterial species was further analyzed, we found a significant seasonal variation in the rate of peritonitis caused by gram-negative bacteria, except Pseudomonas (overall chi-square test, p = 0.002). A similar trend of seasonal variation was also observed in gram-positive peritonitis, but the result was not statistically significant. There was significant seasonal variation in the rate of peritonitis that had coexisting exit-site infection (overall chi-square test, p = 0.02), with peak incidence in July. However, the proportion of peritonitis that had coexisting exit-site infection did not have significant seasonal variation. There was significant correlation between monthly peritonitis rate and average humidity ( r = –0.346, p < 0.002) and temperature ( r = –0.264, p = 0.015).

Conclusions

There is substantial seasonal variation in the incidence of dialysis-related peritonitis, with peak incidence in the months that are hot and humid. Keeping a cool and dry living environment may help to reduce peritonitis in peritoneal dialysis patients in tropical countries.
Nutritional Problems of Asian Peritoneal Dialysis Patients
Authors: Kang Duk-Hee , Kang Ea Wha , Choi So Rae , Yoon Soo-Young , Han Dae-Suk
Published: February 2020

Clear evidence links malnutrition with poor outcome in peritoneal dialysis (PD) patients; however, most studies have evaluated Western populations, which may have clinical and demographic characteristics different from those of Asian populations. Although Asian PD patients are generally regarded to have survival superior to that of Western patients, whether that better survival is related to better nutrition in Asian patients is not clear. Past studies suggest that the overall prevalence of protein–calorie malnutrition as assessed by subjective global assessment (SGA)—especially cases of severe malnutrition—seems to be lower in Asian PD patients than in Western patients. Less activation of systemic inflammatory reaction, less comorbidity, lower prevalence of metabolic acidosis, or better compliance may be responsible for better nutritional status in Asian PD patients. Dietary protein and calorie intake, dialysis dose, and membrane transport characteristics appear not to differ significantly between Asian and non Asian PD patients. Mechanisms that explain the lower prevalence of systemic inflammatory reaction in Asian PD patients need to be investigated, along with their possible impacts on nutrition and cardiovascular morbidity and mortality. Large-scale, prospective studies are also necessary to ascertain the exact correlation between dialysis dose and nutritional status, and to determine the dietary protein and calorie intakes that maintain a positive nitrogen balance and better outcome in Asian PD patients.
Dialysis Adequacy Targets in Continuous Ambulatory Peritoneal Dialysis—Higher is Not Necessarily Better
Authors: Lo Wai Kei
Published: February 2020

Evidence for the recommendations by the Dialysis Outcomes Quality Initiative (DOQI) on peritoneal dialysis targets was obtained largely from observational studies showing improvement of clinical outcome with higher Kt/V. Recently published interventional studies—including the ADEMEX study and several studies from Asia—did not show significant improvement of outcome with increased peritoneal Kt/V or creatinine clearance. The possible reasons for lack of improvement might include the limitations of increased dialysis with regard to middle-molecule clearance and the harmful effects of excessive dialysis. The body of evidence suggests that a total Kt/V below 1.7 is associated with a poorer outcome. A minimal Kt/V target of 1.7 is suggested, with the dialysis prescription also being guided by other clinical parameters.
Adverse Prognostic Indicators in Continuous Ambulatory Peritoneal Dialysis Patients without Obvious Vascular or Nutritional Comorbidities
Authors: Wong Ping-Nam , Mak Siu-Ka , Lo Kin-Yee , Tong Gensy M.W. , Wong Yuk , Wong Andrew K.M.
Published: February 2020

Objectives

Factors that predict the occurrence of vascular events and poor patient survival in continuous ambulatory peritoneal dialysis (CAPD) patients have not been clearly defined. Previous studies have focused on nonselective CAPD patients, in whom pre-existing comorbidity or poor health might complicate interpretation of the significance of individual factors. The present study was conducted with CAPD patients without severe vascular and nutritional comorbidity.

Patients and Methods

This single-center, prospective, observational study was conducted with 66 prevalent CAPD patients without co-existing severe vascular or nutritional problems. The patients were enrolled in January 1999. We monitored baseline demographic data and clinical and laboratory characteristics including average clinic blood pressure (BP), hemoglobin (Hb), serum albumin, intact parathyroid hormone (iPTH), serum cholesterol, triglycerides, dialysate-to-plasma (D/P) creatinine, dialysis adequacy [Kt/V and creatinine clearance (CCr)], and protein equivalent of nitrogen appearance. We followed the patients for 3 years. Outcome measures were actuarial patient survival, time to occurrence of cerebrovascular accident (CVA) and acute myocardial infarction (AMI), technique survival, and hospitalization rate.

Results

Mean age of the patients was 56.7 ± 10.3 years. Mean duration on CAPD at the time of enrollment was 36.4 ± 21.7 months. Nineteen of the patients (28.8%) had diabetes. Most of the patients [ n = 55 (83.3%)] were using three 2-L exchanges daily. Mean body weight was 56.3 ± 12.2 kg. Mean total weekly Kt/V was 1.91 ± 0.47, and mean total weekly CCr was 75.3 ± 30.6 L/1.73 m2. Actuarial patient survival was 96.9% at 1 year, 90.5% at 2 years, and 75.3% at 3 years. Overall technique survival was 96.9% at 1 year, 95.1% at 2 years, and 89.1% at 3 years. Multivariate analysis showed that age, diabetes mellitus (DM), and body size (weight or surface area) were independent predictors of patient survival. We estimated that a 1-kg increase in body weight was associated with a 6% increase in the relative risk of death ( p = 0.015; 95% confidence interval: 1.013 to 1.126). Patients with a body weight of 60 kg or less showed a significantly better 3-year survival as compared with patients with body weight greater than 60 kg (88.1% vs 58.3%, p = 0.0042). No significant predictors were identified for technique failure or occurrence of a major vascular event. High BP and DM were independent predictors for hospitalization. Dialysis adequacy indices and serum albumin showed no significant effect on any outcome measure.

Conclusions

Our study showed that, in addition to age and DM, body size could also be a significant factor affecting survival of CAPD patients. However, the underlying causative mechanisms remain unclear and require further study.
Risk Factors for Poor Outcome of Fungal Peritonitis in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Lo Stanley H.K. , Chan Ching-kit , Shum Hoi-ping , Chow Vincent C.C. , Mo Ka-leung , Wong Kin-shing
Published: February 2020

Objective

Fungal peritonitis is rare among end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), but when it occurs, it is associated with a high risk of mortality and peritoneal membrane failure. In the present study, we identified risk factors for poor outcome and examined the effect of treatment profile on outcome in fungal peritonitis.

Patients and Methods

We identified cases of fungal peritonitis in CAPD patients in a regional dialysis center and analyzed the possible risk factors for poor outcome in fungal peritonitis. To estimate the amount of dextrose presented to the peritoneum, we scored the dextrose content of the peritoneal dialysis fluid used by the patient at the time of admission to hospital (1 point to each bag of 1.5% fluid, 2 points to each bag of 2.3% or 2.5% fluid, and 3 points to each bag of 4.25% fluid daily).

Results

Among 471 episodes of CAPD-related peritonitis in 7.8 years, we identified 22 episodes of fungal peritonitis (4.7%). The ratio of men to women in the fungal peritonitis group was 1.4:1. Seventeen patients (77.3%) practiced dialysis without a helper. Within the 3 months preceding the fungal peritonitis, 12 patients (55%) had had bacterial peritonitis. Among the cases of fungal peritonitis, we identified 9 cases of Candida parapsilosis and 13 cases of non C. parapsilosis. All of the patients received fluconazole, and 7 patients (31.8%) also received flucytosine. The Tenckhoff catheter was removed in 17 patients (77.3%). Eight patients (36.4%) either died or lost peritoneal function. The risk of mortality was increased if the fungal organism was C. parapsilosis [odds ratio (OR): 4.25; 95% confidence interval (CI): 1.8 to 10.0; p = 0.002], if a helper was involved (OR: 11.3; 95% CI: 1.1 to 114; p = 0.024), or if CAPD duration was more than 26 months (OR: 2.2; 95% CI: 1.3 to 3.5; p = 0.034). Addition of flucytosine to fluconazole did not significantly improve the mortality rate in either the C. parapsilosis or non C. parapsilosis group. Multivariate analysis showed that C. parapsilosis was an independent factor associated with mortality ( p = 0.013). A dextrose score greater than 5 was associated with a trend toward increased risk of peritoneal failure (OR: 3.4; 95% CI: 1.6 to 7.1; p = 0.021).

Conclusion

C. parapsilosis is an independent risk factor for mortality in fungal peritonitis.
Training of Peritoneal Dialysis Nurses
Authors: Tan Poh-choo , Morad Zaki
Published: February 2020

Clinical disciplines in which the nurse plays as preeminent a role in total patient care as in peritoneal dialysis (PD) are few. The PD nurse is readily identified by the patient as the principal source of advice on day-to-day aspects of treatment, as a resource manager for supplies of PD disposables and fluids, and as a general counselor for all kinds of advice, including diet, rehabilitation, and medication, among others.

The PD nurse is thus the key individual in the PD unit, and most activities involve and revolve around the nursing staff. It is therefore not surprising that most nephrologists pay considerable attention to the selection of PD nurses, particularly in long-term PD programs such as continuous ambulatory peritoneal dialysis (CAPD). The appointment of a PD nurse depends on finding an individual with the right attributes, broad general experience, and appropriate training.
Independent Effects of Renal and Peritoneal Clearances on the Mortality of Peritoneal Dialysis Patients
Authors: Szeto Cheuk-Chun , Wong Teresa Yuk-Hwa , Chow Kai-Ming , Leung Chi-Bon , Law Man-Ching , Li Philip Kam-Tao
Published: February 2020

Objective

Previous studies show that peritoneal Kt/V is an independent predictor of survival in anuric patients receiving continuous ambulatory peritoneal dialysis (CAPD). We studied whether peritoneal Kt/V has the same effect in CAPD patients with residual renal function.

Design

Observational cohort study.

Setting

Single dialysis center in a university teaching hospital.

Patients

New and prevalent CAPD patients.

Methods

We examined the 5-year follow-up results of our prospective study previously reported ( Kidney Int 2000; 58:400–7). A total of 270 CAPD patients were followed for up to 6 years. Dialysis adequacy indices, residual renal function, and nutritional data were monitored.

Outcome Measures

Primary outcomes included mortality and technique failure. Peritoneal Kt/V rather than total Kt/V was used for multivariate survival analysis.

Results

Average duration of follow-up was 35.1 ± 22.0 months. Average peritoneal Kt/V throughout the study was 1.59 ± 0.37; median residual glomerular filtration rate (GFR) 0.82 mL/minute. Five-year actuarial patient survival was 41.5%, and technique survival was 23.1%. Multivariate analysis showed that sex, age, duration of dialysis, presence of diabetes, serum albumin, dialysate-to-plasma creatinine ratio at 24 hours, peritoneal Kt/V, residual GFR, and normalized protein nitrogen appearance were independent factors of both actuarial patient survival and technique survival. For every 0.1 unit higher peritoneal Kt/V, relative mortality risk was 0.94 (95% CI 0.89 – 0.99, p = 0.03). When prevalent and new CAPD cases were analyzed separately, peritoneal Kt/V predicted survival only for prevalent CAPD patients.

Conclusion

We conclude that, in prevalent CAPD patients with relatively low levels of peritoneal clearance and residual renal function, a higher peritoneal Kt/V is associated with better survival. Peritoneal clearance below 1.6 – 1.7 likely has a major detrimental effect on the clinical outcome of CAPD patients with little residual renal function.
Catabolism of Newly Synthesized Decorin in vitro by Human Peritoneal Mesothelial Cells
Authors: Yung Susan , Hausser Heinz , Thomas Gareth , Schaefer Liliana , Kresse Hans , Davies Malcolm
Published: February 2020

Objective

Previous studies have shown that decorin and biglycan account for over 70% of the proteoglycans (PGs) synthesized by human peritoneal mesothelial cells (HPMCs). Since these PGs are involved in the control of cell growth, cell differentiation, and matrix assembly, we investigated their turnover in cultured HPMCs.

Methods

Confluent HPMCs were metabolically labeled with [35S]-sulfate and the labeled products isolated from the cell medium and the cell layer characterized by sensitivity to bacterial eliminases. Experiments were undertaken with exogenous labeled decorin, and its metabolic state was studied.

Results

In a 24-hour labeling period, 75% of the newly synthesized chondroitin sulfate/dermatan sulfate (CS/DS) PGs appeared in the culture medium, the majority of which (90%) was decorin. In the cell layer, protein-free glycosaminoglycan (GAG) chains accounted for 21% of the total CS/DS at 24 hours and exhibited constant specific activity at 12 – 16 hours. The latter material was turned over with a half-life of approximately 2.5 hours. Exogenous decorin underwent receptor-mediated endocytosis and subsequent intracellular degradation. Uptake but not degradation could be inhibited by heparin.

Conclusions

HPMCs are distinguished by a rapid turnover of decorin. A characteristic metabolic feature is the existence of a large intracellular pool of protein-free DS-GAGs. Understanding the control of decorin turnover in HPMCs might lead to delineation of its potential role in both the physiology and pathophysiology of the membrane in PD patients.
The Effect of Depressive Symptoms on Survival in Peritoneal Dialysis Patients
Authors: Einwohner Rebecca , Bernardini Judith , Fried Linda , Piraino Beth
Published: February 2020

Objective

There is little information on the relationship between depressive symptoms and survival in peritoneal dialysis (PD) patients. We examined whether a single measurement of depressive symptoms using a simple self-administered tool predicts survival.

Design

Screening test of depressive symptoms as a predictor of outcome.

Setting

Three dialysis centers in Southwestern Pennsylvania.

Participants

66 adult PD subjects were screened in 1997–1998 for depression using the Zung scale.

Main Outcome Measures

Baseline data collection included assessments of comorbidity, residual renal function, total Kt/V, nPNA, previous renal transplant, and serum albumin. Outcomes were collected prospectively after completion of the depression survey to 12/01. Cox regression analysis of patient survival was performed using all cofactors with p < 0.05 on univariate analysis.

Results

One third of patients had depressive symptoms. Compared to nondepressed patients, depressive symptom patients were older (62.5 vs 52.5 years, p = 0.012), had borderline lower serum albumin levels (3.47 vs 3.70 g/dL, p = 0.058), and were more disabled (Karnofsky score 70 vs 90, p < 0.001), but had similar Kt/V, residual renal function, and previous time on PD at the point of the testing. Using multivariate analysis and controlling for comorbidity (using a measurement that includes diabetes mellitus and age) and serum albumin, the survival of patients with depressive symptoms was significantly reduced compared to nondepressed patients.

Conclusion

A single measurement of depressive symptoms using a simple self-administered test was an independent predictor of death in a cohort of PD patients, which extends observations in hemodialysis patients. Screening for depressive symptoms should be routine for dialysis patients, and those depressed should have thorough assessment and treatment. Whether treating depression will have an impact on survival is unclear and needs to be studied.
Exercise Capacity in Pediatric Patients with End-Stage Renal Disease
Authors: Pattaragarn Anirut , Warady Bradley A. , Sabath Richard J.
Published: February 2020

Objective

To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis.

Design

Prospective case-control study and retrospective review.

Setting

Dialysis summer camp and Children's Mercy Hospital exercise laboratory.

Participants

Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 ± 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 ± 3.3 years), all of whom received APD.

Intervention

Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed.

Main Outcome Measures

Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2 AT), and respiratory exchange ratio.

Results

The hemoglobin value of the current patient group (12.8 ± 1.6 g/dL) was significantly greater than the previously studied patients (10.5 ± 1.1 g/dL) ( p = 0.001). Treadmill time, VO2, and VO2 AT were significantly lower in both groups of dialysis patients compared to the control subjects ( p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only.

Conclusion

The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.
The Self-Locating Catheter: Clinical Experience and Follow-Up
Authors: Di Paolo Nicola , Capotondo Luigi , Sansoni Enrico , Romolini Valerio , Simola Matteo , Gaggiotti Enzo , Bercia Roberto , Buoncristiani Umberto , Cantù Paola , Concetti Massimo , De Vecchi Amedeo , Fatuzzo Pasquale , Giannattasio Michele , La Rosa Roberto , Lopez Teodoro , Lo Piccolo Giuseppe , Melandri Marcello , Vezzoli Giuseppe , Orazi Ersilia , Pacitti Alfonso , Ramello Adriano , Russo Franco , Napoli Marcello , Tessarin Maria Cristina
Published: February 2020

Background

The self-locating catheter invented by Nicola Di Paolo has been used increasingly in Italy and elsewhere since 1994, with about a thousand patients currently implanted every year. Twelve grams of tungsten inserted into the tip of the conventional Tenckhoff catheter during extrusion does not significantly change its form, but suffices to keep the tip firmly in the Douglas cavity.

Objective

The aim of the present study was to confirm our preliminary results in a large population of peritoneal dialysis patients.

Setting

16 Italian nephrology departments.

Results

In addition to confirming the validity of the new catheter, the present results show that patients with the new catheter have fewer episodes of peritonitis, tunnel infection, cuff extrusion, catheter malfunction, obstruction, and leakage.

Conclusion

The present multicenter control study confirms preliminary results and demonstrates that complications of peritoneal dialysis, such as cuff extrusion, infection, peritonitis, early leakage, and obstruction, are statistically less frequent in patients with self-locating catheters than in patients with classic Tenckhoff catheters.
Effective Homocysteine-Lowering Vitamin B Treatment in Peritoneal Dialysis Patients
Authors: Righetti Marco , Tommasi Adalberto , Lagona Cinzia , La Rosa Lucia , Uccellini Mario , Sessa Adalberto
Published: February 2020

Background

Hyperhomocysteinemia, a risk factor for atherosclerosis, is frequently detected in patients with renal failure. Vitamin B supplementation reduces but rarely normalizes homocysteine (Hcy) levels in hemodialysis patients. There are no data about the effects of vitamin B therapy on Hcy levels in patients on peritoneal dialysis (PD).

Aims

We performed this trial both to observe baseline plasma Hcy levels in PD patients and to assess the effects of vitamin B therapy on Hcy levels in continuous ambulatory PD patients.

Methods

We conducted a 6-month prospective study of the effects of vitamin B therapy on plasma Hcy levels. Biochemical analyses were obtained at baseline and after every phase of treatment with folic acid, folic acid plus vitamin B12, and folic acid plus vitamin B12 plus vitamin B6. Eighteen of the 25 enrolled patients finished the study.

Results

Hyperhomocysteinemia was present in 83% of PD patients. We detected a trend toward a significant inverse relationship between baseline Hcy and folate levels. There were no significant correlations between baseline Hcy and vitamin B12, peritoneal membrane permeability, dialytic efficiency, or computed peritoneal Hcy clearance. We obtained an effective decrease in mean Hcy concentration from 20 to 14.8 μmol/L after folic acid and vitamin B12 treatment. We observed a further reduction in mean Hcy level to 12.8 μmol/L using the triple therapy; 72% of patients normalized their Hcy value.

Conclusions

High doses of folic acid, vitamin B6, and vitamin B12 normalize Hcy values in the majority of PD patients. This treatment may be important in reducing cardiovascular morbidity and mortality.
Cefazolin plus Ceftazidime versus Imipenem / Cilastatin Monotherapy for Treatment of Capd Peritonitis — a Randomized Controlled Trial
Authors: Leung Chi-Bon , Szeto Cheuk-Chun , Chow Kai-Ming , Kwan Bonnie Ching-Ha , Wang Angela Yee-Moon , Lui Siu-Fai , Li Philip Kam-Tao
Published: February 2020

Background

Peritonitis is a serious complication of peritoneal dialysis (PD). We studied the efficacy of imipenem / cilastatin monotherapy in the treatment of PD-related peritonitis.

Methods

We performed an open-label, randomized control study comparing imipenem / cilastatin monotherapy (treatment group) versus cefazolin plus ceftazidime (control group) in the treatment of PD peritonitis. The result was further compared to a historic group treated with cefazolin plus netilmycin. Outcome measures were primary response rate at day 10 and complete cure rate.

Results

We enrolled 51 patients in the treatment group, 51 in the control group, and identified 96 in the historic group. The primary response rate to the assigned antibiotics was 49.0%, 51.0%, and 49.0% for the treatment, control, and historic groups, respectively ( p = 0.97). The primary response rate allowing for change in antibiotic was 82.4%, 90.2%, and 82.3%, respectively, for the three groups ( p = 0.41). The complete cure rate was 72.5%, 80.4%, and 82.3%, respectively ( p = 0.60). Tenckhoff catheter removal was needed in 6 cases in the treatment group, 6 cases in the control group, and 13 cases in the historic group ( p = 0.90).

Conclusions

We concluded that monotherapy of imipenem / cilastatin has similar efficacy compared to the two standard regimens of cefazolin plus ceftazidime or netilmycin in the treatment of PD peritonitis.
Pharmacokinetics of Oral Ciprofloxacin in Continuous Cycling Peritoneal Dialysis
Authors: Yeung Sharon M. , Walker Scott E. , Tailor Sandra A.N. , Awdishu Linda , Tobe Sheldon , Yassa Teraiza
Published: February 2020

Background

In order to avoid aminoglycosides, the International Society for Peritoneal Dialysis recommends cefazolin and ceftazidime for empirical treatment of peritonitis. Ciprofloxacin covers relevant gram-negative pathogens without the resistance associated with ceftazidime. However, ciprofloxacin pharmacokinetic data in patients on continuous cycling peritoneal dialysis (CCPD) are lacking.

Objectives

( 1 ) To determine the pharmacokinetics of oral ciprofloxacin in CCPD patients, ( 2 ) to compare serum and dialysate ciprofloxacin concentrations with minimum inhibitory concentrations (MIC) of the gram-negative bacteria associated with peritonitis, and ( 3 ) to establish oral ciprofloxacin dosing guidelines for the empirical treatment of peritonitis in patients receiving CCPD.

Methods

Eligible CCPD patients received 2 doses of ciprofloxacin: 750 mg orally every 12 hours. Serial blood and end-of-dwell dialysate samples were collected during the first 12-hour interval; an end-of-dwell dialysate sample from the overnight dwell and a final blood sample were collected at the end of the second 12-hour interval. Ciprofloxacin concentrations were determined using a liquid chromatographic (HPLC)-fluorescence method. Pharmacokinetic calculations were completed assuming a one-compartment model.

Results

Eight patients completed the study. The pharmacokinetic parameters determined for ciprofloxacin were (mean ± SEM) serum half-life 10.1 ± 1.2 hours, maximum serum concentration 2.7 ± 0.5 mg/L, time to maximum serum concentration 1.6 ± 0.1 hours after the first dose, and peritoneal clearance 1.2% ± 0.1% of the mean calculated total body clearance. While all patients achieved serum area under the concentration-time curve: MIC > 125 for Escherichia coli and Klebsiella species after the first dose, only 2 patients achieved this goal for Pseudomonas aeruginosa. End-of-dwell dialysate concentrations were above the MIC for E. coli, Klebsiella spp, and P. aeruginosa after the second dose.

Conclusion

Ciprofloxacin 750 mg orally every 12 hours in CCPD patients may be useful for empirical gram-negative coverage of CCPD peritonitis and for treatment of documented peritonitis caused by sensitive E. coli or Klebsiella species. While ceftazidime may be required for documented pseudomonal peritonitis, the oral ciprofloxacin regimen achieved adequate serum concentrations to treat systemic gram-negative infections caused by sensitive E. coli or Klebsiella species.