bluuebunny/crossref_metadata_2025 huggingface dataset:
Exit-site Infections by Non-diphtheria Corynebacteria in Capd
Authors: Schiffl Helmut , Mücke Claudia , Lang Susanne M.
Published: February 2020

Non-diphtheria corynebacteria species cause disease in risk populations such as immunocompromised patients and patients with indwelling medical devices. Despite reports of exit-site infection and peritonitis caused by non-diphtheria corynebacteria, these organisms are frequently dismissed as contaminants. During a 10-year observation period, we prospectively identified 8 cases of exit-site/tunnel infections caused by 2 different species of corynebacteria ( Corynebacterium striatum in 5 and C. jeikeium in 3 cases). Four patients experienced a second episode of exit-site infection 3 months (2 cases), 25 months, and 40 months, respectively, after termination of an oral cephalosporin therapy of 4 to 6 weeks’ duration. Non-diphtheria corynebacteria accounted for 9% of all exit-site infections during the study period. All catheter-related infections healed; no catheter had to be removed. The diagnosis of catheter-related non-diphtheria corynebacteria infection may be suspected when Gram stain shows gram-positive rods and with colony morphology and commercial biochemical identification systems. Susceptibility of non-diphtheria corynebacteria to antibiotics may vary, especially in C. jeikeium. Virtually all Corynebacterium species are sensitive to vancomycin. Empirical antibiotic therapy with vancomycin should be initiated while antibiotic susceptibility testing is being carried out. Oral cephalosporin may be an alternative treatment regimen for exit-site infections if sensitive. This study highlights the importance of non-diphtheria corynebacteria as emerging nosocomial pathogens in the population of end-stage renal disease patients on on continuous ambulatory peritoneal dialysis.
Validation by Computer Simulation of Two Indirect Methods for Quantification of Free Water Transport in Peritoneal Dialysis
Authors: Venturoli Daniele , Rippe Bengt
Published: February 2020

Background

In peritoneal dialysis, approximately 40% of the total osmotic ultrafiltration (UF) induced by glucose can be predicted to be due to “free” water transport across aquaporin-1 (APQ-1). Theoretically, it would be possible to assess the fraction of free water transport in the early phase of a hypertonic dwell, when UF rate is high and the relative contribution of Na+ diffusion is low. La Milia et al. [La Milia V. et al. Fast-fast peritoneal equilibration test (FAST-FAST-PET): a simple method for peritoneal hydraulic permeability study [Abstract]. Nephrol Dial Transplant 2002; 17 (Suppl 1):17–18] suggested a technique to assess sodium-associated water transport based on sodium removal (Na+R) divided by the plasma Na+ concentration during a “fast-fast” (60 minute) peritoneal equilibration test (PET) for 3.86% glucose, yielding an estimate of the UF passing through the small pores (UFSP). Free water transport (UF through ultrasmall pores; UFUSP) was obtained by subtracting UFSP from total UF. Although peritoneal Na+ transport is almost totally convective, this technique will slightly overestimate small-pore UF due to the presence of some small-pore Na+ diffusion from the circulation during the dwell. A way of dealing with this problem was presented recently by Smit (Smit W. et al. Quantification of free water transport in peritoneal dialysis. Kidney Int 2004; 66:849–854).

Methods

In the present study we used the three-pore model of peritoneal transport to predict the degree of overestimation of UFSP for the technique presented by La Milia et al., and any potential deviations from theory for the technique presented by Smit et al. Simulations were performed under ordinary conditions and during simulated UF failure for 3.86% glucose. The fractional UF coefficient accounted for by APQ-1 was set at 2%.

Results

Estimating the UFSP from the sodium-associated water transport according to the method by La Milia et al. consistently overestimated UFSP and underestimated UFUSP. These errors were, however, minimal for dwells lasting between 30 and 80 minutes. The technique by Smit et al. to calculate aquaporin-mediated water flow (UFUSP), using an elaborate correction for Na+ diffusion from the circulation during the dwell, seemed accurate in most situations but, in general, tended to moderately overestimate UFUSP at early dwell times (<30 minutes) and underestimate UFUSP at long dwell times (4 hours).

Conclusions

The technique presented by La Milia et al. to calculate free water transport during a fast-fast PET was found to be surprisingly accurate, although the procedure would further improve by the introduction of a correction algorithm. The technique by Smit is even more accurate for dwells up to 4 hours’ duration. However, since the Smit technique is elaborate, it is less practical for routine determinations of aquaporin-mediated water transport in peritoneal dialysis.
Determination of High and Low Molecular Weight Molecules of Icodextrin in Plasma and Dialysate, Using Gel Filtration Chromatography, in Peritoneal Dialysis Patients
Authors: García–López Elvia , Anderstam Björn , Heimbürger Olof , Amici Gianpaolo , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Objective

The aim of this study was to apply high performance liquid chromatography (HPLC) with modern gel filtration media to determine high molecular weight (HMW) icodextrin fractions and low molecular weight (LMW) icodextrin metabolites in dialysate and plasma in peritoneal dialysis (PD) patients on treatment with icodextrin, and to explore the potential relationships between these compounds, α-amylase activity, and glomerular filtration rate.

Design

Retrospective study of dialysate and plasma samples from PD patients.

Setting

Samples were collected at one PD center.

Patients

Blood and dialysate samples were obtained from PD patients who were subdivided into three groups: patients using only glucose-based peritoneal dialysis fluid (GPDF; GLU group, n = 23), patients studied after the first long dwell with icodextrin-based peritoneal dialysis fluid (IPDF; 1st ICO group, n = 24), and patients who were regular users of IPDF for the long dwells (ICO group, n = 9).

Methods

LMW icodextrin metabolites [ i.e., maltose (G2), maltotriose (G3), maltotetraose (G4), maltopentaose (G5), maltohexaose (G6), and maltoheptaose (G7)] and HMW fractions were determined in plasma and dialysate using two different gel filtration HPLC methods. Enzymatic hydrolysis with amyloglucosidase to glucose yielded the total carbohydrate content and this was used to validate the HPLC results. α-Amylase activity was determined using a routine method.

Results

The results obtained by gel filtration HPLC yielded values of LMW metabolites and HMW fractions in plasma and dialysate in agreement with results obtained with enzymatic hydrolysis. HMW fractions were not detectable in plasma. Absorption of icodextrin from the peritoneal cavity during the long dwell (10 – 16 hours) was, on average, 39% of the amount instilled. During the long dwell, there was a relative decrease in the dialysate concentration of the largest HMW fractions (>21.4 kDa). Plasma concentration of the LMW icodextrin metabolites G2–G7 was highest in the ICO group (2.65 ± 0.54 mg/mL) but also higher in the 1st ICO group (1.97 ± 0.57 mg/mL) compared with the GLU group (0.52 ± 0.23 mg/mL). Plasma α-amylase activity was significantly lower in the 1st ICO group and in the ICO group compared with the GLU group.

Conclusions

Accurate analysis of HMW icodextrin fractions in dialysate and LMW icodextrin metabolites in plasma and dialysate in PD patients can be achieved by gel filtration HPLC with two different columns. This method can be used to study the complex pattern of changes in icodextrin and its metabolites in plasma and dialysate. The finding that HMW icodextrin fractions were not detected in plasma was unexpected, and differs from results of previous studies by other researchers.
Fungal Peritonitis in Peritoneal Dialysis Patients
Authors: Prasad Narayan , Gupta Amit
Published: February 2020

Peritonitis is one of the most frequent complications of peritoneal dialysis (PD) and 1% – 15% of episodes are caused by fungal infections. The mortality rate of fungal peritonitis (FP) varies from 5% to 53%; failure to resume PD occurs in up to 40% of patients. The majority of these FP episodes are caused by Candida species. Candida albicans has historically been reported to be a more common cause than non-albicans Candida species, but in recent reports a shift has been observed and non-albicans Candida may now be more common. Unusual, often “nonpathogenic,” fungi are being increasingly reported as etiologic agents in FP. Clinical features of FP are not different from those of bacterial peritonitis. Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and delayed. New molecular diagnostic techniques ( e.g., polymerase chain reaction) are being developed and evaluated, and may improve diagnosis and so facilitate early treatment of infected patients. Abdominal pain, abdominal pain with fever, and catheter left in situ are risk factors for mortality and technique failure in FP. In programs with high baseline rates of FP, nystatin prophylaxis may be beneficial. Each program must examine its own history of FP to decide whether prophylaxis would be beneficial. Catheter removal is indicated immediately after fungi are identified by Gram stain or culture in all patients with FP. Prolonged treatment with antifungal agents to determine response and attempt clearance is not encouraged. Antifungals should be continued for 10 days to 2 weeks after catheter removal. Attempts at reinsertion should be made only after waiting for 4 – 6 weeks.
The Time Course of Serum C-Reactive Protein is More Predictive of Mortality than its Baseline Level in Peritoneal Dialysis Patients
Authors: Ateş Kenan , Ateş Aşkin , Ekmekçi Yakup , Nergizoglu Gökhan
Published: February 2020

Background

Several recent studies reported that a high baseline serum C-reactive protein (CRP) is a powerful predictor of mortality in dialysis patients. However, the acute-phase response is intermittent and not a continuous feature in an individual patient. The aim of this prospective study was to determine whether serial analysis of serum CRP during follow-up allows better prediction of mortality and echocardiographic cardiac disease than a single baseline measurement in peritoneal dialysis (PD) patients.

Methods

97 PD patients were monitored for 3 years from the beginning of the treatment. We evaluated the effect of demographic features, comorbidity, blood pressure, blood biochemistry, including CRP, residual renal function, and indices of dialysis adequacy, on mortality and left ventricular hypertrophy (LVH). Cox regression analysis using both the baseline and the averaged values of the study parameters was carried out to determine factors predicting mortality. Logistic regression analysis was performed to determine which factors were independently predictive for LVH and the type of time course of serum CRP.

Results

Baseline serum CRP was elevated in 29 patients (29.9%). While serum CRP exhibited a stable course (normal or high) in 55 patients (56.7%), it varied considerably over time in 42 patients (43.2%). In the Cox models, both the averaged serum CRP and the type of variability of CRP were predictors of mortality. On the contrary, baseline CRP did not affect adjusted survival. The averaged CRP was also an independent factor affecting LVH, but baseline CRP was not. Age, comorbidity index, instilled dialysate glucose concentration, and Kt/V urea were independently associated with the type of time course of serum CRP.

Conclusion

The averaged value of serum CRP is more predictive of prognosis compared to the baseline value in PD patients. Determining serum CRP on a regular basis may be helpful to detect early signs of tissue damage or asymptomatic inflammation.
Patient Characteristics Associated with Defects of the Peritoneal Cavity Boundary
Authors: Van Dijk Claudia M.A. , Ledesma Steven G. , Teitelbaum Isaac
Published: February 2020

Background

Conflicting literature exist regarding the patient characteristics that may confer an increased risk for anatomic complications of the peritoneal cavity boundaries.

Methods

We collected data from 75 randomly selected units in the United States and Canada, representing a total of 1864 peritoneal dialysis (PD) patients.

Results

200 of these patients experienced a total of 217 anatomic complications between July 2000 and June 2001; 16 patients had more than 1 complication. Hernias comprised 60.4% of all complications: 24.9% inguinal, 18.9% umbilical, 13.8% ventral, 2.3% femoral, and 0.5% intrathoracic. Other complications included pericatheter or subcutaneous leak (25.3%), hydrothorax (6.0%), and miscellaneous (8.3%). Peritoneal dialysis modalities in use at the time of complication were automated PD (52.3%), continuous ambulatory PD (38.6%), and nocturnal intermittent PD (9.1%). The overall incidence of hernias was 7%.

Conclusions

Logistic regression analysis found no association between hernias and age, body surface area, PD modality, volume of dialysate, time of largest dwell (day/upright vs night/recumbent), or type of catheter used. Cystic disease conferred a 2.5-fold increase in risk for anatomic complications ( p < 0.001); female gender conferred an 80% reduction in risk ( p < 0.0001), and Kt/V ≥2.0 conferred a 52% reduction in risk ( p < 0.05) for hernia.
Impact of Glucose in Peritoneal Dialysis: Saint or Sinner?
Authors: Sitter Thomas , Sauter Matthias
Published: February 2020

Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.
Peritoneal Albumin Excretion is a Strong Predictor of Cardiovascular Events in Peritoneal Dialysis Patients: A Prospective Cohort Study
Authors: Szeto Cheuk-Chun , Chow Kai-Ming , Lam Christopher Wai-Kei , Cheung Robert , Kwan Bonnie Ching-Ha , Chung Kwok-Yi , Leung Chi-Bon , Li Philip Kam-Tao
Published: February 2020

Background

Microalbuminuria is a marker of systemic endothelial dysfunction. We hypothesize that peritoneal albumin excretion in peritoneal dialysis (PD) patients, which is conceptually analogous to microalbuminuria in nonuremic patients, can predict cardiovascular disease in new PD patients.

Method

We studied peritoneal albumin excretion in 43 new PD patients. They were then followed prospectively for the development of cardiovascular events. All-cause mortality and duration of hospitalization for cardiovascular diseases were also recorded.

Result

The average duration of follow-up was 26.5 ± 17.6 months. During the follow-up period, 15 patients developed cardiovascular events. Event-free survival at 36 months was 81.4% and 53.6% for low (<300 mg/L) and high (≥300 mg/L) peritoneal albumin excretion groups respectively (log rank test, p = 0.042). By Cox regression analysis, the only independent factors for event-free survival were diabetic status and peritoneal albumin excretion rate. For every 100 mg/L increase in peritoneal albumin excretion, the adjusted hazard ratio of developing a cardiovascular event was 1.83 [95% confidence interval (CI) 1.11 – 3.02, p = 0.018]. Actuarial patient survival at 36 months was 85.7% and 59.1% for low and high peritoneal albumin excretion groups respectively (log rank test, p = 0.10). After adjusting for the duration of follow-up for individual patients, the average duration of hospitalization was 9.1 ± 16.2 and 21.7 ± 25.7 days per year of follow-up for low and high peritoneal albumin excretion groups respectively (Mann–Whitney U test, p = 0.012).

Conclusion

Although the sample size of our present study is small and does not have adequate statistical power, we conclude that peritoneal albumin excretion may be an important predictor of cardiovascular disease. Further studies are needed to examine the role of dialysate albumin excretion as a means of cardiovascular risk stratification in PD patients.
Measurement of Protein Glycation, Glycated Peptides, and Glycation Free Adducts
Authors: Thornalley Paul J.
Published: February 2020

Protein glycation adducts, early glycation adducts, such as N∊-fructosyl-lysine, and advanced glycation end products (AGEs) are uremic toxins. Glycation adducts are found in plasma and tissue proteins (glycation adduct residues), in peptides (glycation adduct peptide residues), and glycated amino acids (glycation free adducts). The latter two analyte groups arise from proteolysis of glycated proteins and glycation of peptides and amino acids. Quantitation of glycation adducts in uremia is difficult because of the presence of many different AGEs at low concentrations in different forms in the presence of many potential interferences. Application of liquid chromatography with tandem mass spectrometric (LC-MS/MS) detection to plasma, urine, and dialysate samples of uremic patients has provided a comprehensive and quantitative analysis of glycation adducts in uremia. Glycation free adducts accumulate markedly in the plasma of uremic patients and are eliminated in the peritoneal dialysate. Multiple glycation adducts, and also protein oxidation and nitration adducts, may be quantified concurrently. Glycation free adducts are the major form of glycation adduct eliminated in dialysate. LC-MS/MS may now be used to quantify concentrations, extents of protein modification, clearances, and excretion rates of glycation adducts in uremia.
Minilaparoscopic Extraperitoneal Tunneling with Omentopexy: A New Technique for CAPD Catheter Placement
Authors: Ogunc Guner
Published: February 2020

Background

Continuous ambulatory peritoneal dialysis (CAPD) is an effective form of treatment for patients with end-stage renal disease. Open insertion of peritoneal dialysis (PD) catheters is the standard surgical technique, but it is associated with a relatively high incidence of catheter-related problems. To overcome these problems, different laparoscopic techniques have been presented, being preferable to the open and percutaneous methods.

Objective

To introduce and evaluate the efficiency of laparoscopic omental fixation and extraperitoneal placement of the cuff–coil part (the straight portion) of the catheter to prevent catheter tip migration, pericatheter leakage, severe abdominal pain, and the obstruction caused by omental wrapping.

Setting

The study was carried out in the General Surgery Department, Akdeniz University Medical School, in Turkey.

Patients and Methods

Between November 2001 and March 2005, the technique was applied in 44 consecutive patients (mean age 51.6 years, range 18 – 67 years) with end-stage renal disease. During this laparoscopic technique, the omentum was first fixed onto the parietal peritoneum, and then the catheter was introduced through the subumbilical trocar site into the posterior rectus compartment and advanced toward the symphysis pubis. The catheter was then inserted into the abdominal cavity, passing the peritoneal opening, which was prepared before catheter insertion. The straight portion of the catheter was located into the extraperitoneal area of the anterior abdominal wall. The curled end, which contains the side-holes of the catheter, was placed into the true pelvis. Catheter position and patency were verified under direct vision using a 2 mm telescope.

Results

All procedures were completed laparoscopically. Operating time ranged between 40 and 100 minutes (median 52 minutes). There was no intraoperative complication or surgical mortality. Peritoneal dialysis was initiated within 15 – 24 hours after catheter implantation. After a median follow-up period of 17.4 months (range 1 – 38 months), early exit-site infection occurred in 1 of 44 patients. All catheters functioned well postoperatively. There was no pain during CAPD.

Conclusion

This new laparoscopic technique using an extraperitoneal approach with omentopexy for PD catheter placement could prove extremely useful for preventing catheter malfunction caused by catheter tip migration, pericatheter leakage, omental wrapping, and periodic catheter movement that causes abdominal pain in CAPD.
Effects of Peritoneal Dialysis Solutions on the Peritoneal Membrane: Clinical Consequences
Authors: Witowski Janusz , Jörres Achim
Published: February 2020

This review provides an overview of recent studies that show the clinical significance of biocompatibility of peritoneal dialysis fluids.
Initiating Capd with a Regimen Low in Glucose and Glucose Degradation Products, with Icodextrin and Amino Acids (Nepp) is Safe and Efficacious
Authors: le Poole Caatje Y. , Welten Angelique G.A. , Weijmer Marcel C. , Valentijn Rob M. , Van Ittersum Frans J. , ter Wee Piet M.
Published: February 2020

♦ Background

The high levels of glucose, glucose degradation products (GDPs), and lactate buffer present in standard peritoneal dialysis (PD) solutions contribute to peritoneal damage, malnutrition, and dyslipidemia. Therefore, we studied the feasibility of a PD regimen as low as possible in glucose and GDPs.

♦ Methods

In a prospective 30-week study, patients new to continuous ambulatory PD (CAPD) were randomized to either a standard PD regimen (SPD; 4 dwells glucose-/lactate-based) or a low glucose-GDP regimen (NEPP; 1 dwell amino acids, 1 dwell icodextrin, and two dwells bicarbonate/lactate-buffered glucose-based solution).

♦ Results

Results obtained during a 30-week study period for 63 new CAPD patients (30 NEPP, 33 SPD) were analyzed. Intraperitoneal glucose load was lower in the NEPP group (111 ± 76 vs 159 ± 40 g/day at 30 weeks, p < 0.001). Dialysis efficacy, ultrafiltration, weight, blood pressure, and laboratory results were similar in the groups, whereas, in the NEPP group, cancer antigen 125 in dialysate effluents decreased less but dialysate-to-plasma ratios were slightly higher.

♦ Conclusion

Short-term treatment of new CAPD patients with a PD regimen low in glucose and GDPs is feasible. Dialysis efficacy, ultrafiltration, and metabolic consequences are similar to those during a standard glucose-lactate-based regimen, whereas peritoneal transport seems slightly higher and preservation of mesothelial cell mass better during NEPP.
Clinical Epidemiology of Major Nontraditional Risk Factors in Peritoneal Dialysis Patients
Authors: Zoccali Carmine , Enia Giuseppe , Tripepi Giovanni , Panuccio Vincenzo , Mallamaci Francesca
Published: February 2020

♦ Background

End-stage renal disease (ESRD) is a situation with a cardiovascular (CV) risk profile of almost unique severity. While traditional risk factors dominate the scene in the general population, in chronic kidney disease (CKD), nontraditional risk factors play an increasingly important role, being perhaps dominant in ESRD patients.

♦ Objective

We review the role inflammation [C-reactive protein (CRP)], hyperhomocysteinemia, high plasma norepinephrine, and accumulation of the endogenous inhibitor of the nitric oxide synthase asymmetric dimethylarginine (ADMA) in the high all-cause and CV mortality of patients on continuous ambulatory peritoneal dialysis (CAPD).

♦ Results

The association between CRP and clinical outcomes in patients on peritoneal dialysis (PD) was examined in six studies totaling 692 subjects. The largest of these studies in Caucasians indicates that the independent risk of CV events in patients in the top CRP quartile is about five times higher than in the bottom quartile. Seven prospective studies, including over 1000 hemodialysis and 176 CAPD patients, reported both positive and negative associations between homocysteine and mortality and/or CV events. Because homocysteine circulates bound to albumin, negative associations — rather than negating the vasculotoxicity of homocysteine — most likely reflect the very deleterious effects of malnutrition. Plasma norepinephrine is higher in CAPD than in hemodialysis patients, and multivariate analyses suggest the difference quantitatively entails a 16% higher risk of incident CV events. Likewise, ADMA is more elevated in CAPD patients and such an elevation corresponds to a 15% increase in risk.

♦ Conclusion

Nontraditional risk factors are far more prevalent in ESRD patients than in the general population. ADMA and norepinephrine may play a greater role in CV risk in CAPD than in hemodialysis patients.
The Impact of Guidelines for the Prevention of Anemia on Clinical Outcome
Authors: Pollock Carol A.
Published: February 2020

Guidelines for anemia management in renal disease are supported by substantial evidence demonstrating improvement in quality of life and objective markers of physical and cognitive performance. Randomized control studies demonstrating a survival benefit or improved cardiovascular outcomes are inconsistent. However, observational studies clearly demonstrate reduced mortality and hospitalization rate in patient cohorts on hemodialysis with hemoglobin measurements within the recommended target ranges. Data from patients in the predialysis phase of chronic kidney disease and those on peritoneal dialysis are limited and studies assessing the clinical impact of adherence to guidelines should be further explored in these populations. Available evidence suggests a proactive approach to anemia management should be practiced.
Cardiovascular Disease as a Late Complication of End-Stage Renal Disease in Children
Authors: Groothoff Jaap , Gruppen Mariken , De Groot Eric , Offringa Martin
Published: February 2020

♦ Objective

To analyze the late cardiovascular outcome of end-stage renal disease (ESRD) in children.

♦ Design

A nation-wide long-term follow-up study. Determinants of outcomes and causes of death were retrospectively assessed. Patients underwent assessment of overall health state, B- and M-mode ultrasound of the carotid arteries, and echocardiography for cross-sectional analysis.

♦ Results

We analyzed the medical course of all 249 adult Dutch patients with ESRD onset between 1972 and 1992 at age 0 – 14 years, and who were born before 1979. Of the 187 living patients, 140 participated in the cross-sectional part of the study. The standardized mortality rate was 31.0. Overall 5-, 10-, and 20-year survival after ESRD onset was 87%, 82%, and 78%, respectively. Cardiovascular disease accounted for most deaths (41%). In the whole group, left ventricular hypertrophy (LVH), aortic valve calcification, and arterial wall stiffening were highly prevalent. LVH was associated with hypertension at time of assessment. Aortic valve calcification was strongly associated with a long total duration of peritoneal dialysis (β = 0.33, p < 0.001). Arterial wall pathology was not associated with current treatment modality.

♦ Conclusions

As in adults, cardiovascular disease is the most important cause of death in children with ESRD. Stricter reduction of volume overload, prevention of high serum calcium–phosphate product, and more vigorous treatment of hypertension are important targets to improve cardiovascular survival in children with ESRD.
The International Pediatric Peritonitis Registry: A Global Internet-Based Initiative in Pediatric Dialysis
Authors:   Members of the International Pediatric Peritonitis Registry, Feneberg Reinhard , Warady Bradley A. , Alexander Steven R. , Schaefer Franz
Published: February 2020

♦ Objectives

Recommendations for the management of peritoneal dialysis-associated peritonitis in children have recently been developed by an International Society for Peritoneal Dialysis (ISPD) expert committee. The International Pediatric Peritonitis Registry (IPPR) was established in October 2001 as a global consortium of 47 pediatric dialysis centers in order to assess the validity of these guidelines.

♦ Design

The IPPR is an internet-based registry collecting data on pediatric peritonitis episodes treated according to the ISPD guidelines. Data on 375 episodes have been collected as of July 2004.

♦ Data Acquisition

Detailed data are obtained online on the diagnosis of peritonitis, antibiotic and adjunctive therapy, as well as on possible risk factors and treatment results.

♦ Conclusions

Final data analysis of the IPPR will yield extensive information on the treatment and outcome of peritoneal dialysis-associated peritonitis in children.
Successful Surgical Management of Encapsulating Peritoneal Sclerosis
Authors: Kawanishi Hideki , Watanabe Hiroshi , Moriishi Misaki , Tsuchiya Shinichiro
Published: February 2020

♦ Background

Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. Also, therapeutic guidelines for EPS have not yet been established. In our hospital, favorable postoperative results were obtained in 50 patients whose EPS was treated surgically.

♦ Patients

All patients had chronic glomerulonephritis as the underlying kidney disease. All had undergone PD for between 29 months and 220 months (average: 113.9 months). During the course of PD, 3 patients developed EPS and were subsequently transferred to hemodialysis (HD). The other 47 patients (94.0%) developed EPS after discontinuation of PD. The reasons for transfer to HD were inadequate ultrafiltration (26 patients), bacterial peritonitis (16 patients), hypoalbuminemia (2 patients), renal transplantation (3 patients), and occurrence of EPS (3 patients).

♦ Intervention

At laparotomy, a definitive diagnosis of EPS was established in all patients by the presence of clumped intestine cocooned with a dense sclerotic membrane. In all cases, the small intestine was completely released by ablation of the capsules, resulting in resolution of the bowel obstruction symptoms. In 5 patients, the large intestine was ablated solely at the region of the sigmoid colon. The operating time varied from 3 hours to 18 hours (average: 6.9 hours). Oral food intake was initiated 5 – 60 days (average: 10.2 days) after surgery.

♦ Results

Perforation of the small intestine was detected postoperatively in 2 patients, who died 26 days and 37 days after surgery. The remaining 48 patients were followed for between 9 months and 107 months (average: 34.6 months). During follow-up, 6 – 12 months after the initial surgery, 4 patients experienced a recurrence of bowel obstruction symptoms that required a second laparotomy with enterolysis. Excluding the 2 patients with fatal outcomes, 46 patients (96%) experienced complete relief from bowel obstruction symptoms. The remaining 2 patients continued to experience mild, sub-acute bowel obstruction symptoms that could be successfully controlled solely by diet.

♦ Conclusions

Surgical treatment of 50 patients with EPS produced successful outcomes in all but 2 patients (96% success). Encapsulating peritoneal sclerosis should be actively treated by surgeons who genuinely understand this pathologic condition.
Is Normal Saline Harmful to the Peritoneum?
Authors: Breborowicz Andrzej , Oreopoulos Dimitrios G.
Published: February 2020

♦ Background

Normal saline (0.9% NaCl) is used during various abdominal surgical interventions and during peritoneal dialysis to rinse the peritoneal cavity. Although no clear clinical evidence exists for the bioincompatibility of normal saline, various experimental studies have suggested that 0.9% NaCl solution can initiate fibrosis of peritoneum.

♦ Material and Methods

We review the data derived from in vitro and in vivo experimental studies demonstrating the cytotoxic effect of 0.9% NaCl and its ability to initiate peritoneal adhesions.

♦ Results

Normal saline reduces the viability and fibrinolytic activity of peritoneal mesothelial cells. Use of normal saline to wash the peritoneal cavity during abdominal operations or after chronic peritoneal dialysis is more likely to produce adhesions than is no irrigation at all. Chronic exposure of the peritoneum to normal saline causes overgrowth of the connective tissue and formation of new blood vessels within that tissue.

Conclusion

♦ Normal saline is a bioincompatible solution that predisposes to the formation of peritoneal adhesions and fibrosis of the peritoneum. A 0.9% NaCl solution should therefore not be used to rinse the peritoneal cavity after interruption of peritoneal dialysis.
Fluid Status and its Management in Japanese Peritoneal Dialysis Patients
Authors: Nakayama Masaaki
Published: February 2020

This article reviews published studies related to fluid status of Japanese peritoneal dialysis (PD) patients and its impact on technique and patient survival. In addition, some specifics related to clinical background that potentially influence fluid status are described. According to a multi-center survey conducted in Japan, nearly 25% of Japanese PD patients are overhydrated. Available data indicate that a high salt diet may conceivably play an important role in the pathogenesis of fluid overload in Japanese PD patients, and it in turn negatively impacts patient prognosis. Because of the generally adopted policy among Japanese PD experts to avoid regular use of 3.86% glucose solution, icodextrin solution is now used in more than one third of all patients. Other means of managing fluid overload, such as drug therapy, combination (complementary) therapy with hemodialysis, and low sodium PD solution, are also explored and summarized in this article.
Risk Factors and Outcomes of Extended-Spectrum Beta-Lactamase-Producing E. Coli Peritonitis in Capd Patients
Authors: Yip Terence , Tse Kai-Chung , Lam Man-Fai , Tang Sydney , Li Fu-Keung , Choy Bo-Ying , Lui Sing-Leung , Chan Tak-Mao , Lai Kar-Neng , Lo Wai-Kei
Published: February 2020

Objective

To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD).

Patients and Methods

Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined.

Results

Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coli peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12).

Conclusion

Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
Continuous Ambulatory Peritoneal Dialysis in Patients with Hepatitis B Liver Disease
Authors: Chow Kai Ming , Szeto Cheuk Chun , Wu Alan Ka Lun , Leung Chi Bon , Kwan Bonnie Ching Ha , Li Philip Kam-Tao
Published: February 2020

Objective

We hypothesized that patients with hepatitis B virus infection and cirrhosis are more susceptible to peritonitis as a complication of peritoneal dialysis (PD).

Methods

A retrospective study was carried out to compare peritonitis rates between cirrhotic and non-cirrhotic patients with hepatitis B virus infection.

Results

Between 1994 and 2004, 25 PD patients with hepatitis B cirrhosis and 36 patients with hepatitis B without cirrhosis were included for analysis. Mean follow-up duration was 52 months. Subjects with hepatitis B cirrhosis consisted of more males and had higher total body weight. No cirrhotic patients (20 of them being Child–Pugh class A, 2 class B, and 3 class C) had undergone portosystemic shunting or liver transplantation. Cirrhotic patients had slightly higher bilirubin concentration than the non-cirrhotic group (22 ± 50 vs 9 ± 4 μmol/L, p = 0.16). There was no difference in median peritonitis-free survival between cirrhotic and non-cirrhotic patients (40 vs 37 months, p = 0.64 by log-rank test). The average peritonitis rate was 1 episode every 19.2 patient-months in the cirrhotic group and 1 episode every 20.5 patient-months in the non-cirrhotic group. Time to first peritonitis did not differ between the two groups with respect to gram-negative organisms ( p = 0.88) or gram-positive organisms ( p = 0.52). Cirrhotic patients had more frequent Streptococcus species peritonitis, which accounted for 13% of all peritonitis episodes, as opposed to 2% among the non-cirrhotic patients ( p = 0.01). Overall treatment response rate and outcome did not differ between patients with and patients without cirrhosis.

Conclusions

Peritonitis-free survival of cirrhosis patients infected by hepatitis B virus compares favorably with that in patients without cirrhosis. The presence of liver cirrhosis does not appear to compromise PD outcome.
Technological Advances in Peritoneal Dialysis Research Peritoneal Cell Culture: Fibroblasts
Authors: Witowski Janusz , Jörres Achim
Published: February 2020

Fibroblasts have been traditionally viewed as providing little more than a structural lattice for other cell types. However, recent data indicate that fibroblasts play a key and early role in many pathophysiological processes, including inflammation, fibrosis, and neoplasia. Moreover, depending on the anatomical location, fibroblasts display significant functional heterogeneity. Therefore, it is important to study the subpopulation of fibroblasts derived exactly from the organ of interest rather than to extrapolate the observations made in other fibroblast subsets. Cell culture provides a powerful tool for studying the role of fibroblasts in various contexts. In this review, we describe procedures for establishing and identifying primary cultures of human peritoneal fibroblasts. We also briefly discuss the potential involvement of peritoneal fibroblasts in peritoneal pathology.
What is the Optimal Dwell Time for Maximizing Ultrafiltration with Icodextrin Exchange in Automated Peritoneal Dialysis Patients?
Authors: Jeloka Tarun K. , Ersoy Fevzi F. , Yavuz Mahmut , Sahu Krishna M. , Çamsari Taner , Utaş Cengiz , Bozfakioglu Semra , Özener Çetin , Ateş Kenan , Ataman Rezzan , Akçiçek Fehmi , Akpolat Tekin , Karayaylali Ibrahim , Arinsoy Turgay , Mehmet Emin Yilmaz , Süleymanlar Gültekin , Burdzy Dorothy , Oreopoulos Dimitrios G.
Published: February 2020

Background

Icodextrin is increasingly being used in automated peritoneal dialysis (APD) for the long dwell exchange to maintain adequate ultrafiltration (UF). However, the UF reported in the literature varies with different dwell times: from 200 to 500 mL with 12 – 15 hour dwells. In order to maximize UF, it is important to know the relationship between dwell time and UF when using icodextrin in APD patients. With this knowledge, decisions can be made with respect to dwell period, and adjustments to the dialysis prescription can be made accordingly.

Methods

We prospectively studied this relationship in 36 patients from Canada and Turkey. All patients did the icodextrin day exchange manually after disconnecting themselves from overnight cycler dialysis. Dwell period was increased by 1 hour every week, from 10 to 14 hours. Ultra-filtration was noted for each icodextrin exchange. Mean UF for each week ( i.e., dwell period) was compared by repeated measures ANOVA.

Results

We found no difference in mean UF with increasing dwell time: 351.73 ± 250.59 mL at 10 hours versus 371.75 ± 258.25 mL at 14 hours ( p = 0.83). We also compared mean UF between different subgroups and found that males ( p = 0.02 vs females) and high transporters ( p = 0.04 vs low) had higher mean UF. Further analysis of maximal UF showed no correlation to age, sex, diabetic status, transport category, creatinine clearance, Kt/V, duration on peritoneal dialysis, or duration of icodextrin use.

Conclusion

Icodextrin-related UF in APD patients is not related to demographic factors and does not increase significantly beyond 10 hours.
Improvement of Peritoneal Ultrafiltration with Peritoneal Dialysis Solution Buffered with Bicarbonate/Lactate Mixture
Authors: Simonsen Ole , Sterner Gunnar , Carlsson Ola , Wieslander Anders , Rippe Bengt
Published: February 2020

Background

In computer simulations, according to the three-pore model of peritoneal transport, neutralization of conventional acidic peritoneal dialysis fluids is predicted to produce an improved ultrafiltration (UF). However, in a previous study, a two-compartment peritoneal dialysis system with a minimum of glucose degradation products (GDP), PD-Bio, having a pH of 6.3 and being conventionally lactate buffered, did not produce an increased UF.

Setting

We tested a newly formulated, glucose-based, GDP-reduced solution, denoted “N” for “neutral,” containing a mixture of lactate (30 mmol/L) and bicarbonate (10 mmol/L) as buffer system, and having a pH of 7.2. This new formulation was compared with Gambrosol trio (GT) (identical in composition to PD-Bio, but delivered in a three-compartment system; both by Gambro Lundia AB, Lund, Sweden) in an open, prospective controlled study of 13 patients.

Material and Methods

Each of the 13 patients used GT for 14 days, followed by 14 days of N. All bags were weighed on a digital scale before instillation and after drainage to assess the UF in each dwell (and during 24 hours). Glucose concentration in each bag was noted. In the morning and night dwells, dialysis fluid glucose concentration was standardized to 2.5%. Body weight was measured every morning (empty abdomen). In the middle of each 14-day period, a 4-hour standardized (“study day”) dwell was performed, using 125I-albumin (RISA) as volume marker, during which blood and dialysate samples were taken repeatedly and analyzed for RISA, creatinine, urea, phosphate, glucose, standard bicarbonate, lactate, and pH. The permeability surface area product (PS) for small solutes (and A0/ΔX; “area parameter”) was calculated. Clearance (Cl) of RISA to plasma (P) (Cl→P), “direct lymphatic absorption,” and total Cl of RISA out of the peritoneal cavity (Clout) were also determined.

Results

The 13 patients using N, compared to GT, displayed an increased daily UF, the difference being 233 mL ( p < 0.05). The pH values of N were higher during the first 90 minutes of the 4-hour dwell compared to the pH values of GT. Neither the small solute PS values nor RISA determined UF, nor did body weight differ significantly between the GT and the N periods.

Conclusions

A new bicarbonate/lactate-buffered solution, N, with neutral pH (of 7.2) and low in GDP seems to produce an improved UF compared to a lactate-buffered solution with a pH of 6.3, equally low in GDP, partly in agreement with our earlier predictions. A dialysis solution with a neutral pH combined with a reduced lactate concentration, partially replaced by bicarbonate, evidently increases UF, conceivably by causing less peritoneal vasodilatation than solutions buffered by lactate or high concentrations of bicarbonate alone.
EndothelinB Receptor Blocker Inhibits High Glucose-Induced Synthesis of Fibronectin in Human Peritoneal Mesothelial Cells
Authors: Shimizu Miyuki , Ishibashi Yoshitaka , Taki Fumika , Shimizu Hideki , Hirahara Ichiro , Kaname Shinya , Fujita Toshiro
Published: February 2020

Background

Long-term peritoneal dialysis using glucose-based dialysates is associated with peritoneal fibrosis. The object of this study was to investigate the hypothesis that endothelin (ET)-1, which is known to play an important role in various fibrotic diseases, may also be involved in peritoneal fibrosis using human peritoneal mesothelial cells (HPMC).

Methods

HPMC were cultured with 4% d- or l-glucose, or loaded with 10 nmol/L ET-1. In some experiments, the ETA receptor antagonist BQ-123, the ETB receptor antagonist BQ-788, and antioxidants 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (TEMPOL) and diphenyleneiodium chloride (DPI) were used. mRNA expression of ET-1, ETA receptor, ETB receptor, and fibronectin (FN) was analyzed by real-time polymerase chain reaction (real-time PCR). The protein levels for FN and ET-1 were measured by ELISA. CM-H2DCFDA-sensitive reactive oxygen species (ROS) were evaluated by flow cytometry.

Results

d-Glucose significantly induced mRNA expression of ET-1 and the ETB receptor but not the ETA receptor. FN production under high glucose conditions was inhibited by BQ-788. ET-1 directly stimulated HPMC to increase mRNA expression of FN and CM-H2DCFDA-sensitive ROS production. BQ-788, TEMPOL, and DPI inhibited mRNA expression of FN induced by ET-1.

Conclusion

The present study suggests that high-glucose-induced FN synthesis is mediated by the ET-1/ETB receptor pathway and, therefore, an ETB receptor antagonist may be useful in preventing FN production in HPMC.
Physiological Properties of the Peritoneum in an Adult Peritoneal Dialysis Population over a Three-Year Period
Authors: Johansson Ann-Cathrine , Haraldsson Börje
Published: February 2020

Objectives

To describe the physiological properties of the peritoneal membrane in adult patients treated with peritoneal dialysis (PD) and to analyze the effects of patient characteristics and time.

Design

Observational study.

Setting

Department of Nephrology at the Sahlgrenska University Hospital.

Method

Peritoneal function was analyzed by the Personal Dialysis Capacity (PDC) test, based on the three-pore theory of capillary transport. The functional PDC variables are absorption, large-pore flow, and the area parameter (A0/Δx), which determines the diffusion of small solutes. The ultra-filtration (UF) coefficient is determined mainly by A0/Δx.

Patients

All patients ( n = 280) who had at least one PDC test done between September 1990 and August 1999.

Results

In 249 patients examined soon after start of PD, area was 19000 (SD 7100) cm2/cm/1.73 m2, large-pore flow 0.112 (SD 0.052) mL/min/1.73 m2, and the UF coefficient 0.071 (SD 0.032) mL/minute/mmHg/1.73 m2. Absorption was 1.54 (SD +2.64, –0.97) mL/min/1.73 m2. Large-pore flow was greater in patients with severe comorbidity than in patients with fewer comorbid conditions. Elderly patients had a lower UF coefficient than did younger patients ( p < 0.05). Repeated PDC tests were performed in 208 patients during a mean observation time of 18.4 months. There was a slight increase in the slope of the area-versus-time curve of 54 cm2/cm/1.73 m2 per month (approximately 10% after 3 years, p < 0.01); all other parameters remained constant.

Conclusion

Patient characteristics have an impact on peritoneal performance already at the start of dialysis. Peritoneal function can remain essentially stable during medium long-term PD.