bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular Disease in Peritoneal Dialysis
Authors: Prichard Sarah , Sniderman Allan , Cianflone Katherine , Marpole Derek
Published: February 2020

Cardiovascular morbidity and mortality remain high in ESRD patients. Lipid abnormalities in CAPD may be more important than in hemodialysis. Vessel calcification may have a role in atherosclerotic heart disease, but this is only an inference from several clinical observations, and it remains to be defined more clearly as a risk factor. Left ventricular hypertrophy is frequent in this patient population, and is associated with specific clinical patterns and an in creased risk of death. Erythropoietin treatment of anemia and tight blood pressure controls have proved to help in reversing severe left ventricular hypertrophy. Finally, we describe a syndrome of the hypertrophic, high cardiac output hemodialysis heart, which is characterized by a high cardiac output in hemodialysis patients. It is associated with left ventricular hypertrophy and eventually right ventricular hypertrophy with tricuspid insufficiency. This may require fistula revision and even a switch to peritoneal dialysis.
Interleukin-1β Stimulates Glucose Uptake of Human Peritoneal Mesothelial Cells In Vitro
Authors: Kruse Michael , Mahiout Arezki , Kliem Volker , Kurz Peter , Koch Karl-Martin , Brunkhorst Reinhard
Published: February 2020

To investigate whether the glucose uptake (GU) of human peritoneal mesothelial cells (HPMC) is mediated by glucose transporters and whether this uptake is influenced by interleukin 1–β (IL-1β), we measured 2-deoxy-(3H)-GU of HPMC in vitro, after exposing the cells for different times (two and 12 hours) to increasing concentrations (0.1, 1.0, and 2.0 ng/mL) of IL-1 β. To exclude a noncarrier-mediated transport, GU was also tested in the presence of cytochalasin B. All experiments were performed in triplicate in the cells of two donors.

Cytochalasin B inhibits GU of HPMC almost completely. GU of HPMC is not stimulated by insulin. GU is stimulated by IL-1 β in a dose-dependent manner.

These data indicate a GU of HPMC, which is mediated by a glucose transporter and stimulated by IL-1 β. The increased uptake of glucose from the dialysate In patients with peritonitis may be mediated by a (cytokineinduced) increased activity of HPMC glucose transporters.
Peritoneal Dialysis Prescription for Neonates
Authors: Fischbach Michel
Published: February 2020

Despite the major advances in the management of renal failure, the mortality and morbidity rates remain higher in neonates than in older children. But, in most of the cases, effective peritoneal dialysis is possible, giving these neonates a chance of life. In infants and neonates, peritoneal permeability seems to be in a hyperpermeable state, perhaps only related to the volume of the instilled dialysate. Practical peritoneal prescriptions in neonates have to be balanced between either short dwell times optimizing ultrafiltration or long dwell times optimizing the diffusive process and blood purification. The recommendations for peritoneal dialysis in neonates usually admitted are short dwell times, one hour or less, adapted to ultrafiltration need, and small instilled dialysate volumes, 10 20 mL/kg initially, to avoid raised intra-abdominal pressure. Age-related particular risks are hyponatremia and hypophosphatemia.
Intellectual Output of Children with Chronic Renal Failure on Continuous Ambulatory Peritoneal Dialysis
Authors: Jaramillo-Solorio Rosa Maria , Mendoza-Guevara Leticia , Garcia-Lopez Elvia
Published: February 2020

The aim of this study is to quantify the intelligence output in our pediatric population on continuous ambulatory peritoneal dialysis (CAPD) treatment. A total of 30 children were studied, with an age range of eight to 18 years. For evaluating a global intelligence quotient (la), the Wechsler test was applied according to their age. And, as a complement, a Bender test was also requested to deny or confirm brain damage. The Wechsler test showed an average intelligence quotient in most of the children (76.7%); a small group (16.7%) was classified as dull normal, 1 child had mild retardation, and 1 was borderline. All of them had a Bender test that did not correlate with brain damage. Most of them maintained a very high verbal la, but, when the performance la was qualified, 34% got a low score, and a certain difficulty in solving this part of the test was observed. Maybe this was influenced by chronicity of the sickness and/or the blood urea nitrogen level.

In conclusion, the child's plasticity is his best quality to cope with uremia and the alterations caused by it. Therefore the idea is to consider the intelligence quotient as the capacity that the subjects have to use their own resources to cope with their environment. And, even though the neurological alterations exist, the child's plasticity helps him/her maintain a good global intelligence quotient, even though he/she is not having immediate transplantation.
The Influence of Dialysate Calcium Concentration on the Pth Level in Children Undergoing Capd
Authors: Sieniawska Maria , Roszkowska-Blaim Maria , Wojciechowska Beata
Published: February 2020

In 12 children aged four-and-a-half to 18 years (mean 11 ±4.2) undergoing continuous ambulatory peritoneal dialysis (CAPO), serum intact parathyroid hormone (iPTH), ionized calcium (iCa) levels, and calcium mass transfer (CaMT) were measured on three consecutive days: day 1, after a four-hour interval between dialyses; on day 2, after four hours dwell time with peritoneal dialysis (PD) Ca 3.5 mEq/L; and on day 3, after four hours dwell time with PD Ca 2.5 mEq/L.

A significantly more negative CaMT was found when PD Ca 2.5 mEq/L was used, as compared with values obtained using PD Ca 3.5 mEq/L. Significantly lower parathyroid hormone (PTH) values were found after the interval between exchanges. We conclude that in order to properly evaluate parathyroid gland function and to decide whether or not to give vitamin D metabolites, a protocol for determining PTH should be standardized.
Comparison of Patient Hospitalization in Chronic Peritoneal Dialysis and Hemodialysis: A Pediatric Multicenter Study
Authors: Verrina Enrico , Perfumo Francesco , Zacchello Graziella , Sorino Palma , Edefonti Alberto , Bassi Sergio , Calevo Maria Grazia , Caringella Domenica L. , Cattarelli Donatella , Lavoratti Giancarlo , Consalvo Gertrude , Andreetta Barbara , Rinaldi Stefano , Longo Luigi , Gusmano Rosanna
Published: February 2020

Patient hospitalization was compared in 207 pediatric patients (age ≤15 years at the start of dialysis) on chronic peritoneal dialysis (CPD) (127 patients) or center hemodialysis (HD) (80 patients), treated in 17 dialysis centers during the period 1989 to 1994, and followed up for at least three months. The hospitalization rate was expressed as hospital days per patient-month, and was calculated on the overall period of treatment and separately for the first and second year. Since the age at start of dialysis markedly differed between CPD (8.2±4.7 years) and HD (11.2±2.9 years) patients (with no HD patient younger than five years), results are separately presented in three patient groups: CPD patients aged <5 years (A); CPD patients aged five to 15 years (B); HD patients (C). The duration of hospitalization was subdivided according to the following different causes: routine (monitoring of dialysis adequacy), complications of the modality, patient primary renal disease, and other causes. The results are presented in Table 1.

A statistically significant difference in total days hospitalized was found between each of the two groups of CPD patients and the HD patients; the results for hospitalization for dialysis-related complications were higher in the group of younger children on CPD, while the difference between the two age-matched groups of patients on CPD and HD was not significant.
Charge-Affected Transperitoneal Movement of Amino Acids in Capd
Authors: Nakao Toshiyuki , Ogura Makoto , Takahashi Hajime , Okada Tomonari
Published: February 2020

Our objective was to investigate the influence of molecular charge on transperitoneal solute movement in continuous ambulatory peritoneal dialysis (CAPD). Tests of peritoneal equilibration were performed. Two liters of 2.27% or 2.5% glucose CAPD dialysate were infused and the dialysate samples were taken after 2 hr and 4 hr, and blood samples were obtained after 4-hr dwell time. Dialysate-to-plasma concentrations ratios (DIP) were calculated for creatinine (Cr) and three amino acids with almost the same molecular weight but quite different charges: glutamic acids (Glu: negatively charged), glutamine (Gin: near neutrally charged), and lysine (Lys: positively charged). The setting was a university hospital. There were 23 stable CAPD patients with a mean age of 56.5±9.5 years and a mean CAPD duration of 15.2±19.4 months. DIP ratio of Glu was much lower than those of Gin, Lys and Cr at both 2 hr and 4 hr (p < 0.01), and DIP of Lys was significantly lower than that of Gin (p < 0.01). There was no significant difference of DIP between Gin and Cr. The order of transperitoneal mobility among the three amino acids was Gin > Lys > Glu. Transperitoneal movement of solutes in CAPD is influenced by molecular charge, the movement of negatively charged solutes is most remarkably retarded in cases of amino acids.
Bicarbonate: The Alternative Buffer for Peritoneal Dialysis
Authors: Passlick-Deetjen Jutta , Kirchgessner Judith
Published: February 2020

For a long time bicarbonate, the physiological buffer of the body, was suggested to be the best buffer for peritoneal dialysis. However, since the production of bicarbonate containing solutions is associated with technical problems, lactate was favored. To avoid the well-known disadvantages of lactate solution concerning biocompatibility and possible metabolic side effects, different attempts have been made to use bicarbonate as a buffer in peritoneal dialysis. One of the major approaches was the total replacement of lactate by bicarbonate combined with storage of the fluid in a specially designed double-chamber bag. Further solutions of the above-mentioned problem were the on-line preparation of bicarbonate fluids for intermittent peritoneal dialysis, the addition of bicarbonate just before use, the combination of bicarbonate with organic acids, or its combination with the dipeptide glycylglycine as a stabilizing agent.

By now, the beneficial effect of the neutral bicarbonate fluid, for example, on cell viability and cell functions, has been demonstrated in many different in vitro and animal studies. However, only few reports on clinical experience have been published. These investigations demonstrated independently that bicarbonate fluids diminish inflow pain, are well tolerated by the patients, and may correct metabolic acidosis of uremic patients. A controlled randomized multicenter trial using 34 mmol/L bicarbonate for at least three months confirmed that bicarbonate is as efficacious as lactate in equimolar concentrations. Concomitant investigations on energy metabolism and redox state of red blood cells and phospholipid secretion of mesothelial cells additionally demonstrated the improvement of cell function with bicarbonate solutions. For some patients with severe metabolic acidosis the bicarbonate concentration used in the multicenter trial seemed to be too low. Thus, a fluid containing a higher bicarbonate concentration was tested in a pilot study resulting in the expected significant increase of arterial bicarbonate levels.

In summary, bicarbonate-containing peritoneal dialysis solutions are a promising alternative to lactate, especially if bicarbonate concentrations are adjusted individually to the patient's need.
The Predictive Value of Kt/V and Peritoneal Solute Transport in Capd Patients is Dependent on the Type of Comorbidity Present
Authors: Davies Simon J. , Bryan Janet , Phillips Louise , Russell Gavin I.
Published: February 2020

Comorbidity, age, dialysis dose (KT/Vurea)’ plasma albumin, and peritoneal function (DIP treat) were measured cross-sectionally in 228 continuous ambulatory peritoneal dialysis (CAPD) patients, who were then followed up for a mean of two years. Comorbidity, utilizing a semiquantitative score described previously, was the most powerful predictor of mortality in both univariate and multivariate analysis. Using univariate analysis, all the variables predicted outcome with statistical significance, mortality being associated with lower KT/V and plasma albumin and a higher DIP treat On multivariate analysis only comorbidity, age, and KT/V remained independent predictors.

Data was further analyzed on the basis of type of comorbid condition. In those patients without comorbid disease (n = 127) neither KT/V, albumin nor DIP retreamendicted outcome. In patients with clinical evidence of ischemic heart disease the KT/V was a significant predictor of favorable outcome. In those with clinical evidence of left ventricular function, mortality was significantly and independently associated with low plasma albumin, high DIP treat’ and KT/V. It is suggested that the concept of treatment adequacy in CAPD patients must include both measures of dialysis dose and peritoneal function, particularly in the context of the patient's comorbidity.
Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study
Authors: Avram Morrell M. , Fein Paul A. , Bonomini Luigi , Mittman Neal , Loutoby Raphael , Avram David K. , Chattopadhyay Jyoti
Published: February 2020

Our objective was to examine the influence of various demographic, clinical, and enrollment biochemical variables on the long-term survival of continuous ambulatory peritoneal dialysis (CAPD) patients. This was a prospective cohort study investigating the relationship between demographics and enrollment biochemical markers and mortality in CAPD patients in a CAPD unit in a large tertiary care teaching hospital. One hundred and sixtynine patients in the CAPD program were enrolled between 1989 and 1994, and were followed up to 60 months. Independent predictors of mortality determined by Cox proportional hazards model included age, diabetes, serum albumin and creatinine. Enrollment level of serum albumin, and creatinine can predict mortality in CAPD patients up to 60 months. Markers of visceral and somatic nutrition at enrollment are important predictors of mortality in CAPD patients up to five years.
Nutritional Status of Capd Patients at Three Years
Authors: Palop Leocadia , Vega Nicanor , Rodriguez Teresa , Fernandez Ana , Rodriguez Jose C. , Plaza Celia , Hortal Luis , Perdomo Miguel , Baamonde Eduardo , Perez Patricia , Martinez Jose A.
Published: February 2020

A nutritional assessment was carried out in 63 patients starting treatment from April 1990 up to December 1993. Anthropometric measurements were performed showing a prevalence of protein-calorie malnutrition (PCM) of 21 % in a total of 142 clinical surveys carried out in the above-mentioned sample. A steady state of albumin levels in plasma was verified during a three-year follow-up period at a lower level than that of the control group. The patients’ lymphocytic profile throughout the study was characterized by lymphopenia and decreased B and T 8 lymphocytes. During the first two years of continuous ambulatory peritoneal dialysis (CAPD), a high percentage of patients met the “adequacy” dialysis criteria as residual renal function plays an important role as regards treatment.
Impact of the Liver on Peritoneal Transport
Authors: Flessner Michael F.
Published: February 2020

Previously, we developed a distributed model of plasma-peritoneal small solute diffusion for specific tissues surrounding the peritoneal cavity and related the transport coefficients to the mass transport coefficient (MTC) of the “peritoneal membrane” model. Based on this theoretical analysis, we calculated tissue-specific MTCs for sucrose from microvascular data in the literature and found that the MTC for the liver was five times the magnitude of other tissues. We hypothesized that the liver was potentially the most significant single transport organ during peritoneal dialysis. To test this hypothesis, we measured the mass transfer from the plasma to fluid contained in diffusion chambers, which were glued to one of four tissues surrounding the peritoneal cavity. We determined that the rate of small solute transport from the plasma to each diffusion chamber was similar for all four tissues. We calculated the MTC of the liver to be no greater than other visceral or parietal surfaces. We therefore disproved our hypothesis concerning the liver. We conclude that the importance of a particular tissue to plasma-peritoneal transport is primarily dependent on the surface area exposed to the dialysis solution.
Peritoneal Dialysis in Liver Disorders
Authors: Selgas Rafael , Bajo M. Auxiliadora , Jimenez Carlos , Sanchez Carmen , Del Peso Gloria , Cacho Guillermo , Diaz Candida , Fernandez-Reyes M. Jose , De Alvaro Fernando
Published: February 2020

The purpose of this paper is to review the specific role of peritoneal dialysis (PD) in patients with liver disorders. We will pay attention to the confluence of liver diseases and situations for which chronic dialysis treatment is required.

Hemodialysis (HD) and peritoneal membranes are safe barriers against the passage of the hepatitis C virus; consequently, while peritoneal effluent or HD ultrafiltrate drained from hepatitis S patients/carriers is infective, that from hepatitis C patients does not appear to present this risk. An important issue is horizontal transmission, which appears to occur with both viruses in HD units, and which is absent in peritoneal dialysis units. The incidence of hepatitis C among continuous ambulatory peritoneal dialysis (CAPD) patients is quite low, while it may reach almost 50% -60% of HD patients in some units. While hepatitis C transmission mechanisms are not completely understood and a vaccine is not available, PD provides some degree of protection when compared with HD, for end-stage renal disease patients.

In summary, our experience and that of others, with a total of 19 PD-treated chronic liver disease patients, supports CAPD as the treatment of choice for cirrhotic patients with ascites who require chronic dialysis. Data on peritoneal diffusion of low molecular weight substances revealed a marked increase in most patients. The ultrafiltration capacity was clearly augmented with respect to noncirrhotic patients, making the use of hypertonic bags unnecessary. Hemodynamic tolerance was excellent. Complications and death were mainly related to liver disease complications.

Spontaneous bacterial peritonitis (SSP), caused by gram-negative germs, is the most important complication directly related to ascites and may have some points in common with PD-related peritonitis. However, and in contrast to most PD peritonitis, two pathogenetic mechanisms have been suggested for SSP: (1) translocation of bacteria from the gut to the mesenteric lymph nodes, and (2) bacteremia in these patients is secondary to the general abnormal host defense mechanisms. Local factors such as intrahepatic shunting and the impairment of bactericidal activity in ascitic fluid favor the bacteria ascites. The hypothesis of a direct transmural contamination from bowel to ascitic fluid has been relegated to secondary bacterial peritonitis. Would cirrhotic patients with temporal or permanent renal function compromise benefit from peritoneal catheter placement and other PD practices to perform repetitive small ascitic drainages at home? Perhaps the time has arrived when hepatologists and PD nephrologists begin to work shoulder to shoulder in this particular field, as we have a common problem, the peritoneal cavity filled with fluid.
Pd Treatment for Severe Congestive Heart Failure
Authors: Stegmayr Bernd G. , Banga Ravi , Lundberg Lennart , Wikdahl Ann Marie , Plum-Wirell Marianne
Published: February 2020

Our objective was to evaluate if peritoneal dialysis (PD) could improve survival of patients with progressive severe congestive heart failure resistant to drug therapy. The patients were selected by the cardiologist in cooperation with a nephrologist, including patients not responding to conventional medication with an expected fatal outcome within the next months.

The study included 16 consecutive patients with a chronic progressive severe refractory heart failure (sHF) of NYHA class III (n = 6) or IV (n = 10) who did not respond to diuretics and angiotension converting enzyme (ACE) inhibitors. They had a mean age of 60 years (±14, range 30 -75, median 62 years). Nine of the patients had sHF as the only reason for initiating PD (all NYHA IV), while 7 also needed dialysis due to uremia. Five of 7 had been on hemodialysis but switched to PD due to a progressive congestive sHF. ln 2 patients, PD was decided already at start of dialysis therapy due to the severity of their heart failure. The reason for sHF was: valvular dysfunction (n = 5) with defect prosthesis (n = 3); in the course of a myocardial infarction (n = 4); and cardiomyopathy (n = 4). Tenckhoff catheters were inserted under local anesthesia and ultrafiltration was started and maintained until discharge. The survival time and change in heart size by x ray was used for analyses.

All patients improved their stage of congestive heart failure by NYHA classification already during the first month. Six patients died during the follow-up period due to cardiac reasons (sudden death, relapse of sHF) after a mean of 10.7 months (±3.7, range 1 24 months). Ten were alive after a median observation period of 10 months (±12.5, range 1–36 months). Heart size was reduced in 15 of the patients. Three of the patients with sHF but without uremia could stop the PD.

The results showed that ultrafiltration by PD was easy to perform despite low initial blood pressure. The sHF was reduced and life span was prolonged with improved quality of life.
Management of Foot Problems in Diabetes
Authors: Shaw Jonathan E. , Boulton Andrew J.M. , Gokal Ram
Published: February 2020

Many diabetic foot complications are preventable. This requires a team approach, aiming to identify the high-risk patient and provide appropriate education and foot care. An established ulcer needs careful management with the emphasis on pressure relief and establishing a good blood supply.
Health-Care Economics and Peritoneal Dialysis
Authors: Nissenson Allen R.
Published: February 2020

There is no question that the next decade will see an enormous growth in the worldwide dialysis population. Increasingly, old and sick patients will be accepted on dialysis, and the worldwide dialysis population characteristics will approach those now seen in the U.S. In addition, recent attention in the U.S. and elsewhere on the mortality of dialysis patients is already resulting in an improvement in this regard, further expanding the future dialysis population. PD will continue to increase in use, particularly with continued worldwide economic pressures on dialysis providers. To the extent that the efficacy of this treatment can be improved, without eroding its economic benefits over HD, it should fare well in the future. If, on the other hand, expensive “adjustments” in the practice of PD are needed to assure reasonable medical outcomes, PD will likely fade in popularity. The challenge to those involved in PD clinicians, scientists, companies -is to develop a PD system that optimizes patient medical and psychosocial outcomes, and minimizes costs. If this cannot be accomplished, PD is likely to be replaced by new dialytic systems in the future (e.g., daily, slow, home hemodialysis) that can succeed in these areas.
Imaging of the Peritoneal Cavity in Capd
Authors: Wankowicz Zofia , Pietrzak Bozena , Skrobowska Ewa
Published: February 2020

The aim of our study was the use of the optimal imaging of the peritoneal cavity (PC) for continuous ambulatory peritoneal dialysis (CAPD)-related problems. Ultrasonography (USG), direct abdominal radiography (DAR), peritoneoscintigraphy (PSG), and standard peritoneo-computed tomography (PCT) with reconstruction (R-PCT) were performed in 25 patients on CAPD from three to 44 months. Studies were done at the beginning of CAPD (1 -3 months) as well as in the noncomplicated and complicated course of CAPD. Group I comprised 17 patients in whom 77 PC images were taken in the noncomplicated course of CAPD. Group II comprised 15 patients in whom 65 images were taken during or after complications. For USG and DAR we used standard equipment, PSG was done with sulfur colloid labeled with technetium 99m (Tc 99m), PCT, and R-PCT were done with Omnipaque and Somatom HiQ Siemens unit. In PCT, two and three-dimensional reconstruction were done by our own computer program. USG was recommended for imaging of tunnel infections, exit-site infection (ESI), and adhesion. PSG was useful in almost all observed complications of CAPD except thickening of the peritoneal membrane (PM). Standard PCT with R-PCT was more useful than PCT because of a more legible image of the peritoneal cavity, which gives the possibility of monitoring fluid distribution and measuring of intraperitoneal fluid volume.
Peritoneal Dialysis Catheter Complications
Authors: Bernardini Judith
Published: February 2020

A functional peritoneal dialysis catheter is essential for continuous ambulatory peritoneal dialysis to be an effective form of dialysis. The most common mechanical problems that hinder adequate function include obstruction, leaks, hernias, hemoperitoneum, and pain. The reported incidence of mechanical problems varies from 12% to 73%. Symptoms, diagnostic tests, risk factors, and treatment strategies are reviewed. Surgical intervention and catheter replacement are often required to resolve mechanical problems. Avoidance of mechanical problems reduces the risk of interruptions in peritoneal dialysis therapy.
The Use of Community Nurses for Home Peritoneal Dialysis: Is it Cost -Effective?
Authors: Brunier Gillian , Gray Barbara , Coulis Nancy , Savage Judy , Manuel Arif , McConnell Heather , Mildon Barbara , Sherlock Anna Marie
Published: February 2020

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population}. Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working.

Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.
Clinical and Physiological Effects of a New, Less Toxic and Less Acidic Fluid for Peritoneal Dialysis
Authors: Rippe Bengt , Simonsen Ole , Wieslander Anders , Landgren Christina
Published: February 2020

Objective

To report our first clinical experience with a new continuous ambulatory peritoneal dialysis (CAPD)fiuid (PD-Bio), which is nearly devoid of glucose degradation products and has a higher pH (6.3) than conventional peritoneal dialysis (PD) solutions, and to discuss in general terms some acute and long-term effects of conventional acidic solutions containing glucose degradation products.

Design

1) Pilot study on 4 patients investigated using a modified peritoneal equilibration test (PET) and cytobiology parameters. 2) Computer simulation study, assuming that conventional acidic solutions cause vasodilatation and recruitment of capillary surface area initially (during 0–60 minutes) in a PD dwell.

Patients

Four stable CAPD patients were chosen in an open cross-over study. After a period of three months using conventional PD fluid, the patients were switched to three months on the new PD fluid.

Results

Cancer antigen 125 increased significantly, and patients with discomfort/infusion pain during the control period improved during the period with the new fluid. No significant changes were observed in mass-transfer coefficients or drained volumes with the new solution. PH in the effluent dialysis was, however, higher for PD-Bio at all times during a two-hour dwell. In the computer simulation study, a less acidic solution caused an initially lower rate of glucose dissipation and improved ultrafiltration (UF) after a four -hour dwell, as compared to a conventional PD solution.

Conclusion

A new, differently produced, less toxic and less acidic PD fluid (PD-Bio) seems to be better tolerated than a conventional acidic solution with respect to discomfort/infusion pain. Theoretically, neutralized solutions should show slightly improved UF profiles over conventional acidic solutions, according to the computer simulation analysis. Furthermore, it is speculated that a neutral, less acidic, less toxic fluid would cause less interstitial-mesothelial alterations and less impairment of UF capacity than conventional solutions during longterm CAPD.
Glycation and Advanced Glycation End-Product Formation with Icodextrin and Dextrose
Authors: Anne B. , Dawnayand St. J. , Millar David J.
Published: February 2020

Objective

To review protein glycation and advanced glycation end-product formation with particular reference to its occurrence in the peritoneum following exposure to peritoneal dialysis fluid.

Data sources

Articles identified through searches on MEDLINE and BIDS and references cited therein.

Study selection

Studies on the interaction of amino groups with glucose, maltose and glucose polymers. Studies containing evidence of peritoneal advanced glycation end-product formation.

Data extraction

Studies evaluated as to whether they are in vivo, ex vivo or in vitro under non-physiological or physiological conditions.

Results

Protein glycation is slower with maltose and glucose polymers than with equimolar glucose. Advanced glycation end-product formation occurs with all three sugars, but to a greater extent after standard heat sterilization of dialysis fluid and to a lesser extent in heat sterilized fluids containing icodextrin rather than glucose. Glucose degradation products significantly contribute to protein-linked advanced glycation end-productlike fluorescence. Histology and immunohistochemistry demonstrate diabetiform changes and advanced glycation end-products in the peritoneal membrane following exposure to glucose-containing peritoneal dialysis fluids. Their presence is likely to be detrimental to peritoneal function and may contribute to loss of ultrafiltration.

Conclusions

Advanced glycation end-product formation is lower but still significant with heat sterilized peritoneal dialysis fluid containing icodextrin than with glucose. More research is needed to investigate the interaction of glucose degradation products and glucose polymers with proteins and the possible consequences of advanced glycation end-product formation on peritoneal function.
Treatment in Pd Patients of Peritonitis Caused by Gram-Positive Organisms with Single Daily Dose of Antibiotics
Authors: Vas Stephen , Bargman Joanne , Oreopoulos Dimitrios G.
Published: February 2020

This study was a retrospective case analysis of treatment results of peritonitis in PD patients caused by gram-positive organisms in two different but comparable periods.

Cases were entered, regardless of status of exit site, or whether it was the patient's first or subsequent peritonitis episode.

Failure was defined as either recurrence of peritonitis (with same organism within four weeks of cessation of treatment) or the therapeutic decision to remove the catheter.

Cefazolin used in doses of 1.5 g once a day intraperitoneally (1.0 g if body weight was < 50 kg) with initial tobramycin until culture results became available resulted in a 77% overall cure rate compared to 74% cure in a similar group treated with vancomycin 2.0 g IP weekly (1.0 g if body weight < 50 kg).

Peritonitis caused by methicillin-resistant coagulase-negative staphylococci showed a high failure rate; the change to vancomycin after the initial treatment of these cases would be justified.

The cure rate of peritonitis caused by S. aureus is disappointingly low (58% with vancomycin, 67% with cefazolin). This is due to the high rate of exit-site infections with this organism.
Reviews and Original Articles Lipoprotein(A) and Apolipoprotein(A) Phenotypes in Patients with End-Stage Renal Disease
Authors: Kim Soon Bae , Yang Won Seok , Kang Eun Suk , Min Won Ki , Park Jung Sik
Published: February 2020

Objective

To evaluate the distribution pattern of apolipoprotein(a) [Apo(a)] phenotypes in Koreans and the effect of dialysis modality on serum lipoprotein(a) [Lp(a)] concentration according to apo(a) phenotype in patients with end-stage renal disease (ESRO).

Design

Cross-sectional study.

Setting

A university hospital. Participants: 153 normal controls, 99 hemodialysis (HO) patients and 82 continuous ambulatory peritoneal dialysis (CAPO) patients.

Main Outcome Measures

Fasting serum Lp(a), lipids, and apo(a) phenotypes were measured.

Results

The frequencies of the subjects with apo(a) phenotypes of high-molecular weight only, including S3, S4, or S5 or null type were 95.4% of control, 100% of HO patients, and 95.1% of CAPO patients. The frequent apo(a) phenotypes in Koreans consisted of S4, S4S5, S5, and S5S5 isoforms. Significant difference was found in serum Lp(a) concentration among controls and HO and CAPO patients [median (interquartile range): 0.05 g/L, (0.01 0.19); 0.19g/L, (0.10 0.35); 0.63g/L, (0.28 0.90), p< 0.001]. Lp(a) levels in CAPO patients were significantly higher than in HO patients for all four common apo(a) isoforms found in Korean subjects. CAPO patients had higher total and LOL cholesterol levels, and higher ApoB levels than H O patients. Significant differences were found in serum albumin levels between controls and HO and CAPO patients (44 ± 3 g/L, 40 ± 4 g/L, 32 ± 7 g/L, respectively, p < 0.05). There were significant inverse correlations between serum albumin and Lp(a) (r = -0.33, p < 0.01), total cholesterol (r = -0.31, p < 0.01), LOL (r = -0.39, p < 0.01) or ApoB (r = -0.35, p < 0.01) in ESRO patients. A significant positive correlation was found between serum albumin and ApoA1 (r = 0.24, p < 0.01).

Conclusion

These findings indicate that Koreans have mainly high -molecular weight apo(a) phenotypes and serum Lp(a) is elevated in CAPO patients compared to HO patients for common apo(a) phenotypes, which may contribute to the frequent cardiovascular mortality in CAPO patients.
Residual Renal Function Affects Lipid Profile in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Kagan Alexander , Elimalech Eti , Lerner Zvi , Fink Aaron , Bar-Khayim Yaacov
Published: February 2020

Objective

To determine whether lipoprotein abnormalities associated with continuous ambulatory peritoneal dialysis (CAPD) are influenced by residual renal function (RRF).

Design

Open, non randomized prospective and com -parative study.

Setting

Single university teaching hospital dialysis unit and outpatient clinic.

Patients

Twenty adult patients on standard CAPD (1 -38 months) were divided into two groups: group A (RRF ≤ 0.8 mL/min, n = 10) and group B (RRF ≥ 1.1 mL/ min, n = 10). Patients in the two groups were matched for age, time on dialysis, body weight, body mass index, serum urea and albumin levels, peritoneal and urinary albumin losses, and peritoneal transport characteristics such as overnight 8hour peritoneal creatinine and β2-microglobulin clearances and overnight 8-hour effluent glucose concentrations.

Results

The degree of uremia in patients with preserved RRF (group B) was obviously lower than in patients with negligible RRF (group A), that is, patients in group B had significantly lower serum creatinine and β2-microglobulin levels and significantly higher weekly KTN than group A patients. Despite the prevalence of allele 4 of apolipoprotein E genotype in group A patients, their levels of serum total cholesterol, low-density lipoprotein cholesterol, lipoprotein (a) [Lp(a)], apolipoprotein B (ApoB), and apolipoprotein A1 (ApoA1) were significantly lower than those of patients with preserved RRF (group B). The two groups did not differ significantly in the serum levels of triglyceride or high-density lipoprotein cholesterol. Serum concentrations of Lp(a) and ApoA1, as well as ratios of ApoA1 to ApoB, were correlated significantly with RRF (r = 0.63, r = 0.51, and r = 0.61, respectively).

Conclusions

The findings suggest that RRF affects the lipid profile of CAPD patients, especially serum levels of cholesterol-rich lipoproteins.
Predialysis Glycemic Control is An Independent Predictor of Clinical Outcome in Type Ii Diabetics on Continuous Ambula Tory Peritoneal Dialysis
Authors: Yu Chun-Chen , Wu Mai-Szu , Wu Ching-Herng , Yang Chih-Wei , Huang Jeng-Yi , Hong Jenn-Jye , Chiang Chun-Yi Fan , Leu Mei-Ling , Huang Chiu-Ching
Published: February 2020

Objective

To evaluate the correlation between predialysis glycemic control and clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

Sixty type II diabetic patients on CAPD were classified into 2 groups according to the status of glycemic control. In group G (good glycemic control), more than 50% of blood glucose determinations were within 3.3 11 mmol/L and the glycosylated hemoglobin (HbA 1 C) level was within 5 -10% at all times. In group P (poor glycemic control), fewer than 50% of blood glucose determinations were within 3.3 -11 mmol/L or HbA 1 C level was above 10% at least once during the follow-up duration. In addition to glycemic control status, predialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and the modes of glycemic control were also recorded.

Setting

Dialysis Unit, Department of Nephrology of a single university hospital.

Patients

From February 1988 to October 1995, 60 type II diabetic patients receiving CAPD for at least 3 months were enrolled.

Main Outcome Measures

Morbidities before and during the dialysis period, patient survival, and causes of mortality.

Results

The patients with good glycemic control had significantly better survival than patients with poor glycemic control (p < 0.01). There was no significant difference in predialysis morbidity between the two groups. No significant differences were observed in patient survival between the patients with serum albumin greater than 30 g/L and those with less than 30 g/L (p = 0.77), with cholesterol levels greater or less than 5.18 mmol/L (p = 0.73), and with different peritoneal membrane solutetrans port characteristics evaluated by peritoneal equilibration test (p = 0.12). Furthermore, there was no significant difference in survival whether the patients controlled blood sugar by diet or with insulin (p = 0.33). Cardiovascular disease and infection were the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetics maintained on CAPD.

Conclusions

Glycemic control before starting dialysis is a predictor of survival for type II diabetics on CAPD. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.
The Diagnostic Value of Gram Stain for Initial Identification of the Etiologic Agent of Peritonitis in Capd Patients
Authors: Bezerra Dinoráh A. , Silva Mario B. , Caramori Jaqueline S.T. , Sugizaki Maria F. , Sadatsune Teruê , Montelli Augusto C. , Barretti Pasqual
Published: February 2020

Objective

To evaluate the effectiveness of the Gram stain in the initial diagnosis of the etiologic agent of peritonitis in continuous ambulatory peritoneal dialysis (CAPD).

Design

Retrospective study analyzing the sensitivity (S), specificity (SS), positive predictive value (+PV), and negative predictive value (-PV) of the Gram stain relating to the results of cultures in 149 episodes of peritonitis in CAPD. The data were analyzed in two studies. In the first, only the cases with detection of a single agent by Gram stain were taken (Study 1). In the second, only the cases with two agents in Gram stain were evaluated (Study 2).

Setting

Dialysis Unit and Laboratory of Microbiology of a tertiary medical center.

Patients

Sixty-three patients on regular CAPD who presented one or more episodes of peritonitis from May 1992 to May 1995.

Results

The positivity of Gram stain was 93.2% and the sensitivity was 95.7%. The values of S, SS, +PV, and -PV were respectively: 94.9%, 53.5%, 68.3%, and 90.9% for gram -positive cocci and 83.3%, 98.8%, 95.2%, and 95.6% for gram-negative bacilli. The association of grampositive cocci plus gram -negative bacilli were predictive of growth of both in 6.8%, growth of gram -positive cocci in 13.7%, and growth of gram -negative bacilli in 72.5%.

Conclusions

The Gram stain is a method of great value in the initial diagnosis of the etiologic agent of peritonitis in CAPD, especially for gram-negative bacilli.
Measurement of Serum Ionized Magnesium in Capd Patients
Authors: Saha Heikki H.T. , Harmoinen Aimo P.T. , Pasternack Amos I.
Published: February 2020

Objective

To evaluate the magnesium status of continuous ambulatory peritoneal dialysis (CAPD) patients using a new method for assessing the level of the ionized fraction a serume magnesiumy.

Design

Serum ionized magnesium was measured in CAPD patients using the ion-selective electrode for Mg2+.

Setting

The Dialysis Unit of Tampere University Hospital.

Patients

Twenty -six patients on CAPD (age: 21 -81 years, mean 54 ± 16 years; duration of CAPD: 3 -52 months, mean 13 months), and 26 sex and age-matched healthy controls.

Results

Both serum ionized magnesium (0.73 ± 0.11 mmol/L vs 0.56 ± 0.07 mmol/L, p < 0.001) and total magnesium (1.11 ± 0.22 vs 0.81 ± 0.08 mmol/L, p < 0.01) were higher in CAPD patients than in sex and agematched controls. The ionized magnesium fraction of total magnesium was slightly lower in dialysis patients in spite of the fact that 16/26 patients had serum albumin less than 36 g/L. Hypermagnesemia (mean serum ionized magnesium 0.78± 0.10 mmol/L) was observed in the 13 of 26 patients with 0.75 mmol/L Mg2+ dialysate; those with lower magnesium dialysate (Mg2+ 0.50 mmol/L in 10/26 and Mg2+ 0.25 mmol/L in 3/26) had mean serum ionized magnesium at the upper normal margin (0.69 ± 0.10 mmol/L).

Conclusion

In CAPD patients with Mg2+ 0.5 0.75 mmol/L in their dialysis fluid, both serum ionized and total magnesium concentrations were higher but the ionized/total magnesium ratio was lower than in healthy control subjects. Use of ion-selective electrodes to measure ionized magnesium may be a more useful methodology than measuring total magnesium in the evaluation of magnesium status of CAPD patients, because it is not infuenced by hypoalbuminemia or increased complexed fraction of magnesium often present in dialysis patients.
Increase of the Bioavailabllity of Intraperitoneal Erythropoietin in Children on Peritoneal Dialysis by Administration in Small Dialysis Bags
Authors: Reddingius Roel E. , De Boer Alberdina W. , Schröder Cornelis H. , Willems Johannes L. , Monnens Leo A.H.
Published: February 2020

Objective

To establish the effectivity of administration of erythropoietin intraperitoneally in a small amount of fluid in children with renal anemia on continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective study in which children with renal anemia on CAPD were treated with erythropoietin intraperitoneally, administered in a specially designed bag containing 50 mL NaCl 0.9%.

Setting

University hospital.

Patients

The patient population consisted of 9 children treated with CAPD and 1 treated with nightly intermittent peritoneal dialysis. The median age was 7.8 years (range 4.1 -15.2). Four of these children had not been treated with erythropoietin before (group A), and 6 had been treated with erythropoietin administered intraperitoneally in 250 mL of dialysis fluid (group B).

Interventions

Patients in group A started on a dose of approximately 300 units/kg per week (group A). Patients in group B received their previous dose. Do sage was adjusted to achieve a target hemoglobin level of 6.5 7.0 mmol/L (104 -112 g/L). Serum ferritin levels and transferrin saturation were monitored and iron supplementation was prescribed in the case of iron deficiency.

Main outcome measures

Weekly erythropoietin dose in relation to hemoglobin level.

Results

In group A, median hemoglobin level rose from 5.3 mmol/L (85 g/L) to 6.6 mmol/L (106 g/L) after 6 months of therapy, whereas the median erythropoietin dose decreased from 266 to 234 U/kg/week. In group B, hemoglobin levels remained stable and median erythropoietin dose decreased from 262 to 194 U/kg/week. One patient in this group, for unknown reasons, never responded to erythropoietin treatment. He was excluded from further analysis. In the remaining 5 patients the median cumulative erythropoietin dose was 3250 U/kg in the 3-month period prior to the start of the study and 2713 in the 3-month period starting 6 months after the beginning of the study. This difference of 17% was statistically significant using a Wilcoxon test (p < 0.05).

Conclusion

Intraperitoneal administration of erythropoietin in a small amount of dialysis fluid leads to a decrease in the required dose.
Staphylococcus Aureus Carriage in Adult Peritoneal Dialysis Patients and Their Spouses
Authors: Bistrup Claus , Jensen Kjeld Truberg , Kabel Bodil , Pedersen Robert Smith
Published: February 2020

Objective

We hypothesized that carriage of Staphylococcus aureus among continuous ambulatory peritoneal dialysis (CAPD) patients was influenced by their spouses. Furthermore, this carrier status was compared to previous Staph. aureus peritonitis episodes in order to identify the influence of Staph. aureuscarriage on peritonitis rate.

Design

A combined prospective surveillance study (Staph. aureus carriage) and retrospective chart review (Staph. aureus peritonitis).

Setting

A single peritoneal dialysis unit in a county hospital.

Patients and methods

Cultures from patients (n = 32) and spouses (n = 16) were obtained twice, with a 1-month interval, from the anterior nares, the umbilical, and one groin area. All positive cultures were phage typed. Retrospective chart review of all episodes of Staph. aureus peritonitis among the patients was carried out.

Results

Twelve of 32 patients (37.5%) and 5 of 16 spouses (31 %)evaluated were carriers. Half of the spouses of patients who were Staph. aureus carriers, were also carriers, as opposed to 20% of spouses of non carrier patients (p = 0.30). Patients and spouses always shared the same phage type. Among patients, Staph. aureus was found in the nose only (n = 9), in all three regions (n = 2), and extranasally only (n = 1). If only one nasal culture was used to establish carriage, the sensitivity and negative predictive value would be 92% and 95%, respectively. A trend toward a higher incidence (p = 0.062) of Staph. aureus peritonitis was found among carriers (patients), 0.37 versus 0.28 peritonitis episode/dialysis -year.

Conclusions

Only one positive nasal culture was necessary when carriage of Staph. aureus was to be established. Staph. aureuscarriage was found more often in patients who had previously suffered from Staph. aureus peritonitis. The phage types isolated remained fairly constant, and the patients and spouses often had the same carrier state and shared the same phage types, although transmission does not always take place.