bluuebunny/crossref_metadata_2025 huggingface dataset:
Seven-Year Follow-Up of Peritoneal Dialysis Patients in Taiwan
Authors: Shiao Chih-Chung , Kao Tze-Wah , Hung Kuan-Yu , Chen Yin-Cheng , Wu Ming-Shiou , Chu Tzong-Shinn , Wu Kwan-Dun , Tsai Tun-Jun
Published: February 2020

Background

There are no Taiwanese publications and only a few Asian publications on the long-term outcome of peritoneal dialysis (PD) patients. The aim of this study was to evaluate the outcome of PD patients in Taiwan during a 7-year follow-up period.

Patients and Methods

This study enrolled 67 patients (23 males, mean age 46.2 ± 14.5 years) on maintenance PD. We administered the Short-Form questionnaire on 30 September 1998 and recorded major events and outcomes until 30 September 2005. We compared differences in initial parameters between groups categorized by PD patient survival and PD technique survival. Causes of mortality and transfer to hemodialysis were determined. PD patient and PD technique survival rates were measured and risk factors for patient mortality and PD technique failure were analyzed.

Results

Those in patient survival or PD technique survival groups had lower mean age ( p < 0.001 and 0.018 respectively) and higher serum albumin level ( p = 0.015 and 0.041 respectively) compared to those that died or failed PD. The 7-year patient survival rate was 77% and the PD technique survival rate was 58%. The independent predictors for PD technique failure included lower Mental Component Summary scores [hazard ratio (HR) = 0.85, p = 0.031] and diabetes mellitus (HR = 4.63, p < 0.001), whereas lower serum albumin level (HR = 0.22, p = 0.031), lower Physical Component Summary scores (HR = 0.67, p = 0.047), and presence of diabetes mellitus (HR = 5.123, p = 0.009) were the independent predictors for patient mortality.

Conclusion

For our PD patients, both patient and technique survival rates are good. Better glycemic control, adequate nutrition, and enhancement of health-related quality of life are all of potential prognostic benefit.
Oral Health and Inflammation in Patients with End-Stage Renal Failure
Authors: Bayraktar Gulsen , Kurtulus Idil , Kazancioglu Rumeyza , Bayramgurler Isil , Cintan Serdar , Bural Canan , Bozfakioglu Semra , Issever Halim , Yildiz Alaattin
Published: February 2020

Background/Aims

End-stage renal disease (ESRD) patients have an increased risk of atherosclerotic complications. In both hemodialysis (HD) patients and the general population, it has become evident that inflammation plays an important role in the pathogenesis of atherosclerotic complications. Oral and dental problems in ESRD patients could be an important source of inflammation, thus treatment of these problems is important to protect these patients from potential infections. The decayed, missing, and filled teeth (DMFT) index is an indicator of oral and dental health status. Our aim was to analyze and compare salivary flow rate (SFR), salivary pH (SpH), salivary buffering capacity (SBC), and DMFT index and plaque index (PI) values in PD patients to HD patients and healthy controls (C) and establish the relationship between these parameters and C-reactive protein (CRP).

Methods

76 PD patients, 100 HD patients, and 111 Cs were included in the study. SFR (milliliters/minute) was measured in stimulated whole saliva, SpH was measured using the Merck indicator, and SBC was measured according to the method of Ericsson: 1 mL whole saliva was added to 3 mL 0.005 N HCl and a stream of air was passed through this mixture for 20 minutes. Finally, DMFT index and PI values were calculated.

Results

No statistically significant differences were found in age or gender distribution among PD, HD, and C groups. There was also no significant difference in time on dialysis between PD and HD groups. SFR was significantly lower in the PD and HD groups than in the C group (1.30 ± 0.83 and 0.70 ± 0.32 vs 1.64 ± 0.45 mL/min) and lower in the HD than in the PD group ( p < 0.001). SpH (8.35 ± 0.43 and 8.12 ± 0.74 vs 7.16 ± 0.76) and SBC (7.39 ± 0.47 and 6.82 ± 0.70 vs 5.08 ± 0.73) were significantly higher in the PD and HD groups than in the C group and higher in the PD than in the HD group ( p < 0.05 and p < 0.001 respectively). The numbers of filled teeth were significantly higher in the PD than in the HD and C groups ( p < 0.001). DMFT index was significantly higher in the PD than in the HD group ( p < 0.001). Finally, PI values were significantly higher in the PD and HD groups than in the C group ( p < 0.001) and higher in the HD than in the PD group, although this was not statistically significant. In the present study, we also found higher CRP values in HD than in PD patients and a positive correlation between CRP and PI values in PD patients.

Conclusions

PD patients have higher SFR, SpH, and SBC values than HD patients; however, higher DMFT index and higher numbers of filled teeth were observed in PD patients. Compared to healthy controls, patients on dialysis had worse dental and periodontal findings, which might have a role in microinflammation in this group of patients.
Retroperitoneal Leakage as a Cause of Acute Ultrafiltration Failure: Its Associated Risk Factors in Peritoneal Dialysis
Authors: Lam Man Fai , Lo Wai Kei , Tse Kai Chung , Yip Terrence P.S. , Lui Sing Leung , Chan Tak Mao , Lai Kar Neng
Published: February 2020

Background

Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors.

Methods

After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed.

Results

During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP ( n = 16) or MRP ( n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 ± 24.5 (range 0.5 – 87.9) months and 0.70 ± 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35 – 18.69, p < 0.001] and 6.23 (95% CI 1.83 – 21.19, p = 0.003) respectively.

Conclusion

RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF.
Intraperitoneal Urokinase and Oral Rifampicin for Persisting Asymptomatic Dialysate Infection following Acute Coagulase-Negative Staphylococcus Peritonitis
Authors: Demoulin Nathalie , Goffin Eric
Published: February 2020

Background

Coagulase-negative staphylococcus (CoNS) is responsible for cases of refractory and relapsing peritonitis in peritoneal dialysis (PD) patients, probably by biofilm formation on the catheter. The ISPD recommends catheter removal in such cases. Urokinase has been used to dissolve the biofilm lining the PD catheter, thus favoring antibiotic efficacy. Rifampicin has shown its efficacy in penetrating CoNS biofilm.

Methods

We defined persisting asymptomatic CoNS dialysate infection as a peritonitis episode with clinical improvement within 48 hours and dialysate clearing, but with persisting positive dialysate cultures. We retrospectively analyzed the outcome of such cases observed between 1/1998 and 12/2007. In all cases, intraperitoneal (IP) urokinase (100 000 units) and oral rifampicin (600 mg every day for 3 weeks) were added to intravenous vancomycin.

Results

33 cases of CoNS peritonitis were recorded and 11 of them (33.3%) met the criteria of persisting asymptomatic CoNS dialysate infection. All were initially treated with intravenous vancomycin and oral ciprofloxacin, according to our protocol. Dialysate clearing, defined by a white blood cell count <100/μL, was noted at day 8 (range 4 – 17 days) on average, while dialysate cultures were still positive a mean of 6 (range 0 – 16) days later [ i.e., 13.9 (range 5 – 24) days after peritonitis onset]. IP urokinase instillation was performed an average of 18.9 (range 11 – 30) days after peritonitis onset. Treatment success, defined by peritonitis resolution with sterilization of the dialysate, without catheter removal and relapse peritonitis within 6 weeks of treatment completion, was observed in 7 of 11 (64%) cases. No side effects following IP urokinase instillation were noted. One case of rifampicin-induced toxidermia was recorded.

Conclusion

IP urokinase and oral rifampicin in addition to conventional antibiotics resulted in a catheter salvage rate of 64% in persisting asymptomatic dialysate infection following a CoNS peritonitis. Larger studies are needed to confirm these results. In CoNS peritonitis, dialysate cultures should be repeated, even after clearing of the dialysate, to avoid missing persisting asymptomatic infection.
Identification of Inflamed Atherosclerotic Plaque using 123I-Labeled Interleukin-2 Scintigraphy in High-Risk Peritoneal Dialysis Patients: A Pilot Study
Authors: Hubalewska–Dydejczyk Alicja , Stompór Tomasz , Kalembkiewicz Marta , Krzanowski Marcin , Mikolajczak Renata , Sowa–Staszczak Anna , Tabor–Ciepiela Barbara , Karczmarczyk Urszula , Kuśnierz–Cabala Beata , Sulowicz Wladyslaw
Published: February 2020

Background

Patients with end-stage renal disease (ESRD) suffer from markedly increased cardiovascular morbidity and mortality. Common carotid artery (CCA) intima-media thickness (IMT) assessment and CCA plaque identification using ultrasound are well-recognized tools for identification and monitoring of atherosclerosis. A new method for monitoring the inflammatory status of plaque, namely radiolabeled interleukin-2 (IL-2) scintigraphy, was proposed recently. The aim of this pilot study was to perform 123I-labeled-IL-2 carotid plaque scintigraphy in ESRD patients treated with peritoneal dialysis and to correlate obtained results with ultrasound assessment of CCA and selected inflammatory markers.

Methods

CCA-IMT was measured and CCA plaques were identified by ultrasound in 10 patients (5 women, 5 men; mean age 62.4 ± 10.4 years; median peritoneal dialysis duration 32.5 months, range 12 – 55 months) with advanced cardiovascular comorbidity. Following CCA ultrasound, 123I-labeled IL-2 carotid plaque scintigraphy was performed. Several biomarkers of inflammation and atherosclerosis were also measured in all patients.

Results

Mean target/non-target ratio for focal 123I-IL-2 uptake within the plaque was 3.15 ± 0.54, and mean IMT from the site of the scintigraphy analysis was 0.975 ± 0.337 mm. Highly significant correlation was found between CCA-IMT and a target/non-target ratio for focal 123I-IL-2 uptake in a corresponding artery ( R = 0.92, p = 0.01). However, no significant correlations were found between target/non-target ratio for focal 123I-IL-2 uptake and levels of measured biomarkers.

Conclusions

Our preliminary results suggest potential for identification of an inflamed (vulnerable) plaque using IL-2 scintigraphy in ESRD patients with cardiovascular comorbidities.
Continuous Peritoneal Dialysis Compared with Daily Hemodialysis in Patients with Acute Kidney Injury
Authors: Gabriel Daniela Ponce , Caramori Jacqueline Teixeira , Martin Luis Cuadrado , Barretti Pasqual , Balbi Andre Luis
Published: February 2020

Background

In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI.

Methods

A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid–base, and fluid controls were secondary endpoints.

Results

Of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ± 0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65 ( p < 0.01). The two groups were similar in metabolic and acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7 mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ± 8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%).

Conclusion

High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.
Optimal Referral is Early Referral
Authors: Heatley Susan Ann
Published: February 2020

The number of patients receiving renal replacement therapy in the United Kingdom is rapidly rising. Chronic kidney disease (CKD) is a worldwide public health problem with significant comorbidity and mortality. Several organizational guidelines have been developed in an attempt to identify when appropriate referral to nephrology services should occur; however, many of these guidelines provide conflicting recommendations on referral. Recent surveys suggest that more than 30% of patients with CKD are referred later than is ideal. Late referral of patients with CKD is associated with increased patient morbidity and mortality, increased need for and duration of hospital admission, and increased initial costs of care following commencement of dialysis. Additional benefits of early referral include identifying and treating reversible causes of renal impairment and managing the multiple coexisting conditions associated with CKD. Referral time also affects the choice of treatment modality. Patients and their families should receive sufficient information regarding the nature of their CKD and the options for treatment so that they can make informed decisions concerning their care. Literature addressing when to refer to low-clearance or pre-dialysis clinics is limited. Existing data suggest that such clinics and patient education programs may facilitate improved medical care for patients, greater patient involvement in selection of the mode of dialysis, reduction in the need for “urgent start” dialysis, and improved short-term survival and quality of life after initiation of dialysis. Audit of our pre-dialysis clinic has demonstrated improved patient outcomes, and we view the early-referral service as an essential component of the patient pathway.
Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis
Authors: Fortes Paulo Cezar , de Moraes Thyago Proença , Mendes Jamille Godoy , Stinghen Andrea E. , Ribeiro Silvia Carreira , Pecoits-Filho Roberto
Published: February 2020

Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.
Impact of Stratification of Comorbidities on Nutrition Indices and Survival in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Prasad Narayan , Gupta Amit , Sinha Archana , Singh Anurag , Sharma Raj Kumar , Kaul Anupama
Published: February 2020

Background

Case-mix comorbidities and malnutrition influence outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we analyzed the influence of stratified comorbidities on nutrition indices and survival in CAPD patients.

Patients and Methods

We categorized 373 CAPD patients (197 with and 176 without diabetes) into three risk groups: low—age under 70 years and no comorbid illness; medium—age 70 – 80 years, or any age with 1 comorbid illness, or age under 70 years with diabetes; high—age over 80 years, or any age with 2 comorbid illnesses. We then compared nutrition indices and malnutrition by subjective global assessment (SGA) between the three groups. Survival was compared using Kaplan–Meier survival analysis.

Results

Mean daily calorie and protein intakes in the low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79 ± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ± 0.26 g/kg) groups ( p = 0.001 and p = 0.04 respectively). Relative risk (RR) of malnutrition was less in the low-risk group (103/147, 70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64, 84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of patients in the low-, medium-, and high-risk groups were 51 patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3 patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7 patient–months (95% CI: 23 to 36.4 patient–months) respectively (log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-, and 5-year patient survivals in the low-, medium-, and high-risk groups were 96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%, 30%, and 30% respectively.

Conclusions

Intake of calories and protein was significantly lower in the medium-risk and high-risk groups than in the low-risk group. Survival was significantly better in low-risk patients than in medium- and high-risk patients.
Update on Fungal Peritonitis and its Treatment
Authors: Matuszkiewicz–Rowinska Joanna
Published: February 2020

Fungal peritonitis (FP) is a rare but potentially fatal complication of chronic peritoneal dialysis (PD), associated with high morbidity and mortality ranging between 20% and 30%. If not leading to death, the inflammatory process usually causes irreversible damage to the peritoneal membrane with subsequent dropout from PD therapy. Fungal peritonitis accounts for 3% – 6% of all peritonitis episodes; however, in some areas, the numbers can be much higher. The most common cause of the disease is Candida, predominately C. albicans, C. parapsilosis, and—more recently— C. glabrata; other yeasts and filamentous fungi such as Aspergillus, Paecilomyces, Penicillium, and Zygomycetes are found, but much less frequently. The main factors associated with the development of FP include previous antibiotic therapy, particularly for bacterial peritonitis, when two important operative mechanisms coincide: fungal overgrowth in the gastrointestinal tract and declining peritoneal defense because of peritonitis.

The management of FP poses a difficult challenge. Prompt initiation of therapy is critical, but no typical clinical picture has emerged, and the infecting organism can be difficult to isolate. The approach to the disease has changed considerably in recent years, and the 2005 guidelines from the International Society for Peritoneal Dialysis list FP as a strong indication for immediate catheter removal with temporary hemodialysis. The conventional antifungal regimens include fluconazole, amphotericin B, and flucytosine alone or in combination, optimally based on fungal sensitivities. The newer agents such as caspofungin and voriconazole have the potential to alter treatment strategies for FP, but further studies are required to clarify the precise role of these agents in this group of patients.
Peritoneal Dialysis in the Pediatric Intensive Care Unit Setting
Authors: Bonilla–Félix Melvin
Published: February 2020

Acute kidney injury (AKI) is a common complication in pediatric and neonatal intensive care units (ICUs). Renal replacement therapy (RRT) is frequently needed in children in whom supportive therapy is not enough to satisfy metabolic demands or to provide adequate nutrition in cases of oliguric kidney failure. The decision to begin dialysis should not be delayed, because experience in infants shows that the shorter the time from the ischemic insult to the beginning of dialysis, the higher the survival rate. The use of continuous RRT (CRRT) in pediatric patients in the ICU has almost tripled; at the same time, the use of peritoneal dialysis (PD) and intermittent hemodialysis has markedly declined. Patient age seems to be the most important factor influencing the decision on the choice of dialysis modality. Although CRRT is reported as the preferred dialysis modality for acutely ill children, PD is still the most common modality used in patients under 6 years of age. Among the several advantages that PD offers, relatively low cost is probably the most significant. Other advantages include technical simplicity, lack of a need for anticoagulation or placement of a central venous catheter, and excellent tolerance in hemodynamically unstable patients. Much controversy exists regarding the adequacy of PD in hypercatabolic patients in the ICU. Nonetheless, when Kt/V has been applied to acutely ill children, it has been shown that PD can provide adequate clearances for most infants. No prospective studies have evaluated the effect of dialysis modality on the outcomes of children with AKI in the ICU setting. The decision about dialysis modality should therefore be based on local expertise, resources available, and the patient's clinical status.
Does Immunosuppressive Treatment Ameliorate Morphology Changes in Encapsulating Peritoneal Sclerosis?
Authors: Bozkurt Devrim , Sipahi Savas , Cetin Pinar , Hur Ender , Özdemir Özden , Ertilav Muhittin , Sen Sait , Duman Soner
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular.

The aim of the present study was to investigate the effects of various IS treatment strategies—glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)—on regression of EPS.

We divided 52 nonuremic Wistar albino rats into six groups: Control group—2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal rest (weeks 4 – 6); Corticosteroid (GC) group—CG (weeks 1 – 3), plus 10 mg/L prednisolone in drinking water (weeks 4 – 6); AZT group—CG (weeks 1 – 3), plus 100 mg/L azathioprine in drinking water (weeks 4 – 6); and CsA group—CG (weeks 1 – 3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4 – 6).

At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist.

The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group ( p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group ( p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group ( p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy ( p < 0.05).

Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.
Peritoneal Dialysis in the Far East—an Astonishing Situation in 2008
Authors: Lo Wai Kei
Published: February 2020

The dialysis treatment rate varies tremendously in the Far East Asian countries, influenced by the economic status of those countries. The peritoneal dialysis (PD) utilization rate also varies greatly, ranging from 80% in Hong Kong to 3.5% in Japan. In certain low-economy countries, PD is rarely practiced. In recent years, PD utilization has been growing very fast in several countries, particularly China and Vietnam. New policies to encourage a shift from hemodialysis to PD have been undertaken recently in several countries such as Taiwan and Thailand, with a resultant rapid increase in patients on PD. The background and reasons for those changes are discussed.
Serum Carnitine in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Amair Pablo , Gregoriadis Agis , Rodela Helen , Ogilvie Raymond , Khanna Ramesh , Brandes Lidia , Roncari Daniel A. K. , Oreopoulos Dimitrios G.
Published: February 2020

Serum carnitine and serum triglycerides were measured in 45 patients on CAPD and in 14 healthy controls. There was no significant difference between the mean carnitine levels in the two groups. Furthermore, there was no correlation between serum carnitine and serum triglycerides. Our data cast some doubt on the role of carnitine in the development of hypertriglyceridemia in patients on CAPD and on the need for carnitine supplementation in these patients.
The Peritoneal Handling of Digoxin during CAPD
Authors: Gloor Hans Jakob , Karl Harold Moore , Nolph D.
Published: February 2020

We measured digoxin concentrations in serum and dialysate from five digitalized patients on continuous ambulatory peritoneal dialysis (CAPD). Mean peritoneal clearance of digoxin was 3.6 ± 0.4 ml/min (± SEM). Mean mass transfer was 8.6 ± 0.6 μg/min. Our patients lost from 3.7 to 13.3% of their daily oral digoxin intake in dialysate. The mean dialysate over serum (D/S) digoxin ratio was 0.59 and fell between D/S creatinine (0.81) and D/S inulin (0.34). Between patients the range of this ratio was wide (0.25 to 0.90).

We also measured serial digoxin dialysate concentrations during a six hour “dwell” in one patient and determined a D/S equilibration curve. After six hours dialysate digoxin approached a plateau near 0.5. Digoxin removal per week from dialysate was two to three times greater during CAPD than that reported from IPD. Peritoneal losses of digo xin cannot be predicted for an individual patient. In four of eight digitalized patients, the cardiac drug could be discontinued suggesting a beneficial effect of long-term CAPD in controlling congestive heart failure.
Plasma Amino Acid Profiles and Amino Acid Losses in Patients Undergoing CAPD
Authors: Arie Nicholas Dombros , Marliss Oren Errol B. , Anderson G. Harvey , Khanna Arthur N. Stein Ramesh , Lidia Jean Petit , Rodella Brandes Helen , Leibel Bernard S. , Oreopoulos Dimitrios
Published: February 2020

Fasting plasma amino acid levels and 24hour amino acid losses in the dialysate were measured in six nondiabetic female and six diabetic male patients on CAPD. Comparison of their plasma amino acid values with sex matched controls showed that CAPD did not restore the plasma amino acid levels of these patients to normal, and that the abnormalities in the non-diabetics were more marked than in the diabetics. The daily total amino acid losses in the dialysate were small relative to protein intake, averaged 2.25 9 per day and were similar for the non-diabetic and diabetics. The concentrations of most amino acids in the dialysate were proportional to their plasma concentrations. Loss of amino acids in the dialysate does not account for the abnormal plasma patterns of CAPD patients.
Renal Osteodystrophy in Continuous Ambulatory Peritoneal Dialysis
Authors: Gokal Ram
Published: February 2020

CAPD appears to achieve adequate control of serum phosphate and of histological renal osteodystrophy with declining levels of PTH. However, 25 OHD levels are low and patients may need cautious Vitamin D replacement therapy. Calcium balance needs to be studied in greater detail and the correct PD fluid calcium concentration needs to be worked out; PD fluid calcium concentration of 1.5 mmol/1 is too low. It seems that, initially, calcium supplements by mouth are necessary. Serum aluminum levels appear to be elevated in those CAPD patients, who are not exposed to aluminium containing phosphate binders and it has not been determined whether this is related to peritoneal dialysis fluid aluminium content. It is essential, however, to minimise aluminium contamination of PD fluid.
Ischemic Colitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Rolf Martin Wehling , Steurer Jenni Johann , Walter Hugo Buhler , Siegenthaler  , Kuhlmann Ulrich
Published: February 2020

A 63-year-old patient undergoing CAPD developed abdominal pain and rectal bleeding during an episode of hypotension. Endoscopy and histology showed severe colitis extending from the upper part of the rectum to the splenic flexure. Stool bacteriology was negative with regard to bacteria or fungi causing colitis. With correction of body weight and blood pressure the colitis improved rapidly. These observations support the diagnosis of nonocclusive, hypotensive ischemic colitis.
Nutritional Considerations in the Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis
Authors: Haber Margaret O'Neill , Tit Jean M. Pet
Published: February 2020

A diabetic patient on CAPD needs to incorporate the dietary requirements of CAPD into his diet. The dietary recommendations for both CAPD and diabetes are reviewed here. Patients with end-stage renal disease and diabetes have problems related to diet that are similar to those encountered by non-diabetic patients on CAPD, but many diabetics have the anorexia-nauseavomiting syndrome, which is most frustrating. This paper has discussed some possible causes for this syndrome and offered some potential solutions and recommendations. Essential to the care of these patients is a strong team approach.
Renal Transplantation in Children Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Stefanidis Constantinos J. , Gerald S J. Williamson Balfe , Bernard Arbus Brian E. Hardy , Churchill M. , Rance C. Phillip
Published: February 2020

Over the last three years 23 children, who were managed by CAPD at the Hospital for Sick Children, Toronto received a renal transplant. Their actuarial graft survival was similar to those of children on hemodialysis and to patients not dialyzed before transplantation. In addition, we analyzed the actuarial graft survival of 130 children treated before transplantation with peritoneal dialysis (IPD and CAPD), hemodialysis or no dialysis to determine the long-term effects of peritoneal dialysis. Again, we found no significant differences among the various groups. Posttransplantation complications in the CAPD patients included fungal peritonitis in one and ascites in seven.
Recurrent Pol Ymicrobial Peritonitis from a Gynecologic Source as a Complication of CAPO
Authors: Swartz Richard D. , Campbell Darrell A. , Stone Debra , Dickinson Cynthia
Published: February 2020

A 22-year-old woman on CAPD developed recurrent peritonitis with organisms suggestive of a gynecologic source. A concomitant vaginal leaking of dialysate confirmed an abnormal communication between peritoneum and vagina. The recurrent infection led to fungal overgrowth, abcess formation and catheter loss. The appearance of peritoneal infection with normal vaginal organisms should prompt a search for a gynecologic source of contamination such as that demonstrated in this case.
Clinical Trials of the Column Disc Peritoneal Catheter (Lifecath Tm)
Authors: Ash Stephen R. , Struewing Jeffrey D.
Published: February 2020

The column-disc catheter is a peritoneal access device which is affixed to the lower anterior abdominal wall. A large peripheral port allows inflow and outflow of peritoneal fluid with a fluid velocity 20 times less than that of the Tenckhoff catheter. The location and shape of the column-disc catheter completely prevents migration. Forty-six such catheters have been placed in a variety of patients at six institutions. Most of the patients were at “high risk” for Tenckhoff catheter failure, as defined by Ponce et al (3). Total experience is over 250 patient-months; six catheters have been in place for longer than 17 months. Of seven early catheter failures, five were related to faulty placement technique and the other two were in “high risk” patients. Late catheter failures have not been encountered. In three cases the catheter was removed because of peritonitis which failed to clear. No instances of exit site erosion have occurred. Monthly outflow studies have indicated consistent outflow. During each outflow, the deceleration of flow occurred at a later time in each outflow, than with Tenckhoff catheters. The Life Cath TM is an effective alternative to the Tenckhoff catheter, especially indicated for patients at high risk for failure of Tenckhoff catheters.
Effect of the Perioex(R) Fil ter on Peritonitis Rates in a CAPO Population
Authors: Richard Stephen R. Ash , Emilie Horswell Jr , Heeter M. , Bloch R.
Published: February 2020

A unidirectional filter for CAPD fluid was tested in a population of CAPD patients at one center, to determine its effectiveness in reducing peritonitis. Incidence of peritonitis was compared in four groups of patients:

1. High -risk patients who chose to use the filter.

2. Same patients, before filter use. 3.

Overall population of the center before March, 1981 (introduction of filter for high-risk patients).

4. Overall population after filter introduction.
Compatibility of Cephalosporins and Aminogl Ycosides in Peritoneal Dialysis Fluid
Authors: Loeppky Carol , Tarka Eugene , Everett E. Dale
Published: February 2020

Often dialysis -associated peritonitis is treated before the results of cultures are known with a cephalosporin and an aminoglycoside in combination. Because there may be antagonism between the individual drugs in such combinations, we have investigated this possibility through the use of timed, killing curves in dialysate effluent. We tested various cephalosporins and aminoglycosides alone and in combination at concentrations usually instilled into the peritoneum and determined their activity against one strain each of Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. The results of these in-vitro studies show no evidence of antagonism but rather suggest an additive effect as evidenced by more rapid killing.
Metabolic Effects of CAPD in the Child
Authors: Balfe John Williamson
Published: February 2020

CAPD can be used in children of all ages and sizes. Currently, it is the dialysis of choice at our center for young children. Even though a successful renal transplant is our ultimate goal, the best yardstick of successful renal failure treatment is optimal linear and brain growth. Proper and adequate nutrition are mandatory for growth. Nutrition should be approached aggressively in children who are receiving CAPD and yet have persistent anorexia. Nasogastric tube feeding or addition of nutrients to the dialysate may be necessary for such patients. Bone disease on CAPD can be prevented by providing the child with supplemental vitamin D, controlling the plasma phosphate concentration (dietary restriction or phosphate binders) and preventing hyperparathyroidism. Technical improvements will continue in the field of dialysis. Each new attempt at improved therapy should be approached carefully and should be assessed properly for its suitability in children.
Metabolic Bone Disease in the CAPD Patient
Authors: Llach Francisco
Published: February 2020

It seems that CAPD may improve some patients with osteomalacia but may be similar to hemodialysis in regard to osteitis fibrosa. However, long-term prospective evaluation of the incidence of bone disease in CAPD patients is necessary before we can determine how CAPD may alter the incidence and expression of renal osteodystrophy. We need more information before we can conclude that CAPD may improve pure osteomalacia. Finally, the data available are insufficient to clarify the role of vitamin D analogues in these patients.
CAPO in toronto -An overview
Authors: Williams Clair C.
Published: February 2020

During the last five years, 508 patients completed CAPD training. The mean age on entry was 50.4 years. Eighty-nine patients were diabetic. The overall incidence of peritonitis was one episode every 11.1 treatment months. The cumulative patient survival was 65% at four years, and corresponding technique success rate 35%. Cardiovascular causes accounted for 58.7% of deaths and peritonitis was the most common reason for CAPD failure.

An analysis of outcomes by year of entry into the program suggests that survival and technique success improved in patients entered during 1981. Similarly there was a significant reduction in the incidence of peritonitis between 1978 and 1982. CAPD continues to be a successful and well-accepted dialysis modality.
A Review of Peritonitis Episodes that Caused Interruption of CAPD
Authors: Wu George
Published: February 2020

In 49 of 508 ESRD patients, CAPD failed because of peritonitis, constituting the leading cause of such failure. These patients were divided into two groups (I and II) according to frequency of peritonitis. Group I patients (n = 25) had frequent, recurrent peritonitis (one episode every 2.6 months) whereas, among Group II patients, unusual or severe peritonitis (fecal, fungal and TB) was more common -in the latter the frequency of peritonitis was similar to that in the average population.

Fecal peritonitis constituted 19% of all the episodes which led to interruption of CAPD; most of these cases seemed to be the result of diverticulitis. We believe that patients at particular risk of developing diverticulosis i.e., those older than 50 years and those with polycystic kidneys, should have a barium enema; if extensive diverticulosis is found, they should be considered to be at high risk for development of diverticulitis and fecal peritonitis.

Even though the decreasing incidence of peritonitis leads to an overall decrease in peritonitis mortality and CAPD failure, once peritonitis develops, patients have the same risk of dying or failing now, as they had five years ago. For this reason we must undertake further studies in order to improve our management of these patients.
Risk Factors Associated with Time to First Infection and Time to Failure on CAPD
Authors: Corey Paul N. , Steele Cathy
Published: February 2020

The Cox proportional hazards model was used to identify prognostic risk factors for time to first infection and time to failure among 183 patients on chronic ambulatory peritoneal dialysis (CAPD). This methodology permits continuous variables such as albumin and blood pressure to be used in the predictive equation avoiding arbitrary categorization. Initial serum creatinine and albumin were found to be related to the risk of first infection. Serum creatinine increases the risk whereas albumin is protective. Age and blood pressure are related to an increased risk of failure on CAPD whereas albumin is associated with a lower risk. The occurrence of the first infection almost doubles the risk of failure.

Patients who have “high” albumin and “low” blood pressure have a 75th percentile for time to failure on CAPD which is more than 1000 days longer than those who have both “low” albumin and “high” blood pressure.
Hypotension on CAPD: An Approach to Treatment
Authors: Leenen Frans H.H. , Shah Perween , Boer Walther H. , Khanna Ramesh , Oreopoulos Dimitrios G.
Published: February 2020

Development of orthostatic hypotension occasionally complicates treatment of end-stage renal failure by continuous ambulatory peritoneal dialysis (CAPD). The cause may be excessive sodium removal via the dialysate relative to the dietary sodium intake, leading to the gradual development of sodium depletion. Therefore, a group of five symptomatic, hypotensive CAPD patients was treated with oral salt-loading without allowing a concomitant increase in body weight.

Supine blood pressure increased markedly after salt-loading (from 94/67 mmHg to 121/78 mmHg) and symptomatic orthostatic hypotension disappeared. The mechanisms leading to the improvement after salt-loading were studied in three of these patients. The beneficial effect of salt-loading was related to two mechanisms:

1) an increase in extracellular fluid volume and presumably blood volume;

2) an increase in sympathetic tone, as assessed by plasma norepinephrine levels and the pressor responsiveness to norepinephrine
Life After Capo
Authors: Williams Clair C.
Published: February 2020

Of 508 patients trained for CAPD during the first five years, 115 (22.6%) were transferred to an alternative dialysis modality. Of these 87% were transferred to centre dialysis programs, equally divided between hemodialysis and intermittent peritoneal dialysis. Advanced age favoured transfer to intermittent peritoneal dialysis and failure due to peritonitis, transfer to hemodialysis.

Three year survival after transfer from CAPD was 38%. The presence of diabetes and advanced age adversely affected survival after transfer. Dialysis modality and peritonitis as the cause of CAPD failure did not affect survival.

Other treatment options are available to patients who fail CAPD. A relatively high drop-out is therefore acceptable and preferable to continuing CAPD in patients encountering complications which might ultimately influence their survival.

Since its introduction in Toronto in 1977, continuous ambulatory peritoneal dialysis (CAPD) has achieved increasing prominence in the management of end-stage renal disease. Throughout its comparatively short history, one of the major criticisms of this technique has been the relatively high drop-out rate. This report provides a follow-up of patients transferred from CAPD to alternative dialysis modalities.
Quality of Life in End-Stage Renal Disease
Authors: Churchill David N. , Morgan Janet , Torrance George W.
Published: February 2020

Survival in end-stage renal disease seems to depend more on age and associated diseases than on the form of treatment. Previously published comments on the quality of life experienced by patients treated by hemodialysis, peritoneal dialysis and transplantation were based on subjective estimates or on the use of unvalidated instruments. We have used a modified form of a “time trade-off” technique to estimate the patient's perception of the utility or worth of their ESRD health state. It was used successfully in 42 of 50 stable chronic hemodialysis patients. The correlation between paired observations six weeks apart (a test of temporal stability) was 0.80. Evidence for the validity of this instrument was obtained by comparing it with the physicians’ assessment of the patient's health state.

Health was scored on a scale from 0 for death to 1 for perfect health. The mean values for hospital-based hemodialysis, CAPD and transplantation were 0.57, 0.57 and 0.80 respectively. For each form of treatment the distribution of scores was wide suggesting that factors other than form of treatment are important determinants of the per ceived quality of life for these patients.
Chyloperitoneum: A Rare Complication of Peritoneal Dialysis
Authors: Pomeranz Avishalom , Reichenberg Yona , Schurr Daniel , Drukker Alfred
Published: February 2020

An eight-year old girl with extensive burns and aminoglycoside-induced acute renal failure was treated with peritoneal dialysis. She developed chyloperitoneum after medical insertion of a Tenckhoff catheter. Conservative dietary treatment with medium-chain triglycerides, supplemented by parenteral hyperalimentation and temporary cessation of the peritoneal dialysis allowed the chylous fistula to heal, without the need for surgical intervention.

Leakage of milky chyle into the peritoneal cavity (chyloperitoneum or chylous ascites) is a rare clinical entity. Generally it is due to trauma or obstruction of the lymphatic system. It has been observed in adults with intra-abdominal malignancies and/or inflammations and in children with congenital malformations of the abdominal lymphatics (I). Chyloperitoneum also has been seen after abdominal trauma, including surgery (1–5); chyloperitoneum has been mentioned before as a complication of peritoneal dialysis but no details have been provided (1,6). This paper will report the occurrence and treatment of chyloperitoneum in an eight-year-old child undergoing peritoneal dialysis for acute renal failure.