bluuebunny/crossref_metadata_2025 huggingface dataset:
Recombinant Human Growth Hormone (rhGH) Treatment of Children Undergoing Peritoneal Dialysis
Authors: Fine Richard N. , Koch Vera H. , Boechat M. Ines , Lippe Barbara H. , Nelson Pauline A. , Fine Shawney E. , Sherman Barry M.
Published: February 2020

The authors studied the effect of recombinant growth hormone (rhGH) treatment on 5 growth retarded children, age 21/12 to 178/12 years, who had end-stage renal disease (ESRD) and were undergoing continuous cycling peritoneal dialysis (CCPD). Patients received 0.125 mg/kg of subcutaneous rhGH 3 times weekly. Accelerated height velocity compared to the previous year of CCPD was noted in 2 patients and improvement in the standard deviation score (SDS) as a parameter of improved growth velocity was noted in a third patient. This was associated with an increase in weight and improvement in the midarm muscle circumference (MAMC) suggesting an anabolic effect of rhGH treatment. Bone age advancement was consistent with the period of observation; no advancement greater than that expected for the increase in chronological age was observed. No significant side effects were attributable to rhGH therapy. These preliminary results indicate some growth retarded children without growth hormone deficiency with ESRD undergoing CCPD may respond to exogenous rhGH therapy with an acceleration in growth velocity: However, the failure to achieve uniform acceleration of height velocity indicates the need for controlled studies before rhGH can be recommended for all growth retarded children with ESRD undergoing peritoneal dialysis.
Continuous Ambulatory Peritoneal Dialysis (CAPD) of Children with Amino Acid Solutions: Technical and Metabolic Aspects
Authors: Canepa Alberto , Perfumo Francesco , Carrea Alba , Piccardo Maria Teresa , Ciardi Maria Rosa , Cantaluppi Alberto , Gusmano Rosanna
Published: February 2020

The changes in plasma and dialysate amino acids (AA) in 7 continuous ambulatory peritoneal dialysis (CAPD) children after dialysis with a 1% AA solution were compared with a glucose-containing solution. During the AA exchange, the plasma levels of individual AA reached their peaks after 1 h, with their percentage increments significantly correlated (p < 0.001) with the ratio of the amount of AA in the bag to the basal plasma concentration. The plasma concentration of methionine, valine, phenylalanine, and isoleucine remained higher than the basal value at 4 h. The amount of AA absorbed was 66% after 1 h, and 86% after 4 h and 6 h, corresponding to 2574 ± 253 μmollkg body wt. During glucose-dialysis (1.36%), levels of histidine, methionine, valine, phenilal-anine, and isoleucine were significantly decreased in plasma after 1 h, and stayed low throughout the dialysis period. The loss of AA with the peritoneal effluent was 116 ± 69 μmol/kg/body wt.

From this study, it seems that using an AA dialysis solution, with 1 exchange per day, might limit the daily glucose load and compensate for AA losses by supplying an extra amount of AA and by reducing the loss of other AA not contained in dialysis solutions. The AA pattern in plasma following AA-dialysis resembles that observed after a protein meal, with no signs of persistently high, nonphysiological levels.
The Curled Catheter: Dependable Device for Percutaneous Peritoneal Access
Authors: Swartz Richard , Messana Joseph , Rocher Leslie , Reynolds Janice , Starmann Barbara , Lees Patricia
Published: February 2020

The curled peritoneal dialysis catheter is theoretically less prone to catheter migration and drainage failure. It also allows percutaneous placement, rather than surgical placement exclusively, whenever desired or necessary. Review of 213 curled-catheter placements, 134 (63%) percutaneous and 79 (37%) surgical, over the last 4 years, shows that the probability of continuing catheter function by life-table analysis was 88% at one year, 71% at 2 years, and 61% at three years, with no difference comparing percutaneous to surgical placement. Among the 213 total cases, nearly 50% of all catheters were still functioning at last follow up, and 38 catheters (17.8%) have been lost in total, attributed to infectious complications in 24 cases (tunnel-exit infection alone in 5, peritonitis alone in 11, combined infection in 8), refractory drain failure in 9 cases (early drain failure in 4, late drain failure in 5), recurrent late subcutaneous dialysate leaking in 3 cases, and peri-catheter hernia in 2 cases.

Among other complications, the incidence of early drain failure (7.0%), and late drain failure (4.2%), compare favorably to reports describing other devices or other placement methods having comparable size of reported experience. Analyzing our own percutaneous and surgical placements separately, there were no differences in the respective frequencies of early drain failure, late drain failure, late subcutaneous dialysate leaking, outer cuff extrusion, required hernia repair, peritonitis or tunnel-exit infection. Only early external dialysate leaking was more frequent using percutaneous placement methods (21.6% vs. 10.1%; p < 0.05), although no catheters were lost due to early external leaking.

In conclusion, the present experience suggests that the curled catheter is both amenable to safe and convenient percutaneous placement methods in the majority of cases, as well as dependable for long-term peritoneal dialysis in a large university program.
Longitudinal Study of Proteins in Plasma and Dialysate during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Young Gerald A. , Taylor Albert , Kendall Steven , Brownjohn Aleck M.
Published: February 2020

The aim was to evaluate plasma proteins during continuous ambulatory peritoneal dialysis (CAPD) in relation to dialysis losses, membrane permeability, renal insufficiency, and time on CAPD. Ten male patients, established on CAPD for at least 14 months, were studied every 8 weeks for 56 weeks. Blood and dialysate from the morning exchange were analysed for urea, creatinine, and 7 proteins, and used to calculate dialysate to plasma concentration ratios (DIP). These ratios were not significantly changed suggesting that permeability remained constant. However, there was a trend for β2-microglobulin, creatinine, and urea to increase progressively. After 56 weeks, β2-microglobulin had increased from 27.9 to 31.3 mglL (p < 0.05) and creatinine 1006 to 1099 μmoLIL (p < 0.05) and both correlated with time on CAPD (p < 0.001). Plasma α1-acid glycoprotein, albumin, transferrin, IgG, IgA, and complement C3 were not significantly changed, although IgA and complement C3 were each negatively correlated with time on CAPD (r = −0.70 and −0.67, respectively), creatinine (r = 0.51 and −0.54), and urea (r = −0.61 and −0.61) (p < 0.001 for all). It is concluded that increases in β2-microglobulin, creatinine, and urea are not due to loss of membrane permeability but reflect a slight increase in uraemia. Long-term decreases in immunological proteins may be caused by uraemia or progressive depletion.
Factors Predisposing and Contributing to Peritonitis during Chronic Peritoneal Dialysis in Children: A Ten-Year Experience
Authors: Levy Maurice , Balfe J. Williamson , Geary Denis , Fryer-Keene Sue P.
Published: February 2020

Factors contributing and predisposing to peritonitis were studied retrospectively in 83 children treated with continuous ambulatory (CAPD) or continuous cycling peritoneal dialysis (CCPD) from 1978 to 1988. Recurrent peritonitis was the most frequent complication and the major reason for peritoneal dialysis failure. Fifty patients had 171 episodes of peritonitis during the ten years and 33 remained peritonitis -free. The duration of dialysis was significantly shorter in the peritonitis-free group. The incidence of peritonitis was lower with CCPD than with CAPD. Leucopenia was not a predisposing factor nor was blood leucocytosis helpful in diagnosing peritonitis. Serum IgG was low in 33% of patients with episodes of peritonitis, but there was no correlation or predictive value in this finding. The C3 component of complement was relatively lower than the C4 but both components were usually in the normal range. Serum albumin was low in all patients, but lower in those with peritonitis episodes. Age, sex, primary disease, diapers, pyelostomies, dialysis training, and living conditions were not significantly associated risk factors. Sterile dressings gave no benefit over the shower technique. Patient noncompliance, upper respiratory tract infection, skin infections, and dental treatment were potential risk factors. However, peritonitis seemed to be distributed randomly among the patients.
The Management of Hydrothorax in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Green Andrew , Logan Mark , Medawar Walid , McGrath Francis , Keeling Francis , Carmody Michael , Donohoe John
Published: February 2020

Four patients on continuous ambulatory peritoneal dialysis (CAPD) developed large, symptomatic pleural effusions after commencing peritoneal dialysis. Pleuroperitoneal fistula in each case was diagnosed by the presence of a high glucose content in pleural fluid, with a normal corresponding blood sugar, and was confirmed by isotope or contrast peritoneography. Two patients had their effusions drained percutaneously, and then underwent pleural sclerosis with intracavitary tetracycline. Two patients had a thoracotomy performed, of which no fistula was identified in one case, and the other patient underwent pleurectomy. All four patients successfully recommenced CAPD several weeks after therapy, without recurrence of effusions. We conclude that pleuroperitoneal connections associated with CAPD do not mandate cessation of peritoneal dialysis and conversion to maintenance haemodialysis. Definitive diagnosis requires aspiration of pleural effusions for glucose estimation. Contrast or isotopic peritoneography is helpful in localising the fistula, but in our experience did not alter management. Simple sclerotherapy is effective and avoids the need for a formal thoracotomy.
Hematocrit Values in the CAPD/CCPO Population: A Report of the National CAPO Registry
Authors: Lindblad Anne s. , Nolph Karl D.
Published: February 2020

A survey of the National CAPD Registry population was conducted to assess the distribution of hematocrit levels in a large group of peritoneal dialysis patients, to characterize the anemia of the population, and identify factors which relate to variation in hematocrit levels. A random sample of 812 patients was selected from the Registry population. Information was provided on 608 patients. Characteristics of sampled patients were similar to the Registry population as a whole. The mean hematocrit level in this cohort was 29.4% and the median was 29%. Recent peritonitis, time on CAPD, folate therapy, androgen therapy, and iron therapy had no obvious influence on hematocrit distributions. Significantly higher hematocrits were seen in males, whites, and patients with polycystic kidney disease. Significantly lower hematocrits were seen in surgically anephric patients and in patients who had received transfusions 60 days before the survey. Eighty-nine percent of patients had not received a transfusion 60 days prior to the survey. Some patients, especially those with hematocrits below the median, might benefit from recombinant erythropoietin therapy.
Hematocrit and Residual Renal Creatinine Clearance in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Nolph K. D. , Prowant B. F. , Moore H. L. , Reyad S. E.
Published: February 2020

In a recent report, the relationship between renal creatinine clearance and hematocrit in patients with renal creatinine clearances, ranging from 55 to 8 mL per min. per 1.73 square meters of body surface area, was analyzed (1). The authors of this study have performed a crosssectional analysis of the relationship of hematocrit to residual renal creatinine clearance in patients on continuous ambulatory peritoneal dialysis (CAPD). The authors of this study wanted to examine whether or not these hematocrits fall within extrapolations of the published 95% confidence limits for males and females with renal failure prior to end-stage renal disease and dialytic intervention. Authors also compare d regression intercepts at residual creatinine clearances of 0. Most of the CAPD patients had hematocrits within the upper half or above the extrapolated 95% confidence limits for the predialysis population. Within the CAPD population, there were no significant correlations of hematocrit with residual creatinine clearance at these lower ranges. The degree of scatter in the CAPD population for hematocrit values was similar to that in the predialysis population. Residual creatinine clearance appears to be a crude index of the increasing severity of multiple factors that may contribute to the anemia. CAPD appears to maintain or improve hematocrit as renal mass and function decline.
Vancomycin Absorption from the Peritoneal Cavity during Dialysis -Related Peritonitis
Authors: Rubin Jack
Published: February 2020

The uptake of vancomycin from the peritoneal cavity during acute episodes of peritonitis was compared to noninfected patients in 14 patients, 7 of whom had dialysis-related peritonitis. Treatment consisted of 8 hourly dialysate exchanges, followed by 4-h dwells containing 37.5 mglL of vancomycin. On day 4, serum vancomycin concentrations were 13.4 ± 4.8 mglL in the controls and 15.5 ± 6.8 mg/L in the group with peritonitis. After 180 min in the peritoneal cavity, 61% ± 13% of the infused vancomycin remained in controls and 30% ± 15% in patients with peritonitis (p < 0.05). Uptake of vancomycin from the peritoneal cavity is enhanced during episodes of peritonitis.
Stability of Amphotericin B in CAPD Fluid
Authors: Janknegt Robert , Paulissen Ans , Hooymans Piet M. , Lohman Joseph J. H. M. , Hermens Walter A. J. J.
Published: February 2020

Amphotericin B is the drug of choice in continuous ambulatory peritoneal dialysis (CAPD) associated fungal peritonitis and is usually administered intra peritoneally. The drug is stated to be incompatible with anions. All CAPD fluids contain chloride and lactate anions. Therefore, the physical and chemical compatibility of amphotericin B with dextrose 5%, Dianeal 1.36% CAPD fluid, and Dianeal 1.36% peritoneal effluent was studied at amphotericin B concentrations of 1, 2, and 5 mg/L. Amphotericin B was most stable in Dianeal CAPD fluid. The rate of degradation was concentration dependent in dextrose 5% and peritoneal effluent. The higher the concentration, the lower the rate of degradation. After an incubation of 6 h at 37°C, no significant decomposition was found at all concentrations studied in Dianeal CAPD fluid whereas 12–18% decomposition was found in effluent. No physical incompatibility with any solution was observed.
Tobramycin Absorption from the Peritoneal Cavity
Authors: Rubin Jack
Published: February 2020

Previous studies have found serum tobramycin concentrations greater than 8 mg1L among patients undergoing treatment for peritonitis using hourly dialysate exchanges containing 10 mg1L of tobramycin. In this study, tobramycin absorption from the peritoneal cavity was evaluated among patients treated with exchanges of 180 min. intraperitoneal duration. Six patients in each group were studied. Mass transfer coefficients [MTC (mLI min.)] were calculated for noninfected (C) and peritonitis (P) periods. The mean MTC for C was 6.5 ± 2.1 (SD) mLlmin., and for P, 18.5 ± 8.2 (SD) mLlmin. (p < 0.01). Peritonitis increased the rate of uptake from the peritoneal cavity. In these acute studies, the total dose of tobramycin delivered was small, so that serum concentrations remained less than 0.2 mglL among controls and 0.5 mglL among patients with peritonitis. Prolonged exposure to tobramycin, in association with more rapid absorption from the peritoneal cavity, may lead to serum concentrations greater than 8 mgjL.
Mechanical Cardiopulmonary Resuscitation Choice of Patients on Chronic Peritoneal Dialysis
Authors: Tzamaloukas Antonios H. , Zager Phillip G. , Quintana Barbara J. , Nevarez Marie , Rogers Kathleen , Murata Glen H.
Published: February 2020

Fifty-five adult patients (5 women, 50 men) on chronic peritoneal dialysis, mostly continuous ambulatory peritoneal dialysis (CAPD), for 2 to 155 mon were asked whether or not they wanted to have mechanical cardiopulmonary resuscitation (CPR) in case of sudden death. Thirty-five patients (65%) opted for CPR and 20 (36%) declined. Statistically, sex (although the number of women interviewed was too small for a valid sample) and duration of dialysis had no effect on choice of CPR, whereas older age, the presence of diabetes, advanced medical disability, and advanced socioeconomic disability were associated with a tendency to decline CPR. Among the 10 patients who had CPR, 5 developed flail chest, 4 had multiple rib fractures, and only 1 had no chest wall trauma from CPR. Two patients left the hospital alive. One third of the patients on chronic peritoneal dialysis do not want CPR. Advanced age, diabetes, and poor medical and socioeconomic states predispose peritoneal dialysis patients to decline CPR.
Is Initial (24 Hours) Lavage Necessary in Treatment of CAPD Peritonitis?
Authors: Ejlersen Ellen , Brandi Lisbet , Løkkegaard Hans , Ladefoged Jørgen , Kopp Rena , Haarh Pia
Published: February 2020

A randomized trial was conducted to examine the influence of initiallavage on treatment of CAPD peritonitis. Patients with hypotension and shock were excluded from the trial. Thirty -six CAPD patients with acute peritonitis were randomized to treatment with intraperitoneal antibiotics including either initial24 hours lavage before resumption of routine CAPD schedule (prior standard approach) or continued prolonged exchanges as in routine CAPD schedule. Median time to solved infection (normalization of white cell count in dialysis effluent) was identical (3 days) in the two groups. Treatment success rate was found to be 72% in the group with initial lavage and 89% in the group with prolonged exchanges. The difference in treatment success (17%) in favour of continued CAPD schedule was not found significant (95% confidence limits −1% to 35%). The results suggest lavage to be of no clinical benefit in treatment of CAPD peritonitis in patients without profound hypotension and shock.
The Effect of Body Weight on CAPD Related Infections and Catheter Loss
Authors: Piraino Beth , Bernardini Judith , Centa Patricia K. , Johnston James R. , Sorkin Michaell
Published: February 2020

CAPD related infections an d catheter loss continue to be the major problems facing the peritoneal dialysis patient. Few risk factors for infections and catheter loss have been identified. We hypothesized that overweight and underweight patients may be at increased risk for infections and catheter related problems. We examined the effect of the patient's weight at the start of peritoneal dialysis on the subsequent peritonitis and catheter infection rates, as well as catheter loss. Weight was expressed as a percentage of ideal body weight (IBW). Those patients who were more than 110% of IBW were considered to be overweight, 90 to 110% of IBW normal and less than 90%, underweight. An equivalent percentage of patients were overweight and underweight at the initiation of peritoneal dialysis (55/228, 24% for both groups). Overweight, normal, and underweight patients had peritonitis rates of 1.0, 0.9, and 0.8 episodes/y and catheter infection rates of 1.1, 1.2, and 0.8 episodes/y, respectively. Despite these similar rates, catheter loss due to infectious complications was greatest in the overweight group and least in the underweight group (p<0.05). No obvious explanation for the difference in catheter loss rate was found. Neither S. aureus nor P. aeruginosa infections occurred more frequently in the overweight patients. However, S. aureus infections more often led to catheter loss in the overweight patients. Catheter loss due to catheter leaks and failure to drain was similar in the three groups of patients. We conclude that deviation from ideal body weight at the initiation of dialysis is not a risk factor for CAPD related infections. However, for unclear reasons, increasing weight is associated with increasing risk of catheter loss secondary to infections. Further research in this area is warranted.
Recovery of S. Epidermidis and E. Coli from Effluent Peritoneal Dialysate
Authors: Bailie George R. , Eisele George , Venezia Richard A. , Litynski Jim , Hughes Heather
Published: February 2020

The effect of incubation temperature and duration was studied on the growth of organisms in peritoneal dialysate effluent. Penicillin-sensitive, and gentamicin sensitive clinical isolates of S. epidermidis (SE} and E. Coli (EC}, respectively, were inoculated into freshly drained dialysate of 19 CAPD patients who did not have peritonitis. Each dialysate was 1.5% dextrose in strength and had a minimum dwell of 6 hours. Control and test aliquots were incubated at 4°C, 20°C and 37°C for periods of up to 12 hours, and samples collected and plated to determine colony counts. Initial counts at time zero were 9.4 × 104 (SE} and 6.6 × 103 (EC} CFUlml. SE showed no change in count at 4 or 20°C up to 12 hours. There was a significant increase (p<0.005} at 37°C, at 12 hours to 1.72 × 106 CFUlml. EC showed no change at 4 or 20°C. There was a significant decrease in count for EC at 37°C, 6 hours (5.5 × 102 CFUlml, p<0.01} and 37°, 12 hours (2.9 × 102 CFUlml, p<0.0001}. It is recommended that infected dialysate should be stored in cool conditions until it can be transported for culture to ensure adequate recovery of gram negative organisms.
Effect of Intraperitoneal Administration of Heparin to Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Takahashi Susumu , Shimada Akihito , Okada Kazuyoshi , Kuno Tsutomu , Nagura Yuji , Hatano Michinobu
Published: February 2020

The effect of intraperitoneal administration of heparin to patients on continuous ambulatory peritoneal dialysis (CAPD) remains obscure. We examined 8 patients on CAPD to investigate its effect. When 2.5 U/ml or 5 U/ml of heparin was given intraperitoneally, t1/2 of heparin activity in the dialysate was 0.5 to 2 hrs, and 6 hrs after administration its activity was 0.5 U/ml and 1.4 U/ml respectively. Whole blood clotting time was hardly affected because the transfer of heparin to the plasma was minimal. The plasma antithrombin III (AT -III) levels were comparable to patients on hemodialysis, but the AT-111level in the dialysate was only 1.5% of those in the plasma. We conclude that the intraperitoneal administration of heparin at these doses is effective in preventing fibrin precipitation when intraperitoneal AT -III levels are expected to be relatively increased such as at the start of CAPD or in the presence of peritonitis.
Reduced Risk for Peritonitis in CAPD with the Use of a UV Connector Box
Authors: Stegmayr Bernd G. , Granbom Lena , Tranæus Anders , Wikdahl Ann-Marie
Published: February 2020

A common route for peritoneal infection is the bag transfer connecting site. To investigate possible reduction of such transfer infections with the use of a bag transfer set (UV-XD, Travenol, Baxter, Minneapolis), this study sampled patients using a transfer set with or without UV light sterilization. Calculations excluded peritonitis due to penetrating tunnel infection or defective peritoneal dialysis bag (4 episodes in 2 patients). The study included 51 patients with a median age of 62 years (range 25–81). Five were switched from manual connection (Travenol, Type II) to UV-XD, and each suffered from at least 2 peritonitis episodes during 9 −24.5 months prior to the change to UV-XD. In this patient group, the incidence of peritonitis fell significantly from 1 peritonitis/4 to 1/21 months. The bag transfer set was used without UV light in 35 patients for a total of 178 months, producing an incidence of 1 episode/7.7 treatment months. These patients had significantly more peritonitis than 35 patients who used the UV light for a total of 416 months (1 episode/21 months). In 19 patients who used both techniques, there was less risk for peritonitis when UV light was used (p = 0.001). We conclude that the UV-XD device is simple to handle and may reduce the incidence of peritonitis, especially if the box is used in tandem with UV light sterilization.
Design and Testing of the Baxter Integrated Disconnect Systems (IDS)
Authors: Balteau Patrick R. , Peluso Francesco P. , Coles Gerald A. , Michel Catherine , Mignon Françoise M. , Tranaeus Anders P. , Verger Christian , Zaruba Karel
Published: February 2020

This paper describes the result of a miltidisciplinary approach to the design and evaluation of a new CAPD disconnect system: the Baxter Integrated Disconnect System (IDS). This system consists of a bag full of fresh Dianeal®, an empty bag for the drainage of spent dialysate and tubings connecting the 2 in a y fashion. With this system, the patient makes only one connection. The system is disposable. The major property that makes this unique is that all components are preassembled, and the whole system is steam-sterilized as 1 unit. In general, similar systems use different sterilization methods for the various components of the system. Those components are then assembled, under clean conditions by the manufacturer, without final sterilization of the unit. Assembly of the components is sometimes left to the patient. The concept of IDS, therefore, is unique and warrants lower rates of contamination. This system has been tested on patients for a total observation period of 765 patient months, and has proven to be simple, safe and effective. It yields a 63% probability of peritonitisfree patients at 24 months.
Influence of Dialysate Exchange on Cardiac Left Ventricular Function in Children Treated with CAPD
Authors: Besselink Rob A. M. , Schroder Cornelis H. , Van Oort Anton M.
Published: February 2020

The influence of peritoneal dialysate exchange on the ventricular function in 11 children on continuous ambulatory peritoneal dialysis (CAPD) therapy was studied before and after instillation dialysate. Systolic blood pressure, pulse rate, and echocardiographical data (shortening fraction and pre-ejection period/left ventricle ejection time-ratio) were obtained before and after instillation. There were no differences present with respect to the measured parameters after the abdomen was filled. It is concluded that in children treated with CAPD the exchange of normal volumes of dialysate has no influence on the function of the left ventricle.
Vestibular Toxicity Due to Gentamicin in Peritoneal Dialysis Patients
Authors: Chong Tae Kae , Piraino Beth , Bernardini Judith
Published: February 2020

Gentamicin is well known to be a cause of vestibular toxicity. Despite this, gentamicin is often used to treat peritonitis and exit site infections in peritoneal dialysis patients because of the ease of intraperitoneal administration and the broad coverage of aerobic Gram-negative bacilli, including Pseudomonas aeruginosa. We report 4 cases of severe vestibular toxicity occurring in peritoneal dialysis patients treated with gentamicin. They were all treated as outpatients for peritonitis or an exit-site infection while on continuous ambulatory peritoneal dialysis (CAPD) or continuous cyclic peritoneal dialysis (CCPD). The drug was administered to 3 patients in each peritoneal exchange (5 mglL) after a loading dose. A fourth patient was given 1 mglkg of intraperitoneal gentamicin every other day. The mean length of treatment was 21 days. Levels were not used to adjust the doses. All developed severe vertigo from which there was incomplete or no recovery. We suggest that gentamicin and the other aminoglycosides should be used in peritoneal dialysis patients only when there is no suitable alternative antibiotic. When gentamicin is administered, levels should be carefully followed. Studies should be performed in peritoneal dialysis patients on the feasibility of dosing gentamicin intermittently, which may be less toxic than continuous intraperitoneal administration.
The Utility of a Structured Evaluation of Elderly Patients for Continuous Peritoneal Dialysis
Authors: Holley Jean L. , Foulks Charles J.
Published: February 2020

The elderly comprise an increasing proportion of chronic dialysis patients. Recruiting them for continuous peritoneal dialysis (CPO) would help CPO programs maintain a patient population. We retrospectively studied the ability of a prospective evaluation to predict success with CPO in elderly (age >60 years) patients. PO nurses and a renal social worker assigned scores in 10 categories, which were then averaged to obtain an overall evaluation score. Scores were from 1–5 with 1 = good, 5 = poor, and 3 = average. Thirty-four elderly patients began CPO during the study period. Evaluation scores were available for 28 of these patients before they began dialysis. Evaluation scores <3 predicted success with CPO (2.2:1:0.2 versus 3.2:1:0.4 in patients transferring to hemodialysis, p<0.02). Patient motivation and preference were the categories that predicted success with CPO. Elderly patients were more likely than younger patients (those <60 years of age) to decline CPO for social reasons (46% versus 4% respectively, p<0.001). Elderly patients required more CPO training time than young patients (4.9:1:0.7 days versus 3.3:1:0.8 days respectively, p<0.01). We conclude that a prospective assessment of elderly patients can predict success with CPO and provide information important to individual structuring of CPO training and follow-up.
In Vivo and In Vitro Characterization of Mesothelial Lipid Inclusions
Authors: Hjelle J. Thomas , Golinska Barbara T. , Waters Diane C. , Steidley Kevin R. , McCarroll David R. , Pavlina Thomas , Smith Stephen L. , Lloyd John K. , Dobbie James W.
Published: February 2020

The nature of intracytoplasmic lipid inclusions found in cultured rabbit and rat peritoneal mesothelial cells was examined by ultrastructural and biochemical techniques. Transmission electron microscopy also demonstrated extracellular release of these lipid bodies. Differential fixation with tannic acid revealed 2 types of inclusions, lamellated (lamellar bodies) and nonlamellated (homogeneous). The lamellar bodies were found near or in the Golgi apparatus and on the cell surface where occasionally they were observed in exocytotic pouches. The homogeneous inclusions were the predominant species being found primarily intracellularly. Lipid bodies obtained from the culture media over the cells displayed on electron microscopy the same morphological characteristics as those seen intracellularly. Exposure of confluent cultures of mesothelial cells to the vital lipid stain Nile Red caused the appearance of intensely fluorescent droplets in or on the cells at wave lengths consistent with staining for phosphatidylcholine-rich vesicles. Incubation of the cells with r4C)-choline an d subsequent analysis of phospholipid formation revealed high rates of r4C)-phosphatidylcholine addition to both intra and extracellular lipid pools. Taken together, mesothelial cells exhibit lipid bodies similar in ultrastructure to the surfactant containing organelles of Type II pneumocytes.
Day-To-Day Variability of Protein Transport Used as a Method for Analyzing Peritoneal Permeability in CAPD
Authors: Zemel Désirée , Krediet Raymond T. , Koomen Gerardus C.M. , Struijk Dirk G. , Arisz Lambertus
Published: February 2020

The transperitoneal transport of macromolecules is dependent on both effective peritoneal surface area and intrinsic permeability of the peritoneum. For passage of small solutes, the effective surface area is the main determinant. We hypothesized that day-to-day variations in peritoneal clearances are caused by changes in the effective surface area and not in the intrinsic permeability. Four CAPD {continuous ambulatory peritoneal dialysis) patients without peritonitis were investigated on 28 consecutive days. Concentrations of beta-2-microglobulin, albumin, IgG, and alpha-2-macroglobulin were determined daily in dialysate {night bags) and weekly in serum. Clearances and their coefficients of variation were calculated. Mean coefficients of the intraindividual variation of protein clearances increased, the higher the molecular weight: they ranged from 12% for beta-2microglobulin clearance to 22% for alpha-2-macroglobulin clearance. Correlations were present between the clearances of albumin, IgG, and alpha-2-macroglobulin, but not between any of these and beta-2-microglobulin clearance. In all patients, protein clearance {C) was a power function of the free diffusion coefficient in water {D) according to the equation: C=a. Db in which b represents the restriction coefficient of the peritoneum, and thus intrinsic permeability. The coefficient of variation of the restriction coefficient was low (range 4–6%). This supports our assumption that the intrinsic permeability is fairly constant on the short term. Day-to-day variations in protein clearances are thus mainly caused by alterations in the effective peritoneal surface area. Longterm follow-up of the restriction coefficient in individual patients might identify those at risk for the development of structural changes in the peritoneal membrane.
Stimulation of Mesothelial Cells Proliferation by Endogenous Growth Factor(s)
Authors: Breborowicz Andrzej , Rodela Helen , Pagiamtzis Jim , Oreopoulos Dimitrios G.
Published: February 2020

We have attempted to determine whether human mesothelial cells (MC) have the power to influence their own proliferation. A serum -free medium was conditioned with the mesothelial monolayer for 24 hours and then applied to proliferating MC. Conditioned medium increased proliferation rate of MC. When the medium was heated at 60°C for 60 minutes, the growth-promoting activity of the conditioned medium decreased by 50%, suggesting that MC produce at least 2 growth factors, 1 heat-Iabile and the other heat-stable. When MC were exposed continuously to a medium containing 90 mM glucose growth factor, production was decreased by 35%. However, when the cells were exposed to glucose only on alternate days, growth-factor production was similar to that in the control medium. On the other hand, MC exposed continuously for 10 days to 90 mM of glucose exhibited a weaker response to endogenous growth factor, even in a normotonic medium with low glucose concentration. Our results suggest that MC syn thesize factor(s), which stimulate their own proliferation, and that high glucose concentrations interfere with this production and the subsequent action of growth factor.
Antimicrobial Treatment of Peritonitis Associated with Continuous Ambulatory Peritoneal Dialysis
Authors: Millikin Stephen P. , Matzke Gary R. , Keane William F.
Published: February 2020

A multitude of therapeutic regimens have been proposed for the management of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). There are, however, few clinical trials that have evaluated the efficacy of these proposed regimens in a prospective, comparative fashion. This retrospective report is a tabulation of the published data on antimicrobial treatment of CAPD-related peritonitis. The results are presented for combination and mono-drug therapies; Gram-positive bacterial, Gram -negative bacterial and fungal infections; intravenous, oral and intraperitoneal (i.p.) routes of drug administration; various dosages and dosing intervals; and clinical response and relapse rates. The apparent optimal combination regimen for empiric treatment of peritonitis is vancomycin administered in 1 dialysis exchange/week with ceftazidime. This regimen avoids the toxicity associated with the use of aminoglycosides while maintaining effectiveness.
Functional Characteristics of Peritoneal Macrophages of Renal Failure Patients on Peritoneal Dialysis
Authors: Sulowicz Wladyslaw , Hanicki Zygmunt , Chichocki Tadeusz , Zembala Marek , Ruggiero Irena , Uracz Wojciech
Published: February 2020

Functional activity of peritoneal macrophages of 50 patients with end-stage renal failure on intermittent peritoneal dialysis (IPD) and of 30 control subjects with normal renal function was determined. Phagocytosis of latex particles by macrophages of dialyzed patients was significantly lower as compared with the controls. Further depression of the phagocytic activity was observed during bacterial peritonitis. Macrophages from the dialyzed patients also showed nonsignificantly decreased functional expression of Fc receptors (FcR) and increased spontaneous nitro blue tetrazolium (NeT) reduction.
Multiple-Dose-Kinetics of Ofloxacin after Intraperitoneal Application in CAPD Patients
Authors: Kampf Dieter , Borner Klaus , Hain Hannelore , Conrad Wolfgang
Published: February 2020

Pharmacokinetics of ofloxacin in plasma and peritoneal fluid were studied in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Seven patients without peritonitis received 20 mg ofloxacin added to 2L dialysate i.p. every 6 h for one day only, while 4 patients with acute peritonitis were treated with this same dosage every 4 h for 3 days, then every 6 h for the next 7 days. Ofloxacin concentrations in plasma and dialysate were determined by HPLC.

After i.p. drug application there was a rapid elimination of ofloxacin from dialysate, this being significantly faster in patients with peritonitis as compared to those without. Likewise, the total amount lost from the first bag after a 3 h dwell was higher in the peritonitis group (84.7±1.5%; mean±SEM) than in the non-peritonitis group (75.6±2.1 %). Twenty-four h after start of ofloxacin treatment, the mean peritoneal fluid concentrations at the end of each exchange studied were all above 3 mg/L. In patients with peritonitis, plasma concentrations of ofloxacin rose to 0.94±0.05 mg/L after 24 h reaching a Cmax of 1.8±0.2 mg/L after a tmax of 84±23 h.lntraperitoneal administration of ofloxacin was well tolerated, and no local or systemic adverse events were observed. Peritonitis episodes that were caused by Staphylococcus epidermidis (3) and by E. coli (1) were cured in all patients.
Peritoneal Transport Kinetics of Glucose, Urea, and Creatinine during Infancy and Childhood
Authors: Schröder Cornelis H. , Van Dreumel Marie-José , Reddingius Roel , Theeuwes Ad G.M. , Willems Hans L. , De Jong Maria C.J.W. , Monnens Leo A.H.
Published: February 2020

Peritoneal handling of glucose and metabolites is reported to be higher in young children treated with CAPD than in older children. Reference curves for the standardized peritoneal equilibration test (PET) are not available for younger ages. The present study describes the results of the PET in 19 children (mean age 5.0 years, ranging from 0.3–15) during the first month of CAPD treatment. No age dependency for the handling of glucose, urea, and creatinine could be established when the group was subdivided into 1. children below the age of 3 years, and 2. children above that age. There was, however, a significant correlation between equilibration of creatinine and age, indicating more rapid equilibration at younger ages.
The Role of Omentectomy in Continuous Ambulatory Peritoneal Dialysis
Authors: Nicholson Michael L. , Burton Paul R. , Donnelly Peter K. , Veitch Peter S. , Walls John
Published: February 2020

Long-term survival of the peritoneal catheter is essential for successful CAPD. In our unit, all CAPD catheters are now placed by an open surgical technique, which in some cases has included performing a partial omentectomy. The aim of this study was to assess the influence of omentectomy on CAPD catheter survival. Three hundred consecutive CAPD catheters inserted over a 5-year period were analyzed. Omentectomy was performed in 113 cases (38%). Data relating to a number of potentially significant risk/benefit factors were analyzed using multiple regression analysis (proportional hazards method of Cox). Performing a partial omentectomy at the time of catheter insertion was found to significantly improve CAPD catheter survival (p=0.0002).
Exit-Site Infection in Continuous Ambulatory Peritoneal Dialysis: A Review
Authors: Luzar Mary Anne
Published: February 2020

Although the ability of CAPD to successfully treat end-stage renal disease is now well established, exitsite infection (ESI) remains a serious cause of morbidity. The objective of this article is to review recent advancements relating to ESI pathogenesis and its reduction. Current definitions of ESI are reviewed, as are comparative studies of etiology. Emphasis is placed on the literature identifying Staphylococcus aureus as the primary cause of ESI in CAPD. The article reviews reported rates of ESI and discusses reasons for variations of this complication's reported frequency. The selection of catheters available in CAPD are discussed, as are studies demonstrating the threat of S. aureus to catheter survival. The pathogenesis of exit-site infection related to S. aureus nasal carriage in CAPD is reviewed in light of recent findings indicating the pre-CAPD nasal carrier as the patient at risk for subsequent ESI. Postoperative and long-term care of the catheter patient are reviewed for various literature protocols. Treatment recommendations for choice of agents are discussed. Future research should include a better understanding of the morphology of the CAPD catheter exit-site in humans and the healing process. ESI epidemiological studies should be encouraged in tandem with well -designed, controlled studies on the value of prophylactic treatment.
Quality of Life of Patients on In-Center Hemodialysis versus Continuous Ambulatory Peritoneal Dialysis
Authors: Tucker Carolyn M. , Ziller Robert C , Smith William R. , Mars Donald R. , Coons Mary P.
Published: February 2020

This study compared chronic hemodialysis and CAPD patients on several quality of life variables: dietary adherence, self-esteem, hope, wellbeing, marital happiness, perceived control over life, marital status, number of emotional support persons, and participation in social, recreational, and work activities. Statistically significant differences in the quality of life variables due to treatment modality or demographic variables were not found. However, CAPD patients did engage in significantly more social and recreational activity, though not more work activity, than did hemodialysis patients. It is noted that 73% of the CAPD patients were Caucasian and that 72% of the hemodialysis patients were of black origin. Similarly skewed racial compositions in preceding research comparing patients on CAPD and hemodialysis suggest that 1. choice of treatment is occurring on the basis of some set of patient characteristics, or 2. systematic assignment is occurring on the basis of race, sex, and/or education. However, given no significant race/demography differences for variables used in this research, it appears that quality of life across racially different groups of hemodialysis and CAPD patients is comparable.
Pathogenesis of Peritoneal Fibrosing Syndromes (Sclerosing Peritonitis) in Peritoneal Dialysis
Authors: Dobbie James w.
Published: February 2020

Drawing from diverse sources including epidemiological and clinical data, surgical observations, histopathology, serosal healing responses to fibrin and fibrinolysis, tissue reaction to chronic exposure, and to exo and endotoxins, new information on mesothelial stem cells, autocrine and paracrine influences on their proliferation and collagen synthesis, and the effect of glucose on fibroconnective tissue, we have begun to piece together the pathogenetic jigsaw of fibrosis in continuous ambulatory peritoneal dialysis (CAPD).

The reaction of peritoneal mesothelium and stroma to the stress of continual dialysis results in a spectrum of alterations ranging from opacification through a tanned peritoneum syndrome to sclerosing encapsulating peritonitis (SEP). Any agent that causes irritation of the mesothelial layer and induces serositis, or single severe or multiple episodes of peritonitis resulting in mesothelial loss, predisposes the peritoneum to fibroneogenesis. An accurate definition of the histopathological changes of peritoneal thickening is a prerequisite for defining pathogenesis. This paper is the first attempt to create such a framework.

It is evident from many areas of study that fibrin deposition and fibrinolysis, hyalinization of the superficial stromal collagen possibly tanned through nonenzymatic glycosylation by dialysate glucose and the proliferative potential of mesothelial stem cells play an important and possibly interdependent role in excessive fibroneogenesis in certain patients on CAPD.

Many of the pieces of the jigsaw are obviously still missing, and the picture is most surely incomplete. Nevertheless, the outline of the pathologic and etiologic landscape should now be discernible.
The Effect of Recombinant Erythropoietin on the Early Hematocrit Rise after Capd Initiation
Authors: Golper Thomas A.
Published: February 2020

Objective

To determine if the simultaneous initiation of continuous ambulatory peritoneal dialysis (CAPD) and Erythropoietin therapy masks the hematocrit (Hct) rise that frequently follows the initiation of CAPD alone.

Design

Single-center retrospective analysis.

Setting

University multidisciplinary dialysis program.

Patients

All adult CAPD patients with a Hct ≤28% whose nephrologist felt they would benefit from Erythropoietin therapy and who did not have technical reasons for exclusion (N=25).

Interventions

Eight patients began CAPD and Erythropoietin alfa subcutaneously, at a dose of 128:1:9 (X:1:SEM) units/kg/week at the same time. Seventeen patients already on CAPD for 8.7:1:1.5 months received Erythropoietin alfa subcutaneously at a dose of 124:1:7 units/kg/ week. Pre-epoetin Hct's were similar.

Main outcome measures

Hematocrit changes, status of iron stores, incidence of peritonitis, and dosage of Erythropoietin.

Results

In 1 month, the group initiating both therapies simultaneously demonstrated a mean Hct rise of 7.6:1:0.5% while established CAPD patients receiving Erythropoietin increased their Hct by only 4.7:1:1.0% (p<.03). Iron status could not explain this difference. Peritonitis did not appear to dampen the Hct rise following Erythropoietin in either CAPD group. By 2 months after Erythropoietin, the differences were less apparent.

Conclusion

The early rapid increase in Hct is probably the combined effect of CAPD and Erythropoietin and should not be attributed to Erythropoietin alone. When comparing responses to Erythropoietin from patients on different therapies, the timing of dialysis initiation and Erythropoietin initiation must be considered.