bluuebunny/crossref_metadata_2025 huggingface dataset:
The Durability of the Peritoneal Membrane
Authors: Diaz-Buxo Jose A.
Published: February 2020

Severe membrane functional limitations with time on peritoneal dialysis are infrequently reported. Occasional reports where most patients were affected by peritoneal functional loss are in conflict with the good preservation of function reported by others. Such endemic distribution of structural and functional deterioration of the peritoneum should facilitate the search for etiologic factors. In the present state of ignorance it seems wise to treat infectious peritonitis promptly and aggressively, to support research in the area of membrane solution interaction and to carefully monitor the effects of chronic peritoneal dialysis on the peritoneal membrane.

The most important determinant of the success of peritoneal dialysis in providing adequate therapy for chronic renal failure is the durability of the peritoneal membrane. Dobbie et al (I) have clearly stated the magnitude and severity of the problem in the following passage: “In view of the fact that most renal dialysis centres throughout the world are now embarking on a relatively new form of treatment for chronic renal failure -continuous ambulatory peritoneal dialysis, it is perhaps ironic that so little is known structurally of the tissue on which depends a life maintaining procedure and on which so many aspirations are now based.” Our ignorance of the peritoneal architecture is surpassed only by our poor understanding of the relationships between functional and structural changes.

From the functional point of view, the peritoneal membrane includes the mesothelium which covers its free surface, the peritoneal interstitium, probably composed of an aqueous network bathing gels of mucosaccharides and collagen, and the microcirculation. Extensive research has been recently initiated to study the role of each of these components in transperitoneal transport and ultrafiltration and the effect of chemical and mechanical injury on the peritoneal membrane (1,2). The interest in investigating the factors responsible for altered states of solute and water transport during peritoneal dialysis has been stimulated by alanning reports suggesting functional deterioration of the peritoneal membrane system during chronic dialysis (3,4).
Single Cuff versus Double Cuff Tenckhoff Catheter
Authors: Diaz-Buxo Jose A. , Geissinger William T.
Published: February 2020

No significant differences in catheter survival were noted between single cuff catheters and double cuff catheters in patients undergoing intermittent peritoneal dialysis. With continuous peritoneal dialysis techniques, double cuff catheter survival was better than that of single cuff catheters.
Polymers as Osmotic Agents for Peritoneal Dialysis
Authors: Twardowski Zbylut J. , Moore Harold L. , McGary Terry J. , Poskuta Mira , Stathakis Charalambos , Hirszel Przemyslaw
Published: February 2020

A sustained ultrafiltration during long-dwell peritoneal dialysis exchanges cannot be obtained with rapidly absorbable small molecular weight osmotic agents. Slowly absorbable synthetic poly ions tested on rats and rabbits yielded high and sustained ultrafiltration, but were toxic. Gelatin solutions were not toxic in acute rat studies and produced sustained ultrafiltration but were difficult to work with because of gelation. A review of the literature on the properties of gelatin derivatives, used as plasma substitutes, led us to believe that they may be also useful as osmotic agents in the peritoneal dialysis solutions.

In the peritoneal dialysis system, hydrostatic pressure in the blood compartment cannot be readily manipulated. Therefore, traditionally a solute (osmotic agent) is added to the peritoneal dialysis solution to create an osmotic driving force. During the process of ultrafiltration (Figure I), the rate of ultrafiltration decreases with time due to dilution by ultrafiltrate and absorption of the osmotic agent. Thus, ultrafiltration will eventually cease after the dialysis solution is infused. The bigger the molecule of the osmotic agent, the longer ultrafiltration lasts because solute absorption through the peritoneal membrane is slower. Thus, to achieve sustained ultrafiltration, an osmotic agent with a bigger molecule would be more advantageous than the smaller one at comparable osmotic gradients.
Nutritional Problems in Continuous Ambulatory Peritoneal Dialysis
Authors: Flynn Margaret A.
Published: February 2020

There are difficulties in ohtaining trustworthy information about nutritional status. Methods of assessment must be very specific and sensitive. Today's traditional anthropometric and biochemical standards should be re-evaluated. Reliability of plasma proteins as indicators of protein status is suspect. There is need to review contents of food composition tables used in computing nutrients in diets. Diet therapy for uremic patients using CAPD has similar problems encountered by pioneers who originated total parenteral nutrition.

Patients in chronic renal failure who use continuous ambulatory peritoneal dialysis may have a number of nutritional and metabolic problems: glucose intolerance, loss of amino acids in dialysate leading to possible protein depletion, decreased energy intake, hypertriglyceridemia, astro dystrophy, anemia, anorexia, hypocalemia, nausea, constipation. Nephrologists, like other clinicians and researchers who have accepted nutritional care as a required therapy for rehabilitation or management of sick people, have adopted some generally accepted methodologies for assessment of the nutritional status of these individuals. They include diet assessment, biochemical indices, anthropometric measurements and more elegant documentation of body composition.
CAPD/CCPD in Children: Update 1984
Authors: Salusky Isidro B. , Davidson Deborah , Wilson Marcia , Hall Teresa , Jordan Stanley C. , Ettenger Robert B. , Fine Richard N.
Published: February 2020

Between August 1980, when dialysate solution in appropriate volumes for pediatric patients became available in the United States, and February 1984, 68 patients, aged 1 to 21 years, were trained for CAPD/CCPD at UCLA. This report reviews the clinical experience with these home dialytic modalities during the past 31/2 years.
Comparison of the Results of CAPD Treatment in “Experienced” versus “Inexperienced” Centres in Europe
Authors: Moore R. , Brunner F.P. , Jacobs C. , Kramer P. , Selwood N.H. , Wing A.J.
Published: February 2020

Five per cent of almost 80,000 living patients with end stage renal failure (ESRF) in Europe were on CAPD on 31st December, 1982. The use of CAPD has grown dramatically since 1977. Centres which reported the use of CAPD to the EDTA Registry were divided into “experienced” and “inexperienced.” Patients treated in “experienced” centres had less peritonitis and spent less time in hospital because of peritonitis. Patient survival amongst those starting treatment in earlier years was worse in the “inexperienced” centres but improved so that it equalled survival in the “experienced” centres in 1982. At 12 months cumulative patient survival in patients commencing CAPD in 1982 was 87% and technique survival exceeded 95%. It appears that there is now a homogenous population of centres with approximately equal expertise.
Sex Selection Bias in Choosing a Dialysis Therapy
Authors: Burton H.J. , Heidenheim P. , Kline S.A. , Lindsay R.M. , Bolley H.
Published: February 2020

This investigation has sought to determine reasons for the disproportionately higher number of females entering CAPD as opposed to home hemodialysis. A sample of 295 home dialysis patients, 97 women and 198 men, were compared in terms of modality of choice, baseline demographic characteristics, treatment outcome, and quality of life. The results indicate that there is no apparent rationale for the current selection basis.
A Randomized Multicenter Clinical Trial to Evaluate the Effects of An Ultraviolet Germicidal System on Peritonitis Rate in Continuous Ambulatory Peritoneal Dialysis
Authors:   A Multicenter Study Group, Nolph K.D.
Published: February 2020

In continuous ambulatory peritoneal dialysis (CAPD), peritonitis frequently is assumed to result from spike contamination during bag exchanges. An ultraviolet germicidal chamber has been developed, which disinfects the spike and the solution-bag outlet before spike insertion. This report summarizes the results of a multicenter trial carried out to determine if this device reduces the incidence of peritonitis in patients on CAPD. Ten centers contributed 167 patients who were followed during a base-line historical control period for a minimum of four months. Thereafter, 93 patients were randomized to a control group, and 74 to the test group. After an interim period for retraining (both groups) and change over (test group), a trial period of nine months was undertaken. Peritonitis rates and actuarial analyses of time-to-peritonitis showed no significant differences between historical and trial periods in either group, or between groups during either period. In both groups, rates of peritonitis were consistently lower than rates reported in the National Registry. The results suggest that, in the patients participating in these studies, spike contamination may have been an infrequent cause of peritonitis.

In the U.S.A. over 9000 patients with end-stage renal disease are maintained on continuous ambulatory peritoneal dialysis (CAPD) (I). A peritonitis rate of 1.6 episodes per patient year represents the national average in the latest report of the U.S.A. CAPD Registry (2). Most clinicians assume that spike contaminations during bag exchanges are responsible for some portion of these episodes. Popovich, Moncrief and colleagues have described preliminary experiences with an ultraviolet germicidal system shown to disinfect intraspike contaminations with solutions containing 200,000 organisms per ml (3–4). An integrated dose of ultraviolet light within the germicidal chamber kills microorganisms before spike insertion into a fresh bag of solution. An improved chamber has been made available for clinical trials by Travenol Laboratories Inc (Deerfield, Illinois) (5).

This study summarizes the results of a multicenter trial designed to test the effects of this germicidal chamber on the frequency of peritonitis in a population of patients maintained on CAPD.
Effect of Peritoneal Dialysis and a Single Hemodialysis on Erythrocyte Membrane Atpase Activity of Uremic Subjects
Authors: Hakan Ozdogu , Ali Gurcay , Tevfik Akoglu , Emel Akoglu
Published: February 2020

In this study erythrocytic A TPase activities were studied in 21 patients before and after six hours of hemodialysis. In another group of 20 patients A TPase activities were also studied before and after 48 72 hours of peritoneal dialysis. As a control group 20 healthy normal subjects were used. Comparison of the results revealed that all three (Na+/k+, Mg++, Ca++/Mg++) ATPase activities were lower in the chronic renal failure patients than normal controls (p < 0.001). Both peritoneal and hemodialysis increased significantly all three A TPase activities. When peritoneal and hemodialysis results were compared no significant difference was noted. It is concluded that the increase in A TPase activites observed by both dialysis methods is due to removal from the plasma of substances which are responsible for the decrease in A TPase activities before dialysis.

In uremia numerous substances alone or together have been held responsible for various clinical findings. In addition some other metabolic wastes of unknown structure act upon important enzyme systems resulting to an altered cellular function.

A TPase enzymes are a group of enzymes responsible for the maintenance of the ionic and osmotic balance of the cells.

In this study we studied the status of these enzymes in ESRD patients undergoing dialysis and also the acute effect of peritoneal dialysis and hemodialysis on them.
Hemoperitoneum: A Red Flag in CAPD
Authors: Stephen G. , Alfred Nace , George L. , Stone William J.
Published: February 2020

This paper describes two episodes of hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). One patient developed bloody dialysate during an attack of acute cholecystitis, while a second developed this sign immediately after colonoscopy. We found no previous reports which have associated these conditions with bloody dialysate. This paper reviews other causes of spontaneous hemoperitoneum and discusses the significance of bloody dialysate during CAPD.
Electrophysiological Studies of Nerve Function in Patients on CAPD over Long Periods
Authors: Kim Donald , Blair Gordon , Wu George , Ayiomamitis Anthony , Oreopoulos Dimitrios G.
Published: February 2020

The authors studied electrophyhsiological parameters in 29 patients (23 non-diabetics, six diabetics, mean age 47.9, range 16–74 yr.), who had been on CAPD for three to five years. The parameters studied were: motor nerve conduction velocities of the median, ulnar, and peroneal nerves, and sensory nerve conduction velocities of the median and ulnar nerves. These parameters were measured before or within the first month of CAPD and every six months thereafter. The changes in nerve conduction velocities were studied using simple linear regression analysis, and calculating the differences of the slopes from zero. Comparison of the mean values of the conduction velocities in non-diabetics at the beginning of CAPD and in age - matched, non uremic patients showed significantly (p < 0.001) lower values in all parameters measured. The initial nerve conduction velocities in diabetic patients were significantly (p < 0.01) slower than in non-diabetics except sensory conduction velocity of the ulnar nerve. The slopes of nerve conduction velocities plotted against time were not significantly different from zero for any nerve in both non-diabetics and diabetic patients. In conclusion, no significant change in peripheral nerve function was seen after long term CAPD in either diabetic or non-diabetic patients.
Recurrent, Fatal Hemophilus Influenzae Sepsis in a Splenectomized Child on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Cohn Richard A. , Nevins Thomas E. , Moel Donald I.
Published: February 2020

This child, who was on CAPD, had two episodes of Hemophilus influenzae sepsis, the second of which proved fatal. Predisposing factors were prior splenectomy, recent immunosuppression and cytomegalovirus infection. Peritonitis was not present. Nephrologists must consider various risk factors when caring for the increasing number of young children on CAPD, particularly those who are splenectomized.

In some renal transplant recipients splenectomy has been advocated in an effort to improve graft survival (I). The procedure entails both perioperative risk and long-term complications, most notably bacterial sepsis. The risk of overwhelming, post splenectomy infection (OPSI) is higher in young children (2) and may be further increased in patients with end-stage renal disease.

We report a fatal case of recurrent Hemophilus influenzae (H. flu) septicemia in a splenectomized child receiving continuous ambulatory peritoneal dialysis (CAPD). In the absence of an available, effective vaccine to prevent hemophilus infections in children, our experience with this child suggests that prophylactic antibiotics should be given to reduce the risk of OPSI in susceptible individuals.
Allergic Eosinophilic Dermatitis Due to Silicone Rubber: A Rare but Troublesome Complication of the Tenckhoff Catheter
Authors: Kurihara Satoshi , Tani Yoshio , Tateishi Keita , Yuri Takehisa , Kitada Hirohisa , Sugishita Naoyasu , Fukuda Yoshihiro , Ishikawa Isao , Shinoda Akira , Hayakawa Yukinori
Published: February 2020

A 42-year-old Japanese woman developed an eczematous skin rash around the catheter exit during continuous ambulatory peritoneal dialysis (CAPD). The same kind of lesion developed around a Scribner shunt exit. Skin biopsy indicated chronic eosinophilic dermatitis. In the patch test she developed an allergic reaction to the silicone rubber catheter but not to the antiseptic solutions.

Based on these findings, we concluded that her “eczematous” rash represented an allergic response to silicone rubber in the peritoneal catheter. To this date the literature contains no reports of such a catheter complication in CAPD.

Catheter complications in patients on CAPD are mainly infection and mechanical dysfunction such as poor drainage or leaks (I, 2). Eosinophilic dermatitis around the catheter exit caused by the silicone rubber is extremely uncommon (3). As yet no reports have been published concerning this rare catheter complication.
Treatment of Fungal Peritonitis in CAPO Patients Using Peritoneal Lavage
Authors: Keogh J.A. Brian , Carr Michael E. , Murray Frank , McEvoy Marian , Grant Gabrielle , Keane Conor T.
Published: February 2020

This paper describes four CAPD patients with fungal peritonitis. The causative fungi were Candida albicans (twice), C. tropicalis and Cryptococcus neoformans. The infections were managed using the following regimen:

1 Removal of the Tenckhoff catheter.

2 Insertion of a temporary peritoneal catheter and commencement of peritoneal lavage, and administration of intraperitoneal miconazole and oral ketoconazole.

3 Insertion of a new Tenckhoff catheter after resolution of the peritonitis.

Three of these patients recovered.

We believe that it helps to remove the Tenckhoff catheter early and that, with our regimen, we can manage fungal peritonitis without suspending peritoneal dialysis. It appears that a combination of intraperitoneal miconazole and oral ketoconazole constitutes an effective antifungal therapy in CAPD peritonitis.
Surface-Active Material in Peritoneal Effluent of CAPD Patients
Authors: Grahame Gordon R. , Torchia Mark G. , Dankewich Katherine A. , Ferguson Ian A.
Published: February 2020

The dialysis effluent of patients on continuous ambulatory peritoneal dialysis contains a surface-active material (SAM). This is composed of phospholipids; on thin-layer chromatography, this appears to be mainly phosphatidylcholine. Similar to the material described by Hills on the pleural surfaces of dogs (4), this SAM markedly reduces surface tension and promotes water repellency. The authors postulate that it may playa role in ultrafiltration and in the prevention of infection in CAPD patients.

In the 10 years since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has come into increased use to treat patients with chronic renal failure. Two problems stand in the way of the success of CAPD: infection of the peritoneum, and loss of ‘ultrafiltration’ -partitioning of water between the peritoneal cavity and the extracellular space (1, 2). The peritoneal membrane has not been studied extensively and we have a limited understanding of the exchange or non-exchange of water and other materials at this surface (3).

Hills and co-workers (4) who demonstrated surface-active material (SAM) in washings of the pleural space of dogs have shown that biological SAM's, in addition to lowering surface tension, can lubricate a membrane as a boundary or adherent-type lubricant (4) and can confer water repellency to the surface (5,6).

The present preliminary study was undertaken to determine whether the effluent dialysate of patients undergoing CAPD contained a similar surfaceactive material -a finding that would imply its presence on the peritoneal membrane. Secondly, if the dialysate contained SAM, whether that presence might be correlated with successful or complicated CAPD.
Long Term Continuous Ambulatory Peritoneal Dialysis
Authors: Gilmour Janet , Wu George , Khanna Ramesh , Schilling Holger , Mitwalli Ahmed , Oreopoulos Dimitrios G.
Published: February 2020

After five years on CAPD, 10 patients continued to enjoy a good sense of well being and a reasonable quality of life. More women than men survive on CAPD.

After 60 months or more of CAPD, the peritoneal membrane continues to function efficiently, both with regards to dialysis of solutes and ultrafiltration of water.

Long-term CAPD patients are at risk of developing vitamin B12 deficiency and should receive regular supplements of this vitamin before clinical manifestations develop. Dally administration of I mg of folic acid gives adequate replacement of such losses during peritoneal dialysis.

In spite of vitamin D supplementation and phosphate binders, osteitis fibrosa persisted in these patients and they suffered a gradual loss of bone mineral mass. More frequent use of calcium carbonate as phosphate binder and calcium supplement may minimize this complication.

Hypertension is well controlled after initiation of CAPD, but recurs after four to five years of this treatment.

We conclude that long term CAPD is feasible and that, with reduction in drop-out rates, more patients will remain on this treatment for long periods.
pH Equilibration with Acetate and Lactate Solutions during Peritoneal Dialysis
Authors: Cullom Edward T. , Moore Harold L. , Nolph Karl D. , Keller Rebecca S.
Published: February 2020

Commercial dialysis solutions contain acetate or lactate and have pH values usually below 6.5. Losses of ultrafiltration in CAPD have been more frequent with acetate than with lactate solutions. It has been suggested that a slower increase of pH following intraperitoneal instillation of acetate solutions may produce alterations in membrane function. We compared intraperitoneal equilibration of pH in rats with acetate and lactate solutions. In our rat model pH equilibration rates were similar for acetate and lactate solutions.

Commercial peritoneal dialysis solutions contain glucose as an osmotic agent and acetate or lactate as a buffer (1,2). The pH is adjusted to below 6.0 to prevent glucose caramelization during heat sterilization (3). Acetate and lactate are absorbed during peritoneal dialysis and, when metabolized generate bicarbonate (2). Bicarbonate itself is not used in commercial solutions because these solutions also contain calcium and calcium bicarbonate is unstable in solution on storage.

Many workers (4–8) have observed that patients on continuous ambulatory peritoneal dialysis (CAPD) with solutions containing acetate suffer losses of ultrafiltration over time. Also encapsulating sclerosing peritonitis is seen more often in association with acetate solutions (9–11). Pedersen et al (12) fear that prolonged exposure to a low pH may irritate the peritoneal membrane and that, during peritoneal dialysis cycles with acetate as the buffer, the pH in the intraperitoneal solution increases more slowly. These studies were undertaken to determine whether, during peritoneal dialysis exchanges, acetate and lactate solutions had the same rate of change of pH.
Reduplicated Basal Lamina of Small Venules and Mesothelium of Human Parietal Peritoneum: Ultrastructural Changes of Reduplicated Peritoneal Basement Membrane
Authors: Gotloib Lazaro , Bar-Sella Pnina , Shostak Abshalom
Published: February 2020

We examined under the electron microscope samples of parietal peritoneum obtained from nine nondiabetic chronic uremics -six of them on maintenance intermittent peritoneal dialysis, ranging in age from 52 to 82 years -mean 64.4 ± 8.1 years and of nine non-uremic, non-diabetic patients -mean age 40.7 ± 12.2 years. Postcapillary venules and small venules showed areas with several layers of reduplicated basal lamina. Some microvessels showed gaps in basallamina with and/or without focal reduplication. Reduplicated submesothelial basal lamina was found in only one patient. These changes were not observed in the nine non-uremic, non-diabetic controls. To the best of our knowledge, this is the first description in humans of such alterations in the aforementioned locations, which may well be secondary to aging and/or to the intense mesothelial renewal observed in I.P.D. patients. We need to determine the possible influence of these ultrastructural changes on transperitoneal transfer of water and solutes during peritoneal dialysis.

The basal lamina of blood vessels may not be of uniform thickness. Human non-diabetic adults show significant increase in capillary basal lamina thickness as one moves from head to foot (1). Those regional variations may be related to differences in venous hydrostatic pressure effective on the capillary bed (1).

This paper decribes the first observations of reduplicated basal lamina of microvessels in the parietal peritoneum and of that subjacent to mesothelial cells in elderly, non-diabetic uremic patients.
AL Ternate Use of Amino Acid and Glucose Solutions in CAPD
Authors: Pedersen Fritz Bangsgaard , Dragsholt Claus , Laier Erik , Jurgen Jens , Aage Frifelt , Trostmann Franklin , Ekelund Suzanne , Paaby Per
Published: February 2020

For three months we alternately used CAPD solutions based on amino acids or glucose in six patients. At the start, amino acid concentrations in plasma (P) were normal, except that for leucine which was low and citrulline was high. During the study, P-valine, -isoleucine, -leucine, and -serine increased while the concentration of methionine decreased. The increase in the plasma concentration of the three branched-chain amino acids might increase protein synthesis; leucine particularly assists protein synthesis in muscle. However the technical and analytical methods used in this investigation do not permit us to draw such conclusions. Serum concentrations of cholesterol, HDL, LDL, glucose and glycosylated hemoglobin remained unchanged, as did concentrations of albumin, transferrin, and phosphate. The nitrogen load from amino acids did not increase the plasma ammonium concentration, while serum urea increased slightly. Serum triglycerides continued to increase in spite of the amino acid supplementation. Thus the amino acid solution, which was well tolerated, seemed to induce some beneficial alterations in the plasma amino acid concentrations in the uremic patient. The consequence of these changes remains to be evaluated.
The Need for a “Swan Neck” Permanentl Y Bent, Arcuate Peritoneal Dialysis Catheter
Authors: Twardowski Zbylut J. , Nolph Karl D. , Khanna Ramesh , Prowant Barbara F. , Ryan Leonor P. , Nichols W. Kirt
Published: February 2020

In 1968 to ensure optimal function of a permanent catheter during periodic peritoneal dialysis, Tenckhoff recommended that a double-cuff catheter be inserted so that a slightly arcuate subcutaneous course would give the external and intraperitoneal segment a caudal direction. During the rapid growth of CAPD over the past five years, nephrologists generally have adapted the Tenckhoff's methods of catheter insertion but have encountered numerous complications.

This paper describes a retrospective analysis of the complications associated with 83 peritoneal dialysis catheters functioned for 48,325 catheter days (132 catheter years) in 63 patients on continuous ambulatory peritoneal dialysis (CAPD) at our institution.

Pericatheter leaks were seen only with midline insertions. Exit-site infections were significantly more resistant to treatment with singlecuff than with double-cuff catheters as assessed by the proportion of time that the exit-site is infected. If the subcutaneous tunnels were directed downward the infections were more responsive to treatment. Significantly more frequent catheter-tip migrations were observed with subcutaneous tunnel directed left and downward.

Thus, our study supports Tenckhoff's observation that we can expect the lowest complication rate with double-cuff catheters with an arcuate tunnel, convex upwards. However, frequently this shape of tunnel is associated with external-cuff extrusions due to resilience of the straight catheter.

To reconcile these conflicting requirements we recommend a new catheter permanently bent between the cuffs to eliminate one of the forces responsible for cuff extrusion. Such a catheter, named the swan-neck tunnel peritoneal dialysis catheter, should be inserted surgically through the belly of the rectus muscle.
Renal Transplantation in Children Undergoing Peritoneal Dialysis
Authors: Hymes Leonard C. , Warshaw Barry L.
Published: February 2020

Between January 1980 and January 1986, 25 children undergoing peritoneal dialysis (CAPD or CCPD) received 29 renal allografts. Patient survival was 100% and graft survival at 12 and at 24 months was similar to that of transplant recipients who received hemodialysis or no dialysis before operation. In 28 of 29 cases, Tenckhoff catheters were left in situ. Eighteen children were treated for acute rejection while retaining their catheters. Fourteen patients required post -transplant dialysis using the in situ catheter because of rejection or cyclosporine nephrotoxicity. No child developed peritonitis during post-transplant CAPD or while being treated for rejection. Peritonitis developed in one child who had a catheter in situ but who did not require dialysis. We conclude that peritoneal dialysis does not incur unacceptable risks to pediatric transplant recipients. During operation, the dialysis catheter may be left in situ and, if necessary, it may be used for CAPD in the post -transplant period.

Renal transplantation in peritoneal dialysis patients has not been extensively described in children. One report by Stefanidis et al (1) in children and others in the adult population (2–5) found acceptable results among such patients. However, several centers have reported an increased risk of complications after transplantation. including a high incidence of infection (6–8) and inferior allograft survival when compared to hemodialysis patients (9).

The issue is important in children because both continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have become the major forms of renal replacement in many pediatric programs (10–16) including our own. Moreover, since it has been reported that peritonitis is seen with increased frequency among children on peritoneal dialysis (17), we might expect immunosuppression in this group to result in an increased number of infections. This paper describes our experience with children, who received a renal allograft, after undergoing peritoneal dialysis.
A Formula for Correcting Plasma Zinc Levels against Protein Concentration
Authors: Rudolf Kostas Sombolos , Dombros Vogl Nickolas , Oreopoulos Dimitrios , Rapoport Abraham
Published: February 2020

Plasma zinc and total protein concentrations were measured in 13 normal volunteers, before and after a five-minute occlusion of the antecubital vein with a sphygmomanometer cuff. The percentage increment before and after five minutes of venous occlusion was 10.2 ± 4.7% for total protein and 8.8 ± 6.0% for zinc concentration. Both these differences were statistically significant (p < 0.001). We propose an equation for correction of plasma zinc levels according to concentration of total proteins. Using this equation the corrected values of plasma zinc before and after 5 minutes of venous occlusion were similar, that is, 12.33 ± 1.94 and 12.20 ± 2.05 μmol/l. In addition we found that of seven hypoproteinemic patients on continuous ambulatory peritoneal dialysis (CAPD) who had low plasma zinc levels compared to normal (uncorrected for protein concentration) controls, only two had “true” hypozincemia when their plasma zinc was corrected against protein using this formula and compared to normals (corrected for protein) controls. The paper discusses the clinical usefulness of this adjustment of measurements of plasma zinc concentration.
Studies on Ultrafiltration in Peritoneal Dialysis: Influence of Plasma Proteins and Capillary Blood Flow
Authors: Ronco Claudio , Brendolan Alessandra , Stefano Luisa Bragantini , Mariano Chiaramonte , Fabris Feriani Aldo , La Greca Giuseppe
Published: February 2020

This study has evaluated the influence of peritoneal blood flow and plasma protein concentration on the peritoneal ultrafiltration rate. In vitro and in vivo experiments were done to assess the effective peritoneal capillary blood flow.

Based on the assumption that one can compare the behavior of an hollow fiber hemofilter with the peritoneal dialysis system, we have compared the opera tional characteristics of the two systems. After demonstrating that there was filtration pressure equilibrium in the filter, the plasma protein concentration was measured in the venous site of the filter at different applied transmembrane pressures. The nomogram, so obtained, was used to calculate the plasma-protein concentration in the blood leaving the peritoneal capillary during exchanges with an established glucose concentration (and therefore at a given transmembrane pressure), and to calculate the filtration fraction.

Once that fraction had been calculated, based on the value of the ultrafiltration rate, one can calculate the importance of the plasma flow and then the blood flow. In this study the filtration fraction ranged between 45 and 55% and the blood flow ranged between 21 and 27 ml/min. It was concluded that the blood flow may be very low and hence may limit ultrafiltration.
Potential Hazards of Glycerol Dialysate in Diabetic CAPD Patients
Authors: Matthys Erve , Dolkart Ralph , Lameire Norbert
Published: February 2020

The use of glycerol-containing CAPD solutions caused some specific problems, related to the potential accumulation of the glycerol in the blood. The mean peak free glycerol levels during the exchanges with the 1.4% glycerol solution were 0.628 ± 0.079 mmol/l. With the use of the 2.5% glycerol solution, the mean peak levels increased up to 11.650 ± 2.380 mmol/1 with peak values up to 49.670 mmol/l. Sometimes, these high glycerol levels may induce a hyperosmolar syndrome, as in one of our patients. Also they cause an elevation of the blood triglyceride levels, which must be corrected for the free glycerol levels. Before we can recommend the general use of glycerol-containing CAPD solutions in diabetic patients further studies are necessary to better understand the metabolism of glycerol in uremic and diabetic patients.
Survival of Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis for over Five Years
Authors: Zimmerman Stephen W. , Johnson Curtis A. , O'Brien Mark
Published: February 2020

Of 26 diabetic patients starting CAPD before July 1, 1981, six had survived over five years on this mode of dialysis. Considering as “withdrawn alive” those who received transplants or switched to hemodialysis, the one and five-year survival was 70% and 44% respectively. The six type I diabetics who survived over five years were young (mean age 31.8 ± 2 years at onset of CAPD), initially free of cardiac disease and predominantly non-smokers. On CAPD they had relatively low hospitalization rates, including admissions for peritonitis, and a peritonitis rate of one episode every 13.6 patient months. Blood pressure improved but most required therapy at five years. Vision was maintained, but four of six had bone fractures. Serum cholesterol increased with time; one patient had a silent myocardial infarct and two developed angina. As assessed by HgA1c, blood glucose control improved over predialysis values. Four of these six maintained their physical activities and two deteriorated. These results demonstrate that diabetic patients can survive for a long period on CAPD. We suggest that attention be focused on cardiac risk factors and that diabetic patients be encouraged to abstain from smoking.
Prevention and Treatment of Catheter-Related Infections in Children
Authors: Warady Bradley A. , Jackson Mary Anne , Millspaugh Joan , Miller Rose Marie , Ford Douglas M. , Hellerstein Stanley , Lum Gary M.
Published: February 2020

There is no standardized approach to exit site care and the treatment of catheter-related infections. In this study 32 children (age range 1 month -15 years) receiving chronic peritoneal dialysis received an exit-site care regimen using either soap or Povidone-iodine as the primary antiseptic. Therapy of exit-site and tunnel infections consisted of either intravenous Vancomycin (15 mg/kg initially, then 8.5 mg/kg every four days for three doses) or a combination of oral Dicloxacillin (50 mg/kg/day) and oral Rifampin (20 mg/kg/day) for 14 days. In all, there were 48 catheter related infections in 270 patienttreatment months (one case per 5.6 patient treatment months). There was no significant difference in the frequency of infection between the two antiseptic groups. Antibiotics eradicated the infection in all but one patient and in none of these patients did peritonitis complicate an exitsite/tunnel infection.
CAPD Related Peritonitis Management and Antibiotic Therapy Recommendations Travenol Peritonitis Management Advisory Committee
Authors: Keane William F. , Everett E. Dale. , Fine Richard N. , Golper Thomas A. , Vass Stephen I. , Peterson Phillip K.
Published: February 2020

In conclusion, the recommendations provided in this document represent a distillation of various experiences. as well as data obtained from published studies. It is hoped that this compilation will provide a basis upon which future developments and advances in the therapeutic approach to CAPD patients with peritonitis can be made. Paramount among these will be the development of more efficient and rapid diagnostic techniques, as well as new and superior peritonitis regimens utilizing precisely derived dosing recommendations that minimize toxicity and yet provide a high degree of efficacy. In addition, new insights into the clinical approach related to catheter management should be developed, particularly as they pertain to exit and tunnel infections, as well as the optimal interval before catheter reinsertion can be safely performed.
Management of Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis: An Australian Perspective
Authors: Napier Neil W. Royce , Thomson M. , Atkins Robert C.
Published: February 2020

In the decade following the introduction of CAPD by Popovich et al (I) substantial improvements have been made in the management of CAPD peritonitis. This review summarizes the significant advances in the prevention, diagnosis and treatment of CAPD peritonitis in the first 10 years of CAPD therapy (1976–1986) and highlights additional areas where management protocols can be improved further.
Continuous Mesothelial Injury and Regeneration during long Term Peritoneal Dialysis
Authors: Gotloib Lazaro , Shostack Abshalom , Bar-Sella Phina , Cohen Ricardo
Published: February 2020

This study reconstructs the whole sequence of mesothelial injury and regeneration in patients on longterm peritoneal dialysis. Our observations indicate that peritoneal dialysis induces a process of continuous mesothelial injury and regeneration. New mesothelial cells seem to originate from wandering mesothelial cells of the peritoneal fluid, as well as from mesothelial cell precursors localized in the sub-mesothelial connective tissue.
Biofilm on Tenckhoff Catheters: A Negligible Source of Contamination
Authors: Anne-Marie Christian Verger , Thibault Chesneau Michel , Bataille Nelly
Published: February 2020

The authors studied the presence and characterization of biofilm in the lumen of Tenckhoff chronic peritoneal dialysis catheters of 17 CAPD patients to elucidate the role of biofilm as a source of peritonitis.

At the time of investigation, all 17 patients were peritonitis-free. All used a single-use, Y -system without disinfectant. Previously eight had used the conventional system. Seven had experienced II episodes of peritonitis with their present catheter (4 episodes while on conventional systems). Ten patients had no history of peritonitis. Four samples from each catheter were obtained with aseptic technique: swabs from inside the titanium adaptor, a 5 cm proximal segment removed and sectioned longitudinally to obtain luminal scrapings, a nylon brush sample from the entire length of the catheter, and from fluid run through the catheter after introducing the brush. All samples were treated by different microbiological techniques and incubated under various conditions. In vitro control experiments were performed to recover biofilm with the brush technique. Whereas all controls were positive, 100% of the samples demonstrated no bacterial growth after two -weeks’ incubation. Five patients’ catheters (four with previous peritonitis) examined under light microscopy contained amorphous material without viable bacteria as evidenced by both growth experiments and mi croscopy. Ten catheters were examined on scanning electron microscopy: the inner surface of all were covered with a protein-Iike membra nous deposit. Occasional bacteria and various number of macrophages were observed on three catheters. On two other catheters, biofilm looked like bacterial microcolonies but this was not confirmed by gram-staining and cultures. Results suggest that biofilm is not ubiquitous in catheters of CAPD patients and that the catheter does not appear to be a bacterial reservoir that would provoke peritonitis. Biofilm might be secondary to frequent peritonitis and/or frequent asymptomatic intra-luminal catheter contaminations. The low peritonitis rate of the studied patients and the use of Y -line systems could explain the absence of a typical biofilm. Results also suggest there may be two types of biofilm -one made up of adherent bacteria and glycocalyx, and one made up of non-contaminated protein -like deposits. The presence of each type would depend of the efficacy of connectors in avoiding touch contaminations.
Migration of Peritoneal Catheters: Personal Experience and a Survey of 72 Other Units
Authors: Schleifer Charles R. , Ziemek Henrietta , Teehan Brendan P. , Miles Robert L. Benz , Sigler H. , Gilgore Gary S.
Published: February 2020

From 1979 to 1986, nine of 177 Tenckhoff catheters (5.0%) placed for CAPD migrated on a total of II occasions. Straight Tenckhoffs accounted for 64% of these and coiled Tenckhoffs for 36%. Three catheters were repositioned using a Lunderquist guide wire with fluoroscopic guidance. One catheter was removed because of breakage of the guide wire and recurrent peritonitis. On four occasions operative intervention was required to reposition or replace the catheter. Three catheters flipped back into the pelvis and functioned normally. Correspondence with 244 CAPD units resulted in 72 responses (30%). Nineteen units (27%) reported greater than 5 Ofti incidence of migrations. Surgical intervention was required for 125 of 141 migrated catheters (88 Ofti). Five units switched from straight Tenckhoffs to other types of peritoneal catheters because of the problem of migration. Only one center reported successful nonoperative repositioning of a catheter.
Continuous Ambulatory Peritoneal Dialysis Complicated by Fournier's Syndrome
Authors: Walshe J. Joseph , Reddy Padma V.
Published: February 2020

Two patients developed Fournier's syndrome while on continuous ambulatory peritoneal dialysis. In both cases, massive scrotal edema appears to have been the precipitating cause of the polymicrobial genital infection. Early recognition and prompt treatment of this syndrome is essential if one is to avoid the high morbidity and mortality associated with this disease.

Fournier's syndrome, first described in 1883, is a fulminant necrotising subcutaneous infection of the male external genitalia (I). Although initially thought to be idiopathic, recent evidence suggests that an underlying condition can usually be identified as the precipitating cause of this rare but serious infection (2, 3).

Herein, we describe two patients who developed massive scrotal edema while on continuous ambulatory peritoneal dialysis (CAPO). Subsequently, both patients suffered polymicrobial infections of the scrotum with necrosis. We discuss the possible role of CAPO and scrotal edema in leading to the development of Fournier's syndrome.
Chylous Peritonitis: An Infrequent Complication of Peritoneal Dialysis
Authors: Roodhooft Anne Marie , Van Acker Karel J. , De Broe Marc E.
Published: February 2020

A 13-year-old girl, who had been on chronic peritoneal dialysis for 31/2 years, developed chylous peritonitis after a minor abdominal trauma. Conservative treatment with a lowfat, high-caloric diet supplemented with medium-chain triglycerides, was without success. When peritoneal dialysis was replaced by hemodialysis, the chylous peritonitis gradually resolved as judged from the echographic findings.

When chylous peritonitis occurs in the course of chronic peritoneal dialysis and persists after a trial with a dietary regimen, peritoneal dialysis should be temporarily replaced by hemodialysis. A conservative dietary treatment combined with parenteral hyperalimentation may be given at the same time. It is not yet clear whether surgical intervention can thus be avoided in all cases.
Gastrostomy Tube Feeding in Children on CAPD
Authors: Williamson Leo Levin J. , Geary Balfe Denis , Geary Balfe Denis , Wesson David , Steele Brian
Published: February 2020

Inadequate dietary intake contributes to the growth failure seen in children on CAPD. From 1982 to 1986, seven children received supplemental feeding via gastrostomy tube. No increased frequency of peritonitis was noted in six of these. Generally the gastrostomy tubes were well tolerated. Gastrostomy tube feeding is a safe, practical way to provide supplemental nutrition to pediatric patients on CAPD.
The Influence of Dialysate Exchange on Cardiac Output in CAPD Patients
Authors: Vandenbogaerde Johan , Matthys Erve , Everaert Jan , Colardyn Francis , Lameire Norbert
Published: February 2020

The influence of a peritoneal dialysate exchange on cardiac output (CO) in the setting of continuous ambulatory peritoneal dialysis (CAPD), was studied in 12 patients before, during and between two consecutive exchanges. The two exchanges only differed in that, during the second exchange, the patients were more dehydrated because fluid intake was forbidden during the study -mean sum of volume loss between the two exchanges: 319 ± 86 ml/min. During the first exchange, neither removal and instillation of dialysate resulted in significant hemodynamic alterations. During the second exchange, the removal of dialysate resulted in an increase of CO (from 5.7 ± 0.4 l/min to 6.2 ± 0.5 l/min, p < 0.05) and the instillation of fresh dialysate in a decrease of CO (from 6.2 ± 0.5 l/min to 5.8 ± 0.5 l/min, p < 0.05). It is concluded that, in the setting of CAPD, a dialysate exchange does not result in significant hemodynamic alterations, unless the patient's fluid intake has been restricted. Furthermore, the hemodynamic alterations were not more pronounced in those patients with low body weight, despite the use of the same dialysate volume.
Peritoneal Absorption of Vancomycin during and after Resolution of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients
Authors: Bastani B. , Spyker D. A. , Westervelt F. B.
Published: February 2020

We studied the absorption of i.p. loading dose of vancomycin (30 mg/kg of body weight) in five continuous ambulatory peritoneal dialysis (CAPD) patients, both at the time of peritonitis and after its resolution. Mean vancomycin absorption after 6 h of i.p. dwell was 74% from inflamed and 51% from noninflamed peritoneum. Mean peritoneal absorption half-life of vancomycin was 3.2 and 7.2 h in the inflamed vs. non inflamed peritoneum, respectively.
The Stability and Compatibility of Clindamycin Phosphate and Gentamicin Sulfate Alone and in Combination in Peritoneal Dialysis Solution
Authors: Kehoe William A. , Weber Joel N. , Fries David S.
Published: February 2020

The stability and compatibility of clindamycin phosphate and gentamicin sulfate alone and in combination in peritoneal dialysis solution was studied. Peritoneal dialysis solutions (Dianeal PD-2, Travenol) were prepared in triplicate containing either clindamycin 200 mcg/mL, gentamicin 10 mcg/mL, or a combination of the two. Drug concentrations were determined at intervals over a 96-h period. At each time, solutions were observed for visual incompatibility.

No significant changes in drug concentrations or visual characteristics were noted at the times and temperatures tested. We conclude that clindamycin phosphate and gentamicin sulfate are stable and compatible alone and in combination in the peritoneal dialysis solution tested.