bluuebunny/crossref_metadata_2025 huggingface dataset:
Individualization of Exchange Volume
Authors: Twardowski Zbylut J. , Burrows LaVonne M. , Prowant Barbara F.
Published: February 2020

This paper deals with adjustment of instillation volumes to achieve the best efficiency of dialysis in individual patients. Larger volumes may permit fewer daily exchanges which in turn decreases the number of connections and the risk of peritonitis. Factors associated with poor tolerance to increased volumes are discussed. Taller and heavier patients tolerate high volume dialysis better.

It is generally accepted that most patients treated with continuous ambulatory peritoneal dialysis (CAPD) require an integrated (renal and dialysis) small molecule clearance of at least ten liters/day (7 ml/min). If dialysate concentration of small molecules equals that of plasma, a peritoneal dialysis clearance is tantamount to daily drainage volume. However, a wide variation in mass transfer has been observed among patients. Although this variation is more pronounced for large molecular weight solutes, the variation is also clinically significant for small molecules (1). In patients with small molecule dialysate concentration lower than that in plasma. the daily peritoneal clearance of ten liters can be achieved with dialysate flow rate exceeding this value and higher than ten liter drainage volumes per day may be required in some anuric patients.
Diagnosis, Prevention and Treatment of Peritonitis
Authors: Everett E. Dale
Published: February 2020

Recent reports related to the diagnosis, prevention and treatment of peritonitis in patients on chronic peritoneal dialysis are reviewed. The reports deal with modifications of earlier drug therapies, the use of ultraviolet light, the use of the inline filter, and the biocompatibility of antibiotics in dialysis solutions.
ASCITES in the CAPO Patient Post Transplant
Authors: Dutton Sue
Published: February 2020

Our experience with CAPD patients and post-transplant ascites showed: 71 per cent of the transplanted patients required dialysis post transplant. The duration of dialysis ranged from less than one week to greater than two months. Ascites occurred in 33 per cent of the patients post transplant. Mean time of onset of the ascites was 2.8 weeks post transplant. The duration of the ascites, when ascertainable, ranged from one to three weeks. In the 8 patients who developed ascites, only one graft was lost to rejection at 3 months. There was no apparent relationship between time on CAPD and the presence of ascites. Ascites in the post-transplant CAPD patient appears to be a benign process, but the mechanism and causative factors are unclear and further investigations are warranted.

A recent article from Toronto (I) stated that ascites occurred post transplantation in children but that posttransplantation ascites in adults had not been reported. This prompted our analysis of the occurrence of ascites in CAPD patients who had received a transplant at the University of Missouri-Columbia Health Sciences Center.
Povidone Iodine Sterilization of Contaminated CAPD-Exchange Spikes
Authors: Golper Thomas A. , Sewell David L. , West Linda , Trinklein Marge
Published: February 2020

Thirty routine CAPD exchange spikes (Travenol) were dipped in a Staphylococcus aureus suspension and then divided into three equal groups. Group I (G1) spikes were advanced from the bacterial suspension to a povidone-iodine solution for a five-minute soak; Group 2 (G2) spikes were advanced into a sterile, non-bacteriostatic, physiologic saline solution for a five-minute soak. Then G1 and G2 spikes were attached in the usual sterile fashion to dialysis bags pretreated with tryptic soy broth to enhance bacterial growth. Group 3 (G3) spikes were advanced immediately to pretreated dialysate bags. Cultures of the dialysis solution were obtained immediately after the spikes were connected to the dialysis bags, 48 hours later, and at weekly intervals for three weeks. All 10 of the G3 bags connected to spikes without soaking grew greater than 10 colony forming units/mi of S. aureus by 48 hours. All 10 of the saline soaked G2 bags also demonstrated growth at 48 hours. Only one of the 10 Gl povidone-iodine soaked spike bags grew detectable colonies of bacteria at 48 hours. We conclude that a five-minute povidone-iodine soaking of spikes contaminated with S. aureus usually will prevent bacterial growth but is not a perfect solution to the problems of spike contamination.

The frequent occurrence of peritonitis remains the limiting factor to the widespread acceptance of CAPD. Oreopoulos et al proposed that 36.5% of episodes of peritonitis are secondary to contaminations at the connection site during the a CAPD bag exchange (1). Although the exact frequency is unknown, we agree that the likelihood is high that contamination at the time of the exchange is a common mode of bacterial access to the peritoneal cavity.

When we established our CAPD programs we instructed our patients to change the tubing if the spike became contaminated. Patients only rarely notified us of this necessity, despite our suspicion that known contamination was occurring. Two of us asked the Bulletin's editors if one could manage spike contamination simply by soaking the spike in povidone-iodine (2). Vas recommended that the tubing be changed because simple soaking would not deal with contamination inside the lumen (3). We decided to study this issue further because we believed that patients would not comply with this recommendation.
The Effect of Cigarette Smoking and Previous Hypertension on the Survival of Patients Treated by Continuous Ambulatory Peritoneal Dialysis
Authors: Drew Peter J. T. , Cunningham Stephen John , Evans J. W. , Marsh Frank P. , Goodwin Frank J.
Published: February 2020

Life-table survival curves, computed for 107 patients undergoing CAPD at The London Hospital between July 1979 and March 1983, showed that patient survival at two years was 68% and overall treatment survival was 46%. However, when we excluded satisfactory outcomes of CAPD treatment, such as renal transplantation, as causes of treatment failure, the technique survival at two years was 62.5%. Age, cigarette smoking, and a history of severe hypertension had statistically significant and independent effects on survival and most deaths were due to causes not directly related to CAPD.

Although the literature contains several reports on survival rates in patients on continuous ambulatory peritoneal dialysis (CAPD) (I, 2), we know little about the factors which influence the success of this treatment. We therefore performed an actuarial analysis of patient and treatment survival in 107 patients who started CAPD at The London Hospital between July 1979 and March 1983 and examined the effects of age, sex, cigarette smoking and previous hypertension -factors known to affect survival in the general population.
Pharmacokinetics of Intravenous and Intraperitoneal Cefotaxime in Patients Undergoing CAPD
Authors: Matousovic Karel , Stefan Josef Moravek , Prat Vitko Vladimir , Horcickova Milena
Published: February 2020

We investigated the pharmacokinetics of non-metabolized cefotaxime in 10 patients undergoing CAPD. The elimination half-life after IV administration of I g cefotaxime was 3.1 ± 1.3 hr, i.e. two to three times longer than in individuals with normal renal function but similar to patients with severe renal insufficiency. An average of 2.18% of the dose was recovered in the effluent. The halflife of I g cefotaxime administered in the dialysis solutions was 1.4 ± 0.8 hr. This difference between the half-lives after intraperitoneal and intravenous administration indicates a faster transport through the peritoneal membrane. Intraperitoneally administered cefotaxime -250 mg four times daily, was effective in the treatment of peritonitis in three CAPD patients.

Since its introduction in 1976, CAPD has become an effective therapy for end-stage renal disease. The most serious complication is peritonitis and effective treatment is essential. Cefotaxime, a new broad-spectrurn cephalosporin, is active against most gramnegative and gram-positive organisms.

It possesses no nephrotoxicity and may be useful in the treatment of peritonitis and other infections in patients on CAPD. This study was done to evaluate the pharmacokinetics of cefotaxime administered intravenously and intraperitoneally during CAPD.
Longitudinal Study of Nerve Conduction Velocities during Continuous Ambulatory Peritoneal Dialysis
Authors: Sunderrajan Sobha , Nolph Karl D.
Published: February 2020

Nerve conduction velocities were measured repeatedly in 20 patients on continuous ambulatory peritoneal dialysis for one or more years. Nerve conduction velocities remained stable in most cases.

Peripheral neuropathy is a severe, disabling complication of uremia, and it has been reported that patients on chronic intermittent dialysis develop severe neuropathy (1). Few reports have been published concerning the course of neuropathy in patients on continuous ambulatory dialysis. This paper describes the retrospective analysis of motor nerve conduction velocities (MNCV's) in 20 patients from the University of Missouri Hospital and Clinics. who have been maintained on continuous ambulatory peritoneal dialysis (CAPD) for one or more years.
Monolayer Mesothelium from the Ileal Rabbit'S Mesentery: An Experimental Model for Study of Peritoneal Kinetics IN VITRO
Authors: Breborowicz Andrzej , Janecki Andrzej , Breborowicz Grzegorz , Knapowski Jan
Published: February 2020

This paper describes an experimental model of the monolayer mesothelium from the ileal rabbit's mesentery. As proved by the electron micro. scopic examination, this membrane consists of the mesothelium lying on the undamaged basement membrane. To minimize the damage to the membrane's edge, we used a new type of chamber. Over a period of 90 minutes transport rate of the various solutes across the mesothelium in vitro was constant, which proves indirectly the viability of this epithelium during this time. This experimental model seems to be suitable for the in vitro study of the mechanisms which regulate the permeability of the peritoneal mesothelium.

Permeability of the peritoneal mesothelium to various solutes and water has been evaluated during in vitra studies of isolated peritoneal membranes of the mesentery or on the parietal peritoneum (1,2,3). The experimental conditions avoid or significantly diminish the interference of other barriers, like endothelium or connective tissue, which play an important role in viva.

Mesentery consists of two mesotheliallayers, lying symmetrically and, as a result, the permeability so measured doesn't reflect precisely the permeability of the mesothelium. On the other hand models of the parietal peritoneum include a thick layer of muscle and connective tissue which can be a source of some artifacts.

To avoid these disadvantages we developed an experimental model of the monolayer mesothelium obtained from the ileal mesentery of the rabbit. We believe this model is useful for the investigation of the function of this epithelium during the peritoneal dialysis. This paper describes this in vitra model which we have devised for the study of the peritoneal mesothelium.
Sclerosing Peritonitis -The Contribution of Chlorhexidine in Alcohol
Authors: Junor Brian J. R. , Briggs J. Douglas , Forwell Margaret A. , Dobbie James W. , Henderson Iain
Published: February 2020

Sclerosing peritonitis now is recognized as an extremely serious complication of peritoneal dialysis. In Glasgow II of 162 patients on CAPD developed sclerosing peritonitis. All 11 came from a group of 54 patients, who used a connecting system that allowed small quantities of the antiseptic spray, chlorhexidine in alcohol, to enter the abdomen. Experiments showed that I ml of this solution added to 2 litres of dialysate produced up to a 20. fold increase in the particle count of the dialysate. Scanning electron microscopy suggested that these particles probably were plastic. In rats intraperitoneal injections of a mixture of antiseptic spray and dialysate produced an inflammatory reaction in the submesothelial tissues, which might represent the early changes of a fibrotic process. To prevent possible longterm complications such as sclerosing peritonitis we should avoid the introduction into the peritoneal cavity of any unnecessary substance and in particular chlorhexidine in alcohol.
Intracellular Calcium Ions Modulate Permeability of the Peritoneal Mesothelium In Vitro
Authors: Breborowicz Andrzej , Knapowski Jan , Breborowicz Grzegorz
Published: February 2020

The authors studied the in vitro effect of a calcium-channel-blocker -verapamil, local anesthetic -bupivacaine and a calcium ionophore -A23187 on the permeability of the monolayer mesothelium from the rabbit's mesentery. Verapamil and bupivacaine increased transmesothelial flux of calcium while A23187 increased calcium transport only transiently. Verapamil augmented the permeability of the mesothelium to inulin and urea. However A23187 decreased the transmesothelial flux of inulin only whereas it increased the transport of urea. From this study we have concluded, that intracellular calcium may determine the permeability of the peritoneal mesothelium.

Various important biological processes like muscle contraction, secretion of transmitters and hormones, and control of epithelial permability seem to be dependent on intracellular calcium-ion activity (1–4). Our previous paper suggested that a local anesthetic, bupivacaine, produces its effect on the peritoneal mesothelium through interaction with the cytoskeleton of the epithelial cells, and with the mem brane's calcium transport (5). In addition Palant et al found that the permeability of another leaky epithelium, that from the Necturus gallbladder, depends on the extracellular calcium concentrations and may be altered by drugs, which interfere with the entrance of these ions into the epithelial cells (6). Therefore, we decided to study the role that calcium ions may play in the transport of solutes across the peritoneal mesothelium in vitro.
Six-Year Experience with CAPD Catheters in Children
Authors: Watson Alan R. , Vigneux Annette , Hardy Brian E. , Balfe J. Williamson
Published: February 2020

Over a six-year period, 78 chronic peritoneal catheters were implanted in 55 patients; mean age at insertion was 9.6 years (range 0.2 to 19.1 years) and mean body weight was 28.3 kg (range 4.5 to 63 kg). Singlecuff catheters were used almost exclusively and were inserted in the midline under general anesthetic. Complications included leakage (26%) and one-way catheter obstruction (17%). Exit site and/or tunnel infections developed in 25% and hernias in 20% of 55 patients. Twenty-six catheters required replacement or removal. Actuarial catheter survival was 50% at two years. A retrospective analysis of exit-site infections suggested a significant benefit with “covered” as opposed to “uncovered” catheters (p < 0.01). Despite difficulties with catheter function only one patient was taken off CAPD because of a leak into the pleural cavity. Recent experience suggests that paramedian catheter placement and the use of catheters of an appropriate length for children will reduce the incidence of leakage and one-way obstruction.

The complications associated with implantation and the long-term use of chronic peritoneal catheters have produced several modifications of the original Tenckhoff catheter (1–4). However, it remains to be established whether single or double cuff catheters result in fewer exit site, tunnel, or peritoneal complications (5). When our program started in 1978, we used double-cuff catheters but subsequently have implanted single-cuff catheters almost exclusively. Our initial experience with exit-site and tunnel infections was encouraging: only one out of 37 catheters had to be replaced because of tunnel infection (6). This paper describes our additional experience and the complications encountered with increasing duration of catheter use in our pediatric population.
Reactivation of Systemic Lupus in three Patients Undergoing CAPD
Authors: Wu George G. , Gelbart D.R. , Hasbargen James A. , Inman Robert , McNamee Peter , Oreopoulos Dimitrios G.
Published: February 2020

Generally patients with end-stage renal disease (ESRD) due to lupus nephritis, have minimal extrarenal disease activity <Juring hemodialysis. This may be related to immunological changes secondary to chronic renal failure or the dialysis procedure itself, or both. This paper describes three patients with lupus nephritis undergoing continuous ambulatory peritoneal dialysis (CAPD) in whom we observed reactivation of SLE, by both clinical and serological criteria. This may suggest that in patients undergoing CAPD the immune system is more nearly intact than in hemodialysis. These cases should heighten awareness that patients may suffer flare-ups of SLE during CAPD even long after the onset of renal failure.
CAPD Fluid Examination using the Bactec 460
Authors: Dalton Maurice Terence , Prevost Eva
Published: February 2020

In the microbiological laboratory CAPD fluid analysis is an unstandardized and sometimes a labor intensive procedure. This pilot study was set up to demonstrate the value of in-place technology -the Bactec 460 blood culture system, in reducing the work-load. Our results indicate that it is at least as effective as other, more tedious conventional methods.

Since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has proved to be a major advance in the management of end-stage renal disease (I). Despite refinements in technique over the years leading to more widespread use of CAPD, the major hazard remains peritonitis and other infections (2). Also peritonitis is a major cause of failure of CAPD (3,4).

Because CAPD allows more freedom of movement, several laboratories receive the postdialysis effluents from the same patient; furthermore there is no widely recognized, single method for the examination of these fluids (2, 5). Some centers recommend daily sampling for microbiological studies and while this is ideal for patient management, it imposes a significant workload on the microbiology laboratory, particularly in a larger centre (2). Currently it appears that the number of patients on CAPD will continue to increase for the foreseeable future and so will the numbers of specimens to be examined.

To facilitate these examinations, we carried out a five-month pilot study using the Bactec 460 blood-culture system to examine CAPD fluids. We compared these results with a conventional method used previously in our laboratory.
Lipid Metabolism in 31 Chinese Patients on three 2–L Exchanges of CAPD
Authors: Chan Man Kam , Yeung Choi Kit
Published: February 2020

The authors measured nine biochemical parameters -urea, creatinine, albumin, total cholesterol, total triglycerides, HDL- cholesterol, C3, C4 and post-heparin hepatic and lipoprotein lipase activities in 31 Chinese patients, who were carrying out three 2–L CAPD exchanges per day. Uremic plasma from 19 patients also was tested for the presence of hepatic and lipoprotein lipase inhibitors. Anthropometry included a record of height, weight and skin-fold thicknesses. The CAPD patients had mild hypertriglyceridemia -144 ± 60 vs 106 ± 55 in males, p = 0.05 and 176 ± 92 vs 100 ± 45 in females, p < 0.005. Their mean total cholesterol concentration did not differ from that of controls. Mean HDL-cholesterol concentration in CAPD patients was significantly reduced 28 ± 10 vs 42 ± 10 in males and 30 ± 15 vs 42 ± 13 in females. Both hepatic lipase -9.54 ± 4.26 in males and 30 ± 15 vs 42 ± 13 in females, and lipoprotein lipase -1.96 ± 0.93 in males and 1.91 ± 1.09 in females were reduced in CAPD patients. The correlation between serum triglycerides (TG) and lipoprotein lipase activities in CAPD patients was weak, though significant, but there was none between lipoprotein lipase activities and HDL-cholesterol concentrations. The mean albumin concentration of CAPD patients was close to the lower limit of (though still within), the normal range. Serum albumin concentrations did not correlate with total cholesterol concentrations. The mean C3 was reduced below the normal range. C3 concentrations correlated with those of serum triglyceride and with adiposity indices. C4 did not change consistently. Plasma from CAPD patients inhibited lipoprotein lipase but did not interfere with hepatic lipase activities. Hepatic lipase activities correlated with C3, serum TG concentrations and adiposity index, probably reflecting improved nutritional status. Factors other than impaired triglyceride catabolism also are responsible for the lipid abnormalities in CAPD.

Abnormalities in lipid metabolism occur in chronic renal failure and persist in patients on hemodialysis (1). Defects in catabolism of triglyceride-rich lipoproteins have been demonstrated in vivo (2–7) and in vitro (8–13) and it appears that impaired triglyceride break down by peripheral tissues is the dominant cause of hypertriglyceridemia among hemodialysis patients (3, 5, 13). Lipid abnormalities also have been reported in CAPD patients (14–16). Although glucose absorption from the dialysis solutions may play a role, the pathogenetic mechanisms are not well defined. We have been treating our end-stage renal failure patients with CAPD but, unlike those in other centres, our patients carry out three 2– L exchanges daily. This paper describes an investigation of lipid metabolism in 31 patients.
Management of Fungal Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Vassilis Vargemezis Zoe L. , Papadopoulou Homer , Liamos Anna-Maria , Belechri Taisir Natscheh , Vergoulas George , Antoniadou Rodothea , Kilintzis Vassilis , Papadimitriou Menelaos
Published: February 2020

A group of 138 patients (pts) on CAPD for a total of 1889 patientmonths had 176 episodes of peritonitis. Eighteen (13%) had fungal peritonitis at one to 20 months after beginning CAPD. The responsible organisms were Candida albicans (nine pts), Candida parapsilosis (five), Candida torulopsis (three), and Trichosporum capitatum (one). These infections were treated by various combinations of antifungal agents using two different strategies: Removal of the Tenckhoff catheter and interruption of CAPD for 10 to 14 days in nine pts (Group A), and continuous peritoneal lavage for four to six days in the remainder -nine pts (Group B). Fourteen of the 18 were cured (seven of nine in each group). In group A, two patients died, one continues on CAPD while the other six (67%) were transferred to hemodialysis because they developed peritoneal adhesions with significant loss in peritoneal space. In group B, only two patients have been transferred to hemodialysis; the other seven continue on CAPD. In our experience, the preferred initial form of treatment is continuous peritoneal lavage in conjunction with antifungal therapy. Catheter removal should be reserved for those who fail to respond to this treatment.

Continuous ambulatory peritoneal dialysis (CAPD) is now accepted as a alternative treatment for end-stage renal disease. However, despite continuous progress in this field, peritonitis still remains a major complication and results in increased morbidity and cost. Although pathogenic fungi account for only 2 7% of peritonitis in patients on CAPD (1–3), the illness is severe and represents a major clinical challenge to these patients. In addition, the therapy of fungal peritonitis is still controversial, especially with regard to the need for removal of the catheter.

This paper presents a retrospective study and describes our experience during the past four years with the management of fungal peritonitis in 18 patients undergoing CAPD at our center.
Peritonitis Prevention in Continuous Ambulatory Peritoneal Dialysis: Long Term Efficacy of a Y-Connector and Disinfectant
Authors: Cantaluppi Alberto , Scalamogna Antonio , Castelnovo Claudia , Graziani Giorgio
Published: February 2020

We have already described (Lancet 1983, ii, 642) the results of a controlled study in two centres showing the efficacy of a Y-shaped connector, filled with sodium hypochlorite during the dwelling time, for the reduction of peritonitis: one episode every 33 patient-months in the treated group versus one episode every 11.3 patient-months in the control group using the standard method.

During the past 2.5 years we have continued to use the Y-connector. All new patients referred to our hospital for initiation of CAPD program were trained to use the Y-connector, while those patients already on the standard Y-connector continued on it.

From January 1983 to June 1985, among 18 non-diabetic patients using the standard bag-exchange method, there were 23 peritonitis episodes in 14 patients (78%) over a cumulative period of 257 months -one episode every 11.2 patient-months. In contrast, among the 92 patients using the Y-connector, there were 30 peritonitis episodes in 21 patients (22.8%) during 1354 months -one episode every 45.1 patient-months. When we exclude from this group the 10 diabetic patients adding insulin to the bags, the incidence of peritonitis fell to one episode every 92.2 patientmonths.

These results confirm that the Y-connector is extremely effective in reducing the rate of peritonitis in patients on CAPD.

The most widely accepted technique for prevention of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is that described by Oreopoulos et al (I). However, to reduce further the risk of dialysis-fluid
Peritoneal Transport Characteristics of Water, Low-Molecular Weight Solutes and Proteins during Long Term Continuous Ambulatory Peritoneal Dialysis
Authors: Krediet Raymond T. , Boeschoten Elisabeth W. , Zuyderhoudt Floris M.J. , Arisz Lambertus
Published: February 2020

Peritoneal transport of water, low-molecular-weight solutes and proteins was studied on 75 occasions in 38 CAPD patients. Maximal ultrafiltration capacity decreased with time on CAPD, while there was an increase in the number of hypertonic bags used and the peritoneal absorption of glucose. A relationship was found between maximal ultrafiltration capacity and glucose kinetics. The duration of CAPD was longer in the patients with poor ultrafiltration, while they had a faster transport of glucose and creatinine, but not of proteins. In the group as a whole, no obvious changes were found in the mass transfer area coefficients of urea, creatinine and glucose, nor in the clearances of albumin and IgG. In the five patients with severe ultrafiltration loss, we found evidence of either decreased or increased peritoneal solute transport. Contrasting findings in transport of small solutes and proteins may reflect increased effective peritoneal surface area combined with decreased peritoneal permeability.
Red-Cell Survival in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Erve Norbert Lameire , De Paepe Matthys Marc , Karel Emiel Sys , Schelstraete  , Ringoir Severin
Published: February 2020

An early rise in hematocrit due to an increase in red cell mass (RCM) and a decrease in plasma volume (PV) has been noted after six months of continuous ambulatory peritoneal dialysis (CAPD). The present study measured red-cell survival (RCS) together with RCM and PV at the beginning and after six months of CAPD in paired observations in 15 patients.

RCM increased from 890 ± 98 to 1089 ± 142 ml (p < 0.05) and plasma volume decreased from 3026 ± 295 to 2936 ± 178 ml. Mean red-cellsurvival half life at the start was 22.3 ± 1.06 days and rose to 25.2 ± 1.15 days after six months (p < 0.05). The same results were observed in four diabetic patients on a non-glucose, glycerol-containing dialysate.

This study demonstrates that, after six months of CAPD, not only do hematocrit and red cell mass improve but also the red-cell survival is prolonged. However, a correlation could not be demonstrated between the increase in red-cell mass and prolongation of red-cell survival.
The Pharmacokinetics of Bezafibrate in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Williams Anthony J. , Walls John
Published: February 2020

Patients on CAPD often have hyperlipidemia -a known risk factor for morbidity and mortality from cardiovascular disease. We have defined the pharmacokinetic properties of bezafibrate, a new hypolipidemic agent, in CAPD patients. Its serum half-life was prolonged approximately 10 times that of normal subjects, and less than 2% of an oral 200 mg dose appears in the dialysate after 48 hours. If indicated, an appropriate dose for the treatment of hyperlipidemia in the CAPD population would be 200 mg bezafibrate every third day.

Cardiovascular disease remains one of the main causes of morbidity and mortality among patients with end stage renal disease (I). Hyperlipidemia, a known risk factor in the normal population, may be involved in the progression of arterial disease in such patients (2). The hyperlipidemia associated with CAPD is related to the absorption of large quantities of glucose during dialysis (3), and attempts to treat the hyperlipidemia by low-dose intraperitoneal insulin (4) and dietary carbohydrate restriction (3), have met with only limited success. Bezafibrate, a new hypolipidemic agent, is effective in reducing elevated serum triglyceride and cholesterol levels in various hyperlipidemic conditions (5). However, because its pharmacokinetic properties are altered in patients with renal impairment (6), it is necessary to adjust the dose to compensate for the significant proportion of the drug that is excreted in the urine.

This study was done to define the pharmacokinetics of bezafibrate in patients receiving CAPD in order to establish a safe dosage.
Renal Function Recovery and Maintenance of Residual Diuresis in CAPD and Hemodialysis
Authors: Cancarini Giovanni C. , Brunori Giuliano , Silvia Corrado Camerini , Manili Brasa Luigi , Maiorca Rosario
Published: February 2020

During 1981–1984, at our center 6/75 patients on CAPD and 1/86 on HD demonstrated a recovery of renal function. This and the observation that diuresis was maintained on CAPD, led us to study urine output (UO) and creatinine clearance (CrCI) in 41 patients on CAPD (CAPDp) and 45 on HD (HDp) without the use of diuretics. CAPDp had a decline in diuresis from 1201 ± 379 mI/day to 731 ± 572 (p < 0.01). HDp diuresis decreased from 1233 ± 439 to 438 ± 568 (p < 0.01). Creatinine clearance: HDp 5.8 ± 1.6 ml/min before, 1.3 ± 1.5 after; CAPDp 6.4 ± 2.0 before, 3.9 ± 2.9 after. After one year, HDp showed a significant drop in diuresis; three years passed before CAPDp had significant drop. Patients with glomerulonephritis showed the same trend on HD and CAPD. CAPDp with interstitial nephropathy had a smaller mean annual decrease in UO and CrCI, compared to HDp. CAPDp with nephroangiosclerosis showed less decrease in diuresis compared to HDp. These data confirm that, com pared to HD, CAPD treatment maintains residual renal function even in patients not using diuretics, and suggest that CAPD is a treatment of choice for those considered likely to recover renal function.

Some workers have reported a slow decline in residual renal function and diuresis in patients on CAPD (1,2,3). Rottembourg (1), in particular, suggests that diuretics may have helped his patients to maintain diuresis.

In 161 dialyzed patients (75 on CAPD, 86 on HD) who started dialysis between 1981 and 1984, six CAPD patients recovered renal function but only one HD patient. This disparity led us to inquire whether when compared to HD, CAPO enables us to maintain satisfactory, long-term diuresis, without the use of diuretics.
Risk Factors for Hyperaluminemia in Continuous Ambulatory Peritoneal Dialysis
Authors: Mactier Robert A. , Nolph Karl D. , Khanna Ramesh , Twardowski Zbylut
Published: February 2020

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed.

It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.
Plasmid Profile and Slime Analysis of Coagulase-Negative Staphylococci from Capd Patients with Peritonitis
Authors: Horsman Gregory B. , Yuri Leslie MacMillan , RifKin Amatnieks Oretta , Vas Stephen I.
Published: February 2020

Little is known about the epidemiology of infections causing peritonitis in continuous ambulatory peritoneal dialysis (CAPD). The commonest cause, coagulase-negative staphylococci (C-NS), are normal skin flora. The main source is thought to be organisms from the patient's own skin or environment. Using plasmid profiles as an epidemiological marker, the authors identified cases in which surveillance skin cultures taken just before an episode of peritonitis were identical to those isolated from the effluent. On comparing the plasmid profiles from the effluent of patients who had multiple episodes over eight weeks, they identified two patterns. One group had different plasmid profiles between episodes of infection. The second group (the majority of the cases) had identical plasmid profiles between the initial episode and the second which occurred between 10 days and four weeks after stopping antibiotics. This suggests that, in most cases of recurrent infection studied, the second episode represented a reinfection or recurrence with the same organism (as the initial episode). Slime production did not discriminate those patients who would develop recurring peritonitis.
Peritoneal Dialysis in Fulminant Hepatic Failure
Authors: Mactier Robert A. , Dobbie James W. , Khanna Ramesh
Published: February 2020

None of the modes of temporary liver support seems to improve survival in fulminant hepatic failure complicated by “grade four” coma. The authors assessed the efficacy of rapid exchange peritoneal dialysis in five consecutive patients with fulminant hepatic failure and grade four coma. Four had concurrent acute renal failure and the prognosis for combined hepatic and renal failure is extremely poor irrespective of mode of therapy. Despite this poor prognosis, three of the five recovered completely, four regained consciousness during the initial peritoneal dialysis and the level of consciousness improved during six of 10 periods of peritoneal dialysis. Two of these patients died two weeks after beginning peritoneal dialysis; and in both autopsy showed massive hepatic necrosis and no evidence of hepatic regeneration. These preliminary results compare favorably with those of hemoperfusion in grade four coma. We conclude that rapid exchange peritoneal dialysis offers a number of theoretical advantages over hemo perfusion and merits further evaluation in the management of fulminant hepatic failure.
Endogenous Sympathetic Activity in CAPD Patients: Its Relationship to Peritoneal Diffusion Capacity
Authors: Selgas Rafael , Munoz Isabel M. , Conesa Jose , Madero Rosario , Gancedo Pilar G. , Carmona Ana R. , Martinez M.Eugenia , Huarte Emma , Fontan Miguel P. , Sicilia Luis S.
Published: February 2020

Endogenous agents, as catecholamines, may influence peritoneal mass transport by modifying peritoneal blood flow. Such endogenous mechanisms could explain certain functional peculiarities of the peritoneum in CAPD patients. In 27 randomly selected patients on CAPD we calculated peritoneal mass-transfer coefficient (MTC) for urea, creatinine, uric acid and parathormone (PTH) using mathematical modelling techniques. Also we measured simultaneously the renin-angiotensin and catecholamine levels in blood and dialysate.

The dialysate level of catecholamines and especially noradrenaline was significantly higher than the blood levels. Most of these patients had higher renin and aldosterone blood levels than the controls; we found no renin activity in the dialysate of any of these patients; (Plasma) aldosterone values correlated directly with renin activity. Multivariant analysis provided no evidence that the MTCs values were affected by two or more variables. Linear regression analysis of all variables studied showed direct correlation between dialysate noradrenaline and MTCs, and negative relationship between noradrenaline and ultrafiltration capacity. The catecholamine plasma levels, which were within the normal range, did not correlate with MTCs or with ultrafiltration.

Our findings suggest that, in some cases, noradrenaline produced in the peritoneum may influence peritoneal mass transport through a vasoactive effect. Dialysate catecholamine levels correlate with that of plasma, but the latter does not influence peritoneal transport.
Mechanism of Phosphatidylcholine Action during Peritoneal Dialysis
Authors: Breborowicz Andrzej , Sombolos Kostas , Rodela Helen , Ogilvie Raymond , Bargman Joanne , Oreopoulos Dimitrios
Published: February 2020

We studied the effect of phosphatidyl- choline (PDC) (50 mg/L) on the peritoneal ultrafiltration and permeability in vivo and in vitro. Our in vivo studies with normal rabbits confirmed previous observations of increased ultrafiltration mainly by decreasing the reabsorption phase. We observed no effect on glucose absorption rate. In in vitro studies, using isolated section of rabbit's mesentery, phosphatidylcholine increased the permeability of the mesothelium to water, urea and glucose from the vascular to the mesothelial side but not in the opposite direction. Following exposure of the peritoneal membrane to Alcian blue, a positively charged dye, phosphatidylcholine had no effect on mesothelial permeability.

Our observations suggest that necessary for the action of phosphatidylcholine is its attachment to the anionic sites of the mesothelium. We speculate that improvement in UF is achieved by diminishing the thickness of the stagnant fluid layers trapped between the microvilli.
β2-Microglobulin Serum Levels in Patients on Long Term Dialysis
Authors: France Raymonde , Somerville Gagnon Peter , Kaye Michael
Published: February 2020

Recently several workers have described a β2-microglobulin-containing amyloid in patients on chronic hemodialysis. We have demonstrated that, in terms of the degree of elevation and the absence of correlation with duration of dialysis, the β2-microglobulin serum levels of CAPD patients are comparable to those on hemodialysis. Thus all dialysis patients seem to bear an increasing risk of tissue deposition of β2-microglobulin in the form of the newly-described amyloid, and this risk appears to be independent of the mode and duration of dialysis.
A Comparison of Intraperitoneal and Intravenous/Oral Antibiotics in CAPD Peritonitis
Authors: Bennett-Jones David , Penny Val Wass , Taube Mawson David , Chisholm Guy Neild , Cameron Ogg J Stewart , Williams D Gwyn
Published: February 2020

Eighty patients with CAPD peritonitis were randomised to receive either intraperitoneal (IP) vancomycin and tobramycin, or intravenous (IV) van-comycin and tobramycin followed by oral antibiotics, depending on the results of culture and sensitivity. Five patients were withdrawn, and, of the remaining patients, 39 were in the IP group and 36 in the IV group.

When all episodes of bacterial peritonitis are considered, the treatment failure rate was higher in the IV group (34.1%), than in the IP group (10.3%) (p < 0.02). This was also the case when gram-positive organisms resistant to tobramycin were considered separately (p < 0.05), but not for vancoinycin-resistant organisms. We conclude that vancomycin should be administered by the intraperitoneal route: the case for intraperitoneal tobramycin is “not proven”.
Fibronectin in the Normal Peritoneal Fluids of Patients on Chronic Ambulatory Peritoneal Dialysis (CAPD) and during Peritonitis
Authors: Khan Rashid H. , Klein Michel , Vas Stephen
Published: February 2020

The authors have studied the fibronectin (Fn) levels in peritoneal fluids from patients on CAPD. The assay system used is based on ELISA using a monoclonal antibody to Fn. We have tried to determine whether in some of these patients repeated intraperitoneal infections bear any relationship with peritoneal Fn levels. We find that the Fn levels in the peritoneal fluids from these patients are about one twentieth those found in normal plasma. Also we have found that the peritoneal Fn levels significantly increase during peritonitis and come back to normal levels within a few days of the clearing of the peritoneal fluid. We have found no connection between normal peritoneal fluid Fn concentration and subsequent peritonitis. However, the numbers are too small to permit statistical evaluation. The Fn levels were not affected by the presence or absence of heparin in the Dineal fluids. Large day to day variations were seen in the Fn levels in the peritoneal fluid of individual patients. It is not clear from this study, whether the low levels of Fn in the peritoneal fluid reflect a deficit in the local Fn production or are due to dilutional effects.
The Antimicrobial Implications of the Pharmacokinetics of Cotrimoxazole in CAPO Patients
Authors: Ojo Otegbola , Jones Colina , Stevens Donald L.
Published: February 2020

Cotrimoxazole (TMP/SMX) has been used to treat continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis. It is considered bactericidal for some species. The most common single organism responsible for this type of peritonitis is Staph. epidermidis (SE). When the drug is given orally, the typical ratio of TMP to SMX achieved in the peritoneal fluid is 1:5, which is different from the optimal combination for antimicrobial synergy of 1:19. This study investigated the antimicrobial activity of TMP alone and TMP/SMX by agar dilution at ratios of 1:19, 1:10 and 1:5 against 99 strains of Staphylococcus epidermis (SE). The majority of strains were susceptible to TMP and to all ratios of TMP/SMX by the routine agar dilution methods. We studied the bactericidal activity of TMP/SMX against one strain each of SE and of Staph. aureus (SA) in pooled uninfected spent dialysate by killing curve experiments. TMP at concentrations of 0.5 to 2.0 μg/ml was bacteriostatic. TMP/SMX became slowly bactericidal when 5 % lysed horse blood, a source of thymidine phosphorylase, was added to the dialysate.

It is concluded that susceptibility tests of inhibition do not predict bactericidal activity of TMP/SMX in recovered dialysate. Inhibition of TMP/ SMX is most likely due to thymidine present in dialysate. TMP alone was as effective against SE as TMP/ SMX. Until it is shown that bactericidal activity is not required for cure of CAPD-related peritonitis, cotrimoxazole should not be used routinely for its treatment.
Effects of Intraperitoneal Captopril on Peritoneal Transport in Rats
Authors: Lal Sunder M. , Moore Harold L. , Nolph Karl D.
Published: February 2020

We studied the effects of various doses of intraperitoneal (I.P.) captopril, (an angiotensin-converting enzyme inhibitor) during peritoneal dialysis, on urea dialysate/plasma (DIP) ratios, dialysate protein (Dpo), dialysate glucose (DG), and drainage volume (VD) in 19 Sprague-Dawley male rats with normal renal function. Similarly, these parameters were measured in five control rats.

Among the study group, 14 rats received 20 to 100 mg/kg of intraperitoneal captopril without effect. Following a larger intraperitoneal dose (75 mg/exchange (ex)) five rats had delayed increases in urea D/P ratios and dialysate protein losses by 30% (p < 0.05) and by 286% (p < 0.025), respectively. During and following intraperitoneal captopril the rats showed enhanced glucose absorption and consequently significant decreases in dialysate glucose concentration. The rats receiving IP captopril, 75 mg/ex remained hypotensive throughout the drug exchanges and three subsequent exchanges.

Increases in dialysate protein concentration and decreases in the dialysate glucose concentration seen with captopril (75 mg/ex) returned to near baseline values only after four to five hours of drug-free exchanges.

These changes, despite systemic hypotension, may reflect an increase in blood flow, capillary permeability and/or surface area subsequent to blockade of the renin-angiotensin system, suggesting some angiotensin II modulation of the peritoneal microcirculation and solute transport during peritoneal dialysis.
Transperitoneal Calcium and Magnesium Transfer during an 8-Hour Dialysis
Authors: Kwong Mary B.L. , Lee Joseph S.K. , Chan Man Kam
Published: February 2020

The authors studied transperitoneal calcium and magnesium transfer during an eight-hour dialysis in 13 CAPD patients with both 1.5% dextrose and 4.25% dextrose solutions with a Ca concentration of 1.75 mM/L and Mg 0.75 mM/L. The mean mass transfer of calcium was 0.733 mmol with 1.5% dextrose exchanges, and - 0.151 mmol with 4.25% dextrose solutions. The mean mass transfer of magnesium was negative with both 1.5% and 4.25% dextrose solutions. Mass transfer of both calcium and magnesium correlated inversely with the initial peritoneal fluid: blood osmotic gradient and positively with the initial peritoneal fluid/blood calcium or magnesium gradients. The ionic calcium gradient was dissipated rapidly because of the disappearance of pH gradient. Peritoneal fluid ionic calcium concentrations correlated positively with peritoneal fluid pH. It is suggested that calcium traverses the peritoneal membrane in the forms of ionic and chelated calcium.

Transperitoneal transfer of calcium and magnesium during peritoneal dialysis has been the subject of a few studies (1–4), which were concerned with intermittent peritoneal dialysis (1,2) or with continuous peritoneal dialysis (CAPD) involving four 2-litre exchanges daily (3, 4). Because three exchanges per day is our usual practice (15) and because there is a paucity of data on calcium and magnesium transfer during an eight-hour peritoneal dialysis, we undertook to determine transperitoneal transfer of calcium and magnesium, and to examine in detail the various factors affecting these trans peritoneal fluxes.