bluuebunny/crossref_metadata_2025 huggingface dataset:
Patients on Chronic Peritoneal Dialysis for Ten Years or More in North America
Authors: Maitra Sanjay , Burkart John , Fine Adrian , Prichard Sarah , Bernardini Judy , Jindal Kailash K. , Oreopoulos Dimitrios G.
Published: February 2020

Thirty-six patients on peritoneal dialysis (PD) for more than ten years in six North American centers were analyzed retrospectively. In the six centers, the percentage of patients surviving for more than ten years varied between 0.8% and 7.3%. The study group included 27 females and 9 males aged 38.6 ± 14.2 years [mean ± standard deviation (SD)] at the start of treatment. Of the 36 patients, 28 were Caucasian.

The most common cause of end-stage renal disease (ESRD), present in 12 patients, was chronic glomerulonephritis. Only 4 patients had diabetes. At the beginning of the study, 19 patients had hypertension (the most common comorbid condition); 11 had no comorbid conditions at the start.

Creatinine clearance at the start was 4.12 ± 3.5 mL per minute, and the mean duration to anuria was 51 ± 25 months. Mean initial body weight was 55 ± 9 kg, and mean body surface area was 1.5 ± 0.2 m2. Serum albumin levels showed an increase from 33.8 ± 3.6 g/L at the start of the study to 38.2 ± 3.9 g/L at the end.

Hospitalization rate was low at 0.5 ± 0.3 admissions per patient–year, and duration of hospitalization was 4.8 ± 3.7 days per patient–year. Peritonitis was the most common cause of hospitalization. The mean peritonitis rate was 1 episode every 52 ± 48 patient–months.

There were 36 catheter changes in 18 patients; 16 patients had a single PD catheter throughout the period of study. Autonomous hyperparathyroidism was the most common long-term complication.

At the end of the study period, 11 patients were still on PD, 9 had died, 5 had been transferred to hemodialysis (HD), 1 was alive with a functioning allograft, and 1 was lost to follow-up.

We conclude that patients who survive longer than ten years on PD are most likely to be young Caucasian females, small in body size, who are non diabetic, with few comorbid conditions. These long-term survivors have few hospitalizations, and their peritonitis rate is low. In this group of patients, severe autonomous hyperparathyroidism is the most common long-term complication.
Biocompatibility of New Peritoneal Dialysis Solutions: Clinical Experience
Authors: Garcia–Lopez Elvia , Lindholm Bengt , Tranæus Anders
Published: February 2020

The successful development of peritoneal dialysis (PD) during the last two decades has been made possible by using well-established glucose-based solutions with lactate as buffer. On the other hand, awareness has been increasing about the potentially negative effects of the high concentrations of glucose and lactate, and the low pH of conventional PD solutions. This awareness has prompted an intensive effort to search for and test alternative solutions.

As a result, three new, more biocompatible solutions— containing either less glucose or less lactate—are available. Amino acid–based solution uses amino acids instead of glucose as the osmotic agent; it is indicated for treatment of malnutrition. The higher pH and absence of glucose in this solution may prevent alterations of the peritoneal membrane caused by acidity and high glucose concentrations. Bicarbonate/lactate–buffered solution contains a physiologic concentration of bicarbonate and a reduced concentration of lactate; it also has a physiologic pH and markedly reduced levels of glucose degradation products (GDPs). Icodextrin-based solution contains icodextrin as the osmotic agent; it is indicated for long dwells, delivering sustained ultrafiltration for more than 16 hours. This iso-osmolar glucose-free solution may reduce peritoneal membrane alterations caused by glucose or the hyperosmolality (or both) of conventional solutions.

Clinical experience of the new solutions is now extensive, and their efficacy and safety are well documented. It therefore seems appropriate to state that we have entered a new era of PD therapy. Each of the new solutions may be less damaging to the peritoneal membrane than conventional solution. In addition, they permit better management of malnutrition and fluid status, and may thus help to improve PD patient survival.

Although the effects of each of these new solutions have been well described, clinical documentation of the combined use of these new biocompatible PD solutions is still insufficient. However, the results of studies are expected, during the coming years, to support the combined use of the new solutions as the preferred standard practice for PD.
Effects of Peritoneal Dialysis with an Overnight Icodextrin Dwell on Parameters of Glucose and LIPID Metabolism
Authors: Bredie Sebastian J.H. , Bosch Frank H. , Demacker Pierre N.M. , Stalenhoef Anton F.H. , Van Leusen Robert
Published: February 2020

Objective

To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients.

Study Design

Randomized crossover study with two subsequent periods of 6 weeks.

Setting

Home PD unit of a secondary-care hospital.

Patients

Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean age 50.3 ± 11.8 years).

Intervention

Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or with a 7.5% icodextrin-containing solution.

Main Outcome Measures

Relation between reduction in the total amount of intraperitoneal infused glucose and parameters of glucose (plasma glucose, insulin, and HbA1C) and lipid metabolism [free fatty acids, plasma lip-ids, lipoproteins, and low density lipoprotein (LDL) sub-fraction profile].

Results

After the icodextrin dwells, a reduction of plasma total cholesterol (from 5.43 ± 0.85 to 4.86 ± 0.70 mmol/L, p < 0.001) and LDL cholesterol (from 3.38 ± 0.87 to 2.93 ± 0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95 ± 0.27 to 0.90 ± 0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol-to-HDL ratio remained similar. Plasma free fatty acids and triglyceride levels tended to decrease (from 0.16 ± 0.10 to 0.13 ± 0.08 mmol/L, p = 0.06, and from 2.14 ± 1.96 to 1.92 ± 1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultra-centrifugation showed a more buoyant LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin. The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76 ± 1.29 to 5.86 ± 0.80 mmol/L) or insulin levels (from 19.5 ± 14.4 to 20.3 ± 13.0 mU/L).

Conclusion

These results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin.
Association of Hypertriglyceridemia and Insulin Resistance in UREMIC Patients Undergoing CAPD
Authors: Cheng Shu Chien , Chu Tzong Shinn , Huang Kuan Yu , Chen Yung Ming , Chang Wei Kuang , Tsai Tun Jun , Wu Kwan Dun
Published: February 2020

Objective

Hyperlipidemia is frequently encountered in uremic patients and may be worsened by continuous ambulatory peritoneal dialysis (CAPD) treatment. The lipid abnormalities in these patients may be multifactorial. Insulin resistance (or its compensatory hyperinsulinemia) is commonly observed in uremic patients, but its association with hyperlipidemia in these patients has not been studied.

Patients and Methods

Lipid profiles of 35 nondiabetic nonobese patients undergoing CAPD for more than 1 year (mean 52.3 months) were studied. Current laboratory data and parameters related to peritoneal dialysis (PD) within the previous 3 months were recorded. After overnight fasting and interruption of PD, an oral 75-g glucose tolerance test (OGTT) was examined.

Results

After CAPD treatment for more than 12 months, these patients had higher serum triglyceride (TG) ( p = 0.001) and total cholesterol ( p = 0.0058) levels than their values before commencing CAPD. Twelve of 14 patients with serum TG higher than 200 mg/dL (high-TG) were diagnosed de novo, in contrast with only 1 patient diagnosed of de novo hypercholesterolemia (total cholesterol > 240 mg/dL). There was no difference in age, gender, body mass index (BMI), duration of PD treatment, serum albumin, hematocrit, intact serum parathyroid hormone (iPTH), peritoneal glucose load, solute transport, or weekly Kt/V urea between normal-TG and high-TG patients. After adjusting for age, gender, BMI, weekly Kt/V urea, and iPTH, the high-TG patients had higher levels of area under the curve for glucose (AUCGlu), area under the curve for insulin (AUCIns), and AUCIns/AUCGlu ratios (F = 10.63, 10.14, and 8.65; p = 0.0029, 0.0035, and 0.0065, respectively), indicating that the high-TG patients were more insulin resistant. There were 24 patients with normal glucose tolerance (NGT), and 11 patients with impaired glucose tolerance (IGT). The IGT group had higher serum TG (F = 10.43, p = 0.003) and total cholesterol (F = 8.05, p = 0.009) than the NGT group, after adjusting for BMI, duration of CAPD treatment, peritoneal glucose load, solute transport, serum albumin, and lipid levels before PD treatment. The TG levels after CAPD treatment were positively correlated with AUCGlu, AUCIns, and AUCIns/AUCGlu ratio ( r = 0.48, 0.53, and 0.49; p = 0.0037, 0.001, and 0.0028, respectively).

Conclusions

These results indicate that insulin resistance is an important factor in the development of hypertriglyceridemia in CAPD patients.
Experience with a Large Dose (500 MG) of Intravenous Iron Dextran and Iron Saccharate in Peritoneal Dialysis Patients
Authors: Prakash Sunil , Walele Aziz , Dimkovic Nada , Bargman Joanne , Vas Stephen , Oreopoulos Dimitrios
Published: February 2020

Objective

To compare efficacy in anemia correction and side effects of large doses of intravenous (IV) iron dextran and iron saccharate preparations in peritoneal dialysis (PD) patients.

Setting

Tertiary-care teaching hospital of University of Toronto.

Design

Retrospective analysis of 379 PD patients who attended PD clinics in past 5 years. Of these 379 patients, 62 were selected to receive IV iron based on ferrokinetic markers of iron deficiency, noncompliance to or ineffectiveness of oral iron, or increased erythropoietin (EPO) requirement.

Intervention

Sixty-one patients received two IV iron injections of 500 mg each, 1 week apart, 33 patients received iron dextran, 23 received iron saccharate, and 5 received both iron dextran and iron saccharate. One patient developed anaphylaxis to a test dose of iron dextran and was excluded from further therapy. Blood samples were collected before and 3 and 6 months after iron infusions.

Results

At 3 months, the group's average hemoglobin rose from 98.3 ± 18.3 g/L to 110.6 ± 16.4 g/L ( p < 0.0001). Ferritin rose from 104.9 ± 115.4 μg/L to 391.5 ± 294.1 μg / L ( p < 0.0001), and iron saturation from 0.17 ± 0.07 to 0.26 ± 0.19 ( p < 0.0001). Erythropoietin requirements fell from 7278.7 IU/week to 5900 IU/week ( p < 0.01). Five of the 34 patients who received iron dextran developed minor side effects and 1 patient had anaphylaxis to the test dose. Of the 23 patients who received iron saccharate, 1 had an anaphylactic reaction and 2 had transient chest pain, which subsided without therapy. Overall, there were more side effects with iron dextran (7.4% of injections) compared to the iron saccharate group (4.3% of injections), but this difference was statistically insignificant. Although statistically insignificant, there was an increase in the number of peritonitis episodes during the 6 months after IV iron infusion, especially with iron dextran, compared to the peritonitis episodes during the 6 months before iron infusions.

Conclusion

Our study indicates that IV iron in PD patients is effective in restoring iron stores and in decreasing EPO requirements. One anaphylactic reaction occurred in each group. Our data suggest that as much caution be exercised with iron saccharate as with iron dextran. The slight trend toward increased peritonitis rates after iron infusions needs to be investigated in a larger group of patients.
Dialysate Cancer Antigen 125 Concentration as Marker of Peritoneal Membrane Status in Patients Treated with Chronic Peritoneal Dialysis
Authors: Krediet Raymond T.
Published: February 2020

Objective

This study reviews publications on the history of cancer antigen 125 (CA125), the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its practical use in both the follow-up of peritoneal dialysis (PD) patients and as a marker of in vivo biocompatibility of dialysis solutions.

Design

Review article.

Results

CA125 is a high molecular weight glycoprotein. Previous studies in ascites suggested its release by mesothelial cells. In vitro studies with cultured mesothelial cells showed constitutive production, the majority of which was dependent on mesothelial cell mass. Serum CA125 is normal in PD patients, but its concentration in peritoneal dialysate suggests local release, probably from mesothelial cells. Effluent CA125 can be considered a marker of mesothelial cell mass in stable PD patients, but large amounts are found during peritonitis, due probably to necrosis of mesothelial cells. The majority of studies found no relationship between dialysate CA125 and peritoneal transport parameters. Some cross-sectional studies reported a relationship with duration of PD, but others were unable to confirm this, due probably to the large interindividual variability. Longitudinal follow-up has shown a decrease in dialysate CA125, indicating loss of mesothelial cell mass. Application of theoretically morebiocompatible PD solutions causes an increase in dialysate CA125.

Conclusions

Dialysate CA125 is a mesothelial cell mass marker. The concentration of CA125 should be determined after a standardized dwell. A single low value is not informative. A decrease with time on PD suggests loss of mesothelial cell mass. Dialysate CA125 is a marker of in vivo biocompatibility of (new) dialysis solutions. More research is necessary on the best methodology for measuring low concentrations and establishing normal values and a significant change.
Pharmacokinetics of Intraperitoneal Cefazolin and Gentamicin in Empiric Therapy of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Tosukhowong Thanawat , Eiam–Ong Somchai , Thamutok Kannika , Wittayalertpanya Supeecha , Ayudhya Duangchit Panomvana Na
Published: February 2020

Objective

The aim of this study was to measure and evaluate the appropriateness of the actual concentrations of serum and dialysate cefazolin and gentamicin in Thai continuous ambulatory peritoneal dialysis (CAPD) patients treated following the International Society for Peritoneal Dialysis (ISPD) 1996 recommendations for the empiric therapy of CAPD-related peritonitis.

Design

Prospective and descriptive study.

Setting

Institutional level of clinical care.

Patients

CAPD-related peritonitis patients were diagnosed by dialysate effluent white cell count of more than 100/mm3 and polymorphonuclear leukocytes of at least 50%. There were 18 patients, all at least 15 years of age, entered; all completed the study.

Intervention

In accordance with the ISPD 1996 recommendations, the antibiotic regimen included continuous intraperitoneal (IP) cefazolin and once-daily IP amino-glycoside. Cefazolin was administered as loading and continuous maintenance doses of 500 and 125 mg/L dialysate, respectively. Gentamicin, 0.6 mg/kg body weight, was given IP once daily. Duration of treatment was 120 hours.

Main Outcome Measures

Serum and dialysate effluent samples of the 18 CAPD patients with peritonitis were measured and used for the synthesis of pharmacokinetic equations that could predict drug concentrations at any treatment time.

Results

Following administration according to the ISPD 1996 treatment recommendations, serum cefazolin reached levels higher than the recommended levels (8 mg/mL) at 3.3 minutes after drug administration, and persisted through the 5-day duration of the study. Dialysate cefazolin levels during the studied period also were persistently higher than the recommended values. The peak serum gentamicin levels were lower than the suggested values of 4 mg/mL, whereas the trough serum gentamicin levels were higher than the minimal toxic concentrations (2 mg/mL). Dialysate gentamicin levels were higher than therapeutic concentrations for only 4.75 hours in each day. It was difficult, using pharmacokinetic studies, to adjust the dosage regimen of gentamicin to achieve appropriately therapeutic levels in both serum and dialysate.

Conclusions

The ISPD 1996 recommended dosage of continuous IP cefazolin could be appropriate for the treatment of CAPD-related peritonitis. Once-daily IP gentamicin administration, however, has less therapeutic benefit and should be re-evaluated.
The Role of Extracellular Matrix in Transperitoneal Transport of Water and Solutes
Authors: Flessner Michael F.
Published: February 2020

♦ Objective

To define the extracellular matrix (ECM), to discuss the physical properties of its components and their impact on transport, and to review data in humans and in animals on the importance of hyaluronan to peritoneal dialysis.

♦ Methods

Literature survey.

♦ Results

The ECM fills the interstitium between parenchymal cells and blood vessels in the subperitoneal interstitium. It is responsible for the interstitial resistance to solute and water transfer through the peritoneal barrier. Major components are collagen and hyaluronan, which are synthesized locally in the peritoneal tissue. Synthesis and deposition of these components increase with inflammation, and concentrations of the components influence the mechanical properties of the tissue and the interstitial Starling forces as well as transport. Removal of hyaluronan appears to increase the rates of water and large-solute transport. Addition of hyaluronan to dialysate appears to enhance fluid recovery and to reduce protein loss.

♦ Conclusion

Many of the physicochemical properties of ECM components are well described, but a large knowledge gap remains concerning the in vivo consequences of specific alterations in the interstitial components. More research is needed.
Influence of Neutral-Ph Dialysis Solutions on the Peritoneal Membrane: A Long-Term Investigation in Rats
Authors: Wieczorowska–Tobis Katarzyna , Polubinska Alicja , Schaub Thomas P. , Schilling Holger , Wisniewska Justyna , Witowski Janusz , Passlick–Deetjen Jutta , Breborowicz Andrzej
Published: February 2020

♦ Objective

Glucose degradation products (GDPs) and low pH are potential causes of bioincompatibility of peritoneal dialysis fluids (PDFs). The aim of the present study was to compare the effect of 6 weeks’ exposure of the peritoneum in rats to two different PDFs: a standard PDF with a low pH and high level of GDPs (CAPD 3: Fresenius Medical Care, Bad Homburg, Germany), and a modified PDF with a low level of GDPs and a physiologic pH (CAPD 3 Balance: Fresenius Medical Care).

♦ Methods

After catheter implantation, rats were exposed twice daily for 6 weeks to CAPD 3 fluid or to CAPD 3 Balance. At the beginning and at the end of the study, a 4-hour dwell was performed in every rat to evaluate intraperitoneal inflammation and its effect on total collagen synthesis in the in vitro cultured rat mesothelial cells ( ex vivo study). Additionally, after 6 weeks’ exposure, the peritoneal cavity was opened, and macroscopic changes were evaluated according to a semiquantitative scale. Peritoneal samples were also taken for morphology study.

♦ Results

In rats treated with CAPD 3 fluid, intraperitoneal inflammation was comparable at the beginning and at the end of the experiment. In animals exposed to CAPD 3 Balance, the intensity of the intraperitoneal inflammation decreased during the study (cell count, p = 0.0781; neutrophil:macrophage ratio, p < 0.01; nitrite concentration, p < 0.05; hyaluronan level, p < 0.05). The capacity of effluent dialysate from CAPD 3 rats to activate collagen synthesis in in vitro–cultured mesothelial cells was the same at the beginning and at the end of the study. In the CAPD 3 Balance group, this capacity was statistically significantly lower at the end of the study than at the beginning ( p < 0.05). The mean thickness of the visceral peritoneum was comparable in both groups of animals, but, macroscopically, more severe fibrosis was found in the peritoneum of rats exposed to CAPD 3 as compared with animals treated with CAPD 3 Balance ( p < 0.05).

♦ Conclusion

We showed that, in the rat model of peritoneal dialysis, chronic exposure of the peritoneum to PDFs with low GDPs and a physiologic pH diminished the intraperitoneal inflammatory reaction induced by dialysis, and reduced peritoneal fibrosis.
Is Growth a Valid Outcome Measure of Dialysis Clearance in Children Undergoing Peritoneal Dialysis?
Authors: Chadha Vimal , Blowey Douglas L. , Warady Bradley A.
Published: February 2020

♦ Objective

Our study evaluated growth as a clinical outcome measure of peritoneal dialysis (PD) adequacy in children with end-stage renal disease (ESRD).

♦ Design

This retrospective single-center study was carried out in our tertiary-care medical center.

♦ Patients

The study enrolled 24 patients who initiated dialysis after January 1, 1995, and who had been on dialysis for a minimum of 1 year.

♦ Results

The weekly mean total [PD + residual renal function (RRF)] creatinine clearance (CCr) and Kt/Vurea were 70.3 ± 18 L per 1.73 m2 and 3.45 ± 0.73, respectively. Of the 24 patients, 12 (50%) were anuric. The mean height standard deviation score (SDS) changed to –1.78 at the end of 1 year from –1.58 at baseline. Catch-up growth (positive Δ height SDS) was observed in 9 patients (37%), 7 of whom (78%) had residual renal function (RRF). In contrast, only 5 of 15 patients (33%) with a negative ΔSDS for height had RRF ( p < 0.025). The mean height SDS in patients with RRF improved to –1.64 from –1.78; in patients without RRF, it worsened to –1.90 from –1.37 ( p = 0.01). While the weekly total Kt/Vurea in patients with RRF (3.53) was similar to that in patients without RRF (3.37, p = 0.6), only the native Kt/Vurea had a significant (but weak) positive correlation with Δheight SDS ( r 2 = 0.17, p = 0.04). In contrast, the total weekly CCr was significantly higher ( p = 0.001) in patients with RRF (81.1 L/1.73 m2) as compared with those without RRF (59.5 L/1.73 m2). However, only the native CCr—and not the dialysis CCr—had a significant (but weak) positive correlation with Δheight SDS ( r 2 = 0.17, p = 0.04).

♦ Conclusions

These preliminary data provide evidence for a correlation between solute clearance and growth, with RRF exerting a significant influence on that outcome. The Kt/Vurea data also appear to contradict the presumed equivalence of PD and native clearance in children with ESRD.
Effect in a Rat Model of Heparinized Peritoneal Dialysis Catheters on Bacterial Colonization and the Healing of the Exit Site
Authors: Kim Yong-Lim , Cho Seong , Kim Jun-Chul , Cho Dong-Kyu , Kim Yong-Jin , Larm Olle , Mathiesen Torbjorn , Lindholm Bengt , Bergström Jonas
Published: February 2020

We performed a prospective, double-blind, randomized study to evaluate whether stable surface heparinization of silicone peritoneal dialysis (PD) catheters prevents bacterial colonization or biofilm formation and improves healing of the exit site. Heparinized catheters were implanted in 20 Sprague–Dawley rats (group H) and non heparinized catheters in another 20 (group C). The PD catheters, constructed of silicon tubing with two polyester cuffs, were patterned after the standard Tenckhoff catheter. A covalent multipoint method of attachment onto polymeric surfaces was used for stable, permanent chemical immobilization of heparin on the PD catheter. Dialysis exchanges (25-mL instillation volume) were performed twice daily for 4 weeks through the permanent catheter. Prophylactic antibiotics were not used. The exit sites were evaluated at 2-week intervals. The extent of biofilm coverage on the intraperitoneal portion of the catheter (obtained at the end of the experiment) was assessed, and sonicated fluid from the catheter tip was cultured for evaluating bacterial colonization of the catheter.

Exit-site scores in group H were lower than in group C ( p = 0.052) at the end of week 4. Bacterial colonization tended to be less common in group H [2 of 12 catheters (17%)] than in group C [8 of 15 catheters (53%); p = 0.058], but the extent of biofilm, the peritonitis rate, and the inflammation score of tissue adjacent to the cuff were not different between the groups. Those data suggest that heparinized PD catheters can be a practical approach to the prevention of bacterial colonization and can improve healing of the exit site.
Comparison of the Biocompatibility of Phosphate-Buffered Saline Alone, Phosphate-Buffered Saline Supplemented with Glucose, and Dianeal 3.86%
Authors: Wieczorowska–Tobis Katarzyna , Styszynski Arkadiusz , Breborowicz Andrzej , Oreopoulos Dimitrios G.
Published: February 2020

Objective

We compared the effects of intraperitoneal infusion of phosphate-buffered saline (PBS, pH 7.4), of PBS supplemented with 3.86% glucose (G), and of standard dialysis solution [Dianeal 3.86%: Baxter Healthcare Corporation, Deerfield, IL, U.S.A. (D)] on intraperitoneal inflammation in dialyzed rats.

Methods

After catheter implantation, rats were infused on day 1 with PBS, on day 3 with PBS+G, on day 5 with D, and on day 7 again with PBS (PBS-2). After a 4-hour dwell, dialysate samples were collected and analyzed.

Results

All dialysate parameters studied [dialysate cell count, neutrophil:macrophage ratio (Ne:Ma), and total protein], except tumor necrosis factor alpha (TNFα), were comparable during both PBS infusions. During dialysis with PBS+G, the inflammatory response was suppressed as compared with the first dialysis with PBS (cell count, p < 0.001; Ne:Ma, p < 0.05; TNFα, p < 0.001; total protein, p < 0.001). During dialysis with D, peritoneal inflammatory parameters were further suppressed (cell count, p < 0.001 vs PBS and p < 0.01 vs PBS+G; Ne:Ma, p < 0.001 vs PBS and p < 0.05 vs PBS+G; TNFα, p < 0.001 vs PBS and p < 0.001 vs PBS+G; total protein, p < 0.001 vs PBS and p < 0.01 vs PBS+G).

Conclusions

Hypertonicity of the dialysis fluid suppresses intraperitoneal inflammatory parameters in rats. The suppression was even more severe when Dianeal 3.86% was used. That finding could be due to the low pH and presence of GDPs in the fluid.
Lack of Isoprene Overproduction during Peritoneal Dialysis
Authors: Capodicasa Enrico , Trovarelli Gianfranco , Brunori Federica , Vecchi Luigi , Carobi Carmen , De Medio Gianna E. , Pelli Maria A. , Buoncristiani Umberto
Published: February 2020

Objective

Isoprene is the constitutive unit of isoprenoid lipids and sterols. However, it is also a potential toxic and carcinogenic agent. Recent findings of a marked and prolonged isoprene overproduction induced by hemodialysis sessions raises the question of isoprene behavior in patients on peritoneal dialysis.

Design

A study with repeated measures per patient and healthy control.

Setting

Nephrology and Dialysis Unit and Perugia University Medical School.

Patients

Sixteen consecutive patients on regular continuous ambulatory peritoneal dialysis (CAPD) were evaluated. Endogenous isoprene was analyzed using gas chromatographic assay of breath isoprene, collected at set times before and after dialysis fluid exchange.

Results

No significant variations were found in breath isoprene concentrations in the different samples from each patient, and levels were almost stable within the normal range of healthy controls.

Conclusion

These results show that CAPD, unlike hemodialysis, has little or no effect on isoprene and isoprenoid-related lipid turnover. This lack of increased endogenous isoprene synthesis, in addition to being a distinctive metabolic feature of CAPD, could have important pathophysiological and clinical implications.
Efficacy of a Low-Dose Intravenous Iron Sucrose Regimen in Peritoneal Dialysis Patients
Authors: Dittrich Elisabeth , Schillinger Martin , Sunder–Plassmann Gere , Hörl Walter H. , Vychytil Andreas
Published: February 2020

Objective

Sufficient iron substitution leads to a decrease in the required recombinant human erythropoietin (rHuEPO) dose and/or an increased hematocrit in dialysis patients. Intravenous (IV) application of larger doses of iron sucrose may be associated with hyperferritinemia, appearance of catalytically free iron, and impaired phagocyte function. Therefore, we investigated the effectiveness of a low-dose IV iron regimen in peritoneal dialysis (PD) patients.

Patients and Interventions

Forty-five PD patients were followed over a period of 1 year. Serum ferritin, serum transferrin saturation, and hemoglobin were measured monthly. In cases of absolute iron deficiency (serum ferritin < 100 μg/L), 50 mg iron sucrose was given IV every second week. In cases of functional iron deficiency (ferritin ≥ 100 μg/L and transferrin saturation < 20%) and in iron repleted patients (ferritin ≥ 100 μg/L and transferrin saturation ≥ 20%), 50 mg IV iron sucrose was applied monthly. Iron therapy was stopped in cases of acute infection (until complete recovery) and when serum ferritin level was ≥ 600 μg/L.

Results

To analyze the influence of iron substitution on erythropoiesis and rHuEPO requirements, the EPO resistance index (ERI; quotient of rHuEPO dose in units/kilogram/week and hemoglobin in grams per deciliter) was calculated every 3 months. The ERI decreased significantly during the course of the study in the whole patient group ( p = 0.009) as well as in the subgroup of 21 patients with absolute iron deficiency ( p = 0.01). A nonsignificant decrease in the ERI was observed within the group of 14 iron repleted patients ( p = 0.5). There was no significant change in the ERI in 10 patients with functional iron deficiency ( p = 0.6).

Conclusion

The low-dose IV iron regimen used in this study substantially decreased rHuEPO requirements in patients with absolute iron deficiency and was effective in maintaining iron stores in iron repleted patients. However, in the absence of significant hyperparathyroidism, aluminum toxicity, or inadequate dialysis, it did not improve the ERI in patients with functional iron deficiency.
Changes in Peritoneal Coagulation and Fibrinolysis after Discontinuation of Chronic Peritoneal Dialysis
Authors: Homma Sumiko , Masunaga Yoshinori , Kurosu Megumi , Inoue Makoto , Sakurai Toshihiro , Asano Yasushi
Published: February 2020

♦ Objectives

To study changes in peritoneal function after transfer from chronic peritoneal dialysis (CPD) to hemodialysis (HD), especially the effects on peritoneal coagulation, fibrinolytic markers, and mesothelium.

♦ Design

Prospective observational study.

♦ Setting

A tertiary-care university hospital.

♦ Patients

Nine patients who transferred from CPD to HD were enrolled in the study after giving fully informed consent.

♦ Methods

After transfer to HD, the peritoneal cavity was lavaged with low glucose PD solution once per day through PD catheters left in place. Thrombin–antithrombin III complex (TAT) was measured serially as a marker of peritoneal coagulation. As fibrinolytic markers, fibrinogen/fibrin degradation products (FDP) and plasmin–α2-antiplasmin complex (PIC) were assessed. Cancer antigen 125 (CA125) was measured as a marker of mesothelial cell mass.

♦ Results

Levels of peritoneal TAT and FDP were much higher than plasma levels, indicating high local fibrin turnover. Transfer to HD induced a significant fall in mean peritoneal TAT, from 115.8 ± 52.1 to 60.7 ± 21.8 ng/mL, p < 0.05. Except for 1 patient with a 20-fold increase, mean peritoneal FDP decreased significantly, from 43.6 ± 11.1 to 19.6 ± 3.5 μg/mL, p < 0.05. Mean peritoneal PIC increased significantly, from 1.9 ± 0.4 to 3.9 ± 0.6 μg/mL, p < 0.05. Peritoneal CA125 increased from 156.4 ± 57.3 to 1426.2 ± 389.4 U/mL, p < 0.05.

♦ Conclusions

Peritoneal fibrin turnover was accelerated on CPD and stabilized after transfer to HD. Transfer to HD also induced mesothelial regeneration.
Peritoneal Dialysis Retardation of Progression of Advanced Renal Failure
Authors: Berlanga Jose Ramon , Marrón Belen , Reyero Ana , Caramelo Carlos , Ortiz Alberto
Published: February 2020

♦ Objectives

The rate of decline of residual renal function is slower in peritoneal dialysis (PD) than in hemodialysis. However, it is unclear which and whether either of the two techniques modifies the natural course of renal failure. We tested whether PD influences the natural course of the progression of chronic renal failure in humans.

♦ Design

Retrospective review of clinical charts.

♦ Setting

Tertiary-care center.

♦ Patients

Fourteen patients were selected from the 36 patients that were treated with PD in our center from January 1997 to June 2000, applying the following criteria: predialysis follow-up longer than 12 months, renal creatinine clearance 20 mL/minute or more at the start of predialysis follow-up, follow-up while on PD longer than 6 months, and renal creatinine clearance above 0 mL/minute at the start of PD.

♦ Main Outcome Measure

Residual renal function calculated as renal creatinine clearance obtained from 24-hour urine samples.

♦ Results

A lower mean rate of decline of residual renal function was observed during PD than during the predialysis period (–0.06 ± 0.16 vs –0.94 ± 0.74 mL/min/month, p < 0.0005). The rate of decline in renal creatinine clearance was faster in every patient during the predialysis period than during his or her time on PD.

♦ Conclusions

These preliminary data support the hypothesis that PD may contribute to the slowing of the natural progression of renal disease in humans, as it does in rodents. Prospective studies involving a larger number of patients are needed to settle the question.
Peritoneal Dialysis in Asia: An External Perspective
Authors: Blake Peter G.
Published: February 2020

There are almost 30 000 patients maintained on peritoneal dialysis (PD) in Asia, representing about 8% of all Asian dialysis patients. The largest numbers of PD patients are in Japan and China, but the highest PD penetration is in Hong Kong, Korea, and Singapore. Notable features of PD in Asia include the varying rates of use across the different countries. The reasons for this are reviewed here, with particular emphasis on the significance of whether dialysis providers are predominantly private or public. The excellent rates of both patient and technique survival in the richer Asian countries are also examined and interpreted in the context of recent data showing that Asian patients living in North America have generally superior survival on dialysis and better compliance with PD than their Caucasian counterparts. It is concluded that the healthier baseline health status in South East Asian patients, in particular, contributes to their impressive outcomes. The approach to both clearance and ultrafiltration is less aggressive in Asian countries than in the West. Studies looking at the relationship between clearance and clinical outcome in Asia are reviewed and it is concluded that the benefits of higher clearances have been harder to show than in North America because of the relatively better outcomes of the patients. The concern about sclerosing encapsulating peritonitis in Japan particularly is emphasized. The Hong Kong model of dialysis delivery with its high use of PD and the arguments for and against it are also reviewed.
Comparison of the Radioiodinated Serum Albumin (RISA) Dilution Technique with Direct Volumetric Measurements in Animal Models of Peritoneal Dialysis
Authors: Biesen Van Wim , Devriese An S. , Carlsson Ola , Landschoot Van Mike , Dheuvaert Tomy , Lameire Norbert H.
Published: February 2020

Background

Rat models of peritoneal dialysis (PD) are useful for studying the physiology of peritoneal transport and evaluating new osmotic agents. Intraperitoneal (IP) solute concentrations and their evolution over time are easy to measure, but IP volume (IPV) is not. Direct volumetric measurements are the “gold standard,” but they are expensive and do not allow for repetitive measurements in the same animal. The indicator dilution technique is therefore used as an alternative. However, that technique is based on assumptions that are not always valid. The present study compares direct volume measurement with the indicator dilution technique [radioiodinated serum albumin (RISA)] to determine the IPV over time curves in a rat model of PD.

Methods

In series 1, 17 Sprague–Dawley rats were instilled IP with 25 mL 1.36% glucose dialysate through a Teflon catheter. In 9 animals, 0.35 mL dialysate was sampled and discarded at time points 0, 3, 15, 30, 60, 180, and 240 minutes. In the other 8 animals, no sampling was performed. At 240 minutes, all 12 animals were humanely killed, and direct volumetric measurements of IPV were performed. In series 2, rats were instilled IP with 25 mL 1.36% glucose dialysate containing 18.5 kBq 131I RISA. In 9 animals, dialysate was sampled at 0, 3, 15, 30, 60, 90, 120, 180, and 240 minutes for the construction of the RISA concentration-over-time curve, and to calculate the elimination constant Ke. At 30, 60, 180, and 240 minutes, dialysate was sampled in 6 different animals (total n = 24) to calculate IPV using the RISA dilution technique. Immediately afterward, the animals were humanely killed, and direct volumetric measurements of IPV were performed.

Results

In series 1, after 240 minutes’ dwell time, the IPV was lower in the sampled animals as compared with the non sampled animals (27.11 ± 1.85 mL vs 30.75 ± 0.59 mL, p = 0.001). In series 2, the evolution of RISA activity in the dialysate over time was described by piecewise linear regression, yielding 3288 – 8.2T counts (cts) for T < 52.72 minutes and 2973 – 1.99T counts for T > 52.72 minutes. The IPV was better predicted with a Ke that took into account the disappearance of RISA by sampling than with a Ke that took into account disappearance of RISA only by absorption.

Conclusions

If indicator dilution techniques are used to measure IPV, attention must be paid to the disappearance of the osmotic agent and the marker by multiple sampling. The best way to meet that goal is to use micropipettes to avoid large sample volumes.
Abdominal Catastrophe Revisited: The Risk and Outcome of Enteric Peritoneal Contamination
Authors: Kern Elizabeth O. , Newman Lynda N. , Cacho Carolyn P. , Schulak James A. , Weiss Miriam F.
Published: February 2020

Objective

Peritonitis from a visceral source is associated with striking morbidity and mortality in patients treated with peritoneal dialysis (PD). Surgical intervention for both diagnosis and repair is definitive. However, because the antecedents of enteric injury leading to peritonitis are unpredictable, no preventive strategy has been proposed or adopted. The goal of this study was to examine risk factors influencing the occurrence and outcome of anatomically documented peritonitis of enteric origin.

Design

Retrospective chart and database review.

Setting

Peritoneal dialysis unit in tertiary-care referral hospital.

Patients

330 patients treated with PD for end-stage renal disease between 1988 and 2000.

Main Outcome Measures

Prevalence of peritonitis of anatomically documented enteric origin over two consecutive time periods within the study interval: period 1, from 1 January 1988 through 30 June 1996; period 2, from 1 July 1996 through 30 June 2000.

Results

At least 1 episode of peritonitis occurred in 202 of 330 patients during the entire study period of 12.5 years (600.74 patient-years of care). There were 543 episodes of peritonitis. Anatomically documented visceral injury caused bacterial peritonitis in 41 patients with a total of 63 discrete episodes, an incidence rate of 0.1048 per patient-year. Peritonitis-free survival was compared between the two periods using Kaplan–Meier analysis. The curve representing risk distribution for anatomically documented visceral peritonitis remained constant over the two periods, in contrast to improvements found in all other types of peritonitis, taken as a group ( p = 0.044). Logistic regression modeling showed that the only risk factor associated with development of anatomically documented visceral peritonitis was older age. There was no influence of race, sex, time on PD, and underlying disease etiology. 31 deaths were attributed to peritonitis during the study period. The mortality rate from enteric peritonitis due to visceral injury was 46.3% (19/41 cases), compared to 7.5% for all other peritonitis taken as a group (12/161 cases, p < 0.0001).

Conclusions

The experience at University Hospitals of Cleveland suggests that abdominal catastrophe occurs in approximately 10% of all patients treated with PD, and is associated with high mortality, which has not changed over time. Therefore, peritonitis due to spontaneous visceral injury presents a great diagnostic and therapeutic challenge. It is important to develop a research strategy to understand this devastating complication.
Selenium Metabolism in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Apostolidis Nicholas S. , Panoussopoulos Dimitrios G. , Stamou Konstantinos M. , Kekis Panayotis B. , Paradellis Themis P. , Karydas Andreas G. , Zarkadas Charalambos , Zirogiannis Panagiotis N. , Manouras Andreas J.
Published: February 2020

Background

Selenium is an essential trace element for living organisms. In many publications, researchers express concern about a possible Se deficiency in patients with end-stage chronic renal failure (ESCRF) undergoing continuous ambulatory peritoneal dialysis (CAPD). However, in a number of published articles, the data provide no evidence that patients under CAPD develop Se deficiency.

Objective

We investigated Se metabolism in ESCRF patients on CAPD.

Setting

The study was carried out at the Department of Propaedeutic Surgery, Athens University; the Laboratory for Material Analysis of the Nuclear Physics Institute; and the State General Hospital, Athens, Greece.

Patients and Methods

The study group included 24 patients on CAPD treatment, 14 ESCRF patients, and 17 healthy controls. We measured the Se and Fe content of serum, blood, and erythrocytes. We also measured hematocrit, serum total proteins and albumins, and Se in dialysate effluent.

Results

As compared with healthy subjects, the ESCRF and CAPD patients exhibited reduced serum concentrations of Se. However, considering the difference in hematocrit values, the total serum-transported Se per liter of blood was close to normal. Erythrocyte Se proved normal for both groups. The measured Se in the spent effluent indicates that patients under CAPD receive approximately 100 μg Se from their daily diet, as normal subjects do. The Se measurement data from the effluent indicate that 90% of the Se carried by the serum is bound to albumins and that only the remaining 10% is in the form of low molecular weight selenate, free to pass the peritoneal membrane. Of the 24 CAPD patients studied, 4 patients (all women) showed extremely low Se serum levels. Data suggest that those low levels are more likely due to the significantly lower serum albumin levels in the 4 patients than to an insufficient dietary intake.

Conclusions

Data from the present experimental work suggest that patients undergoing CAPD receive the necessary quantities of Se from their regular diet. The data contradict statements in the relevant literature that CAPD patients develop Se deficiency.
Epidemiology of GB Virus C/Hepatitis G Virus Infection in Patients on Peritoneal Dialysis
Authors: Fabrizi Fabrizio , Vecchi De Amedeo F. , Lunghi Giovanna , Finazzi Silvia , Bisegna Sergio , Ponticelli Claudio
Published: February 2020

Background

A new genus in the family Flaviviridae has recently been discovered; it has provisionally been designated GBV-C/HGV. As determined by virologic techniques [reverse-transcription polymerase chain reaction (RT-PCR)], infection with GBV-C/HGV is frequent in renal transplant (RT) recipients and in patients on chronic hemodialysis (HD). The epidemiology of GBV-C/HGV infection in patients on peritoneal dialysis is scarce and mostly based on RT-PCR technology.

Purpose

We report on the prevalence (as detected by serologic and virologic techniques) and the risk factors for GBV-C/HGV infection in a cohort of patients on continuous ambulatory peritoneal dialysis (CAPD). We also tested a control group of blood donors.

Methods

Infection by GBV-C/HGV was assessed by serologic and virologic techniques. Cases of GBV-C/HGV viremia (GBV-C/HGV RNA) were detected by RT-PCR. Antibodies to the envelope protein of GBV-C/HGV (anti-E2 GBV-C/HGV antibody) were analyzed by serologic methods.

Results

We found a high frequency [17/85 (20%)] of GBV-C/HGV. The rates of GBV-C/HGV viremia and anti-E2 GBV-C/HGV positivity were 10.5% (9/85) and 10.5% (9/85) respectively. In most patients [17/18 (94%)], the presence of anti-E2 GBV-C/HGV antibody was associated with clearance of GBV-C/HGV from serum. No relationship was noted between anti-E2 GBV-C/HGV antibody (or GBV-C/HGV viremia) and age, sex, race, time on dialysis, anti-HCV antibody, HBsAg status, and anti-HIV positivity. The frequency of GBV-C/HGV infection in CAPD patients was much higher than that in blood donors, even if the difference did not approach statistical significance. No associations between GBV-C/HGV positivity and biochemical liver tests [aminotransferase and gamma glutamyl transpeptidase (GGT)] were apparent.

Conclusions

Infection by GBV-C/HGV as detected by RT-PCR and anti-E2 antibody was common in patients on CAPD and in controls alike. No association was seen between GBV-C/HGV and various demographic or clinical factors. The clinical significance of GBV-C/HGV in CAPD remains unclear. Larger investigations are in progress.
Malfunctioning Peritoneal Dialysis Catheter and Accompanying Surgical Pathology Repaired by Laparoscopic Surgery
Authors: Ögünç Güner
Published: February 2020

♦ Objectives

To review the laparoscopic salvaging of malfunctioning peritoneal dialysis (PD) catheters, and to present our experience with laparoscopic repair of dysfunctional Tenckhoff catheters and the treatment of accompanying surgical pathologies.

♦ Design

Malfunctioning peritoneal catheters were repaired using laparoscopic rescue techniques. Accompanying surgical problems were treated in the same operation. The effectiveness of these approaches was validated by comparison with other remedial techniques described previously.

♦ Patients

Malfunctioning PD catheters were salvaged by laparoscopic surgery in 8 patients, and accompanying surgical problems were treated in the same operation in 3 of the 8 patients.

♦ Main Outcome Measures

Outcome was measured by the successful return to adequate PD and effective treatment of surgical problems.

♦ Results

Eight patient studies show laparoscopic correction of malfunctioning catheters and the treatment of accompanying surgical pathologies with the return to successful PD.

♦ Conclusion

The salvaging of malfunctioning PD catheters by laparoscopic surgery is an ideal method. This procedure permits simultaneous identification and correction of other surgical problems that could otherwise complicate dialysis therapy.