bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Phosphatidylcholine on Lymphatic Absorption during Peritoneal Dialysis in the Rat
Authors: Mactier Robert A. , Khanna Ramesh , Twardowski Zbylut J. , Moore Harold , Nolph Karl D.
Published: February 2020

The mechanism whereby i.p. administration of phosphatidylcholine increases net ultrafiltration and solute clearances after long-dwell exchanges is not established. We performed 4-h exchanges in rats using 4.25% dextrose dialysis solution with and without the addition of 50 mgl L phosphatidylcholine. Net ultrafiltration was enhanced in the treated rats (p < 0.005) by a reduction in cumulative lymphatic absorption (p < 0.01) and without a concurrent increase in total net transcapillary ultrafiltration during the dwell time. Likewise, urea and phosphate clearances with i.p. phosphatidylcholine were enhanced mainly by the increase in the drain volume since serum to dialysate solute concentration ratios did not differ significantly between the treated and control rats. Thus, phosphatidylcholine increases net ultrafiltration and solute clearances in the rat by decreasing lymphatic absorption and without increasing transperitoneal transport of water and solutes into the peritoneal cavity. The uptake of the india ink by the lymphatics of rats who received dialysis exchanges without phosphatidylcholine and the lack of uptake in rats treated with phosphatidylcholine are supported by this observation. Reduction in lymphatic absorption with the addition of phosphatidylcholine to the infused dialysis solution offers an alternative means of enhancing the efficiency of long-dwell peritoneal dialysis.
Prevention of Postoperative Peritoneal Dialysis Catheter-Related Infections
Authors: Copley John B. , Smith Barbara J. , Koger Diana M. , Rodgers Darlene J. , Fowler Marie
Published: February 2020

Catheter-related infections represent a significant complicaton of peritoneal dialysis therapy for end-stage renal disease, and may even supplant peritonitis as the Achilles’ heel. While the true incidence of all types of postoperative catheter-placement infections is unknown, it is reported that approximately 10% of exit-site infections occur in the immediate postoperative period, prior to healing and the establishment of barriers to microorganism invasion. Generally, little attention is given to this fact, and there exists no standardized procedure for the care of the operative wound and exit site. We evaluated a postoperative catheter-care protocol in 111 consecutive catheter placements. Ninety-seven were placed surgically and 14 with a peritoneoscope. Emphasizing strict aseptic technique, catheter immobilization, and avoidance of contamination, we observed no early and only two late postoperative infections. Our patients were from two different medical centers and we did not attempt to control for exit-site location, type of catheter, or technique and location of placement. Prophylactic antibiotics were utilized in 88%. We believe that our protocol was responsible for our low postoperative infection rate.
Beta-2 Microglobulin in Patients on Peritoneal Dialysis and Hemodialysis
Authors: Scalamogna Antonio , Imbasciati' Enrico , De Vecchi Amedeo , Castelnovo Claudia , Pagliari' Bruno , De Cristofaro' Vincenzo , Ponticelli Claudio
Published: February 2020

Serum β2 microglobulin ( β2μ) levels were determined in 62 patients on chronic dialysis, divided according to the type of dialysis-cuprophane hemodialysis, chronic ambulatory peritoneal dialysis (CAPD), or CAPD staned after 76 ± 47 months on cuprophane hemodialysis-and to residual urine output greater than 400 mLlday or less than 10 mL/day. In addition, for patients on CAPD, peritoneal excretion, peritoneal clearance, and urinary excretion of the protein were determined. In anuric patients serum β2μ levels were significantly higher in HD than in CAPD. In patients with residual urine output, serum concentrations of the microprotein were similar in HD and in CAPD. Significant differences were observed in β2μ serum levels and peritoneal clearances in patients switched to CAPD from hemodialysis as compared to those staning with CAPD. Peritoneal clearances of the microprotein was slightly and non-significantly greater in patients with urine output than in anuric patients.
Peritoneal Surface-Active Material in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Ziegler Carol , Torchia Mark , Grahame Gordon R. , Ferguson Ian A.
Published: February 2020

Phospholipids have been demonstrated to be present in the peritoneal dialysis effluent of 34 patients on continuous ambulatory peritoneal dialysis (CAPD). The phospholipids present have been characterized by chromatography and their relative concentrations are fairly consistent from patient to patient. The predominant phospholipid is phosphatidylcholine (81%). Surface activity of this phospholipid has been demonstrated. The concentration of total phospholipid correlates with the time the patient had been on CAPD. It is lower in those patients who have been on dialysis longer.
Pharmacokinetics of Aztreonam Administered loP o in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Nikolaidis Paul , Dombros Nicholas , Alexiou Panagiotis , Balaskas Elias , Tourkantonis Achilles
Published: February 2020

The pharmacokinetics of Aztreonam (AZT) administered i.p. in six stable patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for end-stage renal disease (ESRD) were studied. One gram of AZT was added into a 2 L bag of dialysate (Medital-Bieffe®) just prior to infusion into the peritoneal cavity. The dwell time was 8 h. The serum maximum concentration of AZT was 42.5 ± 12.4 mg/L (x ± SD), achieved in 4.6 ± 1.0 h. The elimination half-life was 2.4 ± 0.8 h, almost equal to that found in normal subjects (1.7–2 h). The pharmacokinetic parameters of elimination, as elimination rate constant and clearance of AZT from peritoneal cavity were found 0.305 ± 0.101 h-1 and 10.05 ± 3.7 mL/min, respectively, while the bioavailability via the peritoneal mem brane was 90.8 ± 3.05% of administered dose.

It is concluded that AZT is eliminated from dialysate at a high rate after i.p. administration and its dialysate and serum levels exceed the MIC for the majority of sensitive organisms including Pseudomonas species. Aztreonam appears to be a potentially useful antibiotic for CAPD peritonitis.
Staphylococcus Aureus Nasal Carriage, Exit-Site Infection and Catheter Loss in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Davies S.J. , 099 C.S. , Cameron J.S. , Poston S. , Noble W.C.
Published: February 2020

Over a three-year period, 217 episodes of bacterial peritonitis occurred in 183 patient years. Thirty-seven episodes were due to Staphylococcus aureus and 19 (51 %) of these required removal of the catheter to eradicate infection. This compared with catheter loss in 4/63 (6.3%) coagulase negative staphylococci infections ( p < 0.001); 7/67 (9.5%) culture negative peritonitis ( p < 0.001); and 10/30 (33.3%) episodes due to gram-negative organisms ( p < 0.05). Over half (51.3%) the episodes due to S. aureus were associated with exit-site infections, and this rose to 100% (10/10) with recurrent peritonitis ( p < 0.01).

A prospective analysis of nasal carriage and exit-site infections due to S. aureus was carried out in 87 patients. Exit-site infections were present in 21 (24%), almost entirely due to different strains as judged by sensitivity patterns and phage typing. Nasal carriage, defined as two positive swabs within the study period, was present in 20 (23%) patients. Fourteen (70%) of these had exit site infections due to the same strain as that isolated from the nose, whereas no patient grew different strains from either site. Nasal carriage increased the risk of infection sixfold ( p < 0.001).
Tenckhoff Catheter Replacement or Intraperitoneal Urokinase: A Randomised Trial in the Management of Recurrent Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis
Authors: Williams Anthony J. , Boletis Loannis , Johnson Brian F. , Raftery Andrew T. , Cohen Geoffrey L. , Moorhead Peter J. , Nahas A. Meguid El , Brown Colin B.
Published: February 2020

A randomised trial, comparing Tenckhoff catheter replacement as a one-stage procedure and i.p. urokinase, was undertaken in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. In addition to appropriate i.p. antibiotic treatment, 17 patients received i.p. urokinase (5000 i.u.) on the second and fourth days of antibiotic treatment, and 14 patients underwent CAPD catheter replacement. An additional six patients also underwent catheter replacement following the recurrence of peritonitis after urokinase treatment. The subsequent recurrence rate of peritonitis following CAPD catheter replacement (5%) was significantly less than after urokinase (41%) ( p < 0.001). Fourteen patients remained free of peritonitis for at least three months after catheter replacement, and five patients were peritonitis-free following urokinase for this period.
Splenic Abscess and Peritonitis in a Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient
Authors: Blake Peter , Abraham Georgi , Bargman Joanne , Vas Stephen , Mathews Raymond , Haberstroh Bernard , Oreopoulos Dimitrios G.
Published: February 2020

A 26-year-old female was on continuous ambulatory peritoneal dialysis (CAPD) because of diabetic endstage renal failure. She developed an acute peritonitis that relapsed repeatedly despite appropriate antibiotic treatment. Investigations showed the presence of a splenic abscess, and splenectomy and peritoneal cannula removal were required. The patient died of myocardial infarction two weeks postoperatively.

This is the first recorded case of peritonitis secondary to splenic abscess in a CAPD patient. Autopsy findings suggest that the abscess developed from infection of a splenic infarct.
Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Park Min Sun , Lee Jean , Lee Moon Sung , Baick Seung Ho , Hwang Seung Duk , Lee Hi Bahl
Published: February 2020

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month).

There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients.

The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.
Analysis of Factors in the Prognosis of Diabetics on Continuous Ambulatory Peritoneal Dialysis (CAPO): Long Term Experience
Authors: Coronel Francisco , Hortal Luis , Naranjo Pablo , Pozo Carlos , Torrente Jaime , Prats Dolores , Barrientos Alberto
Published: February 2020

After five years of treating diabetics by continuous ambulatory peritoneal dialysis (CAPD), we analyzed the factors involved in prognosis. Forty-one patients were included in the study, with a cumulative experience of 784 months. Good control of blood glucose was obtained with intraperitoneal (i.p.) insulin and the blood pressure was controlled in 87% of patients without medication, which probably favored the stabilization of visual acuity in 60% of 15 patients evaluated after two years. The follow-up of patients was longer in those who began CAPD with a higher residual creatinine clearance. In spite of the large number of patients who were blind or had very poor vision, 83% of all patients were self-sufficient and well-trained for CAPD, and 39% were able to work full time. The incidence of peritonitis declined to 1 episode per 17.5 patient months associated with the introduction of new preventive measures. Patients over 50 years old had the highest mortality rate and myocardial infarction was the main cause of death. Patient survival at 6, 12, 24, 36, and 42 months was 100, 90, 80, 62, and 62%, respectively.

Age and cardiac problems are important factors in survival. Self-sufficiency, rehabilitation, and low incidence of peritonitis are also important factors in the life quality of diabetic patients on CAPD.
Pentoxifylline Does Not Influence Maximum Ultrafiltration Rates and Peritoneal Transport in Rats
Authors: Nolph K.D. , Moore H.L. , Khanna R. , Twardowski Z.J.
Published: February 2020

Previous publications have suggested that peritoneal capillary blood flow and filtration pressure equilibrium may limit ultrafiltration rates with very hypertonic exchanges. Rats were treated with pentoxifylline, which decreases blood viscosity by increasing red blood cell deformability. Decreases in blood viscosity should reduce microcirculatory resistance and increase effective capillary flow. Transport studies were performed after 2, 4, and 8 weeks of therapy with peritoneal dialysis solutions containing 15 grams % dextrose and using 30-min cycles. Even though rats ingested near the maximum recommended dose of pentoxifylline (20 mg/kg) significant changes in blood viscosity and shear stress were not detected compared to controls. Also, there were no significant differences in clearances of urea and phosphorus, glucose absorption, protein losses, and net ultrafiltration compared to controls.
In Vitro Study of the Flush Effect in Two Reusable Continuous Ambulatory Peritoneal Dialysis (CAPD) Disconnect Systems
Authors: Luzar Mary Anne , Slingeneyer Alain , Cantaluppi Alberto , Peluso Francesco P.
Published: February 2020

Previously published in vitro results, confirmed by clinical studies, indicate that the use of a flush significantly reduces peritonitis in single-use and reusable continuous ambulatory peritoneal dialysis (CAPD) systems. Since reusable systems may use the flush plus inline disinfectant between exchanges, the question remains as to whether or not the flush could be used alone in all disconnect systems. Using an in vitro model, we evaluated the flush in two reusable disconnect systems that use both flush and disinfectant in vivo. In a series of twenty sets per organism per incubation (0 h and 10 h), Y sets were inoculated in the lumen with three pure cultures (103 CFU range). Ability of flush without disinfectant to clear sets of contamination was analyzed by collecting multiple samples at each step of the procedure, enriching with tryptone broth and verifying bacterial growth. When contaminated sets were not incubated, flush efficacy of the systems was consistent with previous data showing 100% removal of Staphylococcus epidermidis, but only partial elimination of Staphylococcus aureus and Pseudomonas aeruginosa. After incubation, simulating reusable systems, the flush was able to eliminate S. epidermidis less than 50% of the time. There was no significant difference in results between the two systems tested. Reusable systems allow more contact time between bacteria and plastic resulting in reduced flush efficacy suggesting that, for safest conditions, they should be used with inline disinfectants.
Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): Diagnostic Findings, Therapeutic Outcome and Complications
Authors: Tranæus Anders , Heimbürger Olof , Lindholm Bengt
Published: February 2020

The analysis of all episodes of peritonitis occurring in a uniformly treated continuous ambulatory peritoneal dial ysis (CAPD) population ( N = 128) at one centre during a six-year period showed the following major findings. The initial white cell count (WCC) of the dialysate was <100 .106/L in 10% of the episodes and showed a predominance of mononuclear cells in 15%. The Gram stain results were consistent with the findings of the culture in 28% of the episodes and influenced the initial therapy in only 7% of the cases. Between 9% and 31% of all episodes would not have been classified as peritonitis if positive culture, a WCC of >100 .106/L in the dialysate, or clinical symptoms had been required for the diagnosis. The proportion of negative dialysate cultures was 2% after the introduction of pre-culture membrane filtration. Tunnel infection as a cause of peritonitis was more frequent in episodes due to Staphylococcus aureus than in episodes due to coagulase-negative staphylococci (p = 0.009). Peritonitis caused by coagulase negative staphylococci were followed by a milder course than other organisms (p = 0.02). Of all episodes initially treated with cephradine only 62% were cured with this antibiotic (or cloxacillin) and 35% were followed by recurrency, protracted course or catheter loss, despite intermediate or full in vitro susceptibility. In only 53% of all episodes no complication was observed. Complications were more frequent in women and diabetics than in men (p = 0.01) and non-diabetics (p = 0.03), and were more common in episodes with clinical symptoms (p = 0.02). Peritonitis resulted in drop-out from CAPD in 6% of all episodes. Hospital care was needed in 68% of all episodes. We conclude that turbidity can be used as the sole criterion for the initial diagnosis of peritonitis, and that a first generation cephalosporin should not be used as a first line antibiotic in the treatment of CAPD peritonitis.
Cytotoxic Effects of Commercial Continuous Ambulatory Peritoneal Dialysis (CAPD) Fluids and of Bacterial Exoproducts on Human Mesothelial Cells in Vitro
Authors: Van Bronswijk Hans , Verbrugh Henri A. , Bos Harry J. , Heezius Eric C. J. M. , Oe P. Liem , Van Der Meulen Jan , Verhoef Jan
Published: February 2020

Cultured human mesothelial cells were exposed to peritoneal dialysis fluids, supernatants from cultures of Staphylococcus aureus and S. epidermidis, and antibiotics. Mesothelial cell monolayer cultures were derived from surgically removed omentum. The cytotoxicity of various agents for the cultured mesothelial cells was measured by a 51 Cr-release assay. All brands of fresh peritoneal dialysis fluids induced a more than 50% 51 Cr-release after 18 h. Morphological changes observed included retraction and shrinking of cells, pyknosis of the nuclei and, finally, detachment of cells over an 18-h period. Neutralization of the acid (pH 5.2–5.5) fluids to pH 7.3 did not abolish the cytotoxicity. In contrast, effluent dialysis fluids were not toxic for mesothelial cells; neither was acid (pH 5.5) culture medium nor culture medium with glucose up to 2%. However, higher glucose concentrations induced increasing 51 Cr-release. Furthermore, filter-sterilized supernatants of S. aureus were cytotoxic for mesothelial cell monolayers in 4/7 (57%) strains of S. aureus tested. In contrast, only 4/29 (14%) strains of S. epidermidis produced cytotoxic exoproducts (p = 0.03). Antibiotics were not found to be cytotoxic, with the possible exception of erythromycin.

We conclude that currently available peritoneal dialysis fluids are cytotoxic for mesothelial cells in vitro and that during episodes of peritonitis exoproducts of some bacterial strains may further reduce mesothelial cell viability.
Comparison of Peritonitis Rates during Long Term Use of Standard Spike versus Ultraset in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Burkart John M. , Hylander Britta , Durnell-Figel Theresa , Roberts Denise
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) is an increasingly popular means of end-stage renal disease replacement therapy. Unfortunately, peritonitis continues to be a major source of both morbidity and mortality. The Ultraset incorporates a “flush-before-fill” concept which should theoretically decrease peritonitis rates when compared to the standard spike procedure, while allowing patients the convenience of disconnect. To investigate the impact of long-term use of the Ultraset on peritonitis rates, we conducted the following study.

We prospectively compared 21 new CAPD patients using the standard spike to 20 new CAPD patients using the Ultraset. Peritonitis episodes, episodes of exit -site infection, and the association of peritonitis with exit-site infection were monitored. Peritonitis rates were 7.57 months/episode for the group using the standard spike vs. 27.79 months/episode in the group using the Ultraset. Exit-site infection rates were 22.21 months/infection with the standard spike vs. 37.05 months/infection with the Ultraset. Using Kaplan-Meier plots, there was a statistically significant difference in the estimated time to the first episode of peritonitis, but there was no statistically significant difference regarding the risk of exit-site infections.
Peritonitis-Related Deaths in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Digenis George E. , Abraham Georgi , Savin Eugene , Blake Peter , Dombros Nicholas , Sombolos Kostas , Vas Stephen , Mathews Raymond , Oreopoulos D. G.
Published: February 2020

A total of 636 episodes of peritonitis occurred in 440 patients who entered our continuous ambulatory peritoneal dialysis (CAPD) program from September 1977 to February 1988. Sixteen patients (8 male and 8 female, aged 37–77 years) died during an episode of peritonitis (fatality rate 2.5%). They had been on CAPD for 3 to 105 (average 39) months. Six of them were diabetics. The peritonitis rate among these 16 patients were 1 episode per 12 patient months, while the corresponding figure for the whole (440) CAPD population was 14 patient months. Risk factors present in the 16 patients were: cardiovascular disease (12), cerebrovascular accident (2) peripheral artery disease (1) and pulmonary fibrosis (1). Fever and leukocytosis were present on admission in 11 patients, while total serum proteins and albumin were significantly lower (p < 0.001) than the corresponding values before peritonitis (56 ± 8 vs. 65 ± 5). Staph. aureus was isolated in 8 patients (50%), multiple organisms in 6, Pseudomonas and Candida albicans in 1 each. An abdominal abscess was found in 4 (25%) patients. The peritoneal catheter was removed between the 5th and 10th day in 6 and after the 10th day in 7 patients. Peritonitis with sepsis was the cause of death in 13 patients. Contributing factors were cardiovascular accident in 9, uremic coma in 2, extensive GI bleeding in 2, GI performation in 2, intestinal infarction in 1, and pneumonia in 2 patients.

We conclude that the risk of peritonitis-related death in CAPD patients is increased with Staph. aureus or multibacterial peritonitis. Contributing factors are concomitant cardiovascular disease and delayed (>5 days) catheter removal.
Absence of Leakage by Insertion of Peritoneal Dialysis Catheter through the Rectus Muscle
Authors: Stegmayr Bernd , Hedberg Bengt , Sandzen Birger , Wikdahl Ann Marie
Published: February 2020

To reduce leakage of peritoneal dialysis fluid, insertion of a 2-cuff Tenckhoff catheter (TeC) was performed under local anaesthesia by a lateral approach on 30 occasions in 26 patients. Incision was 3 cm laterally of the linea alba. The inner cuff of the TeC was fixed by a purse-string suture of the peritoneal membrane on the abdominal side of the cuff and another purse-string suture, of the inner fascial blade, around the distal end of the cuff. A third purse-string suture was placed around the TeC at the exit through the outer fascial blade. A subcutaneus tunnel completed the insertion. In all patients, dialysis was started immediately after TeC insertion. The median treatment time was 6.5 months (range 3 days-15 months). No leakage developed in any patient and no hernia was created from this approach. Peritonitis was treated on 8 occasions over a period of 163 months.

We conclude that the technique is simple, enables immediate start of dialysis with low risk for leakage.
Pathophysiology of Ultrafiltration in Peritoneal Dialysis
Authors: Ronco Claudio , Feriani Mariano , Chiaramonte Stefano , Brendolan Alessandra , Bragantini Luisa , Conz Piero , Dell'Aquila Roberto , Milan Massimo , La Greca Giuseppe
Published: February 2020

Pathophysiology of peritoneal ultrafiltration is analyzed in the present study. Peritoneal equilibration test is the easiest procedure to study in detail the possible causes of failure to control the ultrafiltration rate in patients undergoing peritoneal dialysis. Membrane failure, reduction in peritoneal blood flow, excessive lymphatic reabsorption catheter malposition, and fluid sequestration are the most common causes of ultrafiltration loss. Pharmacologic manipulation of peritoneal membrane, correction of mechanical inconvenients, reduction in peritonitis rate and in the level of immunostimulation of the mesotelial macrophages, together with a careful policy in terms of glucose concentration in the dialysate and dwell times may contribute not only to treat different forms of ultrafiltration loss but also to prevent their incidence.
Peritoneal Defence Mechanisms and Staphylococcus Aureus in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Davies Simon J. , Yewdall Virginia M. A. , Ogg Chisholm S. , Cameron J. Stewart
Published: February 2020

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to S. aureus is associated with an adverse clinical outcome, suggesting impaired clearance of this organism by the host. The ability of peritoneal macrophages (PMO) derived from CAPD patients to take up S. aureus and mount a respiratory burst was investigated. Whilst significant activity was observed in the absence of opsonin, both parameters of phagocytosis were augmented by addition of 20% pooled human serum (PHS), complement-depleted PHS, and fibronectin. When used as sole opsonin, fibronectin resulted in a dose-related increase in chemiluminescent response by both blood neutrophils and PMO.

The opsonic activity of dialysis effluent, as judged by neutrophil chemiluminescence, correlated with IgG and fibronectin content, but not with complement as assessed by C3 levels. The addition of urokinase to dialysate improved its opsonic properties whilst having no effect on the activity of PHS-20%; this would suggest that the formation of fibrin in dialysate, promoted by S. aureus, interferes with phagocytosis. This and the low IgG, complement and fibronectin levels in dialysate may explain in part the relatively poor clearance of this organism from the peritoneum.
Indirect Measurement of Lymphatic Absorption with Inulin in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Struijk Dirk G. , Krediet Raymond T. , Koomen Gerardus C. M. , Boeschoten Elisabeth W. , Vd Reijden Hendrik J. , Arisz Lambertus
Published: February 2020

To elucidate the importance of possible trapping of macromolecules in peritoneal tissue on the calculation of peritoneal lymphatic drainage, we compared the transport of inulin administered i.v. and i.p. in nine continuous ambulatory peritoneal dialysis (CAPD) patients on two separate days. In the intraperitoneal study inulin (5 g) was added to the dialysate and in the intravenous study inulin (5 g) was given i.v. 3 h before the test. No differences were found in the mass transfer area coefficients (MTC) of urea, creatinine, and glucose between the two tests. The MTC after inulin i.p. was 3.2 ± 0.7 mLlmin (mean ± SD) and after inulin i.v. 1.8 ± 0.5 (p < 10-5). As the difference in transport kinetics between i.v. and i.p. administration is likely to be caused by lymphatic absorption, a mean lymphatic flow of 1.4 mLlmin could be calculated. This value corresponds to the data obtained with macromolecules. Our results therefore favor the hypothesis that no local accumulation of macromolecules in the peritoneal tissues takes place and that their disappearance from the peritoneal cavity represents lymphatic absorption.
The Disappearance of Macromolecules from the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis (CAPD) is Not Dependent on Molecular Size
Authors: Krediet Raymond T. , Struijk Dirk G. , Koomen Gerardus C. M. , Hoek Fransiscus J. , Arisz Lambertus
Published: February 2020

The transport of macromolecules from the circulation to the peritoneal cavity is a size-selective restricted process, while the transport of these solutes from the peritoneal cavity is probably mainly by lymphatic absorption. If so, it should be independent of molecular size. Therefore, we studied with a clearance technique the disappearance of intra peritoneally administered inulin and polydisperse dextran 70 in nine continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results with the simultaneously measured appearance clearance of serum proteins. Using gel permeation chromatography 18 dextran fractions with different molecular radii could be analyzed. Inulin clearance (2.94 mL/min) was higher than total dextran clearance (1.30 mL/min). The maximal dextran concentration in all dialysate samples was found in the 50.4 Å fraction. The clearances of the dextran fractions were the same for different molecular sizes. All disappearance clearances were higher than the appearance clearances: the protein/dextran clearance ratio ranged from 0.15 for albumin/36 Å to 0.04 for alpha2-macroglobulin/91 Å. This confirms that the appearance of a macromolecule, but not its disappearance is dependent on molecular size. It is concluded that the disappearance of macromolecules from the peritoneal cavity is mainly a size independent convective process, possibly by lymphatic uptake. This implies that total dextran 70 clearance can be used for measurement of lymphatic absorption in CAPD patients.
Stability of Cotrimoxazole in Peritoneal Dialysis Fluid
Authors: Holmes Sandra E. , Aldous Stephen
Published: February 2020

This study examines the stability of both components of the antibacterial combination, cotrimoxazole (trimethoprim and sulphamethoxazole) in peritoneal dialysis fluid stored in polyvinyl chloride bags and glass ampoules at room temperature for up to nine days.

Greater than 10% loss of trimethoprim occurred within three days for admixtures stored in plastic bags, whereas the original concentration remained virtually unchanged after nine days for similar solutions stored in glass ampoules. This indicated that the loss of trimethoprim observed in solutions stored in plastic bags was associated primarily with the nature of the container, presumably due to some form of uptake by or loss through the plastic.

Greater than 10% loss of sulphamethoxazole occurred within two days for all admixtures examined, stored in either glass or plastic containers. This degree of loss was achieved within 12 h for one admixture stored in plastic. There was also the time-dependent appearance of an additional peak in HPLC analyses of these solutions, indicating that loss of sulphamethoxazole was due to chemical decomposition of the drug in the peritoneal dialysis fluid. The shelf-life of such admixtures would be limited by the stability of the sulphamethoxazole component, with the available data suggesting a shelf-life of 12 h for solutions stored at room temperature.
Tidal Peritoneal Dialysis with Racemic or L-Lactate Solutions
Authors: Nolph Karl D. , Twardowski Zbylut J. , Khanna Ramesh , Prowant Barbara F. , Ponferrada Leonor P. , Schmidt Lois M. , Moore Harold L.
Published: February 2020

To see if rapid lactate absorption on tidal peritoneal dialysis (TPD) would overwhelm D-Iactate metabolism using racemic lactate andlor L-Iactate metabolism using all L-Iactate, five patients underwent a- h TPD treatments with racemic lactate solution one day and with L-Iactate another. Lactate concentrations (total) were 40 mmolelL, flow rates 27.3 LIB h, tidal and reservoir volumes each 1.5L, tidal cycles 24–26 min, and net ultrafiltration per tidal cycle 70 to 99 mL. Results: Mean absorptions of D and L-Iactate were 24.2 and 25.1%, respectively, compared to glucose at 14.6%. Urea clearances averaged 21.4 mLlmin. Mean blood D-Iactates at baseline were 0.6 ± 0.5 SD mmolelL and after a h of TPD were 0.6 ± 0.4 and 0.7 ± 0.3 using L-Iactate and racemic solutions, respectively; similar values for L-Iactate were 1.2 ± 0.3 at baseline and 1.2 ± 0.3 and 1.2 ± 0.5 after a h with L-Iactate and racemic solutions. d blood pH values were + 0.02 ± 0.01 and + 0.04 ± 0.03, while d bicarbonate values were + 1.7 ± 0.9 and + 0.7 ± 1.0 for the all L and racemic studies, respectively. The total mmoles of L-Iactate absorbed per a h of TPD with all L solution (>300 mmoles) are greater than ever reported for peritoneal dialysis, but did not increase blood lactate levels. It would seem that either type of solution is suitable for TPD. Absorptions and metabolic rates are similar for L-Lactate and D-Lactate.
Ampicillin and Sulbactam Pharmacokinetics and Pharmacodynamics in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Blackwell Brad G. , Leggett James E. , Johnson Curtis A. , Zimmerman Stephen W. , Craig William A.
Published: February 2020

The fixed combination antibiotic ampicillin/sulbactam may provide a new, safe, and effective method of treating dialysis-related bacterial peritonitis. The pharmacokinetics of this antibiotic combination were determined in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The pharmacodynamic activity of this drug was also determined by use of mean bactericidal titers against selected bacterial strains.

Six noninfected CAPD patients in a randomized twoway crossover study were given a fixed dose of ampicillin (2 gm) and sulbactam (1 gm) either intravenously or intra peritoneally. The mean peak ampicillin and sulbactam serum concentrations following intravenous dosing were 170.3 and 87.5 μg/mL, respectively. The mean peak serum concentrations of ampicillin and sulbactam following intraperitoneal dosing were 48.0 an d 27.8 μg/mL, respectively. Absolute bioavailabilities of the intraperitoneal ampicillin and sulbactam doses were 60% and 68%. Both drugs exhibited similar distribution and elimination characteristics. Renal failure markedly reduced drug elimination.

Intraperitoneal administration of ampicillin/sulbactam provided satisfactory inhibitory and bactericidal antibiotic titers for most organisms in dialysate at 6 h but not 24 h. Ampicillin/sulbactam (2 gm/1 gm) should be administered every 12 h to patients with peritoneal dialysis-related peritonitis.
An Outpatient Maneuver to Treat Bloody Effluent during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Goodkin David A. , Benning Mary G.
Published: February 2020

Asymptomatic episodes of grossly bloody effluent during continuous ambulatory peritoneal dialysis (CAPD) can be treated by following a simple therapeutic maneuver. The patient performs one to three rapid exchanges using unwarmed (room temperature), 1.5% dextrose containing dialysate. No dwell time is employed. This treatment proves successful in a variety of clinical settings, and no adverse effects have been noted. Infusion of unwarmed dialysate likely induces peritoneal vasoconstriction and thus favors hemostasis. Bleeding of nonperitoneal etiology, such as renal cyst hemorrhage or retrograde menstruation, proves resistant.
Pharmacologic Modification of Transperitoneal Movement of Water
Authors: Grzegorzewska Alicja E.
Published: February 2020

Investigations concerning the influence of pharmacologic agents on transperitoneal water movement are predominantly undertaken in the hope that their results can help in a restoration of net ultrafiltration (UF) volume toward normal in cases with declining UF during long-term dialysis treatment. Net UF volume represents the difference between net transcapillary UF and lymphatic absorption.

The choice of a pharmacological agent for enhancing UF depends on the mechanisms responsible for net UF loss, which include: (a) early dissipation of the transperitoneal osmotic gradient; (b) decrease in the peritoneal surface area; (c) Iymphomonokine overproduction; (d) enhanced lymphatic absorption; (e) high residual volumes left in the peritoneal cavity; or (f) a combination of these factors. Leakage of dialysate to the abdominal wall sometimes occurring in peritoneally dialysed patients (1), according to a definition of net UF volume, cannot be regarded as a true UF loss.
Leukocytes in Peritoneal Dialysis Effluents
Authors: Antonsen Steen , Pedersen Fritz B. , Wang Palle ,   The Danish Study Group on Peritonitis in Dialysis (DASPID)
Published: February 2020

The concentration of leukocytes and the fraction of neutrophil granulocytes are two important criteria in the diagnosis of peritonitis in continuous ambulatory peritoneal dialysis (CAPD). We have found that leukocytes are unstable in dialysis effluents, resulting in false low leukocyte concentrations if not counted immediately. At 25°C the leukocyte count decreases 25%–30% in 4–6 hours. Sampling in tubes containing EDTA and storage at 4°C make the leukocyte concentration stable for 6 hours, while the combination of EDT A and storage at 4°C ensures stability for 24 hours. When samples are handled accordingly, concentrations as high as 2 × 108/L are observed without any clinical signs of peritonitis, especially within the first months of CAPD-treatment. Thus, we suggest a leukocyte-concentration of 2 × 1 08/L as the diagnostic limit for peritonitis. Concerning fraction of neutrophils a diagnostic limit of 0.50 still seems relevant.
Effect of Short-Term Essential Amino Acid-Containing Dialysate in Young Children on CAPD
Authors: Honda Masataka , Kamiyama Yasunori , Hasegawa Osamu , Hoshinaga Kiyotaka , Ogawa Osamu , Kawamura Takeshi , Ito Hiroshi
Published: February 2020

In young children on CAPD, hypoproteinemia and malnutrition are often observed. We used essential amino acid-containing dialysate (EMD) to assess short-term effectiveness on serum amino acid concentrations in young children undergoing CAPD. EMD consisted of a 540 ml, 1.5% glucose-containing dialysate and 100 ml of 7.4% essential amino acid (EM) solution. Aside from methionine, all serum EM rose during the 6 hour peritoneal dialysis cycle using EMD, peaking at about 200% of pre-treatment level one hour after start of treatment. They then returned to near pre-treatment levels at the end of the cycle. However, serum methionine increased 680% of pre-treatment level, one hour after start and 390% at the end of the cycle. In the serum non-EM tyrosine, which showed low levels in patients with chronic renal failure, increased after EMD treatment. Other non-EM, most of which showed increased levels in patients with chronic renal failure, decreased after EMD treatment. These changes in serum amino acids suggest that EM, absorbed from EMD, may have increased uptake of non-EM in protein synthesis. This may improve the nutritional status of young children on CAPD.
A Multicenter, Selection-Adjusted Comparison of Patient and Technique Survivals on CAPD and Hemodialysis
Authors: Maiorca Rosario , Vonesh Edward F. , Cavalli PierLuigi , De Vecchi Amedeo , Giangrande Alberto , La Greca Giuseppe , Scarpioni Lino L. , Bragantini Luisa , Cancarini Giovanni C. , Cantaluppi Alberto , Castelnovo Claudia , Castiglioni Alessandro , Poisetti PierGiorgio , Viglino Giusto
Published: February 2020

Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovasculardisease, peripheral vasculardisease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.
Comparative Study between Intact PTH and Fragments of PTH in Patients on Hemodialysis and CAPD
Authors: Martinez Maria , Ausejo Monica , Miguel J. Luis , Gonzalez M. Luisa , Balaguer Gloria , Catalan Pilar , Selgas Rafael
Published: February 2020

Twenty-nine patients on hemodialysis (HO) and 29 patients on continuous ambulatory peritoneal dialysis (CAPO) were studied. Serum calcium and phosphorous levels were similar in the 2 groups. Serum parathyroid hormone (PTH) levels were determined by 4 different methods. Mid-molecule PTH levels were higher in HO (1099.5±876.8 pmol/L) than in CAPO patients (541.0±138.8 pmol/L), p<0.001, while intact PTH levels were similar. The ratio MM-PTHllntact PTH was higher in HO (55.2±29.0) than in CAPO patients (39.0±20.0), where p<0.01. In patients with similar C-PTH, those on CAPO had higher levels of intact PTH (46.0±27.0 pmollL) than those in HO (29.3±29.0 pmoIIL), p<0.01. The ratio C-PTHlintact PTH was higher in HO (104.9±39.6) than in CAPO patients (59.3±32.3), p<0.001. The Peritoneal Saturation Index (PSI) of MMPTH was 23.4±12%, and it showed a hyperbolic correlation in respect to MM-PTH serum levels. We concluded that CAPO can modify the plasma C-PTH and MM-PTH serum levels by peritoneallosses of these fragments.
Factors Affecting Lymphatic Absorption in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Chan Patricia C.K. , Wu P.G. , Tam Sidney C.F. , Ip Mary S.M. , Fang G.X. , Cheng Ignatius K.P.
Published: February 2020

The pathways and physiology of lymph absorption (LA) from the peritoneal cavity are well documented; however, much uncertainty still exists as to the various clinical and demographic factors affecting LA. We studied LA measured by the albumin instillation method, in adult Chinese CAPD patients, and showed that it was independent of age, sex, body surface area, duration of dialysis, intrinsic renal disease, use of intraperitoneal drugs (heparin/antibiotics/deferroxamine) and frequency of past bacterial peritonitis. High lymph absorbers had a relatively highertranscapillary cumulative ultrafiltration than low lymph absorbers. An enhanced LA was associated with a high initial intraperitoneal volume. Assessment of diaphragmatic strength by the decrement in vital capacity on changing from an erect to a supine position failed to distinguish patients with high and low LA.
Strategies for Improving Dialysis Decision Making
Authors: Campbell Anne
Published: February 2020

It is important that every professional involved with guiding ESRD patients through the maze of dialysis decision making critically analyze his or her own behaviors, possible biases and thought processes influencing discussions with patients. Health care professionals need to continue to strive to improve their skills for assuring optimal assistance to their patients in making decisions about the best types of treatments for them. In this era of evermore challenging patients and technologies, the skills for informing patients and assisting them with effective decision making about issues such as medical management, dialysis, transplantation or treatment termination are vita! for assuring quality care.
Treatment of Pseudomonas Infections in Peritoneal Dialysis Patients
Authors: Taber Tim E. , Hegeman Theodore F. , York Susan M. , Kinney Raynel A. , Webb Douglas H.
Published: February 2020

Pseudomonas species infections in the peritoneal dialysis population consist primarily of peritonitis or exit site infections. These organisms have traditionally proven difficult to eradicate, and the standard antibiotic regimen has carried the potential for nephrotoxicity.

At our institution, all peritoneal dialysis patients with Pseudomonas exit site infections or peritonitis were treated with an antibiotic combination of intraperitoneal ceftazidime and oral ciprofloxacin. Treatment duration was dependent upon the site of infection. Recurrent exit site infections were treated with a repeated course of the antibiotics, and with surgical debridement and subsequent shaving of the external cuff of double-cuffed catheters.

We saw a total of 11 Pseudomonas aeruginosa exit site infections in 7 patients (4 recurrent). Patients with recurrent infections were subsequently cured with the regimen as outlined above. Of 7 patients with Pseudomonas species peritonitis (aeruginosa, fluorescens, stutszeri, and maltophilia), 5 were cured with the initial antibiotic regimen. The 2 failures were both infected with Pseudomonas maltophilia, which is consistent with observed organism sensitivity data.

The combination of ceftazidime and ciprofloxacin with the option for surgical debridement of the external cuff (in exit site infections) appears effective in the treatment of Pseudomonas species infections in the peritoneal dialysis population. Sensitivity data should be used to adjust the antibiotic regimen when appropriate.
Peritoneal Catheter Tip Location during Non-Complicated Continuous Ambulatory Peritoneal Dialysis
Authors: Joffe Preben , Christensen Anne-Lise , Jensen Carl
Published: February 2020

In the present study, we evaluated the relationship between 1. the volume and rate of dialysis outflow and subsequent inflow, 2. the patient's impression of the location of the catheter tip and 3. the stability of the catheter tip location. Thirteen patients were studied on 2 random occasions (periods 1 and 2). Inflow (L/min) was significantly faster than outflow (p<0.05). No catheter tips were located in the far upper part of the abdomen. Outflow with the catheter tip located in the middle part of the abdomen was significantly lower than with the tip located in the inferior quadrants (p<0.02). Two patients were able to feel the catheter tip at Period 1, and 4 at Period 2, but only 1 patient was able to state the exact location identical to fluoroscopy. Ninety-two percent of the fluoroscopic evaluations showed catheter tips located in the same anatomical regions in upright as well as supine positions. If vertical “neighbour” anatomical regions were included in the evaluation of the catheter tip migrations, all catheter tips were located at the same or the vertical “neighbour” region in the 2 study periods.
Initiatives in Peritoneal Dialysis: Where Do We Go from Here?
Authors: Finkelstein Fredric a. , Sorkin Michael , Cramton Christina W. , Nolph Karl
Published: February 2020

In 1989, a conference was held to discuss the current status of technique survival for patients treated with continuous ambulatory peritoneal dialysis (CAPO). Major reasons for patient drop -out from CAPO -peritonitis, inadequate dialysis, catheter-related problems and psychosocial factors -were reviewed, as were constructive techniques for dealing with these problems and areas for future investigation.