bluuebunny/crossref_metadata_2025 huggingface dataset:
Red Blood Cell Susceptibility to Lipid Peroxidation, Membrane Lipid Composition, and Antioxidant Enzymes in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Girelli Domenico , Lupo Antonio , Trevisan Maria Teresa , Olivieri Oliviero , Bernich Patrizia , Zorzan Paola , Bassi Antonella , Stanzial Anna Maria , Ferrari Silvana , Corrocher Roberto
Published: February 2020

Objective

To investigate the overall susceptibility of red blood cells (RBC) to lipid peroxidation from patients on continuous ambulatory peritoneal dialysis (CAPD).

Methods

The following parameters were measured: RBC malondialdehyde (MDA) production after oxidative stress with H2O2, RBC antioxidant enzymes glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), and RBC membrane lipid composition. The levels of plasma vitamin E and serum selenium were also as sayed.

Patients

Eleven patients on continuous ambulatory peritoneal dialysis. Twenty-one healthy blood donors of similar age were used as normal controls.

Results

The MDA formation after H2O2 stimulation was normal in CAPD patients (0.79±0.1 μmol/gHb versus 0.78±0.1 in the control group). RBC from CAPD patients also showed a normal SOD activity, a more than adequate vitamin E status, and a peculiar pattern of membrane lipids, with reduced polyunsaturated fatty acids (p<0.001) and increased monounsaturated fatty acids (p<0.001). Both RBC GSH-Px activity, a selenium-dependent enzyme, and serum selenium levels were significantly lower in CAPD patients, and a significant positive correlation (r=0.68; p<0.02) between the two parameters was found.

Conclusions

This study found a normal sensitivity to oxidant stress in RBC from a group of CAPD patients, despite an impaired GSH-Px activity. The peculiar lipid pattern of RBC membrane, characterized by reduced PUFA and increased MUFA content, may contribute, in addition to adequate SOD activity and vitamin E status, to normal RBC lipid peroxidation.
Streptococcus Peritonitis with Urticaria
Authors: Edward Angela , Nolph Karl
Published: February 2020

Peritonitis following urticaria on two occasions in a 46-year-old white female treated with CAPD for nine years is reported. On both occasions an episode of urticaria and pruritis occurred 24 hr before the dialysate became cloudy, and the patient experienced abdominal pain, nausea, and vomiting. The culture of the peritoneal dialysis effluent grew gamma Streptococcus with the first episode. To our knowledge this is the first report of CAPD peritonitis preceded by urticaria where the skin findings were most likely related to the peritoneal infection.
Randomized Study of Peritonitis with Conventional versus O-Set Techniques in Continuous Ambulatory Peritoneal Dialysis
Authors: Owen Julie E. , Walker Rowan G. , Lemon Jeannie , Brett Liliana , Mitrou Danielle , Becker Gavin J.
Published: February 2020

We performed a prospective randomized trial, comparing the incidence of peritonitis between a flushdisconnect (O-System, Baxter, Deerfield, IL) (OS) and a conventional (System II, Baxter) (CS) continuous ambulatory peritoneal dialysis (CAPD) method.

Sixty consenting patients with no significant physical disabilities who commenced CAPD after May 1987 were entered and followed for a minimum of 12 months. Thirty were placed on the OS system and 30 were placed on CS. Age, gender, and time for training did not differ significantly.

The period of observation for OS was 375 months; CS was observed for 430 months. OS patients experienced 28 episodes of peritonitis (13.4 months/patient/episode) compared with 88 (4.9 months/patient/episode) in CS (p<0.005). By 6 months, 32% of OS patients had had at least one episode of peritonitis, compared with 62% of CS patients; at 12 months, these figures rose to 48% for OS and 91% for CS (p<0.01) patients (Life Table Analysis). The median survival time to first peritonitis episode was 5.1 months in CS and 9.7 months in OS (p<0.01). Exit. site infections occurred in 14/30 (46%) of patients on OS and in 13/30 (43%) of CS patients. We conclude that the OS was associated with a significant reduction in the incidence of peritonitis.
Effect of Peritoneal Macrophages from Intermittent Peritoneal Dialysis Patients on Lymphocytes in Culture
Authors: Sulowicz Wladyslaw , Hanicki Zygmunt , Uracz Wojciech , Hajto Barbara , Ruggiero Irena , Zembala Marek
Published: February 2020

To investigate the biological activity of peritoneal macrophages, cells isolated from dialysate of 30 patients with end-stage kidney disease treated by intermittent peritoneal dialysis and from ascites of 6 patients with cardiac insufficiency (relative control group) were added to autologous, phytohemagglutinin (PHA)-stimulated lymphocyte cultures. Macrophages of dialyzed patients induced a dose-dependent increase in autologous lymphocyte proliferation, whereas macrophages obtained from control subjects exerted a suppressive effect on those cultures. The enhanced lymphocyte proliferation by macrophages from dialyzed patients was corroborated by the increased metabolic activity of macrophages as evaluated by the increased nitro blue tetrazolium (NBT) reduction test and increased functional expression of Fc receptors (FcR). The subpopulation of macrophages from patients with HLA -DR antigens as determined by HB55 monoclonal antibody, inhibited Iymphoproliferation in vitro. We conclude that peritoneal macrophages from dialyzed patients represent a heterogenous population of cells with different phenotypic and functional characteristics.
Continuous Ambulatory Peritoneal Dialysis and Renal Transplantation: A Ten-Year Experience in a Single Center
Authors: O'Donoghue Donal , Manos John , Pearson Robert , Scott Patrick , Bakran Ali , Johnson Robert , Dyer Phil , Martin Sue , Gokal Ram
Published: February 2020

Objective

To assess whether a renal graft outcome is dependent on the modality of dialysis prior to transplantation and to assess risk of peritonitis and catheterrelated problems posttransplantation.

Design

Retrospect analysis of the outcome of a first cadaveric renal transplantation from hemodialysis (HD) and CAPD patients over a ten-year period.

Patients

Out of a total of 905 renal transplants over a ten-year period, 699 were first grafts; 500 of these (241 on CAPD, 259 on hemodialysis) were analyzed while the remaining (incomplete data, predialysis, pediatric) were assessed for graft and patient survival only.

Main Outcome

Graft and patient survival cases were identical in the two groups (five-year graft survival: CAPD 67%, hemodialysis 66%; five-year patient survival: CAPD 88%, hemodialysis 87%). CAPD post transplant was necessary in 37 patients, while 10 developed peritonitis mostly related to CAPD use and responded to appropriate therapy. Routine catheter removal posttransplant was undertaken between 8 and 12 weeks.

Conclusion

Excellent graft and patient survival is achieved independent of the modality of dialysis prior to transplantation. Peritoneal dialysis can be used postgrafting, but there is a risk of peritonitis, which can be successfully managed with antibiotics and catheter removal. Great care is needed in executing the dialysis and catheter care after transplantation.
Lipid Perxidtion and Antioxidants in Continuous Ambulatory Dialysis Patients
Authors: Taylor J.E. , Scott N. , Bridges A. , Henderson I.S. , Stewart W.K. , Belch J.J.F.
Published: February 2020

Objective

Oxidative cell damage due to the production of free radical species has been implicated in the pathogenesis of cardiovascular disease for which dialysis patients are at increased risk. Plasma lipid peroxides (malon-dialdehyde), the antioxidants plasma albumin thiol, and red cell superoxide dismutase (SOD) were therefore measured in 18 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), 20 hemodialysis patients, and 30 normal controls.

Setting

Renal dialysis unit.

Results

Malondialdehyde(MDA)concentrationswere significantly higher in dialysis patients compared to controls (p<0.001 ) and were significantly higher in CAPD patients compared to hemodialysis patients, p<0.001 (CAPD, median and range: 11.25 (8.4–15.5) nmol/mL; hemodialysis: 8.75 (7.0–12.6) nmol/mL; controls: 6.65 (5.2–9.6) nmol/mL). Plasma thiol and red cell SOD were significantly lower in dialysis patients compared to controls, but there was no significant difference between CAPD and hemodialysis patients (CAPD thiol: 333.5 (282480) μmol/L; hemodialysis thiol: 344 (203–468) μmol/L; control thiol: 421.5 (351 -504) μmol/L; CAPD SOD: 78.2 (42.4 -112.8) u//2 mL red cells; hemodialysis SOD: 89.4 (44.6–121.1) u//2 mL red cells; control SOD: 96.8 (66.8153.4) u//2 mL red cells). Red cell SOD was significantly negatively correlated with duration of dialysis in CAPD patients (r=-0.683, p<0.01 ).

Conclusion

In dialysis patients there is indirect evidence for increased free radical activity, which may be further influenced by the mode of dialysis.
Peritoneal Clearances in Hypertensive Capd Patients after Oral Administration of Clonidine, Enaldpril, and Nifedipine
Authors: Favazza Antonio , Montanaro Domenico , Messa Piergiorgio , Antonucci Francesco , Gropuzzo Maria , Mioni Giuseppe
Published: February 2020

The authors investigated whether the reduction of arterial pressure, induced by the oral administration of clonidine (CLO), enalapril (EN), and nifedipine (NIF), has any effect on peritoneal transport rates.

The study was performed in nine hypertensive patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The patients were submitted to administration of CLO, EN, and NIF, each in randomized succession for two weeks, after withdrawal of any hypotensive therapy for eight days (washout period). The nine patients underwent a four-hour dwell exchange using a 2.27 g/dL glucose two-liter bag after washout and after each hypotensive period. The following parameters were analyzed: mean arterial pressure (MAP), performed in the sitting position; net ultrafiltration; effluent/initial dialysate glucose ratio (GL DIDo); peritoneal clearance of K, BUN, creatinine (Cr), phosphate, beta-2 microglobulin (β2), total proteins, and the ratio between B2 and Cr clearance. Moreover, residual renal Cr and B2 clearances were analyzed.

The three drugs significantly reduced MAP at a similar rate. The peritoneal transport parameters after CLO were similar to the results in the washout period. On the contrary, after EN and NIF therapy, Crand B2 clearances were significantly increased, and GL DIDo decreased in comparison to the washout period. The other peritoneal transport parameters after EN and NIF were similar to the washout period. Residual renal Cr and B2 clearances after the three drugs were similar to those in the washout.

These data suggest that after two weeks of therapy with EN and NIF, glucose, Cr, and B2 peritoneal transports are influenced by these hypotensive drugs irrespective of the effect on the arterial pressure.

These observations may have implications for hypotensive drug selection in CAPD hypertensive patients.
CAPD and Pancreatitis: No Connection
Authors: Gupta Amit , Vuan Zheng , Balaskas Elias V. , Khanna Ramesh , Oreopoulos Dimitrios G.
Published: February 2020

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis.

We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences.

The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases.

One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.
Small Solute Clearances and Clinical Outcomes in Capd
Authors: Nolph Karl D.
Published: February 2020

The strong correlation of weekly clearances of urea and creatinine with PCR suggests that minimum targets of 50 L/week/l. 73 m2 body surface area of creatinine clearance and a weekly kt/v urea of 1.7 are reasonable if protein intakes in excess of 0.8 g/kg normalized body weight are to be achieved in most CAPD patients. It would seem reasonable that this increases the chances for better nutrition. It would also seem reasonable that this should eventually improve long-term outcomes and survival in large population studies where the impact of dialysis dose could emerge as significant, even with the presence of all the other variables that are known to affect commonly monitored outcome parameters. These recommended targets are well below those achieved by hemodialysis; higher targets could possibly achieve even better long-term results, but this is unknown.
Is Total Creatinine Clearance a Good Predictor of Clinical Outcomes in Continuous Ambulatory Peritoneal Dialysis?
Authors: Blake Peter G. , Balaskas Elias v. , Izatt Sharron , Oreopoulos Dimitrios G.
Published: February 2020

The measurement of the adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) is controversial. The use of weekly total creatinine clearance (TCC) has been recommended, but not validated. We analyzed data from our recent urea kinetics in a CAPD study to investigate TCC and its relationship to patient outcomes. TCC was measured over 24 hours by adding residual renal and peritoneal creatinine clearance, correcting for 1.73 m2 surface area and converting to a weekly value. Seventy-six patients had 218 measurements, on starting CAPD and then at 6–month intervals, with mean follow-up of 20 months (range 1–57 months). The mean TCC was 73.62±32.11 L/week. Due mainly to the loss of residual renal function, the TCC decreased with time (r=-0.40, p<0.0001), from 88.65 L/week initially to 66.11 at one year, 59.84 at two years, and 50.47 at three years. Dialysate-to-plasma creatinine concentration ratios (DIP Cr) increased with time (r=0.28, p<0.0001) from 0.62 initially to 0.66 at one year and 0.73 at two years. The TCC correlated significantly with serum levels of creatinine (r=-0.46, p<0.0001), urea (r=-0.21, p<0.001), potassium (r=-0.14, p<0.05), phosphate (r=-0.25, p<0.001), and hemoglobin (r=0.16, p<0.01), but not with serum albumin or with clinical outcomes including technique failure, hospital days, transfusions, peritonitis rate, nerve conduction velocity, or subjective indices of well-being, except for a weak correlation with the fatigue index (r=0.19, p<0.05). However, of 13 deaths 6 occurred in patients with TCC under 48 L/week (p<0.05). There is little evidence of a proportionality relationship between TCC and clinical outcomes in CAPD, but a TCC of 48 L/week may usefully define a lower limit below which excess mortality occurs.
The Pharmacokinetics of Intraperitoneal Erythropoietin Administered Undiluted Or Diluted in Dialysate
Authors: Bargman Joanne M. , Jones Julie E. , Petro James M.
Published: February 2020

+ Objective

To compare the bioavailability of intraperitoneal erythropoietin (EPO) administered undiluted versus diluted in 2 L of dialysis fluid.

+ Design

Group 1 patients received one dose of EPO, 400 Ulkg BW given with vehicle only. This dwelled for 8 hours after which 2 L of dialysate were infused. Group 2 patients received the same dose of EPO diluted in 2 L of dialysate which dwelled for 8 hours. Both groups resumed their CAPD regimen after the first 8 hours. Blood levels of EPO were measured for 24 hours in both groups.

+Setting

The Home Peritoneal Dialysis Unit, Toronto Hospital, Western Division.

+ Patients

The participants were on CAPD for at least three months, free of peritonitis, and had no abnormalities of peritoneal transport. Three patients took part in both arms of the study, and there were 6 patients altogether in each group.

+ Results

When EPO was administered undiluted, there was a greater than ninefold increase in bioavailability of the hormone as measured by the area under the curve (AUC), compared to when the same dose was diluted in 2 L of dialysis fluid.

+ Conclusions

The previous studies that reported low bioavailability of intraperitoneal EPO used the hormone diluted in dialysate. The current findings suggest that if EPO is given in the dry peritoneal cavity, the bioavailability is greatly improved and may be clinically effective. Intraperitoneal instillation may prove to be an alternative route for EPO in the peritoneal dialysis patient unable or unwilling to receive subcutaneous injections. We are currently studying the effectiveness of undiluted intraperitoneal EPO in CAPD patients.
Six -Year Experience with Swan Neck Catheters
Authors: Twardowski Zbylut J. , Prowant Barbara F. , Nichols W. Kirt , Nolph Karl D. , Khanna Ramesh
Published: February 2020

From the beginning of our continuous ambulatory peritoneal dialysis (CAPD) program in January 1977 until June 1985, we used Tenckhoff and Toronto Western Hospital catheters. Throughout these years catheter survival probabilities of about 30% at three years persisted unchanged and were similar to survival probabilities reported by the National CAPD Registry special survey for these catheters.

The first improvement in catheter results regarding leaks was noted after the adoption of lateral catheter insertion. Malfunction was less using swan neck prototypes from August 1985 to April 1986. The latter catheters were made of 80° are angle tubing between 8.5 cm spaced cuffs and were inserted in a reversed U-shape tunnel with the incision at the top of the tunnel. The use of these catheters was abandoned because of high cuff extrusion and exit infection rates.

The next generation of swan neck catheters, the swan neck Missouri 2 and 3 catheters with straight intraperitoneal segments, improved the results dramatically. These catheters were made of 180° are angletubing between 5 or 3 cm spaced cuffs. The estimated survival probability of 61% at three years more than doubled compared to previously used catheters.

Recently we modified the intraperitoneal segment of the catheters, replacing the straight segment with a coiled one. These modified catheters, the swan neck Missouri coiled catheters, have been used exclusively since February 1990. In addition to an acceptable survival probability of 88% at one year, there are two major advantages of these catheters, the same as for other coiled catheters: elimination of infusion pain due to a jet effect and pain related to straight catheter tip pressure on the peritoneum experienced by some patients.
Effects of Subcutaneous Calcitriol Administration on Plasma Calcium An D Parathyroid Hormone Concentrations in Continuous Ambulatory Peritoneal Dialysis Uremic Patients
Authors: Rolla Davide , Paoletti Ernesto , Marsano Luigina , Mulas Donatella , Peloso Giancarlo , Cannella Giuseppe
Published: February 2020

Objective

To ascertain whether the parathyroid hormone (PTH) secretion of continuous ambulatory peritoneal dialysis (CAPD) uremic patients could be suppressed by repeated subcutaneous injections of calcitriol (CLT).

Design

Nonrandomized prospective study with weekly evaluation.

Setting

Hospital CAPD clinic.

Patients

Seven uremic CAPD patients with signs of severe hyperparathyroidism.

Interventions

Patients were treated with CLT (2 μg), injected subcutaneously three times a week, on alternate days over a period of 8 weeks.

Measurements

Plasma PTH, ionized calcium (Ca), serum phosphate (Pi), and alkaline phosphatase (AP) were assayed before the start of CLT therapy and weekly thereafter.

Results

The average basal PTH was 349±26 pg/mL (mean ±SD).ltfell significantly by the fifth week to 158±20, then leveled off. Analysis of the individual data, however, revealed that only 5 of 7 patients had a significant decrease in plasma PTH. Basal Ca was ±.02 mmol/L; it increased continuously throughout the study, significantly by the fourth week, reaching a level of 1.33±0.3 mmol/L at the sixth week, then declined slightly. In those patients with significantly decreased PTH, there was an inverse correlation between PTH and the corresponding Ca levels.

Conclusions

In some CAPD patients subcutaneous administration of CLT significantly suppresses PTH. This effect is mainly mediated via an increase in ionized calcium, but a direct inhibitory effect of the vitamin on parathyroid glands cannot be excluded.
Determining Peritoneal Dialysis Prescriptions by Employing a Patient -Specific Protocol
Authors: Zabetakis Paul M. , Krapf Randi , DeVita Maria v. , Gleim Gilbert W. , Michelis Michael F.
Published: February 2020

Objective

To develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance.

Design

Prospective study of peritoneal dialysis patients followed for 6 months.

Setting

A primary care teaching hospital in New York.

Patients

Twenty-six patients beginning peritoneal dialysis entered and completed the study.

Intervention

By employing each patient's measured peritoneal equilibration test (PET) and a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour DIP croat was used for continuous cycling peritoneal dialysis (CCPD) and the 4hour DIP patients on continuous ambulatory peritcornoeal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clearance daily.

Main Outcome Measures

Patients were followed for 6 months to assess the ability of this approach of maintaining acceptable levels of blood urea nitrogen, creatinine, albumin, and hematocrit over the 6–month period of observation.

Results

Our study of 26 patients revealed that only 6 patients (23%) could be treated with the standard prescription of 8 L/day on CAPD. The remaining 77% of our patients required 9–13 L/day for CAPD and 12–21 L/day for CCPD. All patients were free of uremic symptoms and demonstrated acceptable biochemical parameters over a 3–6 month period of observation.

Conclusions

A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.
A Comparison of Peritoneal Dialysis-Related Infections in Short and Long Term Peritoneal Dialysis Patients
Authors: Piraino Beth , Bernardini Judith , Holley Jean L. , Perlmutter Jeffrey A.
Published: February 2020

Objective

We hypothesized that the infection rates and organisms would differ in long-term peritoneal dialysis (PD) patients versus those who died or transferred to hemodialysis during the first 4 years on PD.

Design

Data on PD-related infections and outcome were collected from 1979 to 1991 (prospectively since 1982).

Setting

The patients were followed at University and Veterans Administration dialysis centers.

Patients

All patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) for 4 years or more (n=43) were compared to those patients who died or transferred to hemodialysis prior to 4 years on PD (n=213).

Main Outcome Measures

Infection rates due to various microorganisms and reasons for transfer to hemodialysis were examined.

Results

Peritonitis rates were 1.2/year versus 0.8/year (p<0.001) in patients on peritoneal dialysis less than 4 years compared to those on 4 years or more, respectively, a difference due to S. epidermidis (0.32/year vs 0.20/year, p=0.0001) and gram-negative rods other than P. aeruginosa (0.15/year versus 0.06/year, p<0.001). Exitsite infection rates were 1.2/year versuss 0.7 /y (p<0.0001) in the patients on less than 4 years compared to those on 4 years or more, respectively, a difference in part due to S. aureus (0.45/year vs 0.3/year, p<0.001) and other gram positive organisms (0.28/year vs 0.1 0/year, p<0.001). The rates of infections that were similar in the two groups were tunnel infections (0.2/year), P. aeruginosa infections, and S. aureus peritonitis (0.18/year vs 0.14/year, p=0.09). S. aureus was the most common cause of exit-site and tunnel infections in both groups. Forty-two percent of the patients on PD 4 years or more subsequently transferred to hemodialysis, most often due to infections, especially S. aureus.

Conclusions

Although infection rates are lower in patients on peritoneal dialysis 4 years or more, S. aureus and P. aeruginosa continue to account for a high proportion of the infections. Improvement in technique survival will require prevention of these infections.
Calcium and Magnesium Mass Transfer in Peritoneal Dialysis Patients Using 1.25 Mmol/L Calcium, 0.25 Mmol/L Magnesium Dialysis Fluid
Authors: Hutchison Alastair J. , Merchant Mahendra , Boulton Helen F. , Hinchcliffe Rod , Gokal Ram
Published: February 2020

Objective

To examine the effect of a reduced calcium/magnesium dialysis fluid (1.25/0.25 mmol/L, respectively) on calcium and magnesium mass transfer in both 1.36% and 3.86% glucose solutions.

Design

Each patient underwent four test exchanges, two with a standard dialysis fluid containing 1.36% and 3.86% glucose, and two with a reduced calcium/magnesium fluid containing 1.36% and 3.86% glucose. Calcium and magnesium were measured in dialysate and serum at ° and 240 minutes.

Setting

Single renal unit of a university teaching hospital.

Patients

Sixteen patients established on CAPD, and peritonitis-free, for at least 3 months.

Results

A lower dialysate calcium results in negative mass transfer when serum-ionized calcium exceeds dialysate calcium (mean -.0.21±0.15 mmol/exchange), and positive mass transfer when serum-ionized calcium is less than dialysate calcium in 1.36% glucose solutions (mean 0.57±0.18 mmol/exchange). A negative correlation was found between serum-ionized calcium level and calcium mass transfer. With a 3.86% reduced calcium/magnesium solution, calcium mass transfer is always negative (-.0.88±0.18 mmol/exchange) due to ultrafiltration and solute drag. Fifteen patients were found to be hypermagnesemic at the time of the study. Magnesium mass transfer was neutral with the standard 1.36% glucose fluid (mean -.0.01 mmol/exchange), but negative with the reduced calcium/magnesium 1.36% glucose fluid (mean -.0.58±0.13 mmol/exchange). With the 3.86% glucose solution, both fluids produced negative magnesium mass transfer (mean -.0.32±0.11 and -1.07±0.11 mmol/exchange for standard and reduced calcium/magnesium fluids, respectively).

Conclusions

We conclude that this fluid formulation should reduce hypercalcemia and hypermagnesemia in CAPD patients.
Destructive Spondyloarthropathy in a Patient on Continuous Ambulatory Peritoneal Dialysis for 13 Years
Authors: Digenis George E. , Davidson George , Dombros Nicholas V. , Katz Alan , Bookman Arthur , Oreopoulos Dimitrios G.
Published: February 2020

Since 1984 there have been reports of a destructive spondyloarthropathy occurring in patients on long-term hemodialysis. The primary abnormality appears to be an accumulation of β2-microglobulin, which is not adequately removed by dialysis, and forms amyloid deposits in articular and periarticular tissues. We report a case of this disease in a patient treated only by peritoneal dialysis. While this form of treatment may delay the development of arthropathy, as compared to hemodialysis, it does not prevent it. An increasing incidence of this disorder may be expected, since increasing numbers of patients have been on long-term peritoneal dialysis.
Choline Incorporation into Phospholipids in Mesothelial Cells in Vitro
Authors: Hjelle J. Thomas , Steidley Kevin R. , Pavlina Thomas M. , Dobbie James W.
Published: February 2020

Objective

To determine the effect of extracellular choline concentration on phospholipid production and handling by peritoneal mesothelial cells in vitro.

Design and Measurements

Radiolabeled choline was used to monitor the formation of phosphatidylcholine {PC), sphingomyelin (SPH), and Iysophosphatidylcholine (LPC) by rat and rabbit mesothelial cells as a function of concentration and time of exposure to choline. The subcellular location of the newly formed phospholipids was examined by ultracentrifugation in Percoll-sucrose gradients using analytical cell fractionation techniques. The fatty acid composition of the PC formed was determined by thin-layer chromatography (TLC) and gas chromatography.

Results

Choline incorporation into PC, SPH, and LPC increased with extracellular choline levels up to 640 μmol/L, which is 100 times greater than physiological levels of choline in plasma and 20 times higher than choline levels measured in peritoneal dialysis effluent. The newly formed, radiolabeled phospholipids were primarily found in a single subcellular compartment that exhibited a buoyant density of 1.05 g/mL in Percollsucrose gradients. Analysis of the fatty acyl groups of PC obtained from the mesothelial cells showed enrichment in palmitic [16:0], oleic [18:1], and linoleic [18:2] acids.

Conclusion

The rate of phospholipid formation by mesothelial cells in vitro can be manipulated, in part, by choline concentration.
Ultrastructure Analysis of Tenckhoff Chronic Peritoneal Catheters Used in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Giangrande Alberto , Allaria Pietro , Torpia Regina , Baldassari Lucilla , Gelosia Antonella , Donelli Gianfranco
Published: February 2020

The luminal and external surfaces of 18 curled silicone double-cuff catheters removed from patients who had been on continuous ambulatory peritoneal dialysis (CAPO) for 2-77 months (average 37±21 months) were analyzed by scanning electron microscopy (SEM) and microbiological cultures.

Eight catheters (G1) were removed due to recurrent peritonitis or peritonitis refractory to antibiotic management, and the others (G2) due to local or clinical problems.

The peritonitis rate was one episode every 24 patient months in G1, and 80 patient-months in G2.

All catheter surfaces were covered with proteinlike granular deposits (0.15±0.111cm); 6 catheters were covered by microbial biofilm (0.24±0.161cm). Positive cultures of catheter segments were obtained in 6 cases (4 for G1 and 2 for G2) with a preponderance (33%) of StaphYlococcus aureus among the cultivated bacteria.

Structural defects and small linear tears were present on both luminal and external surfaces in 8 catheters. Structural defects were frequent in the catheters removed for recurrent peritonitis. Linear tears appeared more frequently in the catheters used for a longer time. Structural defects of catheter surfaces were also discovered in the newer devices.

The structural defects of the catheter appear to facilitate microbial adhesion and colonization and to predispose the patient to recurrence of peritonitis.

A better catheter design and an improvement in the production process should therefore be recommended.
Serum Carnitine Levels, Lipid Profile, and Metabolic Status of Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Pliakogiannis Theodoros , Chatzidimitriou Christos , Evangeliou Athanasios , Söhles Hans Josef , Kalaitzidis Kleonikos
Published: February 2020

The purpose of our study was to evaluate the influence of serum carnitine levels on the metabolic status and lipid profile of patients on continuous ambulatory peritoneal dialysis (CAPD).

We studied the lipid profile, the metabolic status (triceps, skinfold thickness, midarm muscle circumference, relative body weight, serum total protein, albumin), and serum carnitine levels in 22 patients (11 male, 11 female) on CAPD.

The results are summarized as follows: mean serum total camitine (TC) was normal, free carnitine (FC) was reduced, while acylcarnitine (AC) was elevated in our patients (p<0.001). A positive correlation was found between TC (p<0.02), FC (p<0.05), and serum total protein. A positive correlation was also found between TC (p<0.05), AC (p<0.02), ACIFC (p<0.02), and relative body weight, and TC (p<0.001), FC (p<0.02), AC (p<0.01), ACIFC (p<0.02), and triglycerides.

No correlation was found between carnitine and midarm muscle circumference, triceps skinfold thickness, albumin, total cholesterol, and HDL. or LDL-cholesterol.

Further studies are needed to confirm our results.
Low and High Turnover Bone Disease in Continuous Ambulatory Peritoneal Dialysis: Effects of Low-Ca + Peritoneal Dialysis Solution
Authors: Carozzi Silvia , Nasini Maria Grazia , Santoni Oscar , Pietrucci Angelo
Published: February 2020

Calcium carbonate (CaCO3) is an effective phosphate (P04) binder in uremics, and its use reduces aluminum (AI) intake. By maintaining high serum Ca2+, it decreases serum parathyroid hormone (PTH) levels. Hypercalcemia, however, often limits the dosage.

In order to evaluate the effects of a low-Ca peritoneal dialysis solution (PDS) (1.25 mmol/L) on Ca metabolism, we studied the following in 12 continuous ambulatory peritoneal dialysis (CAPD) patients with hypercalcemia (6 with low PTH levels, low-turnover bone disease, group 1, and 6 with high PTH levels, high-turnover bone disease, group 2, documented by bone biopsies): serum Ca2+; serum PTH; bone morphology. The follow-up was 12 months.

Results show that in both groups within the third month there was a decrease in serum Ca2+. In group 1 serum PTH increased, reaching the norm, and In group 2 it further Increased exceeding the norm. Because In both groups serum Ca2+ was normal, It was possible to increase oral CaC03 (10.5±2.5 g/day) to control P04 levels and to stop AI gels. In group 2, In order to avoid the further rise of serum PTH, the low-Ca PDS was supplemented with 2 μg/day of 1,25(OH)2D3 (vitamin D3); this was followed by a reduction In serum PTH with no increase in Ca2+ and P04.

The use of low-Ca PDS may be useful In preventing hypercalcemia In CAPD patients treated with high oral doses of CaC03 and in improving low-turnover bone disease, while low-Ca PDS supplemented with vitamin D3 improves high-turnover bone disease.
The Sigmoidal Parathyroid Hormone-Ionized Calcium Curve and the Set Point of Calcium in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
Authors: Malberti Fabio , Corradi Bruno , Pagliari Bruno , Romanini Dino , Gazo Antonietta , Sidoti Antonino , Baretta Alvaro , Bellazzi Roberto , Imbasciati Enrico
Published: February 2020

A high Incidence of adynamic bone disease not related to aluminum Intoxication has been reported In continuous ambulatory peritoneal dialysis (CAPD). Since reduced parathyroid hormone (PTH) secretion may predispose to adynamic bone, we Investigated whether parathyroid gland sensitivity may be depressed In CAPD in comparison with hemodialysis (HD). Thus we determined parathyraid function by the evaluation of the PTH-ionized calcium (ICa) relationship, which was obtained Inducing hypocalcemia and hypercalcemia In 19 CAPD and 18 HD patients with biochemical and histological evidence of mild (MILD) or severe (OF) hyperparathyroidism, but negative stainable bone aluminum. Either CAPD or HD patients with OF showed a shift to the right of the sigmoidal PTH-ICa curve in comparison with patients with MILD, greater set point of calcium, and maximal PTH stimulation and Inhibition. The PTH-lCa curve and the other parathyraid function parameters were not different in CAPD and HD patients within the same bone histological group. In conclusion, our data document that parathyroid gland activity Is stimulated either in CAPD and HD patients with OF, but is not depressed in CAPD patients in comparison with HD patients.
Effects of Intraperitoneal Infusion of Dextrose and Amino Acids on the Appetite of Rabbits
Authors: Balaskas Elias V. , Rodela Helen , Oreopoulos Dimitrios G.
Published: February 2020

We studied the effect of Intraperitoneal Infusion of various volumes and concentrations of dextrose (D) and amino acid (AA) solutions, In a variety of peritoneal dialysis schedules on food Intake and biochemical profile in normal and uremic rabbits.

Following omentectomy, a peritoneal catheter was implanted. Animals had free access to food, and consumption was measured daily by weight of the remaining food in the cage.

We studied the effect of volume (30-50-100 mL/kg), dextrose concentration (0.5-1.5-2.5-4.25-6.6 g/dL) and AA (Travasol based) (2% in Dianeal or glucose-free solution).

Dialysis schedules Included once/day, twice/day, or four-daily exchanges similar to CAPD.

The durations of the exchanges were 4–6 weeks and in certain groups, amino acid exchanges for a week alternated with dextrose exchanges.

Our results Indicate the following: omentectomy and catheter implantation significantly decrease food Intake. There is a significant decrease In food Intake after initiation of dialysis that returns to baseline after 2–4 weeks while dialysis continues. Higher volumes (100 mL/kg) decrease food Intake significantly, especially with hypertonic solution of either D or AA. There was no difference in food Intake between D and AA Infusion In any amount of infused volumes.

Amino acids do not seem to have a suppressing effect on appetite. However, large volumes and hypertonicity reduce food Intake.
β2-Microglobulin Elimination in End-Stage Renal Disease Patients on Renal Replacement Therapy
Authors: Stefanovic' Vladisav , Kostic' Svetislav , Djordjevic' Vidojko , Mitic' Marina , Bogicevic' Momcilo
Published: February 2020

β2-microglobulin (β2M) is a small molecular mass protein associated with dialysis amyloidosis. We have studied β2M elimination in end-stage renal disease (EsRD) patients treated by peritoneal dialysis. In 12 patients on continuous ambulatory peritoneal dialysis (CAPD) and 7 patients on intermittent peritoneal dialysis (IPD) 30.4±4.2 mg/day and 21.3± 1.8 mg/12 hour of β2M, respectively, were removed by dialysis fluid. Approximately the same amount of β2M was removed by each of four 2-L exchanges in CAPD; however, the most efficient removal of β2M was in the first IPD exchange. Serum β2M levels in these patients were 25.7 ±4.4 and 31.4±5.2 mg/L, respectively. In 24 patients on hemodialysis using cuprophan membrane the serum level of β2M was 55.1±4.1 mg/L. After a 3-month dialysis on polyacrylonitrile (PAN) membrane, the serum β2M level decreased to 45.0±2.3 mg/L. A substantial amount of β2M was removed by urine, 14.6.:1:2.3 mg/L, and saliva, 2.3±0.4 mg/L.

This study has shown markedly increased β2M levels in patients on conventional hemodialysis treatment, predisposing to β2M-related amyloidosis. A significant amount of β2M was removed during both CAPD and IPD treatment.
Pruritus in Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients
Authors: Balaskas Elias V. , Chu Maggie , Uldall Robert P. , Gupta Amit , Oreopoulos Dimitrios G.
Published: February 2020

To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20–84) years, average time on CAPD 20 (range 1–163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23–81) years, mean time on HD 44 (range 2–242) months. Replies to questions were evaluated and graded by the same Investigator who did not know the patients.

Pruritus was present in 70 (62%) CAPD patients (64% in females and 600/0 in males p=NS) and in 41 (54%) HD patients (69% in females and 43% in males, p=0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.90/0, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients.

This xerodermia was correlated with the severity of pruritus and was also present In 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p=0.004) and HD (61 vs 51 years, p=0.003). A significant correlation was observed only between pruritus score and age for CAPD patients. There were no other correlations between pruritus and the other parameters studied.

We conclude that pruritus Is a frequent symptom In dialysis patients, but It Is severe only In a small proportion. Its prevalence, as also that of dry skin, Increases after start of dialysis and Is higher In females on HD.

Patients with pruritus are older, and the severity of pruritus correlates with age in the CAPD patients. Presence of dry skin correlates with severity of pruritus, and Its prevalence Is high even among patients without pruritus.
Abbreviated Method for Urea Kinetic Modeling in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Dumler Francis , Schmidt Rebecca , Cruz Cosme
Published: February 2020

Urea kinetic modeling (UKM) is an established method for quantitating hemodialysis, with target values clearly defined. Precise methods for measuring continuous ambulatory peritoneal dialysis (CAPD) prescriptions are less well-defined, and 24-hour collections of dialysate effluent are logistically impractical.

UKM parameters derived from an abbreviated (4-hour) collection period were compared with simultaneously obtained 24hour collections of urine and dialysate effluent in 22 CAPD patients. Daily Kt/V was calculated from total (residual renal and peritoneal) urea clearance and an anthropometric-derived total body water volume. Results yielded from the 24-hour collection included a mean Kt/V of 0.29±0.09, and mean protein catabolic rate (PCR) of 0.84±0.24 g/kg/day. Daily Kt/V values were calculated from each individual dialysate cycle. The first morning cycle after an overnight dwell correlated best with results obtained using 24-hour collections (r=0.921; p<0.0001) with no significant differences in Kt/V found (p=0.454) between the short and 24-hour methods. Daily Kt/V values converted by exponential transformation to a thrice-weekly hemodialysis value yielded a Kt/V equivalent of 1.02±0.40.

UKM using an abbreviated collection period is an accurate and practical tool for quantitating CAPD adequacy in a routine clinical setting.
Subcutaneous Recombinant Human Erythropoietin in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
Authors: Pais Maria João , Gaspar Augusta , Santana Alice , Bruges Margarida , Simões Jacinto
Published: February 2020

We compared the effect of twice weekly subcutaneous recombinant human erythropoietin (SC rHuEPO) In two groups of patients treated with a starting dose of 80 U/kg body weight/week: group I, 7 hemodialysis (HD) patients; group II, 8 continuous ambulatory peritoneal dialysis (CAPD) patients. In a third group (group III) of 4 patients transferred from HD to CAPD with anemia previously corrected with Intravenous (IV) rHuEPO, we studied the changes In the maintenance SC dose to maintain the same hemoglobin.

In groups I and II the mean SC doses required to correct anemia and to maintain hemoglobin/hematocrit levels were similar; the mean time for the correction of anemia was significantly longer In HD patients (p=0.032). In group III the maintenance SC rHuEPO does was reduced to more than 50% at 12 weeks of CAPD.

Subcutaneous rHuEPO Is effective In reversing anemia in HD and CAPD patients, but It takes longer to correct anemia In HD with the same initial SC rHuEPO low dose. CAPD patients need lower doses of SC rHuEPO than HD patients in IV therapy to maintain the same hemoglobin levels.
Influence of Erythropoietin on Blood Pressure in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Balaskas Elias V. , Melamed I. Rogers , Gupta Amit , Bargman Joanne , Oreopoulos Dimitrios G.
Published: February 2020

To assess the effect of erythropoietin (EPO) treatment on blood pressure in continuous ambulatory peritoneal dialysis (CAPO) patients, we analyzed in a retrospective study the results of 6 months of EPO treatment in 17 CAPO patients. There were 10 females and 7 males, mean age 52 years, mean duration on CAPO 35 months. They received subcutaneously a mean initial EPO dose of 114±45 U/kg/week (range 59–209). This dose was adjusted throughout 6 months to achieve and maintain a target Hb of 100 g/L (Hct 30%). Seven of the patients were hypertensive before starting EPO treatment.

Fifteen paients (88.2%) achieved the target hemoglobin. For all subjects (n=17) there was a significant increase in lying mean blood pressure (MBP) from 93.8± 10.0 to 1 05.2± 14.4 mmHg (p=0.0024). Four patients required an increase in their antihypertensive medication, and 4 were not treated before we started antihypertensive treatment (Group I). This group represents 46% (8/17) of the patints. There was no change in the antihypertensive medication status of the remaining 9 patients (Group II). The baseline lying MBP was not significantly different for the two groups (98.8±9.8 mmHg vs 96.1±7.2 mmHg). The mean weekly dose of EPO during the first 3 months was higher in Group I (126 vs 100 U/kg) and conversely was lower during the last 3 months (mean dose 108 vs 117 U/kg). Patients of Group I were younger (mean age 47 vs 56 years), had a lower body weight at the time of EPO start (55 vs 66 kg), a higher increase of Hb during the first 2 months (28.8 vs 20.8 g/L), and reached the target Hb sooner (2.25 vs 4.0 months). A comparison group of 17 patients (matched for age, sex, duration on CAPO, underlying disease and antihypertensive treatment) who did not receive EPO did not show an increase in MBP over time, and only 2 patients increased their antihypertensive medication.

Our data suggest that higher Initial EPO doses may be accompanied by hypertension changes In CAPD patients. This may be prevented by a lower Initial dose and lower rates of increase of Hb and Hct.

Our study shows that EPO treatment is effective in correcting anemia in uremic patients on CAPD. Increase of blood pressure during the treatment is frequent. It seems that higher initial EPO doses may be accompanied by increased hypertension in CAPD patients and that this may be prevented by a lower initial dose and lower rate of increase in hemoglobin and hematocrit.
Establishing an Experimental Infection Model for Peritoneal Dialysis: Effect of Inoculum and Volume
Authors: Calame Wim , Afram Charles , Blijleven Nico , Hendrickx Roeland J.B.M. , Namavar Ferry , Beelen Robert H.J.
Published: February 2020

The effect of the number of bacteria and the volume of the inoculum was studied in an experimental infection model to establish a peritoneal dialysis model in the rat. Staphylococcus aureus was used in all experiments, and Staphylococcus epidermidis only in the volume experiments. A bacterial number between 108 and 109 colony forming units (cfu) resulted in a time-dependent decrease of bacteria collected from the peritoneal cavity. Higher concentrations resulted in the death of animals, while lower concentrations were rapidly cleared. There was a positive correlation between the volume in which 3 x 108 cfu were dissolved and the number of bacteria isolated from the peritoneal cavity 24 hours after infection. The results of this study led to an experimental dialysis model using 10 mL of dialysis fluid and 0.5 mL of a suspension containing 3 x 108 cfu of Staphylococcus aureus.