bluuebunny/crossref_metadata_2025 huggingface dataset:
The Roles of Complement Factor C5a and CINC-1 in Glucose Transport, Ultrafiltration, and Neutrophil Recruitment during Peritoneal Dialysis
Authors: Bazargani Farhan , Rother Russell P. , Braide Magnus
Published: February 2020

Background

In a recent experimental study, we showed that low molecular weight heparin improved ultrafiltration and blocked complement activation and coagulation in a single peritoneal dialysis (PD) dwell.

Objective

The aim of the present study was to evaluate the possible contribution of the complement factor C5a and the potential interactions between C5a, the coagulation system, and cytokines of the interleukin (IL)-8 family (cytokine-induced neutrophil chemoattractant; CINC-1).

Methods

Nonuremic rats were exposed through an indwelling catheter to a single dose of 20 mL glucose- (2.5%) based filter-sterilized PD fluid, with or without the addition of anti-rat C5 antibody. The dwell fluid was analyzed 2 and 4 hours later concerning activation of the coagulation cascades, neutrophil recruitment, ultrafiltration volume; CINC-1, glucose, urea, and histamine concentrations; and ex vivo intraperitoneal chemotactic activity.

Results

The numbers of neutrophils and levels of thrombin–antithrombin complex (TAT) and CINC-1 increased significantly during the PD dwell. C5 blockade significantly reduced the levels of TAT and increased the ultrafiltration volumes at 2 hours. Glucose concentrations were significantly positively correlated to ultrafiltration volumes.

Conclusions

Blockade of C5 leads to an increase in ultra-filtration, probably by a mechanism that involves a reduction in glucose transport. This effect may form a basis for improving PD efficiency in situations where high glucose transport limits ultrafiltration. Mechanisms connected to complement activation during PD may involve coagulation. Further studies of the intraperitoneal cascade systems under conditions of PD are indicated.
Impact of Nutritional Status on Peritonitis in CAPD Patients
Authors: Prasad Narayan , Gupta Amit , Sharma Raj K. , Sinha Archna , Kumar Ramesh
Published: February 2020

Objective

To determine the impact of nutritional status on peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in a developing country.

Methods

56 patients with end-stage renal disease on CAPD were randomly selected for this study. These patients were assessed for nutritional status and peritonitis episodes. Nutritional parameters were assessed by anthropometry, diet, body mass index (BMI), Nutritional Risk Index (NRI), serum albumin level, and Subjective Global Assessment (SGA). Based on SGA, patients were categorized into either group 1 (malnutrition, n = 31) or group 2 (normal nutritional status, n = 25). Peritonitis was considered the primary outcome and was compared between the two groups.

Results

Demographic profiles, Kt/V, creatinine clearance, and mean follow-up of the two groups were similar. Number of peritonitis episodes was significantly higher in patients with malnutrition (25/31) compared to patients with normal nutritional status (4/25) ( p = 0.001). Mean peritonitis rate per patient per year was also significantly higher in patients with malnutrition (0.99 ± 1.07) compared to patients with normal nutritional status (0.18 ± 0.42) ( p = 0.007). On univariate analysis, malnutrition based on SGA ( p = 0.009), NRI ( p = 0.02), serum albumin level ( p = 0.005), and calorie intake ( p = 0.006) was a significant predictor of peritonitis. On multivariate Cox regression analysis, only SGA ( p = 0.001, odds ratio 0.08, 95% confidence interval 0.02 – 0.36) was found to be a significant predictor of peritonitis. On general linear model, the observed power of prediction of peritonitis was 0.96 based on SGA. On Kaplan–Meier survival analysis, peritonitis-free survival in patients with normal nutrition (42 months) was significantly higher compared to patients with malnutrition (21 months) based on SGA (log rank p = 0.003).

Conclusion

We conclude that peritonitis rate is high in patients with malnutrition and that malnutrition indices, especially SGA, can predict the peritonitis rate in CAPD patients.
Predictors of Survival and Technique Success after Reinsertion of Peritoneal Dialysis Catheter following Severe Peritonitis
Authors: Cox Sue D. , Walsh Stephen B. , Yaqoob Muhammad M. , Fan Stanley L.-S.
Published: February 2020

Background

Peritonitis remains the most important complication of peritoneal dialysis (PD). The success rate of restarting PD after severe peritonitis (peritonitis unresolved despite treatment with appropriate antibiotics for 3 days, or fungal or pseudomonas infections) is unclear. We wished to determine PD technique survival and overall mortality when PD is offered to these patients and to identify predictors of successful reinitiation.

Method

We conducted a retrospective single-center study of 556 patients undergoing PD between January 2000 and December 2001. We collected demographic information from the 106 patients who had their PD catheter removed for peritonitis, details about their dialysis history and peritonitis, and whether they successfully restarted PD and if not, the reason.

Results

We divided patients into groups as follows: group 1 ( n = 42) underwent catheter reinsertion, group 2 ( n = 16) had no medical contraindication to restarting PD but the patients elected to remain on hemodialysis, group 3 ( n = 35) were deemed medically unsuitable to return to PD, and group 4 ( n = 13) were those that died within 4 weeks of presenting with peritonitis. If there were no medical contraindications, Indo-Asians were more likely to retry PD. In group 1, after a mean follow-up of 20 ± 7.3 months, 23 of 42 patients restarted PD successfully. Technique survival for group 1 as a whole was 69% at 3 months and 55% at the end of follow-up. Patients of greater dialysis vintage were more likely to develop PD technique failure after restarting. Of those judged suitable for PD, there was no statistically significant difference in the mortality of patients who wished to either restart PD or remain on hemodialysis (group 1 vs group 2). Significant numbers of patients returned successfully to PD after pseudomonas and fungal peritonitis.

Conclusion

Restarting PD after severe peritonitis was possible and safe. Ethnicity was an important predictor for wanting to retry PD, but not for technique failure: given the choice, Indo-Asians preferred PD and had a higher failure rate after restarting, but this did not reach statistical significance. Only dialysis vintage predicted technique failure. We conclude that, after severe peritonitis, patients should be given the choice to return to PD but risk stratification based on dialysis vintage is important. Patient retraining and creating a backup arteriovenous fistula might minimize morbidity in these high-risk patients.
Vancomycin Disposition following Intraperitoneal Administration in Children Receiving Peritoneal Dialysis
Authors: Blowey Douglas L. , Warady Bradley A. , Abdel–Rahman Susan , Frye Reginald F. , Manley Harold J.
Published: February 2020

Background

Little information is available on the disposition of vancomycin during chronic peritoneal dialysis (PD) in children. The primary objective of this study was to investigate the disposition of vancomycin following intraperitoneal (IP) administration in children receiving short-dwell [ e.g., automated PD (APD)] and long-dwell [ e.g., continuous ambulatory PD (CAPD)] PD.

Methods

A 6-hour exchange containing vancomycin 500 mg/L, using an exchange volume of 1100 mL/m2 body surface area (BSA), was followed by 4-, 6-, and 8-hour antibiotic-free exchanges. The 8-hour exchange was followed by three to four 90-minute antibiotic-free exchanges. Serial blood and dialysis effluent samples were obtained and analyzed for vancomycin concentration by high-pressure liquid chromatography. Pharmacokinetic parameters were computed using noncompartmental methods.

Results

The bioavailability of vancomycin during a 6-hour IP exchange was 70% ± 5%, resulting in a delivered dose of 12.0 ± 1.8 mg/kg, and a 6-hour serum vancomycin concentration of 23.3 ± 7.2 μg/mL. Total body vancomycin clearance measured 10.72 ± 4.52 mL/minute/1.73 m2 BSA, while clearance attributable to PD measured 2.78 ± 1.08 mL/min/1.73 m2 BSA and accounted for 29% ± 11% of total vancomycin clearance. Dialysis clearance during long-dwell (CAPD) and short-dwell (APD) regimens was similar, measuring 2.46 ± 1.04 and 3.09 ± 1.28 mL/min/1.73 m2 BSA, accounting for 25% ± 13% and 32% ± 12% of total body clearance respectively.

Conclusions

Intraperitoneal absorption and dialysis clearance of vancomycin in children receiving PD are similar to those reported in adult dialysis patients. In contrast, total body clearance of vancomycin appears to be increased and the elimination half-life decreased in children, due to increased elimination by non-renal nondialysis routes. For intermittent IP vancomycin therapy in children with peritonitis, an IP load containing vancomycin 1000 mg/L (or 30 mg/kg), followed a single full-fill (1100 mL/m2 BSA) daily exchange, containing vancomycin 250 mg/L (or 7.5 mg/kg), from day 2 until the end of treatment will maintain a vancomycin dialysate concentration of >4 μg/mL.
Dietary Protein Requirements and Dialysate Protein Losses in Chronic Peritoneal Dialysis Patients
Authors: Westra Wytske M. , Kopple Joel D. , Krediet Raymond T. , Appell Marilyn , Mehrotra Rajnish
Published: February 2020

Background

Recommended dietary protein allowances for chronic peritoneal dialysis (PD) patients are approximately 60% higher than the dietary protein allowances for healthy adults. The relative contribution of dialysate protein and amino acid losses to these high protein requirements or total nitrogen losses is uncertain.

Methods

Following a peritoneal equilibration test, two 24-hour dialysate collections (24–1 and 24–2) were performed in 9 stable patients undergoing automated PD [4 males, 3 diabetics, age 43 ± 5 years (mean ± SEM), dialysis vintage 42 ± 6 months, dialysate-to-plasma ratio of creatinine 0.61 ± 0.04]. Dialysate effluent from nighttime cycling was collected separately from the daytime dwells.

Results

The measured 24-hour protein losses were 9.4 ± 0.6 (24-31) and 10.8 ± 0.8 (24-32) g/day. Even though day dwells accounted for 27% of daily dialysate volume, they accounted for 40% of daily protein and amino acid losses. The frequency of nighttime cycling and duration of dwell were significant predictors of peritoneal protein losses. Dialysate protein and amino acid losses constituted 24% ± 2% and 3.1% ± 0.3% of dialysate nitrogen and 14% ± 1% and 1.7% ± 0.1% of dietary nitrogen intake respectively.

Conclusions

Treatment with automated PD is associated with somewhat higher 24-hour dialysate protein losses compared to previous reports among continuous ambulatory PD patients. Dialysate protein and amino acid losses constitute a small, albeit significant, proportion of total nitrogen appearance and thus may contribute to the increased dietary protein requirements of chronic PD patients.
Hemoperitoneum: Bloody Peritoneal Dialysate in Esrd Patients Receiving Peritoneal Dialysis
Authors: Lew Susie Q.
Published: February 2020

Hemoperitoneum is seen in patients receiving peritoneal dialysis (PD) because the PD catheter provides a window to the peritoneum. Gynecological associated phenomena account for the majority of cases. Intra-abdominal pathology of solid organs such as the kidney, liver, and spleen as well as the gastrointestinal tract is recognized. Unique to PD patients, hemoperitoneum may be associated with the catheter itself, uremic bleeding, or peritonitis. A successful PD program requires nephrologists, PD nurses, and patients assess and manage hemoperitoneum in a systematic fashion. This paper reviews hemoperitoneum in adult PD patients.
Combination of Crystalloid (Glucose) and Colloid (Icodextrin) Osmotic Agents Markedly Enhances Peritoneal Fluid and Solute Transport during the Long PD Dwell
Authors: Freida Philippe , Galach Magda , Filho Jose C. Divino , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Background

Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining.

Method

We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate.

Results

The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultra-filtration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin.

Conclusion

A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.
Expression of Heat Shock Protein 72 in Peritoneal Leukocytes is Induced by Peritoneal Dialysis
Authors: Marzec Lukasz , Liberek Tomasz , Chmielewski Michal , Bryl Ewa , Witkowski Jacek M. , Liberek Krzysztof , Zdrojewski Zbigniew , Rutkowski Boleslaw
Published: February 2020

Background

One of the main limitations of peritoneal dialysis (PD) is deterioration of functional and morphological characteristics of the peritoneum. This complication appears to be related to the low biocompatibility profile of PD fluids. Recently, induction of the heat shock protein (HSP) stress response was demonstrated in cultured human mesothelial cells exposed to PD fluid in vitro. We investigated whether expression of heat shock protein 72 (HSP-72) in peritoneal macrophages is induced upon exposure to PD fluid during continuous ambulatory PD.

Methods

Peritoneal leukocytes were isolated from 4-hour dwell dialysate; peripheral blood mononuclear cells (PBMC) and peripheral blood monocytes isolated from the same patients were used as a control. In separate experiments, PBMC from healthy individuals were exposed in vitro to different PD fluids or to culture media. Expression of HSP-72 was assessed by Western immunoblotting, flow cytometry, and reverse-transcription polymerase chain reaction analysis.

Results

Macrophages and leukocytes isolated from dialysis effluent expressed significantly increased HSP-72 and mRNA levels compared to blood monocytes and PBMC of the same patients. In vitro exposure of PBMC to fresh PD fluids resulted in significantly higher expression of HSP-72 compared to those incubated in culture medium. PBMC exposed in vitro to standard lactate-buffered dialysis fluids also expressed significantly more HSP-72 compared to cells exposed to bicarbonate/lactate-buffered fluids.

Conclusion

Our results indicate that exposure to PD fluids during dialysis triggers a shock response in peritoneal cells, which is manifested by significantly increased HSP-72 expression at both protein and mRNA levels. Analysis of this protein expression in peritoneal macrophages could be a new, convenient, and relevant way to assess the biocompatibility of PD fluids ex vivo.
Pregnancy in End-Stage Renal Disease Patients and Treatment with Peritoneal Dialysis: Report of Two Cases
Authors: Vázquez Jesús Alfredo Gómez , Calva Ignacio Eduardo Martínez , Fernández Ricardo Mendíola , León Verónica Escalera , Cardona Mario , Noyola Hector
Published: February 2020

Pregnancy in end-stage renal disease patients is infrequent and is associated with fetal loss, premature delivery, intrauterine growth restriction, and lack of control of or exacerbation of or onset of hypertension. Even after replacement of renal function, the prognosis for the patient and the fetus is poor. A point of controversy is the renal replacement therapy method. This report is based on two clinical cases of pregnancy in peritoneal dialysis patients that resulted in full-term delivery. Adequate metabolic and blood pressure control was achieved during pregnancy, the only mutual complication being the presence of polyhydramnios. However, both infants were healthy for their gestational age and without neonatal complications. We may conclude that peritoneal dialysis is an acceptable therapeutic option for pregnant patients and their fetuses.
Prevention of Fungal Peritonitis with Nystatin Prophylaxis in Patients Receiving CAPD
Authors: Wong Ping-Nam , Lo Kin-Yee , Tong Gensy M.W. , Chan Shuk-Fan , Lo Man-Wai , Mak Siu-Ka , Wong Andrew K.M.
Published: February 2020

Objective

Fungal peritonitis (FP) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), being associated with significant morbidity and mortality. The role of nystatin prophylaxis during antibiotic therapy in the prevention of FP remains controversial, especially in programs with a modest or low baseline FP rate. The aim of the present study was to evaluate the effect of nystatin prophylaxis on the occurrence of FP in programs with a relatively modest baseline FP rate.

Patients and Methods

Incident and prevalent patients receiving CAPD between April 1995 and April 2005 at our center were included and divided into 2 groups. The control group included 320 patients (total follow-up 8875 patient-months) being treated without nystatin before October 1999; the nystatin group included 481 patients (total follow-up 13725 patient-months) being treated after October 1999. Nystatin tablets (500000 units, 4 times per day) were given orally during whatever use of antibiotics to cover the whole course of antibiotic therapy. Occurrence of FP and antibiotic-related FP (AR-FP) in patients with and without nystatin prophylaxis was compared.

Results

The two groups were of similar age but the nystatin group had a significantly higher percentage of diabetics. In addition, the nystatin group had a higher proportion of patients using disconnecting twin-bag exchange systems and had a significantly lower peritonitis rate compared with the control. There were 13 and 14 episodes of FP in the nystatin and control groups respectively. The fungal peritonitis rate of the nystatin group was slightly lower than that of the control group (0.011 vs 0.019 per patient-year) but it did not reach statistical significance. There was, however, a significant decrease in the incidence and proportion of AR-FP in the nystatin group compared with the control group, which persisted even after adjustment for the peritonitis rate. Kaplan–Meier analysis further demonstrated significantly better AR-FP-free survival in the nystatin group compared with the control group. No significant side effects were observed for nystatin. Subgroup analyses in patients of the 2 different connecting systems revealed a similar but nonsignificant trend toward reduction of AR-FP in patients given nystatin prophylaxis.

Conclusion

Oral nystatin prophylaxis might prevent the occurrence of AR-FP in CAPD patients, resulting in a trend toward reduction in the incidence of FP even in programs with a modest baseline FP rate. A large scale, prospective, randomized controlled trial is needed to further examine this issue.
Risks and Outcomes of Peritonitis after Flexible Colonoscopy in CAPD Patients
Authors: Yip Terence , Tse Kai Chung , Lam Man Fai , Cheng Suk Wai , Lui Sing Leung , Tang Sydney , Ng Matthew , Chan Tak Mao , Lai Kar Neng , Lo Wai Kei
Published: February 2020

Objective

The ISPD 2005 guidelines for peritonitis recommend antibiotic prophylaxis for patients undergoing colonoscopy with polypectomy while on continuous ambulatory peritoneal dialysis (CAPD) but there is little literature to support this recommendation. This study aimed to look into the risks and outcomes of peritonitis after colonoscopy in CAPD patients.

Patients and Methods

All records of flexible colonoscopy performed on our CAPD patients from January 1994 to January 2006 were retrieved. Demographic and clinical data, use of antibiotics before colonoscopy, endoscopic findings, procedure performed, and peritonitis data were analyzed.

Results

77 CAPD patients underwent 97 colonoscopies. No peritonitis developed in the 18 cases where antibiotics were given before colonoscopy. Among those without antibiotic prophylaxis, 4 episodes of peritonitis occurred within 24 hours after the procedure and 1 occurred 5 days later. All responded to intraperitoneal antibiotics. Colonic biopsy and polypectomy were not associated with more peritonitis (2 in 41 with biopsy vs 3 in 38 without biopsy, p = 0.67; 1 in 30 with polypectomy vs 4 in 49 without polypectomy, p = 0.64).

Conclusion

The risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%. All peritonitis episodes responded to intraperitoneal antibiotics. Colonic biopsy or polypectomy did not appear to increase the risk of peritonitis. Although statistically not significant when compared with patients without antibiotic prophylaxis, we observed no peritonitis after colonoscopy in patients that were given antibiotics for prophylactic purposes or for other reasons. The efficacy of prophylactic antibiotics would be better defined by large randomized trials.
A Quarter of a Century of Adult Peritoneal Dialysis-Related Peritonitis at an Australian Medical Center
Authors: Brown Fiona , Liu Wen Jiun , Kotsanas Despina , Korman Tony M. , Atkins Robert C.
Published: February 2020

Background

Peritonitis remains one of the major complications of peritoneal dialysis (PD) and results in reduced technique survival and increased patient morbidity and mortality.

Methods

We prospectively recorded comprehensive data on all episodes of PD peritonitis over a 25-year period, including organisms isolated and antibiotic sensitivities. Data on 1588 PD patient-years with 2073 episodes of peritonitis were analyzed; 2089 organisms were isolated in 608 patients. Peritoneal dialysis technique and patient survival were also recorded.

Results

There was a significant decline over the years in the incidence of peritonitis, from 6.5 to 0.35 episodes/patient-year, with the decline in the post twin-bag era from 2.3 to 0.47 ( p < 0.001) due primarily to a decrease in gram-positive organisms. The most common isolates (68.9%) were gram-positive organisms; gram-negative organisms comprised 26.8% and fungi 4.1%. Coagulase-negative staphylococci were the most common pathogen isolated (35.3%). Culture-negative peritonitis was seen in 13.4% of episodes.

Conclusion

This is the largest series of PD peritonitis reported, demonstrating a dramatic reduction over a 25-year period and also detailing the changing trends of organisms isolated in association with improved technique and patient survival. Although rates have improved, peritonitis remains a major complication and further research needs to be done to improve both PD technique and patient survival.
Transgenic Mouse Models
Authors: Nishino Tomoya , Ni Jie , Devuyst Olivier
Published: February 2020

The development of peritoneal dialysis has been paralleled by a growing interest in establishing suitable experimental models to better understand the functional and structural processes operating in the peritoneal membrane. Thus far, most investigations have been performed in rat and rabbit models, with mechanistic insights essentially based on intervention studies using pharmacological agents, blocking antibodies, or transient expression systems. Since the body size of a species is no longer a limiting factor in the performance of in vivo studies related to peritoneal dialysis, it has been considered that mice, particularly once they have been genetically modified, could provide an attractive tool to investigate the molecular mechanisms operating in the peritoneal membrane. The purpose of this review is to illustrate how investigators in peritoneal dialysis research, catching up with other fields of biomedical research, are increasingly taking advantage of mouse models to provide direct evidence of basic mechanisms involved in the major complications of peritoneal dialysis.
Serum BNP Concentration and Left Ventricular Mass in CAPD and Automated Peritoneal Dialysis Patients
Authors: Bavbek Nüket , Akay Hatice , Altay Mustafa , Uz Ebru , Turgut Faruk , Uyar Mehtap E. , Karanfil Aydýn , Selcoki Yusuf , Akcay Ali , Duranay Murat
Published: February 2020

Objective

To compare ultrafiltration under continuous ambulatory peritoneal dialysis (CAPD) and automated PD (APD), disclosing potential effects on serum B-type natriuretic peptide (BNP) levels and echocardiographic findings.

Patients and Methods

This cross-sectional clinical study included 32 patients on CAPD and 30 patients on APD without clinical evidence of heart failure or hemodynamically significant valvular heart disease. Peritoneal equilibration tests, BNP levels, and echocardiographic measurements were performed in each subject. BNP measurements were also performed in 24 healthy control subjects.

Results

Patients on APD had lower ultrafiltration and higher values of BNP and left ventricular mass index (LVMI) compared with patients on CAPD (respectively: 775 ± 160 vs 850 ± 265 mL, p = 0.01; 253.23 ± 81.64 vs 109.42 ± 25.63 pg/mL, p = 0.001; 185.12 ± 63.50 vs 129.30 ± 40.95 g/m2, p = 0.001). This occurred despite higher mean dialysate glucose concentrations and far more extensive use of icodextrin in the APD group.

Conclusion

Treatment with APD is associated with higher plasma BNP levels and LVMI compared to CAPD. This may be the result of chronic fluid retention caused by lower ultra-filtration in APD patients.
Quality of Sleep and Psychosocial Factors for Patients Undergoing Peritoneal Dialysis
Authors: Yang Ju-Yeh , Huang Jenq-Wen , Peng Yu-Sen , Chiang Shou-Shang , Yang Chwei-Shiun , Yang Chin-Ching , Chen Huey-Wen , Wu Ming-Shiou , Wu Kwan-Dun , Tsai Tun-Jun , Chen Wan-Yu
Published: February 2020

Objectives

Sleep disorders are common in end-stage renal disease patients. This study examined the relationship between self-reported quality of sleep (QoS) and certain psychosocial domains for patients on peritoneal dialysis (PD).

Methods

The study subjects included 190 PD patients from 7 urban dialysis clinics in Northern Taiwan, from whom we obtained biochemical parameters and demographic data. QoS, quality of life (QoL), religious/spiritual activity, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Medical Outcomes Study Short Form (SF-36) for QoL, the Royal Free Questionnaire, and the Beck Depression Inventory, respectively.

Results

The average PSQI score was 9.1 ± 4.1 and, in total, 85.8% of all patients were poor sleepers (global PSQI ≥ 5). There was no difference in age, gender, and mode or duration of PD between good and poor sleepers. Biochemical data did not differ between the two groups. Widowed patients experienced significantly poorer QoS than patients with other marital status (PSQI scores: 12.3 ± 4.9 vs 8.88 ± 4.0, p = 0.006). The percentage of patients that held a bachelor's degree or above was significantly higher in good sleepers (55.6% vs 29.4%, p = 0.008). The PSQI value correlated negatively with the QoL scale in both physical ( r = –0.295, p < 0.001) and mental domains ( r = –0.410, p < 0.001), and correlated positively with the depression scale ( r = 0.351, p < 0.001). There appeared to be no association between QoS and spiritual/religious activity ( r = –0.097, p = 0.223).

Conclusions

Psychosocial factors including depression, patients’ perceptions regarding QoL, marital status, and educational background correlated significantly to the subjective QoS for PD patients. When dealing with sleep disorders in PD patients, physicians should pay considerable attention to their psychosocial backgrounds.
Intraperitoneal Calcitriol in Infants on Peritoneal Dialysis
Authors: Cano Francisco J. , Azocar Marta A. , Guerrero Jose Luis , Delucchi Maria A. , Lillo Ana Maria , Emilfork Marcos , Rodríguez Eugenio E.
Published: February 2020

Background

Calcitriol has long been used as the main therapy in renal osteodystrophy, but the efficacy of the oral route is not always as high as expected.

Objective

To asses the safety and efficacy of intraperitoneal calcitriol in infants undergoing peritoneal dialysis (PD).

Patients and Methods

PD patients on oral calcitriol therapy, with serum parathyroid hormone (PTH) >1000 pg/mL during the previous 3 months of treatment, were switched to intraperitoneal calcitriol therapy, 1 μg twice per week. Dose was increased to 1 μg three times per week if PTH remained >1000 pg/mL, and was later readjusted. Target PTH was 200 – 300 pg/mL according DOQI guidelines. Statistics: All results are expressed as mean ± SE. The Wilcoxon signed rank test was used to evaluate differences in measurements for each pair of values. The confidence interval for differences between population medians was 96.9%. A p value less than 0.05 was considered significant.

Results

Six male children, mean age 17 ± 3.86 months, completed a 12-month follow-up. Mean pretreatment PTH was 1654 ± 209 pg/mL. Mean PTH at months 0, 3, 6, 9, and 12 was 1448 ± 439*, 1277 ± 723, 910 ± 704, 582 ± 282*, and 465 ± 224* pg/mL, respectively (*p < 0.05). Twelve hypercalcemic and 10 hyperphosphatemic episodes were successfully treated.

Conclusion

Infants on PD who fail to respond to oral calcitriol therapy can be safely treated with intraperitoneal administration of active vitamin D.
Ultrafiltration and Absorption in Evaluating Aquaporin Function from Peritoneal Transport of Sodium
Authors: Waniewski Jacek , Debowska Malgorzata , Lindholm Bengt
Published: February 2020

Background

Evaluation of free water transport is a tool for assessing aquaporin function in peritoneal dialysis patients. The dialysate “sodium dip” and estimation of sieving coefficient for sodium may be used for quantification of the free water fraction in ultrafiltration flow from blood to the peritoneal cavity.

Method

The mini peritoneal equilibration test (mini-PET) [La Milia et al., Nephrol Dial Transplant 2002; 17(Suppl 3):17–18] is a simple method for evaluating free water transport using sodium as a marker. We compared the evaluation of free water transport using the mini-PET against detailed data on fluid and sodium transport from clinical dwell studies using a macromolecular volume marker to estimate fluid absorption and ultrafiltration rates, and the modified Babb–Randerson–Farrell model to assess the sodium transport components.

Results and Conclusion

According to our results, the mini-PET may result in underestimation of fluid transport by about 20% because it neglects the impact of peritoneal fluid and solute absorption and sodium diffusion during the peritoneal dwell time. Nevertheless, estimation of the free water fraction in the mini-PET yields values (about 0.4) similar to the more detailed analysis.
Transluminal Replacement of Displaced Peritoneal Catheter Using a Special “Alpha-Replacer” Guidewire: Effectiveness and Limitations
Authors: Terawaki Hiroyuki , Nakayama Masaaki , Nakano Hirofumi , Hasegawa Toshio , Ogura Makoto , Hosoya Tatsuo , Karino Tomokazu
Published: February 2020

Background

Transluminal replacement of a displaced peritoneal catheter (TRC) using a metal guidewire is a noninvasive treatment of catheter displacement with acute malfunction. The “alpha-replacer” is a special guidewire developed specifically for TRC. This wire is usually flexible but becomes harder if coiled in the hand. Application of this unique guidewire might improve the effectiveness of TRC.

Methods

TRC using an alpha-replacer was performed in 10 cases for urgent correction of peritoneal catheter displacement. All patients had received a double cuffed, straight-end swan-neck catheter.

Results

The primary success rate of TRC using the alpha-replacer was 90% (9 of 10 cases). No patients developed complications such as injury of the peritoneum or abdominal organs. Relapse of catheter displacement was observed in 2 cases (20%) within 1 week, requiring surgical intervention to prevent relapse.

Conclusion

TRC using the alpha-replacer as described herein offers effective and safe treatment of peritoneal catheter displacement.
Chronic Peritoneal Dialysis in South Asia — Challenges and Future
Authors: Abraham Georgi , Pratap Balaji , Sankarasubbaiyan Suresh , Govindan Priyanka , Nayak k. Shivanand , Sheriff Rezvi , Naqvi S.A. Jaffar
Published: February 2020

Chronic peritoneal dialysis (PD), especially continuous ambulatory PD (CAPD), is being increasingly utilized in South Asian countries (population of 1.4 billion). There are divergent geopolitical and socioeconomic factors that influence the growth and expansion of CAPD in this region. The majority of the countries in South Asia are lacking in government healthcare system for reimbursing renal replacement therapy. The largest utilization of chronic PD is in India, with nearly 6500 patients on this treatment by the end of 2006. A large majority of patients are doing 2 L exchanges 3 times per day, using glucose-based dialysis solution manufactured in India. Chronic PD is not being utilized in Myanmar, Bhutan, or Seychelles. Affirmative action by the manufacturing industry, medical professionals, government policy makers, and nongovernmental organizations for reducing the cost of chronic PD will enable the growth and utilization of this life-saving therapy.
Comparison between Bicarbonate/Lactate and Standard Lactate Dialysis Solution in Peritoneal Transport and Ultrafiltration: A Prospective, Crossover Single-Dwell Study
Authors: Fang Wei , Mullan Robert , Shah Hemal , Mujais Salim , Bargman Joanne M. , Oreopoulos Dimitrios G.
Published: February 2020

Objective

It has been proposed that biocompatible bicarbonate/lactate based (Bic/Lac), physiologic-pH peritoneal dialysis (PD) solutions will be beneficial in long-term PD. However, we do not yet have detailed knowledge concerning the comparative physiology of buffer transport for these new solutions and their impact on underlying peritoneal transport of solutes and ultrafiltration (UF). The purpose of this study was to investigate the profile of buffer handling and peritoneal membrane transport characteristics during a single dwell of the new Bic/Lac-based versus standard lactate-based (Lac) PD solution.

Methods

In this prospective crossover study, we compared a 25 mmol/L bicarbonate/15 mmol/L lactate buffered, physiologic pH, low glucose degradation product (GDP) solution (Physioneal; Baxter Healthcare, McGaw Park, Illinois, USA) with a standard lactate buffered, acidic pH, conventional solution (Dianeal; Baxter). 18 patients underwent two peritoneal equilibration tests (PETs) with 2.5% Dianeal and 2.5% Physioneal separated by 1 week. Buffer transport, mass transfer area coefficients (MTACs), solute transport, and UF were determined for the two PETs. All bags were weighed by a nurse before instillation and after drainage to assess the net UF in each dwell.

Results

18 patients that met the inclusion criteria were enrolled in this study. Whereas intraperitoneal pH remained constant at 7.52 ± 0.11 throughout the dwell with the Bic/Lac solution, pH was still in the acidic range with the Lac solution after 1 hour (7.29 ± 0.13, p < 0.001); this difference disappeared after the second hour of dwell. The MTACs for creatinine (10.68 ± 3.66 vs 10.73 ± 2.96 mL/minute/ 1.73 m2, p > 0.05) and urea (27.94 ± 10.50 vs 27.62 ± 6.95 mL/min/1.73 m2, p > 0.05), for Bic/Lac versus Lac respectively, did not differ between these two solutions; transport of glucose and other solutes was also similar. However, after a 4-hour dwell with Bic/Lac solution, net UF was significantly lower than that observed with Lac solution (274.2 ± 223.3 mL vs 366.1 ± 217.3 mL, p = 0.026).

Conclusions

Compared to standard Lac-based solution, Bic/Lac based, pH neutral, low-GDP solution avoids intra-peritoneal acidity. Peritoneal mass transport kinetics are similar for small solutes. Net UF is significantly lower with Bic/Lac solution; the mechanism for this is unclear.
How Accurate is the Description of Transport Kinetics in Peritoneal Dialysis According to Different Versions of the Three-Pore Model?
Authors: Waniewski Jacek , Debowska Malgorzata , Lindholm Bengt
Published: February 2020

Objective

The three-pore model of peritoneal transport is used extensively for modeling peritoneal fluid and solute transport, but the currently used versions include certain modifications of the transport parameters that have not been validated quantitatively versus detailed data on fluid and solute kinetics. The aim of this study was to evaluate different versions of the three-pore model.

Method

Detailed clinical peritoneal fluid and solute transport data were obtained from 40 peritoneal dwell studies in clinically stable continuous ambulatory peritoneal dialysis patients in whom the dialysate volume was measured using a macromolecular volume marker (RISA).

Results

Using a new version of the three-pore model with several adjusted transport parameters, good agreement between the measured and the simulated values of dialysate volume and concentrations of small solutes and RISA (but not of endogenous protein) versus dwell time was obtained; however, the predicted peritoneal absorption for longer than the investigated dwell time would be too high.

Conclusion

The three-pore model, with some adjustments proposed in this study, may be used for detailed description of peritoneal transport kinetics, but it should be pointed out that, even after these adjustments, it still does not provide the correct description of peritoneal fluid absorption and transport of macromolecules.
Renal Replacement Therapy in End-Stage Renal Disease Patients with Chronic Liver Disease and Ascites: Role of Peritoneal Dialysis
Authors: Chaudhary Kunal , Khanna Ramesh
Published: February 2020

Chronic liver disease and cirrhosis account for several thousand deaths in the United States and often these patients have renal disease that progresses to end-stage renal disease (ESRD), necessitating renal replacement therapy. These patients provide significant challenges to their physicians, especially in the management of their ESRD with dialysis. ESRD patients with chronic liver disease and ascites are more difficult to manage on hemodialysis (HD) due to their hemodynamic status and risk of bleeding. Peritoneal dialysis (PD) offers them a viable alternative, along with a stable hemodynamic status and a lower risk of bleeding. The overall morbidity and mortality as well as the risk of peritonitis appear to be almost similar between cirrhotic and non-cirrhotic PD patients. In the absence of clinical trials comparing HD versus PD in such a population, and despite the limited clinical observations, the authors support PD as a viable and effective form of renal replacement therapy for patients with ESRD and associated chronic liver disease with cirrhosis and ascites.
Acute Central Hemodynamic Effects of a Volume Exchange in Peritoneal Dialysis
Authors: Verbeke Francis , Van Biesen Wim , Pletinck Anneleen , Van Bortel Luc M. , Vanholder Raymond
Published: February 2020

Background

Although peritoneal dialysis is considered to offer more hemodynamic stability than hemodialysis, the acute hemodynamic effects of peritoneal dialysis have only been investigated scarcely. The present study assesses the central hemodynamic impact of volume infusion using pH-adjusted icodextrin, thus avoiding interference of glucose, pH, and osmolarity.

Methods

Patients were randomized to 3 different starting volumes (A: 1000 mL, B: 1500 mL, and C: 2500 mL) of icodextrin, followed by addition (A and B) or drainage (C) of 200 mL every 10 minutes for 50 minutes. Local carotid systolic blood pressure (BP; as a surrogate for central BP), augmentation index, and augmentation pressure were measured by applanation tonometry before and after infusion of the starting volumes and after each volume change.

Results

We included 13 patients (median age 57 years). Baseline brachial BP was 126/77 mmHg. After infusion of the starting volume, carotid systolic BP and augmentation pressure increased by 4.7 mmHg ( p = 0.006) and 3.1 mmHg ( p = 0.015). Augmentation index increased by 5.7% ( p = 0.04) and heart rate decreased by 2.6/minute ( p = 0.006). Intraperitoneal pressure increased by 2.3 cm H2O ( p = 0.03). No additional hemodynamic changes except for a rise in diastolic BP with increasing volume ( p = 0.004) were observed after subsequent addition or removal of volumes.

Conclusions

Infusion of peritoneal dialysis fluids causes an acute increase in carotid systolic B P, followed by a progressive rise in diastolic BP. These effects persist until complete drainage of the abdomen and may be due to an enhanced preload, resulting from intraperitoneal venous compression, and/or increased wave reflection.
Fluoroscopically Guided Peritoneal Dialysis Catheter Placement: Long-Term Results from a Single Center
Authors: Moon Ju-Young , Song Sebin , Jung Kyung-Hwan , Park Mina , Lee Sang-Ho , Ihm Chun-Gyoo , Oh Joo-Hyeong , Kwon Se Hwan , Lee Tae Won
Published: February 2020

Objective

Despite percutaneous fluoroscopy ensuring appropriate placement of peritoneal dialysis (PD) catheters, the efficacy of this method is not well known. Therefore, we evaluated our long-term experience with fluoroscopy-assisted placement of PD catheters.

Patients and Methods

We retrospectively reviewed 134 PD catheters in 114 PD patients that were treated in the PD center of a university-based hospital. We evaluated complications related to PD catheters, causes for catheter removal, and catheter survival. We used the multivariate Cox proportional hazard model to identify independent factors related to PD catheter survival.

Results

Early complications related to insertion included 1 case of pericatheter bleeding; there were no placement failures. Early complications occurred in 8.5% of patients. Most late complications were migration and leakage, which occurred in 10.4% and 9.7% of patients respectively. The most common cause for catheter removal was intractable and recurrent peritonitis. The 12- and 24-month survival rates of the catheters were 80.0% and 74.9%. The most significant prognostic factor of percutaneous fluoroscopy-assisted PD catheter survival was late leakage ( p < 0.01).

Conclusions

In addition to the advantages of simplicity, minimal invasiveness, and relative safety, the survival rate of PD catheters placed using the percutaneous fluoroscopy-assisted method was comparable to that of more invasive methods. Percutaneous fluoroscopy-assisted placement of PD catheters should be considered when available, and may be preferred to other placement methods.
Laparoscopic Placement of Tenckhoff Catheters for Peritoneal Dialysis: A Safe, Effective, and Reproducible Procedure
Authors: Maio Rui , Figueiredo Nuno , Costa Paulo
Published: February 2020

Background/Aims

Currently there are several techniques for laparoscopic placement of peritoneal dialysis catheters. The aim of this paper is to describe our technique and outcomes.

Patients and Methods

Laparoscopic implantation of peritoneal catheters was performed in 100 consecutive patients. The technique employed laparoscopically guided mus-culofascial tunneling to maintain catheter orientation toward the deep pelvis, and adhesiolysis to eliminate compartmentalization that could affect completeness of dialysate drainage. Mean duration of surgery, hospital stay, morbidity, mortality, and catheter survival were assessed. Analysis of catheter survival was performed using the Kaplan–Meier method, with censoring of catheter loss due to death or successful transplantation.

Results

Mean operative time was 20 ± 7 minutes and average duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to conventional catheter insertion methods. No exit-site or tunnel infections, hemorrhagic complications, abdominal wall hernias, or catheter cuff extrusions were detected. No mortality occurred in this series of patients. Catheter survival was 97%, 95%, and 91% at 1, 2, and 3 years, respectively.

Conclusions

The laparoscopic method described in this report is compliant with consensus guidelines for best-demonstrated practices in peritoneal access placement. Laparoscopy permits direct visualization of all procedure steps in a safe efficient reproducible manner. The laparoscopic approach afforded patients the advantage of short procedure times, a minimally invasive approach, and excellent outcomes. The results reported in this paper support our opinion that laparoscopic Tenckhoff catheter implantation should become the standard of care for clinical practice.
The Clinical Usefulness of Peritoneal Dialysis Fluids with Neutral pH and Low Glucose Degradation Product Concentration: An Open Randomized Prospective Trial
Authors: Choi Hoon Young , Kim Dong Ki , Lee Tae Hee , Moon Sung Jin , Han Seung Hyeok , Lee Jung Eun , Kim Beom Seok , Park Hyeong Cheon , Choi Kyu Hun , Ha Sung Kyu , Han Dae-Suk , Lee Ho Yung
Published: February 2020

Background

Long-term peritoneal dialysis (PD) is associated with the development of various structural and functional changes to the peritoneal membrane when bioincompatible conventional peritoneal dialysis fluids (PDFs) are used. In this study, we looked at patients that were treated with conventional PDFs and then changed to novel biocompatible PDFs with a neutral pH and a low concentration of glucose degradation products (GDPs) to investigate whether this change could result in the arrest or reversal of peritoneal membrane deterioration.

Methods

In an open label, randomized prospective trial, the clinical effects of conventional PDFs and biocompatible PDFs with neutral pH and very low concentration of GDPs were compared in 104 patients equally divided between both study PDFs. Blood and effluent dialysate samples, peritoneal equilibration tests, and adequacy evaluation were undertaken at baseline, 4, 8, and 12 months. The target variables were the ratio of dialysate-to-plasma (D/P) creatinine, peritoneal ultrafiltration, residual renal function, dialysis adequacy indices, and effluent cancer antigen 125 (CA125).

Results

D/P creatinine values were not different in the two groups. Peritoneal ultrafiltration was significantly higher in the low-GDP PDF group than in the conventional PDF group at all follow-up times (4 months: 9.1 ± 4.3 vs 6.0 ± 3.0; 8 months: 8.3 ± 3.4 vs 6.0 ± 3.0; 12 months: 8.9 ± 3.3 vs 6.1 ± 3.3 mL/g dextrose/day; p < 0.05). Peritoneal Kt/V urea values and total weekly Kt/V urea values at 4 months were significantly higher in the low-GDP PDF group than in the conventional PDF group. Residual renal function was not statistically significant. Effluent CA125 levels were significantly higher in the low-GDP PDF group at all follow-up visits (4 months: 37.8 ± 20.8 vs 22.0 ± 9.5; 8 months: 41.2 ± 20.3 vs 25.9 ± 11.3; 12 months: 40.4 ± 21.4 vs 28.6 ± 13.0 U/mL; p < 0.05). Among anuric patients, peritoneal ultrafiltration at 4, 8, and 12 months, total weekly Kt/V at 4 and 8 months, and CA125 levels at all follow-up visits were significantly higher in patients treated with low-GDP PDF than those treated with conventional PDF. However, among anuric patients, D/P creatinine showed no significant differences between the low-GDP PDF group and the conventional PDF group.

Conclusion

The use of biocompatible PDFs with neutral pH and low GDP concentration can contribute to improvement of peritoneal ultrafiltration and peritoneal effluent CA125 level, an indicator of peritoneal membrane integrity in PD patients.