bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Individual Ultrafiltration Time (Apex) and Purification Phosphate Time by Peritoneal Equilibration Test: Application to Individual Peritoneal Dialysis Modality Prescription in Children
Authors: Fischbach Michel , Lahlou Ahmed , Eyer Didier , Desprez Philippe , Geisert Jean
Published: February 2020

Efficiency of peritoneal dialysis (PD) is dependent on adequate ultrafiltration (UF) and purification (solute clearance). These two goals apparently seem to conflict in terms of duration of dwells: short dwell time enhances UF capacity and, conversely, long dwell time enhances solute clearance. Peritoneal equilibration test (PET) allows an approach to the ultrafiltration time: the point at which the over time dialysate urea saturation and glucose desaturation curves cross, called APEX time. PET also allows an approach to the purification time: the point at which dialysate-to-plasma (DIP) concentration ratios over time are high. Because of the value of phosphate as a uremic factor of morbidity, we have chosen the time at which DIP phosphate is equal to 0.6 as a purification phosphate dwell time (PPT). A total of 17 patients were studied, over a five-year period, allowing 142 determinations. APEX times (range 18 71 min) and PPT (range 105 -238 min) were spread over a wide distribution. PPT and APEX times were significantly shorter in children younger than three years of age than in children older than ten years of age. PPT were nearly four times longer than APEX times. Knowledge of these conflicting ultrafiltration and purification times should help, in our view, in the individual choice of the PD modality: if UF is the major goal, short dwell times should be used (automated PD); if purification is the major goal, long dwell times should be used, as in continuous ambulatory peritoneal dialysis; if both are the target goal, tidal PD should be discussed.
The Importance of the Interstitium in Peritoneal Transport
Authors: Flessner Michael F.
Published: February 2020

The peritoneal capillary exchange vessels are located within all the tissues which surround the peritoneal cavity and are separated from the peritoneal dialysis fluid by the tissue interstitium. The interstitium adds an additional barrier to transcapillary transport resistance and slows the diffusion of solutes from the blood to the dialysis fluid. The interstitium also alters the pressure environment of the blood capillary and has profound effects on water transport, causing fluid loss from the cavity to the body during dialysis.
Role of Diaphragmatic, Visceral, and Parietal Pathways in Peritoneal Fluid Absorption in Rat Peritoneal Dialysis
Authors: Kumano Kazuo , Go Kimitoshi , He Me , Sakai Tadasu
Published: February 2020

Assessment was made of the contribution of lymphatic and non lymphatic fluid absorption to net fluid loss from the peritoneal cavity. Diaphragmatic, visceral, and parietal pathways in lymphatics and nonlymphatics were examined using a rat model with adhesion of the diaphragm to the liver, evisceration, these two procedures in combination, and without treatment. In each of these cases, six rats were used, each dialyzed for 180 min with Krebs–Ringer solution. The peritoneal net fluid absorption rate (PNFAR) was determined based on the disappearance of 1251-bovine serum albumin (BSA) from the peritoneal cavity and the lymphatic absorption rate (LAR), was based on the appearance of this albumin in the blood. Seventy-eight percent of net fluid loss occurred via the non lymphatic pathway, primarily through parietal and visceral absorption, and the remaining 22% through the lymphatics, the main pathway being the subdiaphragmatic lymphatics. Nonlymphatic fluid absorption would thus appear to be a major route of fluid loss from the peritoneal cavity in rat peritoneal dialysis.
Optimal Use of Glucose Polymer (Icodextrin) in Peritoneal Dialysis
Authors: Mistry Chandra D. , Gokal Ram
Published: February 2020

The osmotic effectiveness of glucose polymer is now well established. The relative inertness of this macromolecular compound has been the key factor in its success as the first “colloid” osmotic agent in clinical use. In its present form, it produces sustained ultrafiltration for up to 12 hours, and a daily overnight use would obviate the need for hypertonic exchanges, especially 3.86% glucose. In addition, it could be used in automated peritoneal dialysis regimes to enhance ultrafiltration and solute clearance during the daytime. Preliminary reports also indicate that it is beneficial in diabetic patients and in some patients who have lost ultrafiltration. The new “bimodal” formulations look promising, with the potential to replace all the currently used hyperosmolar exchanges with physiological solutions.

Although systemic accumulation of glucose polymer breakdown products occurs, it reaches steadystate levels quickly (within two weeks) and remains stable throughout the duration of polymer use. In the long-term study, these levels of maltose and oligosaccharides over three-and-a-half years represent the longest exposure of these substances in uremic patients without any clinical or metabolic adverse effects and provide an important evidence of safety.

Future work based on studies that are ongoing suggest that a family of physiological solutions (“bimodal” preparations in iso-osmolar combination) could be available, and the individual's dialysis prescription could be tailored to take into account the ultrafiltration, metabolic needs, as well as the longterm viability of the membrane. Glucose polymer will be a key component of such solutions.
Acid-Base Balance with Different Capd Solutions
Authors: Feriani Mariano , Ronco Claudio , La Greca Giuseppe
Published: February 2020

Our objective is to investigate transperitoneal buffer fluxes with solution containing lactate and bicarbonate, and to compare the final effect on body base balance of the two solutions.

One hundred and four exchanges, using different dwell times, were performed in 52 stable continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate effluent lactate and bicarbonate and volumes were measured. Net dialytic base gain was calculated. Patients’ acid-base status and plasma lactate were determined.

In lactate-buffered CAPD solution, lactate concentration in dialysate effluent inversely correlated with length of dwell time, but did not correlate with plasma lactate concentration and net ultrafiltration. Bicarbonate concentration in dialysate effluent correlated with plasma bicarbonate and dwell time but not with ultrafiltration.

The arithmetic sum of the lactate gain and bicarbonate loss yielded the net dialytic base gain. Ultrafiltration was the most important factor affecting net dialytic base gain.

A previous study demonstrated that in patients using a bicarbonate-buffered solution the net bicarbonate gain is a function of dwell time, ultrafiltration, and plasma bicarbonate.

By combining the predicted data of the dialytic base gain with the calculated metabolic acid production, an approximate body base balance could be obtained with both lactate and bicarbonate-buffered CAPD solutions.

The body base balance in CAPD patients is self-regulated by the feedback between plasma bicarbonate concentration and dialytic base gain. The level of plasma bicarbonate is determined by the dialytic base gain and the metabolic acid production. This can explain the large interpatient variability in acid-base correction. Bicarbonate-buffered CAPD solution is equal to lactate solution in correcting acid-base disorders of CAPD patients.
How to Reach Optimal Creatinine Clearances in Automated Peritoneal Dialysis
Authors: Durand Pierre Yves , Freida Philippe , Issad Belkacem , Chanliau Jacques
Published: February 2020

This paper summarizes the basis of prescription for automated peritoneal dialysis (APD) established during a French national conference on APD. Clinical results and literature data show that peritoneal clearances are closely determined by peritoneal permeability and hourly dialysate flow rate, independently of dwell time or number of cycles. With APD, peritoneal creatinine clearance increases according to the hourly dialysate flow rate to a maximum (plateau), then decreases because of the multiplication of the drain-fill times. The hourly dialysate flow giving the maximum peritoneal creatinine clearance is defined as the “maximal effective dialysate flow” (MEDF). MEDF is higher for high peritoneal permeabilities: MEDF is 1.8 and 4.2 L/hr with nocturnal tidal peritoneal dialysis (TPD) for a 4-hr creatinine dialysate-to-plasma ratio (DIP) of 0.50 and 0.80, respectively. With nightly intermittent peritoneal dialysis (NIPD), MEDF is 1.6 and 2.3 Llhr for a DIP of 0.50 and 0.78, respectively. Under these conditions, tidal modalities can only be considered as a way to increase the MEDF. Using the MEDF concept for an identical APD session duration, the maximal weekly normalized peritoneal creatinine clearance can vary by 340% when 4hr DIP varies from 0.41 to 0.78. APD is not recommended when 4-hr creatinine DIP is lower than 0.50. However, the limits of this technique may be reached at higher peritoneal permeabilities in anurics because of the duration of sessions andlor the additional exchanges required by these patients.
How Much Extra Does “Adequa Te” Peritoneal Dialysis Cost?
Authors: Blake Peter G. , Floyd Jet , Spanner Evelyn , Peters Karen
Published: February 2020

Our objective was to investigate the extra cost associated with implementing an adequacy program in peritoneal dialysis (PO) and to evaluate the cost effectiveness of a variety of PO prescriptions. This was a cross-sectional study of all 37 patients attending the PO clinic at a university teaching hospital. Extra costs incurred on dialysate, tubing, and cyclers as a consequence of implementing an adequacy program in PO were measured. Costs per unit KT/V for a variety of PO prescriptions were also calculated. Thirteen patients (35%) required an alteration in prescription for adequacy reasons. The average extra costs incurred for all patients was Cdn. $2,323 per annum, which represents a 16% increase per patient. The most costeffective prescriptions were high volume continuous ambulatory peritoneal dialysis (CAPO) and automated peritoneal dialysis (APO) with two daytime dwells. The least cost-effective prescriptions were day dry APO and high volume APO with only one daytime dwell. Significant extra expense is incurred when an adequacy program is implemented in PO. This is mainly due to the requirement to put more patients on APO. An alternative pricing policy for PO is suggested.
Compliance Study in Peritoneal Dialysis Using Pdadequest Software
Authors: Amici Gianpaolo , Viglino Giusto , Virga Giovambattista , Gandolfo Carmen , Da Rin Giorgio , Bocci Carlo , Cavalli Pier Luigi
Published: February 2020

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient.

Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values.

The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.
A Comparison of Bone Scans in Uremic Patients Treated with Intermittent Peritoneal Dialysis Or Hemodialysis
Authors: Plotast Hanna , Grzegorzewska Alicja E. , Junik Roman , Sowinski Jerzy , Gernbicki Maciej
Published: February 2020

The aim of the study was a comparative analysis of bone scans in uremic patients treated with intermittent peritoneal dialysis (IPD) or hemodialysis (HD). Bone scintigraphy was performed using technetium Tc 99m etidronate (EHDP) in 28 uremics (age 46.0±13.5 years, x±SD) on IPD for 3.1±3.0 months and 28 uremics (age 43.5±11.6 years) on HD for 47.3±33.9 months. Serum c terminal parathormone (cPTH) exceeded 5.3±3.3 and 6.8±3.5 times the upper normal limit of 1.4 ng/mL in IPD and HD patients, respectively. Despite significant differences in dialysis treatment duration in IPD and HD patients, an increased Tc 99m EHDP uptake in bones was shown with similar frequency, when all the groups were compared. However, in the group of patients with serum cPTH exceeding four times the upper normal limit (n = 30) or in the age group less than 45 years old (n = 26), a greater marker uptake was observed in HD patients. Significant differences (p < 0.05) were shown in the cranial vault: 33% of HD patients (n = 18) with higher cPTH and 47% of those less than 45 years old (n = 15) revealed an increased marker uptake, whereas it was not observed in any IPD patient. When scans of HD patients dialyzed less than (n = 11) and more than (n = 17) 30 months were compared, a significantly higher appearance of increased marker uptake was shown in cranial vault (41% vs 0%, p < 0.02) and in sacral bone (82% vs 36%, p < 0.02) in patients with longer dialysis. The latter group of HD patients also showed an increased marker uptake in cranial vault compared to the entire group of PD patients (41% vs 7%, p < 0.01). Our studies suggest that bone scan changes, indicating secondary hyperparathyroidism, progress significantly with prolongation of dialysis treatment, especially in patients with higher cPTH levels of younger age.
Peritoneoscopic Placement of Swan Neck Peritoneal Dialysis Catheters
Authors: Copley J. Brian , Lindberg Jill S. , Back Sandra N. , Tapia Nina P.
Published: February 2020

Peritoneoscopic placement of peritoneal dialysis catheters, although accomplished in only about 10% of dialysis centers, is a nonsurgical technique that fulfills requirements for safety and dependability. Over a 40-month period, 136 catheters were placed with the peritoneoscope, 135 of which were double-cuffed, Swan neck curled catheters, with a uniform radiopaque stripe. Patients were followed longitudinally for outcome. Catheters were placed in 44 diabetic patients, 1 human immunodeficiency virus (HIV)-positive patient, and 18 morbidly obese patients. No complications occurred as a direct result of placement. Catheters were used, on average, nine days after placement (many on days 1 to 4) usually with 1.5 to 2 L exchanges.

With 1183 patient-months’ experience, complications were few: 28 patients experienced catheter-related infections, and there were five leaks that resolved with supine, low-volume dialysis for several days. Leakage did not correlate with time of usage after placement. Of ten outflow/mechanical problems that required catheter removal, nine involved catheter migration, probably due to lack of attention during placement to orientation of the radiopaque stripe. One was due to a preperitoneal placement early in this institution's experience with the peritoneoscope. Five of the migrated catheters were removed and then successfully replaced with the peritoneoscope at the same sitting. Four patients requested surgical removal and replacement. Sixteen catheters were removed because of catheter-related infections: five refractory Staphylococcus aureus, six Pseudomonas aeruginosa, two fungal, two Serratia species, and one Mycobacterium chelonei. Actuarial life table analysis showed that at the end of the 40-month follow-up, 62% of the catheters were expected to survive. Because more than 50% survived, median catheter survival could not be calculated. The adverse responses were removal because of infection or catheter migration.

Peritoneal dialysis catheter implantation with the peritoneoscope represents a safe and dependable method for catheter placement. Literature review and comparison indicate that catheter-related complications are fewer and catheter longevity is better with peritoneoscopic placement than with surgical placement. Our experience with prompt postplacement utilization suggests the need for further evaluation of catheter break-in procedure with the peritoneoscope.
213 Elderly Uremic Patients over 75 Years of Age Treated with Long Term Peritoneal Dialysis: A French Multicenter Study
Authors: Issad Belkacem , Benevent Daniel , Allouache Mahmoud , Durand Pierre Yves , Aguilera Didier , Milongo Robert , Dubot Philippe , Lavaud Sylvie , Gary Jacques
Published: February 2020

We report our experience in 213 elderly patients over 75 years treated by peritoneal dialysis (PC) as first and exclusive dialysis therapy. The mean age at start of PC was 79.4t3.6 years, and the cumulative time on PC was 4551 months (mean time: 21.4 %19.8 months). Twenty-six patients lived in institutions and 187 1ived at home. Thirty patients had an effective autonomy with the ability to carry on normal activities. One hundred and two patients were cared for by a private nurse at home, and 46 patients were cared for in a family environment. Most cases were treated by three exchanges per day (152 cases) and used a nondisconnect system (175 cases) on account of absence of autonomy. The rate of peritonitis per patient month was one episode per 16.8 patient-months. Patient survival (Kaplan-Meier curves) was 74%,59%,45%, and 19% at one, two, three, and five years, respectively. The causes of death were various with a higher frequency of cardiovascular causes (48.3% of the 116 deaths). Thirtythree patients died in less than six months including 18 patients in less than three months. In conclusion: elderly uremic patients can be treated with long-term PC with relatively good results. Mortality is high but essentially due to age and poor general status -the dedication of private home nursing is very important in treating elderly PC patients. This fact often is a necessary condition in maintaining these elderly patients at home.
Planes, Kangaroos, and the Capd Manual
Authors: Carruthers Dale M. , Whishaw Jennifer M. , Thomas Mark A.B. , Thatcher Geoffrey
Published: February 2020

The Western Australian (WA) Remote Area Dialysis Programme was developed in 1988 due to the cultural need to dialyze an increasing number of aboriginal patients in their own communities, rather than relocating them up to 3000 km away in Perth. The success of the program relies on remote area health services (RAHS), which have no prior experience in continuous ambulatory peritoneal dialysis (CAPD), providing consistent routine and emergency medical care to the patients. Our aim was to standardize the care of all CAPD patients in remote WA by providing the RAHS with an easy -to-follow manual. Although the RAHS received treatment protocols and in-service education, consistent care was not always provided. We confirmed this by: (1) examining the existing quality assurance tools, peritonitis and hospital admission rates, (2) discussion with remote area staff regarding patients, and (3) informal assessment of remote area staff receptiveness to in-service education by a CAPD nurse. We identified the causes of the inconsistent care to be: (1) high remote area staff turnover (six months average for a registered nurse), (2) the protocols were difficult to follow, and (3) confusion for the RAHS as to the appropriate contact person at our hospital. In 1994, the situation was exacerbated by the dramatic increase in the number of patients and RAHS involved (14 new patients, bringing the total to 20 patients in 12 centers) plus the introduction of a second treating hospital (with differing protocols). A team of two CAPD nurses and two nephrologists was established, to collaborate with two remote area hospitals and the second treating hospital to produce the “Remote Area CAPD Manual.” The manual is an easy-to-follow, stepby-step guide for the management of CAPD by nondialysis personnel. It has led to improved management of CAPD, improvement in communication with RAHS, and the increased confidence of remote area staff in the management of CAPD patients. In conclusion, RAHS can give consistent care if provided with clear, concise guidelines.
A Home Visit Program for Capd
Authors: Warmington Victoria
Published: February 2020

In the U.K. in the last five years a reassessment of the central role of the hospital has taken place, with a fundamental shift in care for people with increased dependencies to community settings. For patients using peritoneal dialysis a need has been realized for a home-visiting service by specialist renal nurses who can manage and coordinate the program of care, thus reducing the strain on hospital resources.

In addition, the provision of a community nurse to visit the patient at home means that ongoing education and training can be undertaken in a suitable learning environment. The home-visiting program creates an opportunity to develop an holistic care plan using strategies of general health promotion as well as practical nursing care.

This paper highlights the experiences of a pioneering model of community continuous ambulatory peritoneal dialysis care in South London. Auditing of this unusually funded post has shown significant reductions in peritonitis, exit-site infections, and hospital admissions In this growing patient population.
Recommendations for Treatment of Exit-Site P a Thology
Authors: Khanna Ramesh , Twardowski Zbylut J.
Published: February 2020

Good local care including measures to prevent trauma keeps healthy exit sites free of infection. Acute infection can be cured with aggressive therapy. Chronic infection may progress to cuff infection, which even when treated, may progress to peritonitis. Cuff and tunnel infections require deroofing, cuff shaving, and/or catheter removal. Therapy may prolong the life of a catheter. An equivocal exit site requires aggressive therapy in order to achieve cure. Local care of the exit should include measures to prevent trauma. Should trauma occur, aggressive therapy that includes a systemic antibiotic should be instituted immediately. Aggressive therapy is particularly indicated during the healing period. Prophylactic antibiotics, systemic or topical, are indicated in trauma, recurrent infection, and may be beneficial during the healing period.
Clinical Experience with a 39 Mmol/L Bicarbonate-Buffered Peritoneal Dialysis Solution
Authors: Feriani Mariano , Carobi Carmen , La Greca Giuseppe , Buoncristiani Umberto , Passlick-Deetjen Jutta
Published: February 2020

Objective

To investigate the effect on the patient's acidbase status of a 39 mmol/L bicarbonate-buffered continuous ambulatory peritoneal dialysis (CAPD) solution.

Design

This was an open, controlled, cross-over, two-center study in 9 patients. After three months of treatment with a 34 mmol/L bicarbonate-buffered solution (to) patients were switched to a 39 mmol/L bicarbonate-containing solution for four weeks. At the end of the study period (t4) patients were again treated with a 34 mmol/L bicarbonate-buffered CAPD solution for one month (t8).

Results

Mean venous plasma bicarbonate level significantly increased during the study and decreased at the baseline level during the control period (to = 22.94±2.54, t1 = 26.74±3.07, t2=28.47±2.68, t3=28.11±3.56, t4=28.71±3.27, t8=24.94±2.56). Arterial blood pH and plasma bicarbonate significantly increased during the study and significantly decreased attheend of the control period (pH: to= 7.37±0.04, t4= 7.42±0.04, t8= 7.37±0.06. Bicarbonate: t0= 21.97±2.57, t4= 25.85±2.02, t8= 21.87±2.89). The changes in plasma bicarbonate during the study period were inversely correlated with the metabolic acid production calculated from the protein catabolic rate and with the apparent distribution space for bicarbonate (ABS) of patients.

Conclusions

The 39 mmol/L bicarbonate-buffered CAPD solution improved the patient's acid-base status. Potential undesirable metabolic alkalosis could be prevented by analyzing the ABS and the metabolic acid production of patients.
Icodextrin'S Effects on Peritoneal Transport
Authors: Krediet Raymond T. , Ho-Dac-Pannekeet Marja M. , Imholz Alexander L.T.
Published: February 2020

Objective

To give a survey of the principles of peritoneal fluid transport in general, followed by an analysis of the effects of icodextrin on the transport of fluid and solutes.

Design

A review of the literature and of data on the effects of icodextrin in continuous ambulatory peritoneal dialysis (CAPD) patients at the Academic Medical Center, Amsterdam.

Results

Icodextrin had no effect on the mass transfer area coefficients of low molecular weight solutes. Also no effect was found on the clearances of albumin and larger serum proteins. Due to convective transport, the clearance of β2-microglobulin was greater with icodextrin than with glucose solutions. Icodextrin was especially superior to glucose in the induction of net ultrafiltration during long dwells, during peritonitis, and in patients with ultrafiltration failure caused by a large effective peritoneal surface area.

Conclusion

Icodextrin has no effect on the permeability characteristics of the peritoneal membrane, but increases convective flow through the small-pore system. As a result, the peritoneal clearance of β2-microglobulin is higher than with glucose-based solutions.lcodextrin is especially indicated for long dwells and in patients with impaired ultrafiltration caused by a large peritoneal surface area, leading to high transport rates of low molecular weight solutes.
A Randomized Controlled Trial of a Bicarbonate and a Bicarbonate/Lactate-Containing Dialysis Solution in Capd
Authors: Coles Gerald A. , Gokal Ram , Ogg Chisholm , Jani Fiona , O'Donoghue Donal T. , Cancarinu Giovanni C. , Maiorca Rosario , Tranaeus Anders , Faict Dirk , De Vos Catherine
Published: February 2020

Objective

To evaluate the safety and efficacy of bicarbonate and bicarbonate/lactate-based PD fluids.

Design

A randomly allocated prospective controlled trial lasting eight weeks.

Setting

Five renal units in Europe.

Patients

Individuals who have been treated by CAPD for at least three months and who have had at least one month's therapy with 40 mmol/L lactate PD fluid. Those with recent infection, diabetes or other serious illness are excluded. Forty-seven individuals have entered the study so far.

Interventions

Patients are randomly allocated to three groups. Group 1 receive 40 mmol/L lactate dialysate, Group 2 are given 38 mmol/L bicarbonate fluid and Group 3 are tested with a 25 mmol/L bicarbonate and 15 mmol/L lactate dialysate.

Outcome measures

The primary outcome measure is the plasma bicarbonate level. Adverse events and ease of use of the two-chambered bags used by Groups 2 and 3 are also being assessed.

Results

To date, plasma bicarbonate levels have been the same in all treatment groups up to the end of the trial period. There are no differences in serum lactate levels. No side effects are attributable to the test fluids. The patients have managed the two-chambered bags successfully.

Conclusion

This trial is still ongoing, but to date, neutral bicarbonate based fluids have been as effective as lactate dialysate in treating uremic acidosis.
Calcium Kinetic Studies in Patients on Capd: Improvement of Secondary Hyperparathyroidism without Concomitant Improvement of Calcium Turnover
Authors: Kurz Peter , Tsobanelis Theoharis , Brunkhorst Reinhard , Roth Paul , Werner Eckhard , Schoeppe Wilhelm , Vlachojannis Jannis
Published: February 2020

Objective

An association between the development of low turnover osteopathy and the form of dialysis treatment, that is, continuous ambulatory peritoneal dialysis (CAPD), has been described. To examine the effect of a year-long CAPD treatment on calcium (Ca) turnover, 12 patients were studied prior to and one year after initiation of CAPD treatment with a dialysate calcium of 1.75 mmol/L.

Design

A prospective analysis.

Setting

Academic teaching hospital dialysis unit.

Patients

Twelve patients with an average age of 54.8 years (range: 23 76 years) at commencement of dialysis and after 13 months of CAPD treatment.

Measurements

Calcium kinetic studies were performed using two calcium isotopes: 45Ca as an oral tracer and 47Ca as an intravenous tracer. Measurements of plasma and whole body activities were performed over a four week period. From these measurements, kinetic parameters describing calcium turnover in different compartments were studied. These measurements were repeated after a mean time of 13.4 months. Patients were not treated with vitamin D, but received aluminum and calcium -containing phosphate binders, in order to keep inorganic phosphate below 2.0 mmol/L and calcium within the normal range.

Results

After one year on CAPD, serum levels of calcium increased from 2.2 mmol/L to 2.35 mmol/L. Inorganic phosphate also increased from 1.4 mmol/L to 1.9 mmol/L, despite increased use of oral phosphate binders. Serum levels of intact parathyroid hormone (i PTH) decreased from 51.2 pmol/L to 28.3 pmol/L. Alkaline phosphatase did not change, nor did serum levels of vitamin D. Despite improvement of serum iPTH levels and better control of serum calcium, the kinetic parameters describing calcium turnover in the different calcium pools did not improve. In addition, the calcium retention of bone remained below normal range and did not rise. Perhaps more importantly, the relationship between Ca efflux and Ca retention did not change. While Ca retention remained low, plasma Ca efflux was normal. This imbalance was seen at the beginning of CAPD and did not change under CAPD.

Conclusion

These data demonstrate that, after one year of CAPD treatment without vitamin D treatment, calcium turnover did not improve, despite a significant fall in serum iPTH levels. Studies on a larger number of patients are warranted to verify these results.
Limitation of Small-Solute Exchange across the Visceral Peritoneum: Effects of Vibration
Authors: Zakaria El Rasheid , Carlsson Ola , Rippe Bengt
Published: February 2020

Objective

To evaluate the importance of the peritoneal membrane diffusion resistances to small solutes prevailing outside the capillaries in the visceral versus the parietal peritoneum during acute peritoneal dialysis (PD).

Design

Experimental study in anesthetized Wistar rats undergoing PD in a single exchange (120 min) using 1.36% Dianeal as dialysis fluid. Vibration, using a standard laboratory shaker at 10 Hz, was used to induce dialysate mixing and reduce the impact of “unstirred layers” in intact and eviscerated rats. Nonvibrated rats served as controls.

Measurements

The mass transfer area coefficient (PS) for chromium 51-ethylenediamine tetraacetic acid (51 Cr-EDTA), continuously infused intravenously, the plasma-to -peritoneal clearance (CI→D) of radioiodinated (1251) serum albumin (human) (RISA), as well as the total clearance out of the peritoneal cavity (CI) of Evans blue labeled albumin, given as an intraperitoneal volume marker, and the portion of this C1 reaching the plasma per unit time (CI→P) were assessed.

Results

In intact rats there was a marked increase in PS for 51Cr -EDTA, from 0.297:I: 0.036 mL/min to 0.642 :I: 0.122 mL/min (n = 7, p < 0.01), and a moderate increase in CI and CI→D, from 37.6 :I: 1.3 μL/min to 63.3 :I: 9.0 μL/min and from 6.04 :I: 0.51μL/min to 9.54 :I: 0.93 μL/min (n = 7, p < 0.05), respectively, upon vibration. However, the plasma absorption clearance of albumin (CI→P) was unchanged after vibration. Furthermore, in eviscerated rats, vibration caused no significant changes in either of the exchange parameters measured.

Conclusion

In conclusion, the visceral peritoneal transport of small solutes is normally limited by the presence of diffusion resistances outside the capillaries, which may be markedly reduced by “stirring” of the dialysate by vibration. Normally, the parietal, rather than the visceral, peritoneum is the major site for small-solute mass transfer in stationary animals. However, the visceral peritoneum apparently becomes increasingly important after stirring. The moderate increases in transperitoneal clearances of macromolecules occurring upon vibration, which were quite unexpected, indicate that vibration may also increase the dialysatelperitoneal membrane contact and/ or cause some recruitment of capillaries.
Ten Years’ Experience with Capd in a Nursing Home Setting
Authors: Anderson John E.
Published: February 2020

Objective

We reviewed our experience with end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) in a nursing home with the aims of describing their demographic and clinical characteristics, evaluating CAPD technique success and patient outcomes.

Setting

University-based, teaching nursing home.

Design

Retrospective review of patients in our nursing home treated with CAPD between 1 June 1986 and 1 June 1996.

Patients

One hundred and nine patients: 66 (60.5%) were female and 59 (54%) were white. Their mean age was 62.7 years ± 12.8 SD (range 31 -88). Females were significantly older than males (64.9 years ± 10.7 SD vs 59.1 years ± 14.6 SD, p < 0.05). Sixty-eight (62.4%) were diabetics. Main outcomes studied:Cox -adjusted patient survival. Cause of death. Peritonitis and hospitalization rates. Logistic analysis of predictors of discharge home.

Results

Six and 12-month survival rates were 51.7% and 37.2%, respectively. Age greater than 75, poor functional status, coronary artery disease (CAD), and decubitus ulcers were significant mortality risks. Vascular disease was the leading cause (41.7%) of death. The peritonitis rate in the nursing home was 1.19 episodes per patient year. Gram-positive organisms predominated. The hospitalization rate was 22.4 days per patient year. Gangrene/ stump infections and peritonitis accounted for 14% and 10% of admissions. Those patients admitted for rehabilitation and with higher activity of daily living (ADL) scores were more likely, and those with diabetes, age ≥75, and CAD less likely to be discharged.

Conclusions

We continue to believe that peritoneal dialysis is a reasonable option for ESRD patients placed in nursing homes. Technical problems do not limit its use, but overall poor patient outcomes are an important issue. Patients, their families, and referring physicians should be informed of the limited survival expectations particularly for the very old and/or severely functionally impaired patient. Patients whose discharge is anticipated on admission are those most likely to return to the community and are the most likely to truly benefit from nursing home placement.
Measuring Compliance with Prescribed Exchanges in Capd and Ccpd Patients
Authors: Bernardini Judith
Published: February 2020

Objective

To measure compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients using inventories of home dialysis supplies; to determine the reliability of the ratio of measured to predicted creatinine (MIP) in predicting compliance with prescribed exchanges; to determine the effects of the ingestion of preformed creatine on the excretion of creatinine.

Design

A prospective analysis.

Setting

A university dialysis center.

Patients

Twenty patients on home peritoneal dialysis (PD).

Measurements

An inventory of supplies during two home visits over a 4 -8 week interval determined the number of PD exchanges performed. This number was divided by the number of exchanges prescribed for the period to determine the percent compliance. Three consecutive days of dialysate and urine were measured with all food consumed recorded during those days. MIP creatinine ratios and dietary protein intake (DPI) for each day were calculated.

Results

Of the patients tested, 8120 (40%) were found to be noncompliant with the prescribed number of exchanges based on the home visit inventories, performing a mean of 75% of their exchanges. There was no significant difference in the MIP creatinine ratios of compliant and noncompliant patients, nor were the MIP ratios distributed differently for compliant and noncompliant patients. The MIP ratios did not vary significantly over the 3 days. There was no correlation between the measured creatinine on a given day and the DPI for the same day.

Conclusion

Based on assessment of the patient's inventory, 40% of the patients studied were noncompliant with their prescribed exchanges, indicating this is a serious and common problem in PD patients. The MIP creatinine ratio is not a predictor of compliance in PD. We suggest the use of home visit inventories to assess compliance in PD patients.
Adequacy of Dialysis in Automated Peritoneal Dialysis: A Clinical Experience
Authors: Rodriguez Ana Marla Fernández , Dlaz Nicanor Vega , Cubillo Leocadia Palop , Laborda Eduardo Baamonde , Umpierrez Adelaida Morales , Perez Borges Patricia , Zurita Manuel Navarro , Toledano Celia Plaza
Published: February 2020

Objectives

To compare the peritoneal clearances of urea and creatinine in continuous ambulatory peritoneal dialysis (CAPD) with three types of automated peritoneal dialysis (APD): continuous cycling peritoneal dialysis (CCPD), 50% tidal peritoneal dialysis (TPD), and 25% TPD and to assess the usefulness of the peritoneal equilibration test (PET) in predicting peritoneal clearances in overnight APD.

Patients

Eleven uremic patients (mean age 44.5 ± 15.45 years with a mean time on dialysis of 42.63 ± 25.62 months) were included in the study.

Measurements

PET for urea and creatinine following Twardowski's method. Peritoneal clearances for urea and creatinine CAPD: samples of blood and dialysate within 24 hours. APD: blood mean levels of urea and creatinine before and after nighttime dialysis. Dialysate: urea and creatinine in nocturnal and daytime dialysate.

Results

Peritoneal clearance of creatinine was 38.14 ± 9.99 L/week/1.73 m2 in CAPD, 44.28 ± 12.4 L/week/1.73 m2 in CCPD, 50.07 ± 17.86 L/week/1.73 m2 in 50% TPD (p < 0.05) and 40.18 ± 6.65 L/week/1.73 m2 in 25% TPD. Peritoneal clearance of urea improved significantly in the three modalities of APD: 51.91 ± 12.58 L/week/1.73 m2 in CAPD; 66.7 ± 9.9 L/week/1. 73 m2 in CCPD (p < 0.05); 76.3 ± 14.5 L/week/1. 73 m2 in 50% TPD (p < 0.001) and 64.3 ± 11.4 L/week/1.73 m2 in 25% TPD (p < 0.05). The dialysatel plasma (DIP) ratio of creatinine at 30,60, 120,180, and 240 minutes showed significant correlation with nighttime APD clearance. Nevertheless, only the DIP ratio of urea at 30, 60, and 120 minutes correlated with overnight APD clearance.

Conclusions

A remarkable improvement was observed with APD regarding the clearance of urea mainly when 50% tidal peritoneal dialysis was used, whereas it was less noticeable in the clearance of creatinine. The PET is a helpful tool in predicting overnight peritoneal clearances of creatinine but it is less useful in predicting urea clearance.
Absence of Modulating Effects of Cytokines on Antioxidant Enzymes in Peritoneal Mesothelial Cells
Authors: Chen Jinn-Yang , Yang An-Hang , Lin Yao-Ping , Lin Jen-Kou , Yang Wu-Chang , Huang Tung-Po
Published: February 2020

Objective

To investigate the modulation of superoxide dismutase, glutathione peroxidase, and catalase by cytokines and endotoxin in human peritoneal mesothelial cells.

Design

Cultured human peritoneal mesothelial cells were treated with various concentrations of interleu kin-1 α, tumor necrosis factor-α(TNFα), interleukin-6, interleukin-8, transforming growth factor-β (TGFβ), and lipopolysaccharide. Cell morphology was observed and the activities of superoxide dismutase, catalase, and glutathione peroxidase were assayed. The antioxidant enzyme activities of human peritoneal mesothelial cells were also compared with those of human liver and kidney tissues.

Results

Interleukin-1α, TNFα, TGFβ, and lipopolysaccharide caused dose-dependent cytotoxicities in mesothelial cells. The activities of these three antioxidant enzymes did not change after treatment with cytokines and endotoxin. The total superoxide dismutase activity of confluent human peritoneal mesothelial cells was found to be greater than that of human liver and kidney tissues and was composed mostly of manganese superoxide dismutase activity. Furthermore, glutathione peroxidase and catalase activities of human peritoneal mesothelial cells were lower than those of human liver and kidney tissues.

Conclusion

In human peritoneal mesothelial cells, lack of induction of antioxidant enzymes by inflammatory cytokines, as well as high superoxide dismutase activity accompanied by insufficient glutathione peroxidase and catalase activities may both contribute to the susceptibility of these cells to oxidative damage. Therefore, appropriate management to decrease oxidative injury to the peritoneum should be taken into consideration when treating long-term continuous ambulatory peritoneal dialysis patients.
Toward Targets for Initiation of Chronic Dialysis
Authors: Mehrotra Rajnish , Saran Rajiv , Moore Harold L. , Prowant Barbara F. , Khanna Ramesh , Twardowski Zbylut J. , Nolph Karl D.
Published: February 2020

Objectives

To better defaine the targets for initiation of chronic dialysis, we compared the relationship between the normalized protein equivalent of nitrogen appearance (nPNA, g/kg standard weight/day) and weekly urea clearance (Kt) normalized to total body water (V) in predialysis chronic renal failure (CRF) patients and in patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD). We also studied the relationships of other nutritional parameters to weekly Kt/Vurea in CRF patients.

Design

This cross-sectional study was a prospective observational design meant to study each patient once.

Setting

The University Hospital and Clinics and Harry S. Truman VA Medical Center, Columbia, Missouri.

Patients

Forty-five consecutive predialysis CRF patients were enrolled and the results compared with patients on CAPD and HD.

Results

In CRF, the nPNA calculated from urea appearance correlated with the weekly Kt/Vurea (r = 0.57, p < 0.0001) and, using exponential best-fit, nPNA = 1.217 x (1 - e-0.769Kt/v). This exponential relationship was similar to that for CAPD and both were different from that in patients on HD. Likewise, nPNAs, calculated from Kjeldahl nitrogen output, and weekly Kt/Vurea were correlated (r = 0.37, p = 0.014) and, using exponential best-fit, nPNA = 1.102(1 - e-0.867Kt/v), similar to the relationship in patients on CAPD. Evidence is presented that these relationships are not explained only by mathematical coupling. There was a significant correlation between the weekly Kt/Vurea and 24-hour urinary creatinine excretion.

Conclusions

The findings suggest that in CRF, as in CAPD, a weekly Kt/Vurea less than 2.0 is likely to be associated with a nPNA less than 0.9 g/kg standard weight. In CRF patients, initiation of chronic dialysis should be considered if weekly renal Kt/Vurea falls below 2.0 and a nPNA greater than 0.8 is desired.
Increase of Intra-Abdominal Fat in Patients Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Fernström Anders , Hylander Britta , Moritz Ake , Jacobsson Hans , Rössner Stephan
Published: February 2020

Objective

To evaluate changes in amount and distribution of body fat in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective study. Computed tomography (CT) and dual energy x-ray absorptiometry (DEXA) were used for determination of body composition at commencement of CAPD, and after a mean of 7.2 months of dialysis treatment.

Setting

CAPD unit at an academic teaching hospital.

Patients

The study included 19 consecutive patients who started CAPD during a 15-month time frame. Of these 19 patients, 12 (8 males) with a mean initial age of 60 years completed the study.

Main Outcome Measures

Siemens Somatom HiQ (Erlangen, Germany) was used for CT of the abdomen and of the right thigh. Fat and muscle areas were expressed as square centimeters. The proportion of total fat mass was determined by body composition analysis using DEXA (DPX-L densitometer) (Lunar, Madison, WI, U.S.A.) and expressed as percentage of total body weight (FAT%).

Results

Body weight changed from 67.1 to 68.4 kg (p = 0.20), and the intra-abdominal fat area increased 22.8% (p = 0.02). This increase was predominantly seen in male patients (p = 0.007). The FAT% changed from 27.8% to 30.9% (p = 0.25), without difference between sexes.

Conclusion

The increase of intra-abdominal fat found in this study may suggest a mechanism by which the established risk for CAPD patients to develop cardiovascular morbidity and mortality may be at least partially explained.
The Effect of a Nitric Oxide Inhibitor (L-Name) on Peritoneal Transport during Dialysis in Rats
Authors: Breborowicz Andrzej , Tobis Katarzyna Wieczorowska , Korybalska Katarzyna , Polubinska Alicja , Radkowski Maciej , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To assess the effect of an inhibitor of nitric oxide synthesis [NG-nitro-L-arginine methyl ester (L-NAME)] on peritoneal transport during peritoneal dialysis (PD) and peritonitis in rats.

Methods

The authors studied peritoneal transport of small and large solutes, and net ultrafiltration (UF) in rats during PD with Dianeal 3.86 (Baxter, McGaw Park, IL, U.S.A.). They evaluated the effect of L-NAME used as an additive to dialysis fluid in concentrations 0.5 -5 mg/m L on peritoneal transport of small and large molecules and on transperitoneal UF. In addition, they studied the effect of L-NAME (5 mg/mL) during acute peritonitis induced by lipopolysaccharides (5 μg/mL) given intraperitoneally.

Results

The addition of L-NAME to dialysis fluid increased the selectivity of the peritoneum and net UF during dialysis. Lipopolysaccharides used as an additive to the dialysis fluid, together with L-NAME, did not induce changes in transperitoneal transport of small and large solutes and did not cause a significant decline in net UF. L-NAME given intraperitoneally reduced both local and systemic production of nitric oxide, which might explain its effects on peritoneal transport.

Conclusions

Nitric oxide is an important mediator of changes in peritoneal transport and its effect is especially significant during peritonitis.