bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic and Health-Care Policies and Peritoneal Dialysis
Authors: Prichard Sarah S.
Published: February 2020

1. All ESRD treatment is expensive and a modality change adds considerably to that expense.

2. Ideally, the cost of ESRD therapy should be re ported as the cost incurred for all aspects of the treatment to the health-care system.

3. Most studies show peritoneal dialysis to be less expensive than hemodialysis, but this can vary depending on the local costs of supplies and labor.

4. Strategic decisions with regard to new innovations should be made after a full analysis of all of the involved costs and savings that the innovation might introduce.

5. Economic factors and reimbursement rates appear to have an important impact on modality selection.
Survival on Chronic Peritoneal Dialysis: Have Results Improved in the 1990s?
Authors: Rodríguez-Carmona Ana , Falcon Teresa García , Fontán Miguel pérez , Bouza Pablo , Adeva Magdalena , Rivera Constantino F. , Valdés Francisco
Published: February 2020

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B).

Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patient or technique survival.

The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.
Hepatitis C Antibodies in Patients on Peritoneal Dialysis: Prevalence and Risk Factors
Authors: Lee Grace S.L. , Roy Dilip K. , Fan Fung-Yin , Thanaletchumi K. , Woo Keng Thye
Published: February 2020

Our objective was to determine the prevalence of the antibody to hepatitis C (anti-HCV) in a population of endstage renal failure patients on continuous peritoneal dialysis (CPD) and study the possible risk factors associated with anti-HCV seropositivity and seroconversion. A cross-sectional study included 155 adult patients enrolled in the CPD program in a single renal unit of a teaching hospital who were screened for anti-HCV by second-generation enzyme immunoassay, which was confirmed by recombinant immunoblot assay. Serum was also assayed for hepatitis B surface antigen (HBsAg). History of renal transplantation, blood transfusions, and exposure to hemodialysis was obtained from medical records.

Ten of 155 patients (6.5%) in this study population were anti-HCV positive [anti-HCV(+)] and 11/155 (7.1%) were HBsAg positive; no patient was positive for both. All the anti-HCV(+) patients were on continuous ambulatory peritoneal dialysis (CAPD); no continuous cycling peritoneal dialysis (CCPD) patient was anti-HCV(+). Exposure to hemodialysis was a risk factor for anti-HCV seropositivity, with 7 out of 10 (70%) anti-HCV(+) patients having been on hemodialysis compared to 55/134 (41%) anti-HCV(-) (p < 0.05, Fisher's exact test). No difference was noted between anti-HCV(+) and anti-HCV(-) groups in relation to age, gender, duration on CPD, renal transplantation, or exposure to blood transfusions. Seroconversion occurred in only one patient after a mean observation period of 20±0.6 months.

The prevalence of anti-HCV seropositivity in this population of CPD patients is 6.5%, and HBsAg is 7.1%. Exposure to hemodialysis is a significant risk factor for development of anti-HCV seropositivity. Seroconversion rate appears to be low.
Nursing Involvement in Research: An Academic Pursuit Or Relevant to Nursing Practice?
Authors: Schneider Anni E. , Donald Catriona , Short Pam , King Bruce B. , Junor Brian J.R. , Rowe Peter A.
Published: February 2020

It is said that nursing is ‘informed by research.’

We evaluated the effect a clinical research project had on the nursing procedure of a nonrotating, permanent continuous ambulatory peritoneal dialysis (CAPD) team involved primarily in patient care. A trial of the overnight solute clearance as a simple measure of the adequacy of CAPD was carried out and its effect on the following aspects of nursing practice was assessed:

1. Teamwork Can research be successfully incorporated within the team's work structure in a clinical environment?

2. Nurse's role -Duties of the nurse involved in the research (selection of patients, organization of appointments, collection of samples, and calculation of results).

3. Nurse/patient relationship -Individual knowledge of patients’ needs and communication skills employed (necessity for true informed consent).

The experience showed us that participation in research is not only possible, but also interesting from the nurses’ viewpoint and of direct benefit to the patients.
Successful Pregnancy Complicated by Peritonitis in a 35-Year-Old Capd Patient
Authors: Tison Andree , Lozowy Christine , Benjamin Alice , Usher Robert , Prichard Sarah
Published: February 2020

A 35-year-old woman conceived six months after initiating continuous ambulatory peritoneal dialysis (CAPO). A medical plan was developed to give the patient adequate dialysis for a 1.5 g/kg/day protein Intake. In addition, alterations in calcium, magnesium, and erythropoietin administration were required to reach the objectives set by the obstetrical/renal team.

Three weeks prior to delivery, an amniotic leak developed, and vaginal cultures were positive for Escherichia coli. Oral amoxiclllin was administered (500 mg per os q.i.d.) until the day of delivery.

A 1545-g baby girl was delivered by cesarean section at 32 weeks. Five days postpartum the patient developed severe peritonitis, which subsequently grew E. coli. The patient fully recovered from the peritonitis, but catheter removal was required.

Successful pregnancy can be expected on CAPO, and adequacy can be achieved with aggressive dialysis. Cesarean section delivery should probably be accompanied by full peritonitis therapy.
Modification of An Amino Acid Solution for Peritoneal Dialysis to Reduce Risk of Acidemia
Authors: Jones Michael , Kalil Roberto , Blake Peter , Martis Leo , Oreopoulos Dimitrios G.
Published: February 2020

Objective

Some patients develop a mild acidemia during treatment with amino acid-based peritoneal dialysis solutions due to hydrogen ion produced by metabolism of lysine, arginine, and methionine. In this study we modified the formulation of such a solution by reducing these amino acids and adding anionic amino acids so as to provide minimal net acid production.

Design

A modified formula (MF) was compared to a conventional formula (CF) of the solution in a randomized crossover study in 12 stable continuous ambulatory peritoneal dialysis patients. Patients were given each solution for 14 days without a wash-out period. Each patient replaced one or two dextrose dialysis exchanges with amino acid solution, depending upon oral protein intake and body weight. Total intake (oral protein plus amino acids absorbed) was equivalent to 1.1 -1.3 g protein/kg body weight/day.Plasma bicarbonate and urea were assessed at the beginning and end of each 14-day period.

Results

In the group as a whole, without regard to the order in which the solutions were given, patients had a decrease in serum bicarbonate with CF and an increase in bicarbonate when they received MF. Similar trends were observed regardless of the order in which the solutions were administered. Serum urea did not differ between the two solutions.

Conclusion

The results suggest that patients are less prone to develop acidemia when receiving MF as opposed to CF. Further studies will be necessary to determine the long-term effects and the relative nutritional benefits of the two solutions.
Estimation of Total Daily Creatinine Clearance in Capd from Serum Creatinine Concentration
Authors: Jones Colin H. , Newstead Charles G. , Will Eric J.
Published: February 2020

Objective

To establish whether estimation of creatinine clearance (CrCI) from serum creatinine, gender, age, and weight might reduce the number of 24-hour urine and dialysate collections required to monitor adequacy of delivered dialysis on continuous ambulatory peritoneal dialysis (CAPO).

Design

Retrospective single-center study.

Setting

University Hospital.

Patients

Creatinine excretion and CrCI were measured in 187 24-hour urine and dialysate collections from 99 CAPO patients (55 male, 44 female). Multiple regression analysis was used to estimate creatinine excretion from age and weight in males and females. CrCI was derived and also calculated using the Cockcroft-Gault and Mitch-Walser formulas. Positive and negative predictive values for indicating adequacy of dialysis were determined.

Results

Measured and derived CrCI were correlated (males: r = 0.85; females: r = 0.83; p < 0.001), but agreement was poor (95% limits of agreement: males, 26.05 to -25.75 L/wk; females, 37.47 to -19.49 L/wk). Taking the minimum acceptable CrCI as 60 L/week, the respective positive predictive values of the derived, Cockcroft, and Mitch methods in predicting underdialysis were 88%, 100%, and 100% in males and 88%, 88%, and 89% in females. Negative predictive values were 83%, 57%, and 53% in males and 53%, 48%, and 45% in females.

Conclusion

A derived CrCI >6 0 was not predictive of adequate dialysis. Because the detection of underdialysis is our objective, formal clearance studies should be performed in this group. A derived CrCI <60 L/wk was predictive of underdialysis in males and females and an increase in dialysis dose without formal clearance measurements could be suggested in these patients. The use of this approach could allow an important reduction in the number of clearance studies required to monitor CAPO adequacy.
Calcium Metabolism in Blood and Peritoneal L Ymphocytes from Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Lewis Sharon L. , Kutvirt Susan G. , Seamer Larry C. , Holmes Clifford J.
Published: February 2020

Objective

Cellular immune function in peritoneal dialysis patients has been shown to be depressed, but the mechanism of this immunosuppression has not been ascertained. Because calcium is an important mediator of lymphocyte activation, this study was designed to investigate if there was an alteration of calcium metabolism in the lymphocytes of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Sixteen CAPD patients were studied at the initiation of CAPD and after two months of treatment. Twenty-three normal controls were also enrolled in the study. Cytoplasmic calcium changes were investigated in response to the mitogen phytohemagglutinin (PHA) in peripheral blood and peritoneal lymphocytes, using the intracellular calcium probe indo-1 and flow cytometry. Baseline cytoplasmic calcium levels and changes in cytoplasmic calcium in response to PHA were assessed at the initiation of CAPD and after two months of therapy.

Results

Peripheral lymphocytes of patients and controls had similar calcium baseline levels, but the peritoneal lymphocytes had baseline cytoplasmic calcium levels averaging 81% higher than the corresponding calcium levels of the patients’ peripheral blood lymphocytes. As compared to peripheral lymphocytes, the response to PHA stimulation was significantly less in the peritoneal lymphocytes, increasing an average of only 46.8% above baseline. Peripheral blood lymphocytes of the patients responded by an average increase of 78.9% over baseline. Control cells increased an average of 66.3% over baseline. Follow-up studies done two months after the initiation of CAPD indicated there were no significant changes (as compared to month 0) that occurred in baseline or stimulated intracellular calcium concentrations.

Conclusions

While the peripheral lymphocytes of CAPD patients respond adequately to PHA, the high baseline calcium levels of the peritoneal lymphocytes suggest that these cells may be in a state of chronic activation and may respond minimally to an antigenic challenge.
Technique Failure in Peritoneal Dialysis and Its Impact on Patient Survival
Authors: Woodrow Graham , Turney John H. , Brownjohn Aleck M.
Published: February 2020

Objective

To determine the frequency and causes of continuous ambulatory peritoneal dialysis (CAPD) technique failure and its effect on patient outcome.

Design

Retrospective study of CAPD technique and patient outcome.

Setting

Teaching hospital renal unit.

Patients

All 221 patients commencing CAPD over a 14-year period. Outcome measures: Outcomes assessed included patient survival and technique survival (with change to hemodialysis being considered as technique failure).

Results

CAPD failure occurred in 46 patients, with a CAPD technique survival of 93%,73%, and 63% at 1,3, an d 5 years after start of treatment. Peritonitis was the major cause of technique failure. CAPD system had no effect on technique survival, despite the lower peritonitis rate in patients using Y-connection systems. Overall patient survival was 91 %, 72%, and 53% at 1, 3, and 5 years after start of treatment, with increasing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later.

Conclusion

Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or indirectly by the later effects of damage to the peritoneal membrane with loss of dialysis adequacy. The high mortality in the period following CAPD failure warrants careful monitoring of patients during this phase, along with efforts to optimize correctable factors such as nutrition, adequacy of the new form of dialysis, and treatment of residual sepsis.
Continuous Flow through Peritoneal Dialysis (Cfpd): Comparison of Efficiency to Ipd, Tpd, and Capd in An Animal Model
Authors: Ash Stephen R. , Janle Elsa M.
Published: February 2020

Objective

To determine whether continuous flow through peritoneal dialysis (CFPD), a treatment schedule in which peritoneal dialysate is infused continuously into one part of the abdomen (over the liver) and is drained from a distant part of the abdomen (the pelvis), can provide greater clearance than continuous ambulatory peritoneal dialysis (CAPD), tidal peritoneal dialysis (TPD), or intermittent peritoneal dialysis (IPD).

Design

A prospective study comparing four schedules of peritoneal dialysis in the awake, normal dog, using glucose clearance as a substitute for urea clearance.

Methods

We placed two chronic dialysis catheters into the abdomen of anesthetized dogs (with intraperitoneal portions of fluted or miniature column-disc design). On successive days, with the dogs awake and prone, we performed peritoneal dialysis for 4 hours with 1.5% dialysate according to one of four schedules, each with 2 L maximum intraperitoneal volume: CFPD (unidirectional flow at an average of 3.6 L/hr), IPD (2 L/hr), TPD (average of 3.6 L/hr, 1 L residual volume), and CAPD (2 L/4 hr). Glucose and urea clearances were calculated from blood and peritoneal concentrations and dialysate flow rates.

Results

Stabilized glucose clearances (from 60 to 240 minutes) averaged 11 ± 5 mL/min for IPD, TPD, and CFPD, and 5 ±2 mU minfor CAPD. However, glucose clearances of CFPD were 13 ± 6 mL/min when the intraperitoneal volume was maintained at 800 -1000 mL, and 16.5 ± 6 mL/min when flow rate was 6 L/hr. Urea clearances were twice the measured glucose clearances.

Conclusion

When CFPD is performed with an appropriate intraperitoneal volume and flow, it is the most chemically effective method of peritoneal dialysis in removing small molecules like urea.
Limited Systemic Absorption of Intraperitoneal Ceftizoxime in a Patient with Serratia Marcescens Peritonitis
Authors: Grabe Darren W. , Bailie George R. , Eisele George , Venezia Richard
Published: February 2020

Ceftizoxime is a third-generation, semisynthetic cephalosporin that has activity against many grampositive and gram-negative micro-organisms. In the treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis, ceftizoxime is usually reserved for organisms which show in vitro susceptibility once the organism has been cultured (1). The pharmacokinetics of ceftizoxime have been previously studied in CAPD patients without peritonitis (2). However, there are no pharmacokinetic data or efficacy studies of ceftizoxime in patients with peritonitis. We report dialysate and serum levels following the use of intraperitoneal (IP) ceftizoxime for the treatment of peritonitis caused by Serratia marcescens.
Effect of Dialysis Modality and Membrane Transport Characteristics on Dialysate Protein Losses of Patients on Peritoneal Dialysis
Authors: Kathuria Pranay , Moore Harold L. , Khanna Ramesh , Twardowski Zbylut J. , Goel Sharad , Nolph Karl D.
Published: February 2020

Objective

To determine if peritoneal dialysis modality has an impact on protein losses in dialysate.

Design

Retrospective, cross-sectional study.

Patients

190 patients who had selected peritoneal dialysis were classified into one of four transport categories (high, high-average, low-average, or low) based on standard peritoneal equilibration test results. Patients were then assigned to continuous ambulatory peritoneal dialysis (CAPD) or nightly intermittent peritoneal dialysis (NIPD) based on membrane transport characteristics and individual preferences.

Results

Patients with similar membrane transport characteristics had essentially no differences in dialysate protein and albumin losses whether treated with CAPD or NIPD.

Conclusions

Although high transporters may be better managed with short -dwell therapies such as nocturnal intermittent peritoneal dialysis or daily ambulatory peritoneal dialysis, consistent marked decreases in protein losses cannot be cited as a benefit of NIPD over CAPD.
Is Heparin Therapy Necessary in Capd Peritonitis?
Authors: Nadig Canradin , Binswanger Ulrich , Van Felten Arthur
Published: February 2020

Objective

Heparin therapy in continuous ambulatory peritoneal dialysis (CAPD) peritonitis seems well established; it is costly due to the necessity of hospitalization. There are no clinical studies that show a benefit of such a treatment. The aim of this study was to investigate whether heparin therapy in CAPD peritonitis isnecessary.

Design and Patients

194 samples of peritoneal dialysates were collected from 17 patients over a period of 24 months. Samples were subdivided into three groups: those without peritonitis (<100 leukocytes/ILL), those with mild peritonitis (100 -499 leukocytes/ILL), and those with severe peritonitis (≥500 leukocytes/ILL).

Measurements

The number of leukocytes per ILL dialysate and total protein concentrations were determined. Furthermore, dialysate concentrations of thrombin-antithrombin 111 (TAT-) complexes (indicator of thrombin formation), D-dimers (indicator of fibrinolysis), and plasminogen activator inhibitor 1 (PAI-1) were measured.

Results

The dialysate protein concentration progressively increased from no peritonitis to mild and severe inflammation. In parallel, dialysate TAT -complex and D-dimer concentrations increased. Thrombin-antithrombin 1I1-complex and D-dimer concentrations correlated strongly in 179 cases (r = 0.76; 62 samples showing peritonitis, 117 samples with no evidence of peritonitis). In the remaining 15 samples of 3 patients, high PAI-1 levels (>40 ng/mL) and low D-dimer concentrations were found. Eleven of the 15 samples showed evidence of peritonitis. In these 11 samples with evidence of peritonitis, high levels of TAT -complexes were detected, while Ddimer concentrations were found to be very low, pointing to a blocked fibrinolysis. The P AI-1levels were not related to leukocyte counts or protein concentrations in the dialysates.

Conclusions

Based on our findings, the routine intraperitoneal administration of heparin in CAPD peritonitis is not necessary. In rare cases an imbalance between coagulation and fibrinolysis due to high PAI-1 levels exists (15 of 194 dialysate samples, 11 of the 15 samples showing peritonitis). These cases -which do require heparinization -can be identified by demonstrating low D-dimer levels in CAPD dialysate at times of peritonitis.
Calcium Concentration in the Capd Dialysate: What is Optimal and is There a Need to Individualize?
Authors: Bro Susanne , Brandi Lisbet , Daugaard Henrik , Olgaard Klaus
Published: February 2020

Objective

To evaluate risk/benefit of various continuous ambulatory peritoneal dialysis (CAPD) dialysate calcium concentrations.

Data Sources

A review of the literature on the effects of various CAPD dialysate Ca concentrations on plasma Ca, plasma phosphate, plasma parathyroid hormone (PTH), doses of calcium carbonate, doses of vitamin D analogs, and requirements of aluminum-containing phosphate binders.

Study Selection

Eleven studies of nonselected CAPD patients, and 13 studies of CAPD patients with hypercalcemia were reviewed.

Results

In nonselected CAPD patients, treatment with a reduced dialysate Ca concentration (1.00, 1.25, or 1.35 mmol/L) improved the tolerance to calcium carbonate and/or vitamin D metabolites and reduced the need for Al-containing phosphate binders. When using dialysate Ca 1.25 or 1.35 mmol/L, the initial decrease of plasma Ca and increase of PTH could easily be reversed with an immediate adjustment of the treatment. After 3 months, stable plasma Ca and PTH levels could be maintained using only monthly investigations. In patients with hypercalcemia and elevated PTH levels, treatment with dialysate Ca concentrations below 1.25 mmol/L implied a considerable risk for the progression of secondary hyperparathyroidism. When hypercalcemia was present in combination with suppressed PTH levels, a controlled increase of PTH could be obtained with a temporary discontinuation of vitamin D and/or a reduction of calcium carbonate treatment in combination with a dialysate Ca concentration of 1.25 or 1.35 mmol/L.

Conclusion

Most CAPD patients can be treated effectively and safely with a reduced dialysate Ca concentration of 1.35 or 1.25 mmol/L. Treatment with dialysate Ca concentrations below 1.25 mmol/L should not be used. A small fraction of patients with persistent hypocalcemia need treatment with high dialysate Ca, such as 1.75 mmol/L.
Touch Contamination of Connection Devices in Peritoneal Dialysis-Aquantitative Microbiologic Analysis
Authors: Miller Thomas E. , Findon Glenne
Published: February 2020

Objective

To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD).

Design

The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberatetouch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag.

Subjects

Patients undergoing PD were used as the “test” group. Departmental secretarial and laboratory staff served as the comparative control group.

Setting

The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes.

Outcome

The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels.

Results

Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms trans located to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95% -99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group.

Conclusion

Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95% -99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.
Peritoneal Dialysis in Children under 5 Years of Age
Authors: Hölttä Tuula M. , Rönnholm Kai A.R. , Jalanko Hannu , Ala-Houhala Marja , Antikainen Marjatta , Holmberg Christer
Published: February 2020

Objective

We report our experience with maintenance peritoneal dialysis (PD) in small children.

Design

This is a retrospective analysis of the patient records of all children under the age of 5 years treated with continuous peritoneal dialysis (CPD) between 1986 and 1994 in Finland.

Setting

Treatment was started and the patients were seen at the outpatient clinic at the Hospital for Children and Adolescents, University of Helsinki, every 3 months. Between these visits, they had controls at their local hospital every 2 -4 weeks.

Patients

The most common primary renal disease in these 34 patients was congenital nephrotic syndrome of the Finnish type (27 patients). Others were: congenital nephrotic syndrome (3 patients), polycystic kidney disease (1), urethral valve (1), neuroblastoma (1), and renal dysplasia (1).

Results

Mean age at onset was 1.6 years and median treatment time 9.3 months. Time spent in hospital decreased from 270 days/year in the 1980s to 150 days/year in the 1990s. Two children died (5.9%). The peritonitis rate on continuous cyclic peritoneal dialysis was 1:11.5 patient-months. Hernias were diagnosed in 29% of the patients. After 3 months half of the patients were on antihypertensive medication. Pulmonary edema was diagnosed once in 12 patients and twice in 2 patients. During the first 6 months on PD the mean height standard deviation score (hSDS) increased from -2.13 to -1.66 (p < 0.0001). The 6-month change in hSDS before initiation and 6 months after the start of CPD increased from -0.12 ± 0.68 to +0.59 ± 0.64 (p = 0.0008).

Conclusions

Our results indicate that peritoneal dialysis is feasible and safe in small children. Mortality was low and growth was good. The major challenges presented by CPD therapy were maintenance of optimal nutrition, avoidance of peritonitis, and control of volemia.
Detrimental Effects of Peritoneal Dialysis Solutions upon In Vivo and In Situ Exposed Mesothelium
Authors: Gotloib Lazaro , Shostak Avshalom , Wajsbrot Valeri
Published: February 2020

The constancy of the internal environment is in itself evidence that physiological agencies are acting, or ready to act, to maintain this constancy. W.B. Cannon (1)
Peritoneal Dialysis
Authors: Burkart John M.
Published: February 2020

These presentations highlighted some of the current research needs in peritoneal dialysis. They are not meant to eclipse other important issues, such as adequacy and nutrition. These needs have become apparent as the therapy has evolved and progressed. They in fact are a testament to the increasing acceptance, use, and development of the therapy and suggest that there is potential for even further advancement for the therapy of peritoneal dialysis in the future.
Outcome Studies in Adequacy of Dialysis
Authors: Churchill David N.
Published: February 2020

The theoretical constructs indicate that, for a 70kg high transport anephric patient, adequate dialysis requires a weekly KtN of 2.0 2.25 (1–5). The prospective cohort studies, with one exception, suggest that better survival requires a weekly KtN >1.89 (7–11). Multivariate analyses confirm the statistical association of patient survival with higher Kt/V(14–17) and with higher CCr (16,17). The use of initial values in one study (15), mean values in two studies (14,16), and time -dependent values in another (17) makes comparison difficult. In general, higher values are associated with better survival and are consistent with the values suggested by theoretical constructs (i.e., KtN 2.0 2.25).
Surfactant Barrier Lining Peritoneal Mesothelium: Lubricant and Release Agent
Authors: Hills Brian A. , Burke John R. , Thomas Kristen
Published: February 2020

Objective

Five studies are described to determine whether there is an outermost lining of surface-active phospholipid (SAPL) adsorbed to the peritoneum and to quantify its ability to act as a release (antistick) agent and boundary lubricant by standard tests.

Methods

Using a hydrophobic probe (phosphin E), epifluorescence microscopy was used to demonstrate an outermost lining of oligolamellar SAPL by spectral analysis of the emitted light, a finding consistent with the appreciable hydrophobicity demonstrated on canine peritoneal mesothelium and its virtual elimination by incubation with bile salt. Good release and excellent lubricating capabilities of human peritoneal SAPL have been quantified as the release factor and coefficient of friction, respectively, by standard tests from the physical sciences.

Results

A well-defined outermost layer was clearly visible on peritoneal mesothelium whose color spectrum was identical to that produced by pure phosphatidylcholine ultrasonicated into its oligolamellar state. Further evidence for a SAPL lining was demonstrated by a parietal contact angle of 43° (47° visceral) on this surface and its virtual elimination by incubation with dilute bile salt. Human SAPL from continuous ambulatory peritoneal dialysis (CAPD) effluent proved an effective release agent, reducing adhesion by 67%, and an excellent lubricant as quantified by a coefficient of friction of 0.091 under load (1.9 kg/cm2).

Conclusions

The good release and excellent lubricating properties of SAPL adsorbed to mesothelial surfaces are highly desirable in reducing wear and exfoliation of epithelial cells. In spanning epithelial cells, the same lining might also serve to render tight junctions tight and reduce macromolecular escape while compatible with many aspects of CAPD, including lipid permeability and conflicting results obtained from administering exogenous SAPL.
Intraperitoneal Pulse Calcitriol in the Treatment of Secondary Hyperparathyroidism in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Chan Hilda W.H. , Tsang Wai-Kay , Chan Chor-Man , Fung Samuel K.S. , So Sheung-On , Tang Hon-Lok , Tong Matthew K.L. , Lee Kam-Cheong , Chan Albert Y. W.
Published: February 2020

Objective

To determine whether it is practicable to use intraperitoneal calcitriol to treat continuous ambulatory peritoneal dialysis (CAPD) patients with secondary hyperparathyroidism and whether this form of therapy is effective and safe.

Design

A prospective, nonrandomized study.

Setting

Division of Nephrology, Tertiary Hospital.

Method

Eight patients from our CAPD population were recruited (5 F,3 M), aged 24 to 63 years (mean 38.9 ± 7.6 yr). They had been on CAPD for 8 to 84 months (mean 47.6 ± 24.6 months). All the patients had bone biopsy -proven secondary hyperparathyroidism with 2 patients showing mixed lesions. The CAPD system was changed to the twinbag system (Ultrabag, Baxter Healthcare, McGaw Park, IL, U.S.A.) in all 8 patients, who were taught to inject the calcitriol directly through the short transfer set and the Tenckhoff catheter into the peritoneal cavity, twice per week before bedtime. Calcium carbonate or calcium acetate was used as the main phosphate binder. Intact parathyroid hormone level (iPTH), serum ionized calcium (iCa), serum phosphate, and serum total alkaline phosphatase (alk. phos.) levels were measured at baseline and then every 4 weeks. The mean duration of follow-up was 10.5 months ± 1.9 months.

Results

There was a significant drop of iPTH level from the pretreatment level of 100.6 ± 35.8 pmoll L to a level of 63.8 ± 48.7 pmoll L at 24 weeks (p = 0.036). The lowest level of iPTH attained was 43.4 ± 27.0 pmol/L at 48 weeks. Serum total alk. phos. also dropped from 232.4 ± 83.3 lUlL pretreatment to 147.9 ± 52.0 lUlL at 24 weeks (p = 0.017). The decrease in alk. phos. level paralleled the decrease in iPTH level. The mean serum iCa level did not show any significant rise throughout the study period. The maximum dose of calcitriol used was 6.6 ± 1.5 μg/week and the average dose of calcitriol was 5.4 ± 1.2 μg/week. One patient did not respond satisfactorily and she subsequently had a parathyroidectomy. Two episodes of peritonitis occurred during the study period, giving a peritonitis rate of one episode per 42 patient-months. There was no significant change in the urea clearance tests or the peritoneal equilibration tests before and after the study.

Conclusion

Intraperitoneal calcitriol is practicable, effective, and safe in the treatment of secondary hyperparathyroidism in CAPD patients.
Pharmacokinetics of Clodronate in Peritoneal Dialysis Patients
Authors: Saha Heikki H.T. , Ala-Houhala Ilpo O. , Liukko-Sipi Sirpa H. , Ylitalo Pauli , Pasternack Amos I.
Published: February 2020

Objective

To study the pharmacokinetics of clodronate in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

A single intravenous dose pharmacokinetic study.

Setting

University hospital.

Patients

Ten CAPD patients (3 female, 7 male, age 39 79 year, median 55).

Methods

Clodronate disodium in serum, urine, and dialysate was collected for 24 hours and analyzed by capillary gas chromatography with mass-selective detection.

Results

Only 7% of the infused dose of clodronate was eliminated through peritoneal dialysis during 24 hours. Clearance via CAPD (CLCAPD) was 2.4 ± 0.6 mL/min, which was less than 10% of the total serum clearance (CLtot’ 26.0 ± 19.3 mL/min). Even the kidneys were a more important route of elimination than CAPD in those patients with residual diuresis of more than 500 mL/24 hr. However, in all patients most of the clodronate serum clearance (77% ± 13%) took place via routes other than peritoneal dialysis or kidneys, that is, via nonrenal-non-CAPD clearance (CLNRD). CLNRD most likely represents the part of the drug deposited in the skeleton. There was a positive correlation between CLNRD and the plasma intact parathyroid hormone concentration.

Conclusions

CAPD removed clodronate poorly from the circulation. Most clearance took place via routes other than CAPD or kidneys. This CLNRD most likely represents the skeletal deposition of the drug, and this is related to the severity of hyperparathyroidism. When treating CAPD patients with hyperparathyroid bone disease, the administration of clodronate should be adjusted as in those subjects with severe renal failure.
Repair of Chronic Peritoneal Dialysis Catheter
Authors: Usha Kumari , Ponferrada Leonor , Prowant Barbara F. , Twardowski Zbylut J.
Published: February 2020

Background

Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement.

Objective and Design

Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.).

Results

The life of these seven catheters was extended by a mean of 26 months (range 1 -87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site.

Conclusions and Recommendations

Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.
Serum Leptin Correlates with Fat Mass but not Dietary Energy Intake in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Parry Robin G. , Johnson David W. , Carey David G. , Hibbins Mark , Chang Wendy , Purdie David , Rigby Russell J.
Published: February 2020

Objectives

In view of previous studies demonstrating hyperleptinemia in uremic and hemodialysis patients, the aims of the present study were to determine whether serum leptin levels are elevated in peritoneal dialysis (PD) patients, to establish whether leptin is significantly removed by PD, and to elucidate the relationship of plasma leptin to body composition, dietary intake, nutritional indices, and dialysis adequacy.

Design

Cross-sectional analysis of PD patients and matched healthy controls.

Setting

Tertiary-care institutional dialysis center.

Participants

The study included 49 PD patients [35 women and 14 men; median age 63 years, interquartile range (IQR) 49.5 -68.5 yr; body mass index (BMI) 25.5: I: 0.8] and 27 controls (11 men and 16 women; median age 42 years, IQR 34.8 51; BMI 27.2: I: 0.9). For evaluation of leptin clearance, 8 patients receiving nocturnal intermittent PD were also evaluated.

Main Outcome Measures

The primary outcome measure was plasma leptin concentration. Dialysate leptin concentration was also measured in 7 patients.

Results

Serum leptin levels were significantly higher (p < 0.01) in patients (males: median 11 nglmL, IQR 9 19 ng/mL; females: 53 ng/mL, 19.5 -128 ng/mL) compared with controls (males: 5.5 nglmL, 4 9.5 nglmL; females: 12 ng/mL, 9.8 17.3 ng/mL). Leptin levels in both groups correlated positively with BMI (r = 0.64 and 0.60, respectively; p < 0.0001) and with percentage body fat determined by dual-energy x-ray absorptiometry (r = 0.86 and 0.82, respectively; p < 0.01). Dialysis patients exhibited a greater increase in serum leptin for any given increase in BMI. No significant correlation was observed between leptin concentration and residual renal function, dialysis adequacy (Kt/V), dietary protein or caloric intake, or serum levels of albumin, prealbumin, C-reactive protein, glucose, and insulin-like growth factor-1. Although leptin was detectable in peritoneal dialysate after a 6-hour dwell (median 4.2 ng/ mL, IQR 1.1 -8.5 ng/mL, n = 8), serum leptin levels were not appreciably lowered following intermittent PD via an automated cycler (63.9: I: 19.3 ng/mL vs 57.6: I: 20.5 ng/mL, p = NS, n = 8).

Conclusions

Serum leptin levels are elevated in PD patients and are not appreciably cleared by PD. Although hyperleptinemia correlates poorly with dialysis adequacy and protein intake, a strong and significant relationship was maintained between serum leptin and fat mass. Serum leptin could therefore serve as a useful clinical marker of body fat content in PD patients.
Clinical Evaluation of a Peritoneal Dialysis Solution with 33 mmol/L Bicarbonate
Authors: Cancarini Giovanni C. , Faict Dirk , De Vos Catherine , Guiberteau Robert , Tranæus Anders , Minetti Luigi , Maiorca Rosario
Published: February 2020

Objective

To evaluate the efficacy and safety of a new peritoneal dialysis solution with 33 mmol/L bicarbonate.

Design

In an acute, prospective, randomized crossover study, 8 patients were randomized in two groups of 4. On the first study day, the first group performed two consecutive 4-hour exchanges with a dialysis solution containing 35 mmol/L lactate: the first exchange with 13.6 g/L and the second with 38.6 g/L dextrose. On the second study day, the same type of exchanges were performed with bicarbonate. The second group underwent the same treatment, but used bicarbonate solutions on the first day and control solutions on the second study day. Thirty-three patients participated in a 2-month prospective and randomized study. After a 4-week baseline period using solutions containing 40 mmol/L lactate, the patients were dialyzed with either 33 mmol/L bicarbonate solutions or 40 mmol/L lactate solutions.

Setting

Peritoneal dialysis units at the University Hospital of Brescia and the Niguarda Hospital of Milan, Italy.

Results

Acute study: Control and bicarbonate solutions had similar effects on blood chemistries and peritoneal transport. Chronic study: Mean venous bicarbonate concentrations remained unchanged in the control group (26.6 -27.2 mmol/L), but decreased significantly in the bicarbonate group from 28.8 mmol/L at the start of the study to 23.0 mmol/L after 2 months of bicarbonate administration. Other biochemical parameters remained unchanged.

Conclusion

A peritoneal dialysis solution with a bicarbonate level of 33 mmol/L does not adequately correct uremic acidosis.
Pseudomonas Exit-Site Infections in CAPD Patients: Evolution and Outcome of Treatment
Authors: Lo Chi Yuen , Chu Wai Ling , Wan Kit Mui , Ng Suk Yi , Lee Wai Ling , Chu Mui Fun , Cheng Suk Wai , Lo Wai Kei
Published: February 2020

Objective

To examine the natural history of Pseudomonas aeruginosa (PSA) exit-site infections (ESI) in patients treated with antibiotics with or without surgical interventions.

Design

Retrospective record review from May 1994 to April 1997.

Setting

A single dialysis unit in a district hospital.

Patients

The review included 353 patients who had undergone continuous ambulatory peritoneal dialysis (CAPD).

Outcome Measures

The prevalence and etiology of ESI, the treatment regimen for PSA ESI, and the outcome of treatment.

Results

The prevalence of ESI was 55%. A total of 131 episodes (range 1 -5) of PSA ESI occurred in 78 (40.2%) of the 194 patients who experienced ESI. Among these 78 patients, 4 groups with different outcomes were identified.ln group 1,35 patients (44.9%) were treated successfully with antibiotic therapy alone. Among these 35 patients, 4 developed PSA peritonitis at a mean of 5 months (range 2 -10 mth) after apparent clinical resolution of PSA ESI. Two of the 4 patients switched to long-term hemodialysis (HD) because of peritoneal failure. In group II, 8 patients (10.3%) responded to a combination of antibiotics and shaving of the external cuff. In group III, 21 patients (26.9%) with recurrent ESI underwent elective Tenckhoff catheter removal and reinsertion. One of the 21 patients had relapse of PSA ESI 14 months after the operation. In group IV, 14 patients (17.9%) had recurrent PSA ESI that failed to respond to multiple courses of antibiotics and shaving of the external cuff. Consent for Tenckhoff catheter removal was not obtained and 4 of these 14 patients subsequently developed PSA peritonitis. One of the 4 patients changed to permanent HD due to peritoneal failure.

Conclusions

Considering the increased risk and the poor outcome of PSA peritonitis in patients with persistent PSA ESI, early Tenckhoff catheter removal is recommended if the patient fails to respond to antibiotics with or without externalization of the external cuff.
Relation of Calcified Macroangiopathy to Peritoneal Small Solute Transport Property
Authors: Hiroshige Kinya , Watanabe Yujiro , Suda Takeshi , Yuu Kougi , Ohtani Akira
Published: February 2020

Large interindividual variability in peritoneal solute transfer, determined by the peritoneal equilibration test (PET) at the start of peritoneal dialysis (PD) therapy, has been previously shown (1,2). The contributing factors are not well defined, but may include differences in age, peritoneal surface area, peritoneal permeability, or peritoneal blood flow. The structural or functional changes in peritoneal vasculature produced by systemic atherosclerosis may influence peritoneal solute transport properties. In this study, we quantified the degree of systemic atherosclerosis and investigated its correlation with solute transport in the early phase of PD therapy.
Tranexamic Acid Increases Peritoneal Ultrafiltration Volume in Patients on Capd
Authors: Kuriyama Satoru , Nakayama Masaaki , Tomonari Haruo , Kawaguchi Yoshindo , Hosoya Tatsuo
Published: February 2020

Objective

The preservation of ultrafiltration (UF) capacity is crucial to maintaining long-term continuous ambulatory peritoneal dialysis (CAPD). The aim of the present study was to investigate whether the antiplasmin agent tranexamic acid (TNA) increases UF volume in CAPD patients.

Patients and Methods

Fifteen patients on CAPD, 5 with UF loss and 10 without UF loss, were recruited for the study. The effect of TNA was evaluated with respect to changes in UF volume, peritoneal permeability, peritoneal clearance, bradykinin (BK), and tissue plasminogen activator (tPA) concentration.

Setting

Dialysis unit of the Saiseikai Central Hospital.

Results

In patients with UF loss, 2 weeks of treatment with oral TNA produced a significant increase in UF volume in all subjects (5/5). TNA also produced a significant increase in peritoneal clearances of urea and creatinine (Cr). However, the peritoneal equilibration test (PET) revealed that TNA had no effect on dialysate/plasma (D/P) Cr, Kt/V, or the protein catabolic rate (PCR). TNA also had no effect on net glucose reabsorption. In contrast, significant decreases in BK and blood tPA concentrations in response to TNA treatment were noted. BK concentration in drainage fluid was also reduced. In the case of patients without UF loss, TNA produced an increase in UF volume in 70% (7/10). However, no differences were found in blood and drainage BK and tPA concentrations between the TNA treatment and nontreatment periods in these patients. A comparison of basal BK and tPA concentration showed that there were no differences in these parameters between patients with UF loss and those without loss of UF. Furthermore, TNA given intraperitoneally to a patient also produced a marked increase in UF volume.

Conclusion

The present study suggests that TNA enhances UF volume in patients both with and without UF loss. Since TNA did not affect peritoneal permeability and glucose reabsorption, the mechanism by which TNA exerts an enhancing action on UF is largely unknown. We speculate that it may be associated with suppression of the BK and/or tPA system, at least in patients with UF loss.