bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Patient with Glucose-6-Phosphatase Deficiency
Authors: Vandepitte K. , Lins R.L. , Daelemans R. , Zachée P. , Kuyken Ch. , De Broe M.E.
Published: February 2020

The metabolic disturbances in glucose-6-phosphatase deficiency (von Gierke's disease) are the consequence of hypoglycemia, occurring mostly during the night. Continuous provision of glucose is the aim of every recently introduced treatment procedure.

We studied the influence of continuous ambulatory peritoneal dialysis (CAPD) on the metabolic disturbances in a 42-year-old female patient with von Gierke's disease and end-stage renal disease.

During six months of CAPD, there were no dialysis-related complications. The metabolic acidosis didn't worsen: arterial bicarbonate and lactate were not changed. Mean glycemia was 118.6 ± 14.4 mg %. Total lipemia, cholesterol and triglycerides were not different from those before CAPD, despite the fact that all hypolipidaemic drugs were stopped.

Three different exchange procedures were compared during the night: no dialysis, one exchange with a 2 L solution without buffer containing glucose 15 g/L and containing glucose 42.5 g/L.

The results show that the 4.25% glucose solution prevents hypoglycaemia, and diminishes the increase in lactate and pyruvate concentration. Intraperitoneal glucose normalizes the plasma free fatty acid concentration. A very important result is the disappearance of hypo-insulinism.

We conclude that, from a clinical point of view, CAPD is a well-tolerated treatment in von Gierke's disease. The limited results provide some evidence that the use of a 4.25% glucose solution as an overnight exchange, instead of the usual 1.5% solution, can prevent at least partly the glycogenolysis and consequently the metabolic disturbances of von Gierke's disease.
Longitudinal Study of Peritoneal Defence Mechanisms in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: McGregor Sheila J. , Brock Jeremy H. , Briggs J. Douglas , Junor Brian J.R.
Published: February 2020

Peritoneal cellular and humoral defence mechanisms have been examined in a group of 16 patients over a nine-month period from the day of commencement of continuous ambulatory peritoneal dialysis (CAPD). Significant decreases in the levels of IgG, C3, and opsonic activity occurred with the passage of time in the overnight peritoneal dialysis effluent (PDE). The ability of PDE to inhibit in vitro growth of Staphylococcus epidermidis also decreased. The number ot cells in the PDE and their ability to kill S. epidermidis decreased, although there was no significant change in their ability to ingest this organism. These results suggest that the immunological protection of the peritoneal cavity decreases with time, and this may account for the increase in the incidence of peritonitis with length of time on CAPD that some workers have reported.
Peritonitis in Continuous Ambulatory Peritoneal Dialysis {CAPD): A Multi-Centre Randomized Clinical Trial Comparing the Y Connector Disinfectant System to Standard Systems
Authors:   Canadian CAPO Clinical Trials Group, Churchil O.N. , Taylor O.W. , Vas S.I. , Oreopoulos O.G. , Bettcher K.B. , Fenton S.S.A. , Fine A. , Lavoie S. , Page O. , Wu G. , Beecroft M.L. , Pemberton R. , Wilczynski N.L. , Deveber G.A. , Williams W.
Published: February 2020

sixty-one new continuous ambulatory peritoneal dialysis (CAPD) patients were allocated to a Y connector disinfectant (Amuchina, Italy) and 63 to standard systems (Baxter Systems II & III) in a randomized clinical trial addressing peritonitis rates in 8 CAPD programs in 6 Canadian cities. In the Y connector-disinfectant group, 15 patients experienced 21 episodes of peritonitis in 452 patient-months or 1 per 21.53 patient-months. In the standard systems group, 30 patients experienced 47 episodes of peritonitis in 467 patient-months or 1 per 9.93 patient-months ( p = 0.009). The peritonitis risk reduction was 61% (95% confidence limits 27–79%). Exit-site infections occurred in 36% of each group.

Prior to the development of exit -site infection, the monthly risk for peritonitis was 3.12% for the Y connector disinfectant system and 7.37% for the standard system. After an exit -site infection, these probabilities increased to 6.15% and 15.47%, respectively. Skin organisms were responsible for peritonitis in 8/21 (38%) in the Y connector-disinfectant group and 30/47 (64%) in the standard group. There were 75 days hospitalized for peritonitis in the Y connector-disinfectant group compared to 257 days for the standard group. The Y connector disinfectant system decreases the peritonitis rate through its effect on skin organisms. Exit -site infections are a major source of organisms responsible for peritonitis.
Oral Lecithin Improves Ultrafiltration in Patients on Peritoneal Dialysis
Authors: Chan Hilda , Abraham Georgy , Oreopoulos Dimitrios G.
Published: February 2020

Three patients on peritoneal dialysis (two on continuous ambulatory and one on intermittent) with severe ultrafiltration failure were treated with 2 capsules of Lecithin three times a day (containing of 1.08 g of phosphatidylcholine). Their ultrafiltration improved significantly to the point that their edema improved and were able to continue on peritoneal diaysis with fewer daily hypertonic exchange.
Comparison of Large Volume Culture to Other Methods for Isolation of Microorganisms from Dialysate
Authors: Sewell David L. , Golper Thomas A. , Hulman Peter B. , Thomas Catharine M. , West Linda M. , Kubey Winnie Y. , Holmes Clifford J.
Published: February 2020

Patients on continuous ambulatory peritoneal dialysis (CAPD) who reside long distances from a CAPD center often use community medical laboratories to document and manage episodes of peritonitis. We examined the feasibility of using large volume cultures as an alternative to more costly and labor intensive methods and to enhance earlier recovery of microorganisms from these patients.

Three methods of processing dialysate from patients on CAPD were compared: (a) inoculation of 400 mL dialysate into a transfer bag (Baxter Healthcare, Inc., Round Lake, IL) containing 100 mL of 5-fold concentrate of trypticase-soy broth: (b) inoculation of 5 mL into each of two Bactec bottles (Johnston Laboratories, Towson, MD): and (c) centrifugation of 50 mL and culture of the sediment without white cell lysis on plated media and two Bactec bottles.

Of the 58 specimens cultured, 34 (59%) were positive by one or more methods. Antimicrobial activity was detected in 20158 (34%) dialysates, which represent 54% of all no-growth cultures. Of the 34 culture-positive specimens, microorganisms were recovered on plated media in 22 (65%); by the centrifugation system in 32 (94%); by the routine Bactec system in 28 (82%); and by large volume culture in 30 (88%).

The large volume culture system is an acceptable alternative to the more costly Bactec System and the labor intensive centrifugation method but does not significantly improve recovery of microorganisms.
Failure of Demonstrated Clinical Efficacy of Antibiotic-Bonded Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheters
Authors: Trooskin Stanley Z. , Harvey Richard A. , Lennard T. w. J. , Greco Ralph S.
Published: February 2020

Previous in vitro, in vivo, and a preliminary clinical report have demonstrated efficacy of noncovalently bonding antibiotics to the surface of continuous ambulatory peritoneal dialysis (CAPO) catheters in decreasing infectious complications. A larger prospective randomized clinical trial was completed. Eighty-six patients with chronic renal failure were enrolled in the study and randomized to receive either a surfactant treated or untreated control catheter. All catheters were soaked in cefoxitin at the time of insertion. Groups were comparable in terms of pre-existing illnesses, age, and gender. No differences were shown in the incidence of cathetertract infections, peritonitis or mechanical complications. There was also no differences in microbiologic culture results. Therefore, it is concluded that this clinical trial did not demonstrate a reduction in catheter-related infectious complications by antibiotic bonding.
A Comparison of Two Types of Catheters for Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Akyol A. Murat , Porteous Colin , Brown Malcom W.
Published: February 2020

This study was undertaken to critically examine the value of the curled Tenckhoff catheter for continuous ambulatory peritineal dialysis (CAPD) access with respect to the incidence of catheter-related complications. In the setting of a prospective, randomised, double-blind comparison, we were unable to demonstrate any advantage of the curled Tenckhoff catheter over the conventional straight type.
Oral Neostigmine and Lymphatic Absorption in a Myasthenia Gravis Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Chan Patricia C. K. , Tam Sidney C. F. , Cheng Ignatius K. P.
Published: February 2020

The effects of oral neostigmine on peritoneal lymph absorption and transcapillary and net ultrafiltration were studied in a myasthenia gravis patient on continuous ambulatory peritoneal dialysis (CAPD). Oral neostigmine decreased lymphatic absorption, but only up to a threshold dose. The effect on net ultrafiltration however was nullified to some extent by a concurrent decrease in cumulative transcapillary ultrafiltration.
Branhamel1A Catarrhalis Peritonitis in Two Continuous Ambulatory Peritoneal Dialysis Patients
Authors: MacArthur Rodger D.
Published: February 2020

Two cases of peritonitis caused by Branhamella ca tarrhalis are presented. Both occurred in CAPD patients dialyzed and hospitalized at the same institution, but no common source of infection could be found. Branhamella catarrhalis infections can be difficult to treat and cause significant morbidity if not recognized early and treated aggressively with appropriate antibiotics.
Continuous Ambulatory Peritoneal Dialysis (CAPD) or Center Hemodialysis? Retrospective Evaluation of the Success of Both Methods
Authors: Marichal J. F. , Cordier Beatrice , Faller Bernadette , Brignon P.
Published: February 2020

In a retrospective study, the authors analysed the dialysis-technique success rate in 276 chronic renal patients. Of these, 137 patients have been treated with in center hemodialysis (CHD) from 1972 to 1989 and 139 with continuous ambulatory peritoneal dialysis (CAPD) from 1978 to 1989. The six-year technique success rate was 28% in CAPD and 31% in CHD (statistically not significantly different). Various risk factors influence the technique-success rate of both methods in the same way. The results suggest that in our center CAPD is as effective as CHD in the treatment of patients with endstage renal failure.
Initial Treatment of Dialysis Associated Peritonitis: A Controlled Trial of Vancomycin versus Cefazolin
Authors: Flanigan Michael J. , Lim Victoria s.
Published: February 2020

Objective

To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) im proves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic.

Setting

A university operated teaching hospital, with patient treatment initiated at home.

Patients

One hundred thirty-one patients trained to perform peritoneal dialysis (CAPD and CCPD) and followed at the University of Iowa Hospitals and Clinics Home Dialysis Treatment Center.

Design

Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, orcefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing.

Findings

Compared to cefazolin, initial peritonitis therapy with vancomycin improved the peritonitis resolution rate [67% vs 81 %; p=0.008], reduced the incidence of hospital admissions [68% vs 48%; p=0.001], and decreased the risk of superinfection [4% vs 0%; p=0.039].

Conclusion

Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.
CAPD Peritonitis and Fluoroquinolones: A Review
Authors: Janknegt Robert
Published: February 2020

Fluoroquinolones are potentially useful agents in the treatment of CAPD peritonitis, due to their wide spectrum of antimicrobial activity, favourable pharmacokinetics, oral availability and their relatively low toxicity.

The microbiological, pharmacokinetic, and clinical aspects of these drugs in CAPD are reviewed.

Ciprofloxacin showed superior in-vitro activity in comparison with various beta lactam agents; gentamicin and vancomycin against staphylococci and particularly against Gram-negative bacteria. Its activity against streptococci is low. The in vitro activity of fiuoroquinolones is reduced in peritoneal dialysis fluid.

A limited rise in serum levels is observed with daily administration of fiuoroquinolones in CAPD patients during 5–15 days. Effective dialysate levels are reached in most patients after oral dosing, but these levels are highly variable and low levels are often observed during the first day, an d with short dwell times. Concurrent administration with phosphate binding antacids should be avoided.

Initial clinical experience shows that ciprofloxacin and ofloxacin may be effective agents to treat CAPD peritonitis via the oral route. They are usually well tolerated, although convulsions have been observed. The relative efficacy in comparison with “standard therapies” will have to be shown in comparative studies.
Disposal of CAPD Waste in the Community
Authors: Bailie George R. , Kowalsky Steven F. , Eisele George , Schwartzman Michael S.
Published: February 2020

Fifty-nine patients returned a confidential mailed questionnaire, to determine their procedures for disposal of CAPO waste including bags, fluids and needles, and to assess their instruction and opinions on health risks from their wastes. Patients came predominantly from rural communities. Sixty four percent used disposal boxes for used needles, 80% discarded drained bags in the garbage without wrapping them in plastic and 7 to 17% of patients discarded needles straight to the garbage, depending on circumstances. Thirty seven percent did not recall receiving instruction on waste disposal, and of those who did, instructions came predominantly from nurses. Twenty of 32 patients who had suffered peritonitis disposed of their bags during peritonitis in the same manner as when they did not have peritonitis. Most patients (61%) felt issues dealing with CAPO waste disposal were “important” or “very important”, but fewer “agreed” or “strongly agreed” that it posed a health risk to others (16%) or to the environment (10%). Inconsistencies in methods of disposal and potential risks of infection dictate that guidelines must be developed to deal with these issues.
Sclerosing Peritonitis Complicating Prolonged Use of Chlorhexidine in Alcohol in the Connection Procedure for Continuous Ambulatory Peritoneal Dialysis
Authors: Lo Wai-Kei , Chan Kwok Tat , Leung Anthony C.T. , Pang Siu-Wah , Tse Chun-Yan
Published: February 2020

Sclerosing peritonitis (SP) is an uncommon but serious complication of CAPD with various suggested etiologies. We have documented 14 cases of SP in 18 patients who had used chlorhexidine in alcohol (ChA) in the connection procedure for CAPD. Thirteen died. Nine of the 14 patients had been transferred to hemodialysis or renal transplantation, yet all still developed symptoms of SP within a few months after transfer -even the 5 who were originally asymptomatic. The main symptoms of SP were peritoneal ultrafiltration failure, exudative bloody ascites and intestinal obstruction. They presented at around 5 years (30–80 months) after commencement of CAPD. Most deaths were related to intestinal obstruction. Four other patients with a comparable duration of ChA exposure were continued on CAPD with the Travenol Spike System (TSS), without further exposure to ChA. They were all asymptomatic of SP after 9–12 months. Comparing the 2 groups of asymptomatic patients, those transferred to TSS had a much better outcome after 9 months than those transferred to HD or renal transplantation (P=0.0476). We suggest that ChA is the main cause of SP in our patients and that continuing CAPD without further exposure to ChA is a better alternative than stopping CAPD to prevent the progression of SP.
A New Stable Bicarbonate Dialysis Solution for Peritoneal Dialysis: Preliminary Report
Authors: Yatzidis Hippocrates
Published: February 2020

This paper describes the use of glycylglycine to prepare dialysis solution containing bicarbonate, calcium and magnesium. Bicarbonate with glycylglycine form a buffer with a constant pH of 7.35, which prevents reaction with calcium or magnesium and the formation of insoluble carbonate salts. This bicarbonate-based solution is stable over long periods and can be used with the same simplicity and convenience as lactate solution for peritoneal dialysis (PD) in humans.
Lectin Staining of Peritoneal Mesothelial Cells in Vitro
Authors: Hjelle J. Thomas , Golinska Barbara T. , Waters Diane C. , Steidley Kevin R. , Miller Marcia A. , McCarrol David R. , Dobbie James W.
Published: February 2020

A survey of lectin-binding specificities present on rodent and human mesothelial cells propagated and maintained in tissue culture was made using fluorescein isothiocynate conjugated (FITC) lectins. Rodent and human cells exhibited cell-associated fluorescence following exposure to the FITC-Iectins from C. ensiformis, T. vulgaris, A. hypogaea, E. cristagalli and B. simplicifolia, but not with lectins from G. max and D. biflorus. Rodent cells were also positive for FITC-M. pomifera lectin binding. Human, but not rodent, cells were positive for FITC T. purpureas lectin binding. Exposure of rabbit mesothelial cells in vitro to FITC-Iectins that bound to the cell surface resulted in the appearance of discrete loci of putatively intracellular fluorescence. Exposure of cells to ferritin-Iabelled T. vulgaris lectin at 37°C for as little as 7.5 minutes resulted in the appearance of ferritin-size particles in intracellular vesicles. These results demonstrate 1. the presence of lectinbinding sites in and on peritoneal mesothelial cells from rodents and humans and 2. a possible role of such sites in mediating the entry of lectin-Iike endogenous molecules into the vacuolar apparatus of these cells.
Short Term Effects of Low-Calcium Dialysis Solutions on Calcium Mass Transfer, Ionized Calcium, and Parathyroid Hormone in CAPD Patients
Authors: Pagliari Bruno , Baretta Alvaro , De Cristofaro Vincenzo , Samà Francesco , Cantaluppi Alberto , Martis Leo , Imbasciati Enrico
Published: February 2020

Patients on CAPD using calcium carbonate (CaC03) as phosphate binder might benefit from low -calcium (Ca) concentration dialysis solutions; however, no data are available for the effects of this regimen on Ca metabolism. We studied 10 patients on stable CAPD regimens with standard dialysis solutions (Ca 7 mg/dL) who were taking CaC03 to control hyperphosphatemia (mean daily doses 4.5±2.4 g). Hypercalcemic episodes had been recorded in 6 patients. Standard dialysis solutions were replaced with solutions containing 5 mg/dL of Ca. Calcium and phosphate peritoneal mass transfer (MT), serum concentrations of total Ca, ionized Ca (Ca++), phosphate, intact PTH, and mid-molecular PTH, were evaluated before and 48 hours after change of dialysate. The switch to low-Ca solutions was accompanied by significant changes in calcium mass transfer (Ca MT) (+9.84±48.22 versus −96.74±48.32 mg/day, p<.001). Ca MT was significantly (p<.05) correlated with the serum/ dialysate Cagradient. There was no difference in phosphate MT. Serum Ca++ significantly (p<.05) decreased from 5.20±0.32 to 4.88±0.36 mg/dL, and intact PTH significantly increased (81.5± 139 versus 112.4± 168 pg/mL, p<.05). It is concluded that dialysis solutions with Ca 5 mg/dL result in a negative peritoneal Ca MT and can be useful to prevent and treat hypercalcemia in CAPD patients taking CaC03 as phosphate binder. A careful monitoring of ionized calcium, PTH, and phosphate is suggested when an extensive and long-term use of this solution is considered.
Catheter Infections in Insulin-Dependent Diabetics on Continuous Ambulatory Peritoneal Dialysis
Authors: Holley Jean , Bernardini Judith , Piraino Beth
Published: February 2020

We compared a group of 60 insulin-dependent diabetics maintained on CAPO with 60 nondiabetic matched controls to determine if the diabetic patients were at increased risk for catheter-related infections. Although catheter infection rates were 17% higher in the diabetics (1.4/year versus 1.2/year in nondiabetics), time to first catheter infection was not different between the groups (p=0.6). Rates of peritonitis, peritonitis associated with catheter infection, multiple catheter infection, and catheter removal were also similar among the diabetics and controls. S. aureus caused 52% (42/81) of the catheter infections in the diabetics and 60% (35/58) in the controls. More catheter infections in the nondiabetics versus the diabetics lacked drainage or resulted in sterile cultures (17/75 versus 7/88 respectively, p≤0.01), but the significance of this finding is uncertain. In conclusion, we did not find insulin-dependent diabetes mellitus to be a statistically significant risk factor for catheter-related infections.
Management of Refractory Peritonitis to Maintain the Peritoneum for Subsequent Dialysis
Authors: Shusterman Neil H. , Jacobs Joseph
Published: February 2020

Peritonitis and its sequelae remain major clinical problems in treating peritoneal dialysis (PD) patients. One of these sequelae is the formation of intra-abdominal adhesions, preventing a patient from returning to peritoneal dialysis after a Tenckhoff catheter is removed for refractory peritonitis. We have recently applied a technique that appears to reduce the incidence of this severe complication. When it is determined that a catheter will be removed for refractory peritonitis, hourly peritoneal dialysis exchanges are performed for 12 hr prior to surgery. Postoperatively, the abdomen is rested for 48 hr, after which a temporary peritoneal dialysis catheter is placed at the bedside and hourly exchanges (with antibiotics) are performed for 2–3 days or until the dialysis fluid white blood cell count improves. Then the temporary catheter is removed and the abdomen is rested until the Tenckhoff catheter is replaced in 10–14 days. We treated 5 consecutive patients with refractory peritonitis (2 Pseudomonas, 1 Proteus, 1 Candida, 1 S. aureus) with this technique. All 5 patients were able to return successfully to peritoneal dialysis. At our institution over the past five years, 9 patients with refractory peritonitis due to the same organisms have had their catheters removed. Only 5 (56%) were able to return to PD. Although preliminary, our technique holds promise for those patients wishing to return to peritoneal dialysis after having a catheter removed for refractory peritonitis.
Dialysis at Home in the West of Scotland: A Comparison of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis in Age and Sex-Matched Controls
Authors: Grant Alexander C. , Rodger R. Stuart C. , Howie Catherine A. , Junor Brian J.R. , Briggs J. Douglas , Macdougal1 Alisdair I.
Published: February 2020

Objective

To audit the outcome of patients treated at home by hemodialysis and continuous ambulatory peritoneal dialysis (CAPD).

Design

Retrospective comparison of nondiabetic hemodialysis patients with age and sex-matched nondiabetic patients treated by CAPD.

Setting

Renal Units, Stobhill General Hospital and Western Infirmary, Glasgow, providing the home dialysis service for the West of Scotland.

Patients

Between 1982 and 1988, 139 hemodialysis patients starting treatment at home, compared with 139 matched patients starting CAPD over the same time period.

Main Outcome Measures

Patient characteristics and cardiovascular risk factors at the start of home treatment. Patient and technique survival with both forms of dialysis.

Results

Patients selected for home hemodialysis were less likely to be smokers (p<0.02) and to have electrocardiographic evidence of ischemia or left ventricular hypertrophy (p<0.05) than patients treated by CAPD. Patient survival and technique survival (excluding death and renal transplantation) at 3 years were 93.8% versus 86.2% (p<0.05) and 94.2% versus 80.8% (p<0.04) for hemodialysis and CAPD, respectively. Cardiovascular events were responsible for the majority of deaths in both groups, but there was a greater proportion of deaths from other causes in patients treated by CAPD. There was no significant difference in the transplantation rate between the two treatment groups.

Conclusions

Home dialysis is an effective method of renal replacement treatment for patients with end-stage renal disease. The results of hemodialysis are superior to CAPD, but this may be partly due to selection bias.
Effect of Erythropoietin in Continuous Ambulatory Peritoneal Dialysis Patients: Comparison between Intravenous and Intraperitoneal Administration
Authors: Nasu Takahito , Mitui Hiroshi , Shinohara Yoichi , Hayashida Shigeaki , Ohtuka Hiroyuki
Published: February 2020

The administration of recombinant human erythropoietin (rHuEPO) in CAPD patients is usually done subcutaneously. Only a few authors have reported on its intraperitoneal (IP) administration. We compared the effect of IP administration of rHuEPO in CAPD patients to that of intravenous (IV) administration. Ten anemic CAPD patients injected rHuEPO into their dialysis bag once a day, 3 times a week, for 18 weeks. The initial dose was 12000 U. The dwell time of the exchanges with rHuEPO was about 6 hours. Nineotheranemic CAPD patients were treated with IV rHuEPO once a week for 18 weeks. The initial dose was 6000 U. In the IP group the hematocrit rose from 24.04±2.7% to 33.3±3.8% (mean±SD). In the IV group 2 patients were excluded from the efficiency evaluation. In 7 of the 9 patients in the IV group, the hematocrit rose from 23.27±2.6% to 32±5.5% (mean±SD).

The intraperitoneal administration of rHuEPO in CAPD patients is sufficient in improving anemia, although it requires a much larger dosage to yield the same level of improvement as the one obtained with the intravenous administration. However, in patients on continuous cycling peritoneal dialysis or IP dialysis, a smaller dosage during the prolonged dwell time may be effective.
The Need for Second-Generation Antihepatitis C Virus Testing in Uremic Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Ng Yee-Yung , Lee Shou-Dong , Wu Shiao-Chi , Liu Wu Tse , Chia Wei-Lian , Huang Tung-Po
Published: February 2020

Objective

To assess the prevalence and clinical relevance of a hepatitis C virus (HCV) infection in continuous ambulatory peritoneal dialysis (CAPD) patients by first (Ortho) and second-generation (Abbott and UBI) HCV antibody enzyme immunoassays.

Design

Thirty-two serum samples tested by first generation HCV antibody enzyme immunoassays (EIA's) were reevaluated using two second-generation HCV antibody EIA's. Basic demographic data, history of blood transfusions, and duration of hemodialysis and CAPD were reviewed. Results were analyzed by chi square analysis, Wilcoxon rank sum, and the paired t-test.

Setting

The medical college's affiliated teaching hospital.

Results

The prevalence of the antibody anti-HCV increases with the duration of previous hemodialysis, but not with the duration of CAPD. The positive detection of anti-HCV by second-generation HCV antibody EIA's was higher than first-generation EIA's (25% and 34.4% vs 12.5%).

Conclusion

The prevalence and clinical relevance of HCV infection can be more accurately studied using the second-generation assays in uremic patients.
Heat Sterilization of Fluids for Peritoneal Dialysis Gives Rise to Aldehydes
Authors: Thorell Carin B. Nilsson , Muscalu Natalia , Andrén Anders H.G. , Kjellstrand Per T.T. , Wieslander Anders P.
Published: February 2020

Objective

To chemically identify and quantify glucose degradation products in heat sterilized fluids for peritoneal dialysis.

Design

Three different brands of commercial PD-fluids and one laboratory made fluid, sterilized either by heat or filtration, were investigated for the presence of aldehydes.

Measurements

Aldehydes were identified and quantified using high performance liquid chromatography and gas chromatography.

Results

The tested brands of heat sterilized PD-fluids were found to contain several different aldehydes while the sterile filtered PD-fluid contained none. The highest concentrations in commercial PD-fluids of these aldehydes were: acetaldehyde (420 μm), glyoxal (14 μm), methylglyoxal (12 μm) and formaldehyde (11 μm). Valeraldehyde was also identified but not quantified. The presence of 5–HMF (15 μm) and 2-furaldehyde (2 μm), which has been identified by others, was confirmed.

Conclusions

The heat sterilization of commercial PD fluids gives rise to several aldehydes which may contribute to adverse effects of PD-fluids on patients.
A Three-Pore Model of Peritoneal Transport
Authors: Rippe Bengt
Published: February 2020

The three-pore model of peritoneal transport treats the capillary membrane as a primary barrier determining the amount of solute that transports to the interstitium and the peritoneal cavity. According to the three-pore model, the principal peritoneal exchange route for water and water-soluble substances is a protein-restrictive pore pathway of radius 40–55 A, accounting for approximately 99% of the total exchange (pore) area and approximately 90% of the total peritoneal ultrafiltration (UF) coefficient (LpS). For their passage through the peritoneal membrane proteins are confined to so-called “large pores” of radius approximately 250 Å, which are extremely few in number (0.01% of the total pore population) and more or less nonrestrictive with respect to protein transport. The third pathway of the three-pore model accounts for only about 2% of the total LpS and is permeable to water but impermeable to solutes, a so-called “water-only” (transcellular?) pathway.

In contrast to the classical Pyle-Popovich (P&P) model, the three-pore model can predict with reasonable accuracy not only the transport of water and “small solutes” (molecular radius 2.3–15 Å) and “intermediatesize” solutes (radius 15–36 Å), but also the transport of albumin (radius 36 Å) and larger molecules across the peritoneal membrane. The model operates with reflection coefficientsa (a's) for small solutes <0.1. These are approximately one order of magnitude lower than the & sigma's In the P&P model. Furthermore, the peritoneal LPS is one order of magnitude higher than In the P&P model. As a consequence, the major portion of the “fluid loss” from the peritoneal cavity In continuous ambulatory peritoneal dialysis (CAPD) can be explained by the operation of the so-called Starling forces (the transcapillary hydrostatic pressure gradient opposed by the plasma colloid osmotic pressure as multiplled by the LpS), and to a much lesser extent by lymphatic absorption (L). Furthermore, In contrast to the P&P model, the three-pore model can with reasonable accuracy predict the UF profiles produced when glucose Is substituted by high molecular weight solutes as osmotic agents In CAPO.
Risk Factors of Ischemic Cardiac Disease in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Cavagna Romano , Schiavon Renzo , Tessarin Cristina , Papa Nunzio , Scorrano Dante , Casol Daniela , De Silvestro Linda
Published: February 2020

Elevated plasma levels of fibrinogen, factor VII coagulant activity (F VIIc), and plasminogen activator inhibitor (PAI-1) have been reported to be strictly associated with thrombotic events and are considered to be important risk markers of atherothrombotic caridovascular disease. Therefore, we evaluated in 15 patients on continuous ambulatory peritoneal dialysis (CAPD) the plasma levels of these coagulation factors, basal insulin values, and the lipid pattern in comparison with 33 hemodialysis (HD) patients and 59 healthy subjects.

In CAPD the total cholesterol and triglyceride results were significantly increased, but no difference was found in HDL cholesterol.

Fibrinogen and F VIIc results were significantly higher In CAPD and HD than In the control group, probably due to an increased hepatic synthesis as a nonspecific response to the peritoneal protein loss.

Elevated F VIIc activity may be caused by the presence of large negatively charged lipoproteins, in viva thrombin formation, or reduced hepatic clearance.

Both PAl 1 and t-PA results were higher in CAPD, probably due to an increased synthesis by endothelial cells activated by glucose peritoneal absorption and hypertonic dialysis solutions.

The contemporary elevation of fibrinogen, F VIIc, PAI-1, and t-PA suggests that CAPD patients present a hypercoagulability and hypofibrinolysis condition, which may promote the development of atherothrombotic events.
Body Composition and Lipid Abnormalities in Hispanic and Black Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Henriquez Mario A. , Gonzalez Alfredo , Bemis James A. , Esquivel Jorge
Published: February 2020

Cardiovascular disease Is the leading cause of death In patients undergoing maintenance dialysis. This study was undertaken to evaluate the lipid abnormalities and body composition by bioelectricalimpedance in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The patients were between the ages of 28 and 77 and had been on dialysis for periods ranging from 6 -48 months. Body composition studies performed by electricalimpedance showed that the CAPD patients generally had elevated levels of body fat. Most of these patients had waist-to-hip fat ratios of more than 1.0, and lean tissue was decreased. Serum chemistries showed that most of the patients had albumin levels less than 3.5 g/dL. The most frequent lipid abnormalities found were: hypertriglyceridemia; hypercholesterolemia; decreased HDL levels; elevated cholesterol/HDL and apoproteins (Apo B/A-1); and elevated lipoprotein [Lp(a)] levels. Cardlovascular disease was prevalent in the patients studied. Ten had a positive history of angina, with three documented myocardial Infarction and two documented cardlovascular disease. In conclusion, standard CAPO treatment may Increase the risk of cardiovascular disease.
Dislipemia in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Pharmacological Therapy (Simvastatin) versus Hemodialysis
Authors: Marangoni Roberto , Civardi Fernando , Masi Franceso , Cimino Roberto , Maltagliati Luca , Longhena Giorgio Romei
Published: February 2020

Peritoneal dialysis can worsen disllpemia, which is frequent in chronically uremic patients.

In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPO) and who had developed an IV-type dislipemia. Twelve have continued CAPO treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPO and have begun HO, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: In patients treated with CAPO and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p<0.001), and highly significant increases were noted in HOL-cholesterol (HOL-cho) (p<0.005) and apolipoprotein-A 1 (Apo-A 1) (p<0.01). In patients treated with HO, only slightly significant decreases were noted in T-cho (p<0.01) and TG (p<0.02), a slightly significant increase in Apo-A1 (p<0.05), and no significant change in HOL-cho. Apollpoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPO, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPO must abandon treatment and must be transferred to extracorporeal methods.
The Effect of Simvastatin on Dyslipemia in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Dimitriadis Athanassios , Antoniou Staveos , Hatzisavvas Nikolaos , Pastore Franca , Kaldi Loanna , Stangou Maria
Published: February 2020

The efficacy of simvastatin, an inhibitor of HMG-CoA reductase, was evaluated in 14 nondiabetic hypercholesterolemic continuous ambulatory peritoneal dialysis (CAPD) patients with or without hypertriglyceridemia. Following a hypolipemic diet for 6 weeks, simvastatin was administered at a dose of 10 mg/day for 6 months.

After 6 weeks on simvastatin, cholesterol was reduced by 22% (p<0.001), triglycerides by 24% (p<0.001), lowdensity lipoprotein (LDL) by 27% (p<0.001), while high density lipoprotein (HDL) increased by 18% (p<0.005). These changes remained steady for 6 months. Apolipoprotein-B (Apo-B) was reduced by 17.8% (p<0.0001), while Apo-A was stable. There were no liver function abnormalities observed. In 3 patients serum creatinine kinase (CK) was increased, and in 2 treatment was stopped. No new lens opacities or other side effects were detected.

Simvastatin seems to be an effective and relatively well-tolerated drug for dyslipemias in CAPD.
Evaluation of Carnitine Levels According to the Peritoneal Equilibration Test in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Chatzidimitriou Christos , Pliakogiannis Theodoros , Evangeliou Athanasios , Tsalkidou Theodora , Böhles Hans Josef , Kalaitzidis Kleonikos
Published: February 2020

The evidence of carnitine abnormal metabolism in patients on continuous ambulatory peritoneal dialysis (CAPO) is unclear, and previous studies have reported conflicting results.

The total (TC), free (FC), and acylated (AC) carnitines were estimated in blood and dialysate, as well as the AC/FC ratio, in 29 patients on CAPO, grouped into high (H-Abs) and low (L-Abs) absorbers, according to the results of the peritoneal equilibration test (fast PE-test).

Ourdata demonstrated that patients with higher peritoneal transport rates, which was the H-Abs group, males and females, showed a better carnitine metabolic status compared to the L-Abs group. Although the H-Abs group lost significantly more free carnitine than the L-Abs group, the AC/FC ratio of the H-Abs group remained within normal range.

All the patients in our study showed abnormally high triglyceride (TAG) levels and an abnormally high total cholesterol/HOL cholesterol ratio. In particular, the patients In the L-Abs group showed significantly higher TAG levels and total cholesterol/HOL cholesterol ratios than the H-Abs group. Those patients who have been on CAPO for more than 2 years showed significantly abnormally higher AC/FC ratios than those with shorter periods on CAPO treatment. In patients with AC/FC ratio greater than 0.4, the supplementation of L-carnitine may have a beneficial effect on their carnitine and lipid metabolism.
Peritoneal Sclerosis: Role of Plasticizers in Stimulating Interleukin-1 Production
Authors: Fracasso Agostino , Calo Lorenzo , Landini Silvano , Morachiello Paolo , Righetto Flavio , Scanferla Flavio , Toffoletto Pierpaolo , Genchi Rosangela , Roncali Davide , Cantaro Salvatore , De Silverstro Giustina , Cavatton Gianni , Masiero Mauro , Plebani Mario , Borsatti Arturo , Bazzato Giorgio
Published: February 2020

The role of plasticizers (PLS) in inducing water flow inhibition and peritoneal sclerosis has been demonstrated in both In vivo and In vitro studies. Interleukin-1 (IL-1) has been shown to be a regulator of fibroblast proliferation as well as collagenase production.

The aim of this study was to evaluate the role of PLS in stimulating mononuclear ce1l1L-1 secretion.

Two cultures containing 103 cells/mL were obtained from 14 healthy subjects. One was used as the control, and the other was mixed with diethylhexylphthalate (DEHP) to reach a final concentration of 2.8x10” M. After 4 hours the samples were centrifuged, and the supernatants were tested by radioimmunoassay for IL-1α and IL-1β.

The results showed a significant increase In both IL-1α and IL-1 β production In DEHP-stimulated cells in comparIson to the controls: 42.6±15.4 versus 29.3±10 ng/L (p<0.015) for IL-1α. and 153.6±55 versus 113.6±32 ng/L (p<0.03) for IL-1β

In conclusion, PLS added to mononuclear cells were able to Induce IL-1 secretion. This mechanism could be responsible, at least in part, for the development of peritoneal sclerosis. Thus the employment of plasticlzer-free bags should be elective in peritoneal dialysis.
Effect of Erythropoietin Treatment on Nutritional Status of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Balaskas Elias V. , Melamed I. Rogers , Gupta Amit , Bargman Joanne , Oreopoulos Dimitrios G.
Published: February 2020

Seventeen patients -10 females, 7 males -mean age 52 years (range: 21–77 years), on CAPD for an average of 35 months (range 10–160 months) were studied. Mean initial dose of EPO was 114±45 U/kg/week subcutaneously (range: 59–209). The dose was adjusted to achieve and maintain a target Hb of 100 g/L and Hct 30%. Fifteen of the patients (88.2%) achieved this target within 6 months [baseline to month 6 changes: Hb 72±10 g/L to 107±12 g/L (p=0.0001); Hct 22±3% to 33±4% (p=0.0001)]. Serum total protein also increased significantly over the time of EPO use (p=0.0133); changes from baseline were significant by the fourth month [68±9 g/L to 72±9 g/L (p=0.0115)]. Serum albumin also increased significantly over time (p=0.0157). The change from the baseline result (37±4 g/L) was statistically significant by month 2 (p=0.0060) and was maintained over the following 4 months [month 6 result: 40±3 g/L (p=0.0180)]. The increase was greater for 8 patients with initial serum albumin <35 g/L (mean change 5.75 g/L) than for the 9 subjects with levels >35 g/L (mean change 0.11 g/L). In a comparison group of 17 patients (matched for age, sex, duration of CAPD, underlying disease and antihypertensive treatment), who did not receive EPO treatment, albumin and protein did not appear to increase over time. Mean body weight increased from 60.9± 14.0 kg at the start to 62.1± 13.9 kg at month 6 (p=0.281) and the absolute lymphocyte count from 1.6±0.8 x 109/L to 1.8±1.0 x 109/L (p=0.0472). Serum potassium, urea, creatinine, phosphorus, cholesterol, tri. glycerides, WBC and platelets did not show significant changes over time. Serum phosphorus increased at the end of the second and third months (from 1.6±0.5 mmol/L to 1.9±0.4 and 1.8±0.4 mmol/L and then decreased at the sixth month (1.7±0.5 mmol/L); this is probably due to an increase in phosphate binders in 9 of 17 patients. An improvement in appetite, sleep and well-being, by patients’ self-assessment, was noted during the treatment.

We conclude that the treatment with EPO is associated with improvement of the nutritional status of patients on CAPD.
Hematocrit Influence on Peritoneal Dialysis Effectiveness during Recombinant Human Erythropoietin Treatment in Patients with Chronic Renal Failure
Authors: Ksiazek Andrzej , Baranowska-Daca Elzbieta
Published: February 2020

Seven intermittent peritoneal dialysis (IPD) patients were investigated before and after correction of anemia with recombinant human erythropoietin (r-HuEPO). When hematocrit exceeded 300/0, the peritoneal equilibration test was performed at 1, 2, 4, 8 hours.

Correction of anemia was associated with a mean value Increment In creatinine and phosphate clearance In 1 and 2-hour dwells. Differences In clearance of sodium, potassium, and urea In protein loss and glucose absorption before and after r-HuEPO therapy were not statistically significant.

Increased creatinine and phosphate clearance during short dwells can be effected in IPD patients.
The Effect of Dialysate Osmolality on Ultrafiltration and Vascular Refilling Rate
Authors: Burdiel Luis G. , Jiménez Antonio , Martin-Malo Alejandro , Castillo Domingo , Rodriguez Mariano , Alvarez M. Antonia , Aljama Pedro
Published: February 2020

The osmotic gradient is the main driving force for ultrafiltration (UF) in continuous ambulatory peritoneal dialysis (CAPD). Depending on glucose absorption, its changes over a period of time could influence the plasma refilling rate. The aim of this study was to evaluate the Influence of changes In the plasma refilling rate obtained by dlalysates of different osmolalities upon the rate of UF. Stable CAPD patients were studied twice during a 4-hour exchange 2 weeks apart with dialysate containing 1.5% and 4.25% glucose, respectively. UF was estimated by the autologous hemoglobin dilution method every 30 minutes. Hematocrit and colloidosmotic pressure (COP) decraase when using 1.5% glucose dialysate, reflecting a rise In plasma water mediated by the plasma refilling rate. This water shift Is greater than the osmotic gradient generated between peritoneal and intravascular compartments as reflected by a low UF rate. However, when the osmotic gradient Increases by means of 4.25% glucose dialysate, the plasma refilling rate is efficiently counterbalanced by UF.
The Use of Alternative Peritoneal Dialysis Solutions in Pediatric Patients
Authors: Balfe John Williamson , Qamar Izhar
Published: February 2020

Changes in the formulation of peritoneal dialysis solutions will continue. For the present, dextrose dialysis will remain the osmotic solute of choice. How amino acids and glucose polymers as solute replace ments for glucose fit into the dialysis prescription remains to be seen. The lower concentration of calcium and magnesium appears to be gaining acceptance in many centers. It is feasible that in the next few years the challenge of adding bicarbonate to the peritoneal dialysis solution will be circumvented, because there appears to be a real clinical need for such an improvement. Pediatric modifications will be necessary, appreciating that such changes will have an economic penalty, and thus must have proven value.
Paramedian Insertion of Tenckhoff Catheters with Three Purse-String Sutures Reduces the Risk of Leakage
Authors: Stegmayr Bernd G.
Published: February 2020

Starting peritoneal dialysis (PD) Immediately after insertion of a peritoneal dialysis catheter is essential in some patients. However, due to a poor insertion technique, leakage may occur in up to 20% of patients after insertion of a peritoneal dialysis catheter, for example, in the midline.

PD was started in 50 consecutive patients (age range 7–81 years).

Under local anesthesia the Tenckhoff catheter was inserted about 3 cm lateral to the linea alba (mostly to the right) near the navel. The ventral and dorsal fasciae of the rectus muscle were split sagitally before entering the peritoneal membrane by a small incision. One pursestring suture fixed the peritoneal membrane around the Inner cuff, while the second suture fixed the dorsal fascia of the rectus muscle around the outer side of the cuff. A third suture was placed around the catheter in the ventral fascia. Dialysis in all our patients was started peroperatively, Initially by the use of 1 L of peritoneal dialysis fluid (Dlaneal, Baxter Medical AB, Sweden). Bed rest for 2 or 3 days was requested of and performed by most patients.

Only one early and no late leakages occurred. At reoperation of the patient with the leak, the second suture was found to have been loosened.

The technique is easy to handle and enables immediate dialysis. The risk for leakage Is very low.