bluuebunny/crossref_metadata_2025 huggingface dataset:
Divergent Effects of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis on Cardiac Diastolic Function
Authors: Weiss Günter , Lhotta Karl , Reibnegger Gilbert , König Paul , Knapp Edwin
Published: February 2020

Objective

To investigate the effects of dialysis procedures on cardiac diastolic function.

Design

Comparative, nonrandomized matched pair study.

Setting

Nephrology and cardiology departments at a university hospital.

Patients

Thirty-four patients on hemodialysis (HD) (n = 17) and continuous ambulatory peritoneal dialysis (CAPD) (n = 17), matched by sex, age, duration of dialysis treatment, and presence/absence of diabetes.

Measurements

Cardiac function was estimated by means of M-mode, two-dimensional, and spectral Dopplerechocardiography, and results were statisticallyevalu-ated by means of univariate and multivariate analytical procedures.

Results

Although not statistically significant, trends towards differences between the two patient groups were detected for left ventricular mass (p = 0.083) and parameters of diastolic function (p = 0.079). These differences in left ventricular performance and diastolic function between HD and CAPD patients were also evident when calculating Spearman rank correlation coefficients. Left ventricular mass and diastolic function were closely correlated to each other in all dialysis patients. Moreover, by means of a multivariate analytical procedure (Hotelling T square test), diversities in diastolic function between the two patient groups could be clearly established (p = 0.037), with more impaired diastolic function in HD patients. In addition, cardiac performance was shown to depend to a certain extent on hemoglobin concentration.

Conclusion

Clear differences in diastolic function and cardiac performance were evident between CAPD and HD patients. From the data of our pilot study, it may be speculated whether decrease of left ventricular mass could be beneficial for the improvement of diastolic function and cardiac hemodynamics in dialysis patients.
Phospholipases and the Activation and Priming of Neutrophils by Peritoneal Dialysis Effluent
Authors: Lindsay Mark A. , Daniels Ian , Fletcher John
Published: February 2020

Objective

To investigate the role of phospholipases during the activation and priming of neutrophil nicotinamide adenine dinucleotide phosphate (NADPH) oxidase by peritoneal dialysis effluent (PDE).

Design

Examine the action of 4-hour dwell PDE upon phospholipase activation in the circulating neutrophils obtained from healthy individuals.

Results

We have previously reported that PDE stimulated superoxide release by the NADPH oxidase of human neutrophils and primed the response to the bacterial peptide, fMLP (fMetLeuPhe). To elucidate the biochemical mechanisms underlying these observations, we have examined the roles of phospholipases (PL) C, D, and A2, whose activation causes the release of a range of intracellular secondary messengers. Following fMLP stimulation, we observed a rapid activation of both PLC and PLD as well as a small but nonsignificant increase in PLA2 activity. Peritoneal dialysis effluent alone failed to stimulate either PLC or PLD, while pre-incubation with PDE had no affect upon fMLP-induced PLC and PLD activation. However, PDE caused a small but nonsignificant increase in PLA2 activity (which was comparable to that observed with fMLP) and primed the fMLP-induced response. In common with a role for PLA2 and the subsequent release of arachidonic acid (AA), we have demonstrated dose-dependent inhibition of PDE-induced superoxide release by the PLA2 inhibitor mepacrine, as well as activation and priming of the fMLP-induced superoxide generation by AA.

Conclusions

These results imply that PDE-induced NADPH-oxidase activation and priming in human neutrophils is mediated via a PLA2-dependent but PLC and PLD-independent mechanism.
Oral versus Intraperitoneal Application of Clindamycin in Tunnel Infections: A Prospective, Randomized Study in Capd Patients
Authors: Plum Joerg , Artik Suzan , Busch Theo , Sahin Kurtulus , Grabensee Bernd
Published: February 2020

Objective

To evaluate the potential superiority of either oral or intraperitoneal treatment of catheter tunnel infections (TI), using clindamycin as a first-Iine antibiotic and ultrasound as a diagnostic tool.

Design

This was a prospective, randomized study in continuous ambulatory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically and ultrasound-proven episodes of TI were randomly assigned to either an oral or an intraperitoneal (IP) treatment (100 patients, 1414 patient-months). Main criteria for TI diagnosis were purulent drainage from the exit site and/or a positive ultrasound (pericatheter fluid collection of at least 2 mm, 7.5 MHz transducer). Initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case of incompatibility or resistance to clindamycin, either oxacillin orciprofloxacin were used orally or IP.

Results

Based on ultrasound criteria, the mean time until a ≥50% reduction of pericatheter abscess diameter was 26 days (median) (range: 8 28 days) in the oral, and 15 days (8 27 days) in the IP group (p ≤ 0.05). Showing no significant difference of pericatheter fluid at study entry with 4 mm (median) (range: 2 -6 mm) in the oral group and 4 mm (2 -4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0 2 mm) after 28 days (p < 0.05), while the diameter was still 2 mm (0 10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitoneal group (51 vs 15 days, NS). Catheter removal had to be done once in the IP group and twice in the oral group within 6 months after study entry.

Conclusions

The results give evidence for greater efficacy of the IP application of clindamycin as a first -Iine antibiotic compared to the oral route for the treatment of tunnel infections.
Beta-Blockers May Cause Ultrafiltration Failure in Peritoneal Dialysis Patients
Authors: Stegmayr Bernd G.
Published: February 2020

Objective

To elucidate mechanisms of ultrafiltration failure (UFF) in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

Retrospective analysis of patients with UFF during CAPD compared with cross-sectionally selected controls.

Setting

University peritoneal dialysis center.

Patients

Thirteen patients with UFF during CAPD necessitating change to hemodialysis (n = 6) or continuous cycling peritoneal dialysis (n = 1), or causing greatly increased need for high glucose-containing solutes, were compared with 18 CAPD patients without such problems.

Statistics

Fisher's exact test, Student's independent t-test, univariate and multivariate correlation analyses.

Main Outcome Measures

Data were collected prior to analyses.

Results

Systolic blood pressure and total cholesterol and triglyceride levels were higher in the UFF patients than in the controls (p = 0.006, p = 0.028, p = 0.013). Betablockers were used by 12 of the UFF patients, but only 2/ 18 controls (p < 0.0001). There was no intergroup difference in number of women, patient age or weight, incidence of diabetes or previous peritonitis, duration of PD, serum levels of albumin, creatinine, iron, or ferritin, or dosage of erythropoietin. Correlation was found between the daily amount of glucose instilled into the abdomen and serum triglycerides (r = +0.72, p < 0.001), total choles terol (r = +0.56, p = 0.008), and HbA1C(r =-0.41, p =0.039). Many patients were high absorbers of dialysis glucose.

Conclusion

The study indicates that beta-blockers may cause UFF, and that glucose and lipid metabolism differed between these patients and controls without UFF.
Effect of Bicarbonate-Based Dialysis Solutions on Intracellular Ph (Phi) and Tnfα Production by Peritoneal Macrophages
Authors: Rogachev Boris , Hausmann Michael J. , Yulzari Robert , Weiler Michal , Holmes Clifford , Faict Dirk , Chaimovitz Cidio , Douvdevani Amos
Published: February 2020

Objective

To compare the effect of Dianeal and two newly-formulated bicarbonate-based peritoneal solutions on intracellular pH (pHi), tumor necrosis factor-α (TNFα) mRNA level, and TNFα secretion by peritoneal macrophages (PMΦ).

Design and Measurements

Peritoneal macrophages were isolated from dialysates collected after overnight dwells in peritonitis -free continuous ambulatory peritoneal dialysis patients. Dialysis solutions contained 1.5% or 4.25% dextrose. HCO3 concentrations of bicarbonate(TB)and bicarbonate/lactate-buffered (TBL) solution were 38 mM and 25 mM, respectively. TBL also contained lactate at a concentration of 15 mM. pCO2 levels were 78 mmHg and 51 mmHg, respectively. In all experiments pC02 was carefully maintained at a stable level. The pHi was measured by spectrofluorometry in BCECF-Ioaded PMΦ exposed to different dialysis solutions or Hank's balanced salt solution. TNFα levels were measured by ELISA in the supernatant of lipopolysaccharide (LPS) stimulated PMΦ after their incubation in different solutions for 15 and 30 minutes. TNFα mRNA was measured by reverse transcriptase polymerase chain reaction (RT PCR) of total RNA extracted from LPS-stimulated PMΦ after their incubation in different solutions for 30 minutes. β-actin mRNA was used as the control.

Results

Dianeal caused a profound drop in pHi to below 6.2. Following an initial drop, pHi stabilized after 4 minutes at levels of 6.96 and 6.8 after incubation in TB and TBL, respectively. In comparison to the control solution, a fall of 11% and 21% in TNFα secretion was seen after incubation in TB for 15 and 30 minutes, respectively, and 15% and 26% after incubation in TBL. Under identical conditions, Dianeal (Baxter, McGaw Park, IL, U.S.A.) caused 59% and >95% suppression of TNFα secretion. Accordingly, TNFα mRNA level in PMΦ was severely depressed by Dianeal but no detectable inhibition was observed following incubation for 30 minutes in TB and TBL. When dextrose concentration in TB and TBL was increased from 1.5% to 4.25%, TNFα secretion by PMΦ was not suppressed by more than 49%, even after 30 minutes incubation. Moreover, suppression of TNFα mRNA levels could not be detected with TB or TBL even at high dextrose concentrations.

Conclusions

In contrast to Dianeal, both bicarbonate based solutions caused only a mild drop in pHi of PMΦ. We postulate this effect to be responsible for the improved capacity of PMΦ to secrete TNFα when incubated in bicarbonate-based solutions compared to Dianeal. Reflecting its known cytotoxicity, dextrose in high concentrations diminishes the protective effect of TB and TBL on immune function of PMΦ. TBL is as effective as TB in preventing the deleterious effect of Dianeal on PMΦ function.
Computerized Kinetic Modeling: A New Tool in the Quest for Adequacy in Peritoneal Dialysis
Authors: Flessner Michael F.
Published: February 2020

Until recently, kinetic modeling of peritoneal dialysis (PD) was performed by engineers, scientists, or nephrologists at major teaching institutions. Now there are several “user-friendly” computer programs which permit the practicing nephrologist and dialysis staff to monitor adequacy of the individual PD patient and to optimize the dialysis prescription. In this brief article, the capabilities, methods, and data requirements of three programs are reviewed, and specific recommendations for the selection of a particular program are discussed.
Increased Endothelin-1 Mrna Expression in Peripheral Blood Monocytes of Dialysis Patients
Authors: Ebihara Isao , Nakamura Tsukasa , Takahashi Toshimasa , Tomino Yasuhiko , Shimada Noriaki , Koide Hikaru
Published: February 2020

Objective

To compare plasma endothelin (ET)-1 level and ET-1 mRNA level in peripheral blood monocytes of patients undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD).

Design

Endothelin-1 mRNA level in peripheral blood monocytes and plasma ET -1 level were studied in 30 HD patients, 15 CAPD patients, 20 chronic renal failure patients not being dialyzed, and 20 normal healthy controls. Hemodialysis patients were dialyzed three times per week with a bicarbonate dialysate. Different types of dialyzer membrane, viz., cellulose triacetate, cuprophane, poly-sulfone, polyacrylonitrile, and ethylenevinylalcohol were used in 8,6,6,5, and 5 patients, respectively. Continuous ambulatory peritoneal dialysis patients were dialyzed with four daily exchanges of a 2-L dialysate containing glucose at a concentration of 1.5% to 2.5%.

Results

Higher levels of ET -1 mRNA in monocytes were observed in HD patients than in CAPD patients (p < 0.01), chronic renal failure patients (p < 0.01), or normal healthy controls (p < 0.001). The level of ET -1 mRNA in monocytes at the end of HD was not significantly higher than that at the start of HD. ln addition, these mRNA levels in HD patients showed littledifference with different types of dialysis membrane. Plasma ET -1 level in HD patients (10.2 ± 2.4 pg/mL) was also higher than that in CAPD patients (7.8 ± 1.6 pg/mL, p < 0.01), in chronic renal failure patients (4.8 ± 1.2 pg/mL, p < 0.01), or in normal controls (2.6 ± 0.8 pg/mL, p < 0.001).

Conclusion

Dialysis itself did not significantly affect ET -1 mRNA levels in monocytes. Chronic stimulation of peripheral blood monocytes may be associated with higher levels of ET -1 mRNA and plasma ET -1 in HD patients than in CAPD patients.
Swan Neck Presternal Peritoneal Dialysis Catheter: Five-Year Experience in Children
Authors: Warchol Stanislaw , Roszkowska-Blaim Maria , Sieniawska Maria
Published: February 2020

Objectives

To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titanium connector, with the exit site located on the chest wall, was designed.

Design

A prospective study was undertaken to estimate the usefulness of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children.

Setting

University Children's Hospital, Medical Academy, Warsaw, Poland.

Patients

From December 1991 to June 1997, 11 SNPCs were implanted in 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More than one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted.

Intervention

In all children the presternal catheter was implanted surgically by the modification of the technique described by Twardowski et al.

Results

The observation period ranged from 1 -60 months. The rate of ESI was 11162 patient-months. The major complication was trauma of the exit site (4 times in 3 of 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two parts of the SNPC became disconnected in 2 children (after 7 and 33 months respectively).

Conclusion

Our results achieved with the SNPC in children are very good. The presternal catheter reduces the risk of ESI. However, the chest localization of the exit site does not help to prevent trauma in children. This type of PD catheter should be reserved for patients with specific indications.
Acute in Vivotoxicity of Heat-Sterilized Glucose Peritoneal Dialysis Fluids to Rat Peritoneal Macrophages
Authors: Jonasson Peter , Braide Magnus
Published: February 2020

Objective

To evaluate the in vivo effects of heat-sterilized peritoneal dialysis (PD) fluids on the respiratory burst response of rat peritoneal leukocytes.

Design

Rats were exposed to intraperitoneal injections of a laboratory-made PD fluid that was either heat-sterilized (HPD) or filtered (F-PD). Control groups of animals were given Hank's buffer (HBSS) or saline (NaCI). Leukocytes were harvested by intraperitoneal lavage at different times in different animals and analyzed with respect to cell numbers, differential counts, and production of superoxide (chemiluminescence) in response to opsonized zymosan. The chemiluminescence responses of the macrophage and the neutrophil populations, respectively, were obtained by curve-fitting techniques from the responses of the mixed populations.

Results

All fluids induced a recruitment of neutrophils, the PD fluids causing a cell number increase that was more transient than that caused by NaCI and HBSS. Macrophage numbers were only slightly influenced, but were generally higher after NaCI and HBSS injections than after PD fluid injections. The H-PD exposure induced a significant inhibition of the macrophage chemiluminescence response after 2 and 12 hours, compared with the exposure to F-PD. The neutrophil chemiluminescence response was not significantly affected.

Conclusion

The toxins produced by heat-sterilization of glucose-containing PD fluids inhibit in vivo the respiratory burst response of peritoneal macrophages.
The Use of TWH Catheters in Capd Patients: Fourteen-Year Experience in Technique, Survival, and Complication Rates
Authors: Apostolidis Nicholas S. , Panoussopoulos Dimitrios G. , Manouras Andreas J. , Pararas Basil N. , Voudiklari Sophia G. , Zirogiannis Panagiotis N.
Published: February 2020

Objective

To evaluate the technique of insertion, complication rates, and survival rates of Toronto-Western Hospital (TWH) peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients.

Patients and Methods

A total of 222 TWH catheters were inserted into 203 CAPD patients (113 males and 90 females) with end-stage chronic renal failure during a period of 14 years (1 January 1982 to 31 August 1995). The mean age of the patients was 58.5 years (range 18 86 years). For the first 6 years, the peritoneal cavity approach was performed via a lower midline incision (45 insertions), various other approaches (17 insertions), and, finally, for the last 160 insertions (for approximately 8 years) the transverse paraumbilical incision was exclusively employed. The duration of CAPD ranged between 1 to 151 months (mean time 33.2 months).

Results

Regarding early and late complications (namely leakages, obstructions, eviscerations, tunnel infections, herniation, and others), as well as catheter survival, the transverse paraumbilical insertion, compared to other approaches, had the smallest number of complications. Thus, early leakage occurred in 5/222 (2.25%) versus 10/222 (4.5%), obstruction nil versus 2/222 (0.9%), and evisceration nil versus 1/222 (0.45%). In addition, as far as the late complications are concerned: tunnel infections 5/222 (2.22%) versus 13/222 (5.85%), herniations 1/222 (0.45%) versus 16/222 (7.3%), and cuff protrusion nil versus 7/222 (3.1 %). Finally, overall peritonitis occurred with a rate of one episode every 21.2 months. Actuarial survival for 1 and 3 years was 75% and 37%, respectively.

Conclusions

The transverse paraumbilical incision seems to be the most advantageous approach in inserting (by “surgical method”) the TWH catheters. We found it to be a safe, simple, versatile procedure, giving good results in all parameters concerned.
1996 Peritoneal Dialysis Core Indicators Study: Report on Nutritional Indicators
Authors: Flanigan Michael J. , Bailie George R. , Frankenfield Diane L. , Frederick Pamela R. , Prowant Barbara F. , Rocco Michael V.
Published: February 2020

Objective

The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996.

Design and Patient Population

The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996.

Outcome Measures

Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status.

Results

The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/V urea) and weekly creatinine clearance (wCrCI) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that “dialysis efficiency,” over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6 ± 20.0 kg and BMI = 27 ± 7), 47% of patients had an average serum albumin below “normal” (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day.

Conclusions

Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.
Nystatin Prophylaxis: Its Inability to Prevent Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Thodis Elias , Vas Stephen I. , Bargman Joanne M. , Singhal Manoj , Chu Maggie , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To evaluate the potential effectiveness of nystatin as prophylaxis for fungal peritonitis (FP) in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

This historically controlled study was designed to investigate the effectiveness of nystatin in the prevention of FP. For this purpose we compared the incidence of FP among 240 (new and prevalent) CAPD patients between January 1996 and November 1996 (period A) with its incidence in 240 new and prevalent CAPD patients in our program between January 1997 and November 1997 (period B) when nystatin prophylaxis was used. There were 2400 patient-months in each period. Nystatin (500000 IU four times per day), was given orally at the beginning of other antibiotic therapy (usually for peritonitis) and continued for 5 days after the end of the antibiotic therapy.

Results

During period A, 133 peritonitis episodes were recorded, and during period B, 99 episodes were recorded. Six episodes of FP were identified in over 2400 patient months of period A, and 12 in over 2400 patient-months of period B. This difference was not statistically significant. Three episodes of antibiotic-related FP were seen in period A, and four in period B. The remaining episodes arose de novo, that is, unrelated to the use of antibiotics. We observed no side effects for nystatin.

Conclusion

In CAPD patients the use of nystatin, a nonabsorbable antifungal agent, as prophylaxis in every instance of peritonitis or other indications for antibiotics, did not lower the incidence of fungal peritonitis.
Does a High Peritoneal Transport Rate Reflect a State of Chronic Inflammation?
Authors: Wang Tao , Heimbürger Olof , Cheng Hui-Hong , Bergström Jonas , Lindholm Bengt
Published: February 2020

Objective

It has recently been reported that a high peritoneal transport rate was associated with increased mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. One possible explanation is that a high peritoneal transport rate might be caused by a state of chronic inflammation, which also per se might result in increased mortality. Therefore, in this study we investigated whether high peritoneal transport rate patients are in a state of chronic inflammation.

Methods

The study included 39 clinically stable peritoneal dialysis patients (free of peritonitis) who had been on PD for more than 3 months (16.8 ± 11.8 months). Seven patients were treated with continuous cycling peritoneal dialysis (CCPD) and the others were on CAPD. A 4-hour standard peritoneal equilibration test (PET) using 2.27% glucose solution was performed in each patient. Dialysate samples at 4 hours and blood samples at 2 hours were measured for interleukin-1β (IL-β), tumor necrosis factoroc (TNFα), C-reactive protein (CRP), and hyaluronan as markers of inflammation.

Results

There was no significant correlation between dialysate/plasma (D/P) creatinine (0.82 ± 0.15, range 0.51 - 1.15) and blood concentrations of IL-1β (11.2 ng/L, range <5 - 65.9 ng/L), TNFα (12.1 ng/L, range <5 - 85.4 ng/L), CRP (<10 mg/L, range <10 - 76 mg/L), nor with the blood hyaluronan concentration (165 μg/L, range 55 - 955 μg/L). The dialysate concentrations of IL-1β and TNFα were below the detectable level in most of the samples. Although dialysate hyaluronan concentration (334 μg/L, range 89 - 1100 μg/L) was correlated with D/P creatinine ( r = 0.36, p < 0.05), there was no correlation between the total amount of hyaluronan in the effluent and D/P creatinine. However, a significant correlation was found between serum hyaluronan concentration and glomerular filtration rate (GFR) ( r = -0.49, p < 0.005); GFR also tended to be correlated with serum TNFα ( r = -0.31, p = 0.058) but not with serum IL-1β and serum CRP.

Conclusion

Our results suggest that a high peritoneal transport rate is not necessarily related to a state of chronic inflammation in CAPD patients. The high mortality rate observed in high transporters may relate to other issues, such as fluid balance or abnormal nutrition and metabolism, rather than to chronic inflammation.
Analysis of the Peritoneal Equilibration Test in Mexico and Factors Influencing the Peritoneal Transport Rate
Authors: Cueto-Manzano Alfonso M. , Díaz-Alvarenga Angel , Correa-Rotter Ricardo
Published: February 2020

Objective

To validate the peritoneal equilibration test (PET), establish reference values in the Mexican population, compare our results with those reported by Twardowski et al., and analyze the influence of some factors on the peritoneal transport rate (PTR).

Design

Retrospective, cross-sectional study.

Patients

Eighty-six PETs were performed in 45 female and 41 male patients; 35 of the patients were diabetics. Creatinine D/P and glucose D/D0 ratios were calculated and compared with those from Twardowski et al. In a multi-variate analysis, age, gender, diabetes mellitus (DM), time on dialysis, and peritonitis rate were considered as independent factors influencing the PTR.

Results

Creatinine D/P and glucose D/D0 ratios at 4 hours were not significantly different from those reported by Twardowski et al. Creatinine D/P at 4 hours was not different between DM and non-DM patients when the rate of peritonitis and time on dialysis were not taken into account. Multivariate analysis did not result in any significant model predicting the creatinine D/P at 4 hours.

Conclusions

PET validation is reported for the first time in a Latin American population. The PET results of this study are similar to those in the literature. We found that DM, peritonitis rate, time on dialysis, age, and gender did not clearly influence the PTR.
Risk Factors Influencing the Decline of Residual Renal Function in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Shin Sug Kyun , Noh Hyunjin , Kang Shin Wook , Seo Bo Jung , Lee In Hee , Song Hyun Yong , Choi Kyu Hun , Ha Sung Kyu , Lee Ho Yung , Han Dae Suk
Published: February 2020

Objective

To assess the nature of the decline in residual renal function (RRF) after the initiation of peritoneal dialysis, and to identify risk factors influencing the preservation of RRF.

Design

A retrospective single-center study.

Setting

Tertiary medical center.

Patients

Eighty patients who were clinically stable and had been on continuous ambulatory peritoneal dialysis (CAPD) for a minimum of 6 months.

Main Outcome Measures

All subjects had at least three measurements of RRF, which was calculated as the average of creatinine clearance (Ccr) and urea clearance from a 24-hour urine collection. All measurements of RRF were plotted on a logarithmic scale and a linear scale against the duration of CAPD. Covariables used in the correlation analyses were age, sex, the presence of diabetes mellitus, mean blood pressure, mean diastolic blood pressure, hematocrit and Ccr at the start of peritoneal dialysis, peritoneal membrane transport characteristics by peritoneal equilibration test (PET), and the rate of peritonitis.

Results

A significant correlation was found between CAPD duration and RRF decline represented on a logarithmic scale with a correlation coefficient ( r) of 0.355 ( p < 0.001). In contrast, on a linear scale, the correlation coefficient was only 0.273 ( p < 0.01). By linear multiple regression analysis, the only independent risk factor for the decline of RRF was the rate of peritonitis ( r = -0.446, p < 0.001).

Conclusion

These results suggest that RRF declines exponentially rather than linearly with time, and that the rate of peritonitis is an independent risk factor for the decline of RRF in CAPD patients.
Efficacy of Gastrostomy Feeding in Infants and Older Children Receiving Chronic Peritoneal Dialysis
Authors: Ramage Ian J. , Geary Denis F. , Harvey Elizabeth , Secker Donna J. , Balfe Judie A. , Balfe J. Williamson
Published: February 2020

Objective

To assess the efficacy of supplemental gastrostomy tube (g-tube) feeding in infants and children receiving chronic peritoneal dialysis (CPD).

Design

Retrospective observational study.

Setting

Pediatric nephrology division of tertiary care center.

Patients

Fifteen patients undergoing g-tube insertion while receiving CPD were included in the study, and were subdivided, on the basis of age, into the following groups: infants (≤ 2.5 years, n = 8); older children (> 2.5 years, n = 7).

Main Outcome Measures

Assessment of the effect of CPD and g-tube feeding on statural growth assessed by height standard deviation score (SDS) and percentage weight-for-height, and measured anthropometric variables including triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), and midarm mean circumference (MAC). Assessment of the effects of CPD and g-tube feeding on measured biochemical variables including total protein, albumin, cholesterol, triglycerides, and high density lipoprotein.

Results

No significant change in height SDS was observed; however, the reported continuing decline in height SDS in infants was arrested. Percentage weight-for-height increased significantly in infants at 6 months ( p = 0.008) and 12 months ( p = 0.006) following initiation of g-tube feeding. An increase was also observed in the older child group, being significant at 12 months ( p = 0.031) following g-tube insertion. Increases in all anthropometric variables occurred in the infant group during CPD and post g-tube insertion, significant only for MAMC at 12 months ( p = 0.037) post g-tube insertion. In older children little change occurred during CPD, with all variables increasing post g-tube insertion, significant only for MAMC at 6 months ( p = 0.02) and 12 months ( p = 0.02). An increase in total protein and albumin was noted; however, no significant changes in any biochemical parameters were observed.

Conclusions

Supplemental g-tube feeding facilitates weight gain in infants and older children receiving CPD and arrests the decline in height SDS traditionally observed in infants with end-stage renal disease. No significant alteration was observed in measured biochemical variables, although an increase in total protein and albumin was noted.
Attitudes of Canadian Nephrologists toward Dialysis Modality Selection
Authors: Jung Beverly , Blake Peter G. , Mehta Ravindra L. , Mendelssohn David C.
Published: February 2020

Objective

To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design.

Participants

Members of the Canadian Society of Nephrology.

Intervention

A mailed survey questionnaire.

Results

A 66% response rate was obtained. Decisions about modality are reported to be based most strongly on patient preference (4.4 on a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3.85), and rehabilitation (3.69), while neither facility (1.78) nor physician (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemodialysis (HD) is slightly overutilized (2.53), continuous ambulatory peritoneal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distribution to maximize survival revealed that a type of HD should constitute 62.8% of the mix, with more emphasis on cycler PD (14.9%), community-based full care HD (13.8%), self-care HD (14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fell slightly to 57.8%.

Conclusions

These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysis system without compromising patient outcomes.
Effect of Intraperitoneal Administration of Heparin on Advanced Glycation End-Products in Capd
Authors: Mizuiri Sonoo , Miyata Satoshi , Sakai Ken , Kobayashi Miyuki , Miyagi Moriatsu , Nakanishi Tsutomu , Liu Bing-Fen , Kojima Hiroshi , Hasegawa Akira
Published: February 2020

Objective

To evaluate the effect of intraperitoneal (IP) administration of heparin on clearance of advanced glycation end-products (AGEs) and peritoneal dialysis efficiency.

Design

Sequential self-controlled intervention study.

Setting

University hospital, Department of Nephrology.

Patients and Methods

Pyrraline, urea, and creatinine levels in plasma and dialysate, along with AGE-derived fluorescence intensity (excitation, 370 nm; emission, 440 nm) in dialysate were measured 0, 30, and 60 days after IP administration of heparin in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Pyrraline levels were determined by ELISA.

Results

Heparin induced a significant decrease in plasma pyrraline levels; the values on days 0, 30, and 60 were 162.0 ± 89.8 μmol/L, 101.1 ± 32.1 mmol/L ( p < 0.01), and 94.0 ± 19.8 μmol/L ( p < 0.001), respectively. Heparin also induced a tendency of increased dialysate pyrraline levels and a significant increase in AGE-derived fluorescence intensity in the dialysate. The values for the latter on days 0, 30, and 60 were 51.0 ± 9.3 AU (arbitrary units/ mg of collagen), 73.5 ± 16.0 AU ( p < 0.001), and 65.6 ± 15.5 AU ( p < 0.01), respectively. Furthermore, heparin administration resulted in a significant ( p < 0.01) increase in the dialysate/plasma ratio of urea (means 0.80, 0.90, and 0.94 on days 0, 30, and 60, respectively).

Conclusion

These results suggest that a beneficial effect of IP administration of heparin is in part due to its action on AGE kinetics, supporting a potential preventive strategy for peritoneal membrane distortion in CAPD.
Randomized Prospective Comparison of Laparoscopic and Open Peritoneal Dialysis Catheter Insertion
Authors: Wright Mark J. , Bel'eed Khalid , Johnson Brian F. , Eadington David W. , Sellars Leslie , Farr Malcolm J.
Published: February 2020

Objective

To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival.

Design

Randomized prospective study.

Setting

Tertiary referral renal unit.

Patients

Fifty patients commencing peritoneal dialysis.

Intervention

Catheters were implanted laparoscopically or by a conventional surgical technique.

Main Outcome Measures

The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared.

Results

The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed.

Conclusions

The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.
Effects of Amino Acid Dialysis Solution on the Nutrition of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Grzegorzewska Alicja E. , Mariak Irena , Dobrowolska–Zachwieja Agnieszka , Szajdak Lech
Published: February 2020

Objective

To evaluate the influence of 1.1% amino acid dialysis solution (AADS) on parameters of nutrition in continuous ambulatory peritoneal dialysis (CAPD) patients.

Study Design

Studies were performed in 8 men, using AADS for the overnight exchange. Before starting AADS, food intake, nutritional status, and laboratory indices were evaluated and compared to the respective parameters obtained after 3 and 6 months of treatment with AADS, as well as after 3 months of AADS withdrawal. With the start of AADS, doses of antacids were increased and modified during AADS administration; the modified doses were continued through 3 months after cessation of AADS. Another group of CAPD patients using standard dialysis solutions served as controls. In these patients the same parameters were evaluated four times at 3-month intervals.

Results

Administration of AADS resulted in: (1) 91% absorption of amino acids and improvement of serum amino acid pattern; (2) no change in nutritional intake during the treatment, but after the 3 months of AADS therapy, levels of nutrient intake were lower than those 3 months after withdrawal of AADS with correction of metabolic acidosis; (3) no change in indices of nutritional status, but 3 months after AADS discontinuation, total body weight, lean body mass, and body mass index were significantly higher than those shown after 3 months of treatment; (4) an increase in hemoglobin concentration, hematocrit, BUN, and blood H+. The examined parameters were not significantly changed in patients treated for 9 months with standard dialysis solutions exclusively. The values of nitrogen balance obtained during AADS administration and after 3 months of AADS withdrawal were significantly higher than those obtained in the respective periods in the control group. The blood pH, pCO2, and HCO3– in the last period of the study were higher in the AADS group than in the control group.

Conclusion

In relatively well-nourished CAPD patients, overnight AADS administration results in increased serum concentration of amino acids without changes in other nutritional parameters. The use of AADS should be associated with increased doses of antacid medication, which abolishes the metabolic effects of acidosis that develop during AADS administration and facilitates positive nitrogen balance.
Automated Peritoneal Dialysis in Asia
Authors: Lai Kar Neng , Lui Sing Leung , Chan Daniel T.M.
Published: February 2020

The socioeconomic statuses of Asian countries are diverse, and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment, but also the choice of dialysis modality. A close correlation is demonstrated between the dialysis treatment rate for end-stage renal disease (ESRO) and the gross domestic product (GOP) per capita income. A biphasic relationship with the GOP per capita income and the peritoneal dialysis (PO) utilization rate is observed, in that the countries with the highest and lowest treatment rates tend to have lower PO utilization rates, whereas countries with modest treatment rates tend to have higher PO utilization rates.

In contrast, countries with high continuous ambulatory peritoneal dialysis (CAPO) utilization rates have the lowest automated peritoneal dialysis (APO) utilization rates. The low APO utilization rates are due to fact that, in most instances, patients themselves must purchase the APO machine, and the machines are relatively more expensive in Asian Pacific countries. Continuous cycling peritoneal dialysis (CCPO) is most frequently practiced.

Generally, convenience for employment is the main indication for the utilization of APO. Other important indications are the convenience of treatment in young or elderly uremic patients. Contrary to the practice in CAPO treatment, detailed documentation of dialysis adequacy and nutritional status is not routinely done in patients undergoing APO treatment in most Asian Pacific countries.

In conclusion, APO is an underdeveloped treatment modality in the renal replacement programs of Asian Pacific countries. The low utilization of APO is clearly influenced by non medical factors including government reimbursement policy and the cost of PO machines.
Major and Minor Risk Factors for Cardiovascular Disease in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Prichard Sarah
Published: February 2020

Uremia in general and peritoneal dialysis in particular bring with them risk factors for the development of cardiovascular disease. These factors include multiple lipid abnormalities, hyperhomocysteinemia, abdominal obesity, chronic inflammation, hypoalbuminemia, oxidative stress, and AGE formation. When these are combined with conventional risk factors, one can appreciate why the incidence of cardiovascular disease is so high in peritoneal dialysis patients. Treatment strategies should address each of these risks appropriately.
Role of Hypoalbuminemia in the Genesis of Cardiovascular Disease in Dialysis Patients
Authors: Kim Soon Bae , Yang Won Seok , Park Jung Sik
Published: February 2020

Our objective was to review the articles about the association between hypoalbuminemia and atherosclerotic or thrombotic cardiovascular disease (CVD) and to look for possible explanations for the role of hypoalbuminemia.

Increased incidences of CVD were reported in patients with hypoalbuminemia owing to renal or other diseases. Hypoalbuminemia increases plasma levels of lipoprotein(a), fibrinogen, and arachidonic acid metabolites; it also increases platelet aggregability and blood viscosity, all of which may contribute to the development of CVD. This cause-effect association is thought to be “dependent.” Changes in atherogenic lipoproteins or lipids, such as LDL cholesterol, triglycerides, and apolipoprotein B, are controversial in hypoalbuminemic dialysis patients, possibly because coexistent malnutrition and volume status can affect both albumin and lipids. In our recent study, there was a negative correlation between serum albumin and C-reactive protein, D-dimer (an index of intravascular thrombogenesis), and von Willebrand factor (a marker for endothelial cell injury), but infusion of albumin did not affect the level of these parameters, which suggests that the correlations may be an effect-effect association by a confounding variable, such as inflammation.

In conclusion, hypoalbuminemia is associated with cardiovascular disease via two pathways: one, a “dependent” cause-effect association; the other, an effect-effect association.
Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Wu Mai-Szu , Yu Chun-Chen , Wu Ching-Herng , Haung Jeng Yi , Leu Mei-Lin , Huang Chiu-Ching
Published: February 2020

Objective

To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO).

Materials and Methods

One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded.

Results

The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO.

Conclusions

Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.
Gene Therapy for Diabetic Nephropathy
Authors: Kitamura Masanori
Published: February 2020

Gene therapy has been considered for a broad array of diseases. Recent investigation has suggested that gene therapy may be applied to the treatment of diabetes mellitus and associated pathologies involving several organs. In the kidney, glomerulopathy is the most typical pathologic feature. This article addresses potential strategies towards gene therapy for diabetic glomerular disease.