bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies on the Resistance of the Peritoneal Mesothelium to Solute Transport
Authors: Breborowicz Andrzej , Knapowski Jan
Published: February 2020

Permeability of the mesothelium for rubidium and albumin was evaluated in vitro. There were pores through which free diffusion of rubidium occurs in 0.03% of the mesothelium area. On the other hand, albumin seems to be transported through transport system by some mechanism other than simple diffusion.

The role of the mesothelium as a barrier to the transport of solutes during peritoneal dialysis is not cleared finally (I). Most of the data characterising the transport characteristics of the peritoneal membrane were obtained from in vitro studies (2–4). From their in vitro studies Gosselin and Berndt calculated that, on the aggregate, water-filled pores, through which small molecules may diffuse, occupy 0.6% of the area of the mesentery (5). However we showed, recently, that the values of the transport rate of various substances across the mesentery in vitra are overestimated because of damage to the membrane edges (6). All the membranes studied in vitro are damaged as a result of compression between the edges of the chambers used for study. This damage creates an additional (shunt) pathway through which solutes can be transported at the same time as they cross the undamaged membrane.

We decided to re-evaluate the calculations of Gosselin and Berndt, based on our studies of the bidirectional, transmesothelial transfer of rubidium (m. w. 86) and albumin, (m. w.X 68000) and correcting for the existence of the edge damage.
CAPD in Canada in 1982
Authors: Pose” Gerald , Lam Eric , Rappaport Anita
Published: February 2020

This study examined the role of CAPD in the treatment of end stage renal failure in Canada in 1982, using data obtained from the Canadian Renal Failure Registry. In comparison to 1981, there was an increase in the number of patients on peritoneal dialysis. As of December 31, 1982, equal proportions of patients had started on hemodialysis and peritoneal dialysis. The average patient age was slightly lower for the hemodialysis. The most common reason for discontinuing CAPD was transplantation, followed by peritonitis and other abdominal complications. Over one-half of CAPD patients had no peritonitis; most of the episodes occurred in a minority of patients. In the initial treatment of children, CAPD and hemodialysis were used with equal frequency. At two years the survival of non-diabetic patients on CAPD was similar to that of hemodialysis patients.

The Canadian Renal Failure Registry, which was established in 1981, receives data from all 68 dialysis units in Canada (1–2). The Registry has two parts: the first receives data from each centre, and the second concerns data only on patients who were started on treatment after the Registry came into existence, that is, 1981. This report examines the place of CAPD in the overall management of all patients in Canada with end-stage renal failure, and the use and complications of CAPD in patients who started therapy in 1981 and 1982.
Anti-Hypertensive Drug Requirements in Continuous Ambulatory Peritoneal Dialysis
Authors: Young Michael A. , Nolph Karl D. , Dutton Sue , Prowant Barbara
Published: February 2020

This retrospective analysis documents changes in antihypertensive drug requirements with time on CAPD. In 59 patients who were hypertensive at initiation of CAPD, antihypertensive drug use decreased from almost 1.2 to less than 0.3 drugs per patient during the first month. In this group, the proportion in whom blood pressure was controlled without drugs went from 0% to nearly 60% after 12 months. These results, which most likely reflect control of body -fluid volumes and sodium balance, are similar to those reported with hemodialysis.

It has been noted that patients receiving antihypertensive medications to control blood pressure at the initiation of continuous ambulatory peritoneal dialysis (CAPD) frequently require fewer or no anti-hypertensive medications with time on CAPD (1–2). The purpose of this retrospective analysis was to quantitate the extent and the timing of this trend in a CAPD population at a single center.
Experience with the Toronto Western Hospital Permanent Peritoneal Catheter
Authors: Khanna Ramesh , Izatt Sharron , Burke Debby , Mathews Raymond , Vas Stephen , Oreopoulos Dimitrios G.
Published: February 2020

Prospective controlled trial with Tenckhoff, Toronto Western Hospital and Goldberg catheter showed a lower incidence of catheter-tip dislodgement from the pelvis with the Toronto Western Hospital catheter. A 1982 retrospective review of experiences, revealed significantly better one and two year catheter survival with the Toronto Western Hospital catheter #2 compared to the straight Tenckhoff catheter inserted at the bed side but not compared to the surgically inserted Tenckhoff catheter. Early dialysate leak was a significant compilation observed with the use of all catheters. Lateral placement of catheters has practically eliminated this complication. Catheter exit site infection now is the major cause of catheter failure.
Vitamin Status in Continuous Ambulatory Peritoneal Dialysis
Authors: Henderson Lain S. , Leung A.C.T. , Shenkin A.
Published: February 2020

The vitamin status of nine uremic patients was assessed before the institution of CAPD, after six months of CAPD with oral water-soluble vitamin supplementation (as in hemodialysis) and after a further six months without vitamin supplementation. We concluded that it is necessary to provide supplements of pyridoxine and ascorbic acid but probably not folic acid. Levels of the lipid soluble vitamins A and E were within the normal range.
An in VITRO Test of the Efficacy of the Perioexr CAPD Filterset
Authors: Poole-Warren Laura A. , Spencer Peter C. , Farrell Peter C.
Published: February 2020

In an attempt to reduce the incidence of peritonitis caused by contamination during CAPD bag change procedures, Millipore (Bedford, Mass) developed the Peridex R CAPD filterset. Using the bacterium Serratia marcescens as the challenge organism, this filterset has been evaluated in vitro during 30 days of mock CAPD conducted in our laboratory. S. marcescens was chosen because it has been shown to remain viable in peritoneal dialysis (PD) fluid for more than 30 days.

During the test period, the membrane filter and bypass lines were separated to allow identification of the route of bacterial invasion; in essence, two artificial peritoneal cavities were created. The membrane filter, composed of 0.22 [IJ.]m cellulose ester, maintained sterility of the filtered dialysate (n = 5) during the test period. However, the one-way bypass valve had a 60% failure rate by day 18, allowing the test organism to enter the other peritoneal cavity.

Under the conditions of this study, the CAPD filterset was shown to be bacteriologically safe for up to 17 days, since contamination was detected following the 18th overnight dwell. Therefore we recommend that filtersets be changed twice monthly to prevent peritonitis due to touch contamination, resulting from failure of the one-way bypass valve on the dialysate outflow line.
The Demography of CAPD in Europe
Authors: Wing AJ , Moore R , Brunner FP , Jacobs C , Kramer P , Selwood NU
Published: February 2020

Five per cent of European patients on therapy for end stage renal failure and reported to the EDTA Registry were treated by CAPD on 31st December, 1982. The percentage varied between 12.7% in the United Kingdom to less than 1% in Eastern European countries. In the total area covered by the Registry (population 574 millions) 5.6 patients pmp commenced CAPD during 1982. Commencements reached 18.9 pmp in Switzerland, 17.4 pmp in the United Kingdom and 9.8 pmp in Italy. National programmes of CAPD fulfil different roles in the pattern of RRT and select different populations of patients. Therefore comparisons of the results achieved have not been made.
Response to Graded Exercise Testing in Patients Treated with CAPD
Authors: Painter P.L. , Messer D. , Widener C. , Zimmerman S.W.
Published: February 2020

Exercise tolerance in patients treated with CAPD is low compared to normals, however comparable to most studies of patients treated with hemodialysis. Blood pressure responses to graded exercise in the CAPD patients are abnormal, with dramatic yet non-symptomatic decreases in systolic pressure. In three patients tested with and without dialysate present in the abdomen, blood pressure responses were more appropriate (no fall in systolic pressure) in the empty condition. Recommendations at this time for exercise training for these patients is walking a minimum of three days per week at an intensity of 65–80% of maximal oxygen consumption (or below which any fall in systolic blood pressure occurs), working up to 30 minutes per exercise session. Patients exhibiting abnormal blood pressure responses to graded exercise should exercise with no fluid in the abdomen.

Exercise tolerance in renal patients treated with hemodialysis has been reported to be low (1–4). A goal of CAPD is to allow the patient to be more active, however, little is known about the effect of CAPD on exercise tolerance and hemodynamics during dynamic exercise.

The present study was designed to quantitate exercise tolerance in patients treated with CAPD and evaluate heart rate, electrocardiogram, and blood pressure responses to graded dynamic exercise.
Effect of the Perioex® Fil Ter on Peritonitis Rates in an Unselecteo CAPO Population
Authors: Ash Stephen R. , Winchester James F.
Published: February 2020

The use of the inline filter in a CAPD population was associated with a low incidence of peritonitis (0.064 infections per patient month). Pre-filter rates of peritonitis indicated that the population was in general a group of “high risk” patients for peritonitis.
Use of Amino Acid Containing Solution in CAPD Patients
Authors: Khanna Ramesh , Wu George , Rodella Helen , Oreopoulos Dimitrios G.
Published: February 2020

A number of CAPD patients may develop malnutrition due to multiple causes. Average daily amino acid loss during CAPD was 2 gm per day. Serum concentrations of almost all essential and non essential amino acids were significantly lower than controls. Amino acid containing solution is an effective osmotic agent and at the same time is suitable for nutritional supplementation. Use of this solution up to 4 weeks did not lead to any abnormal accumulation of amino acids and patient appeared to tolerate it well.

A number of CAPD patients may develop malnutrition which appears to be brought about by a combination of decreased appetite, and increased nutrient loss in the dialysate. In a group of 13 patients whose daily protein and caloric intakes at the beginning of CAPD were 1.5 9 per kg, and 35 Kcal/kg respectively, intakes decreased spontaneously after one year on CAPD even though they were being advised during their clinic visits to maintain initial protein and caloric intakes (1). Reduced intakes appear to result from decreased appetite and a feeling of fullness, although these factors are difficult to evaluate quantitatively. To gain information as to the etiology of appetite suppression during CAPD, we performed CAPD in nonuremic rabbits.
The Effect of CAPD on Phalangeal Bone Mineral Density
Authors: Colbert Charles , Jerison Andrew , Bachtell Richard S.
Published: February 2020

Using radiographic absorptiometry we measured changes in phalangeal bone mineral density (BMD) in mass units/cm2 of a CAPD patient group (N = 32) during a nominal two-year span and compared the average rate of change with the normal rate due to aging. We did the same for five patient groups on hemodialysis (HD) ranging in size from N = 46 to N = 87. Average annual BMD rates of change of the CAPD group and of one HD group were not significantly different from normal aging. Theaverage BMD of each of the other four HD groups declined significantly relative to norms.
Convective Characteristics of Pediatric Peritoneal Dialysis
Authors: Morgenstern Bruce Z. , Pyle W. Keith , Gruskin Alan B. , Kaiser Bruce A. , Perlman Sharon A. , Polinsky Martin S. , Baluarte H. Jorge
Published: February 2020

The convective aspects of pediatric peritoneal dialysis (PD) -fluid transfer with its attendant solvent drag -were evaluated in vivo in 8 children on maintenance PD. The evaluation was performed according to the mass transport model of pyle. Reflection coefficients were calculated for urea, creatinine, uric acid, glucose and idealized total protein. These values were compared to adult means. There were no differences in reflection coefficients, except for total protein, which had a lower value. Maximum ultrafiltration rates were also calculated for the three commercially avail able dialysate glucose concentrations (1.5%, 2.5%, 4.25%). These values were scaled for body surface area to allow comparison with adult means. All values were lower than the adult means, but were not outside two standard deviations. Convective transport in PD in children over 1 Vl years of age, does not appear to be significantly different than that in adults.

There are two components to solute removal in peritoneal dialysis: diffusion and convection. Convective transport, the passive movement of solute in a solvent stream across a semipernleable membrane, is directly related to the rate of ultrafiltration. The convective component of solute removal in peritoneal dialysis may be responsible for a significant per cent of transport of larger molecular weight solutes (I). Little infornlation is currently available concerning this aspect of pediatric peritoneal dialysis. Kohaut and Alexander have reported that it is more difficult to achieve ultrafiltration in infants than in older children, adolescents, and adults (2). The convective component of peritoneal dialysis in infants may therefore contribute less to overall solute removal than in older children and adults.
Effects of Continuous Ambulatory Peritoneal Dialysis (CAPD) on Renal Osteodystrophy
Authors: Loschiavo Carmelo , Fabris Antonia , Adami Silvano , Tomelleri Luciana , Tessitore Nicola , Valvo Enrico , Lupo Antonio , Oldrizzi Lamberto , Rugiu Carlo , Gammaro Linda , Maschio Giuseppe
Published: February 2020

The authors performed a metabolic and morphologic investigation of calcium metabolism in 22 patients on continuous ambulatory peritoneal dialysis (CAPD), selected as the first procedure. The patients were kept on a diet containing about 30 Kcal/ kg, 1 g/kg of protein, 950 mg of phosphate and 1500 mg of calcium per day. They showed normal mean values of serum calcium, phosphate, alkaline phosphatase, total protein and albumin at the start and after six, 12 and 21 months of CAPD. Serum PTH levels showed a progressive decrease over 21 months. Serum 25-OH-D3 were low at start and showed a further decrease after 12 months of CAPD. Before and during CAPD, serum 1,25 (OH)2D3 levels were undetectable. The bone mineral content was within normal range at start and showed a slight decrease after 12 months of CAPD. In 64% of the patients, bone biopsies, obtained from the iliac crest at the start showed osteomalacia, either isolated or associated with hyperparathyroidism. After 12 months, osteomalacia was still evident in 71% of this group. The authors concluded that dietary restriction of phosphate is important in preventing secondary hyperparathyroidism in patients on CAPD. However, prevalence of osteomalacia is due to defective vitamin D metabolism and its management requires administration of vitamin D metabolites.

In its morphological aspects and clinical features, renal osteodystrophy (RO) may differ significantly between patients on CAPD and those on hemodialysis (1–3). In addition, workers have reported conflicting opinions concerning the incidence and severity of bone lesions in CAPD patients (4–6). We undertook this investigation in order to evaluate the evolution and clinical, biochemical and morphologic aspects of RO in 22 ESRD patients treated with CAPD after long-term restriction of dietary protein and phosphate.
Peritoneal Catheter Survival and Complications in end Stage Renal Disease
Authors: Bierman Martin H. , Kasperbauer Jan , Kusek Anthony , Hammeke Michael D. , Fitzgibbons Robert J. , Egan John D.
Published: February 2020

Peritoneal catheter survival and complications were determined retrospectively over an eight-year period.

Two hundred and twenty-two peritoneal catheters were placed in 124 patients; the 107 failures, which required catheter replacement, were due to dislodgment (38), one-way obstruction (31), peritonitis (28), leakage (7), and tunnel infection (3). Forty per cent of all catheter failures occurred within the first week due mainly to dislodgment and obstruction. Females had significantly more leakage-related catheter failures. Diabetic patients had fewer total catheter failures and fewer failures due to peritonitis. Over a 24-month period no difference was seen in the number or types of failures between straight and curled Tenckhoff catheters. By life-table analysis cumulative per cent catheter survival was 45% at 52 weeks; this was not affected by sex, type of catheter, or use of radiography during placement. In patients with multiple peritoneal catheter placements, subsequent catheters did not have a lower survival.
Complete Dialysate Drainage: An Unnecessary Step in Intermittent Peritoneal Dialysis
Authors: Indraprasit Suchati , Taramas Wandee , Panpakde Orasa
Published: February 2020

Peritoneal dialysis was performed in 16 renal-failure patients to study the necessity of complete drainage during the outflow period. Comparison between complete drainage (CD) and the accelerated inflow and limited outflow (AILO) showed no difference of drainage volume despite the accelerated outflow during the AILO period. It is postulated that the higher level of dialysate in the fluid line during the AILO period resulted in a relative increase availability of the outflow through the catheter perforations. In the CD period the peritoneal clearances of urea, creatinine and inulin were lower because of inefficient transport of these solutes during the outflow phase. The authors concluded that complete drainage is not necessary in intermittent peritoneal dialysis.

During intermittent peritoneal dialysis, dialysate drainage volume usually is a major concern among medical and nursing staffs. Particularly during the initial exchange, dialysate frequently is retained because of a pocket of fluid in an inaccessible area of the peritoneal cavity (1). Thus, in subsequent exchanges considerable effort is made to stimulate drainage so as to avoid further accumulation. This prolongs outflow time and takes up the time and attention of paramedical personnel. The present study was done to evaluate the necessity of complete dialysate drainage in term of mechanics and efficiency of dialysis.
Chronic Peritoneal Dialysis is Associated with Progressive Thrombocytosis
Authors: Zimmerman Stephen W.
Published: February 2020

The mean platelet count of chronic peritoneal dialysis (cpD) patients (371.000 ± 15.500/mm3) was significantly greater than the mean of hemodialysis (HD) patients (224.000 ± 11.000/mm3. P <. 001). Thrombocvtosis (platelet count > 400.000/ mm3) was noted in 23 of 57 CPD patients hut in only two of 50 chronic HO patients (P < .001). Platelet counts increased with time on CPD. Of CPO patients on dialysis for two years or more .62 % h3d thrombocytosis, in contrast to 6% of HD patients. Platelet counts of CPD patients correlated positivelv with time on PD and serum creatinine. and negatively with age. While there is a progressive increase in platelet counts with peritoneal dialysis. we do not know the underlying mechanisms of thrombocvtosis. the relationship to a possible hypercoagulable state and potential risk for thromboembolic events.

The urem1c bleeding tendency 1S associated with abnormal platelet function but platelet counts usually are normal III both uremic patients and those on hemodialysis (1. 2). The bleeding tendency in uremia is corrected by peritoneal dialysis (PD) (3–5), and several have suggested that hypercoagulability may exist in continuous ambulatory peritoneal dialysis (CAPD) (5). However. except tor a rare patient with thrombocytosis (4,6) platelet counts of most PD patients are normal (3–5), although these counts may increase after starting peritoneal dialysis (4). This study was done to assess platelet counts in chronic PD patients and compare them to those on hemodialysis (HD). Platelet counts were elevated in PD when compared to HD and we performed further correlations with clinical and laboratory parameters in PD patients.
Defective Opsonic Activity of Peritoneal Effluent during Continuous Ambulatory Peritoneal Dialysis (CAPD): Importance and Prevention
Authors: Lamperi Silvano , Carozzi Silvia
Published: February 2020

To evaluate peritoneal immunological defenses and to find a way to prevent peritonitis we have studied the capacity of peritoneal dialysis effluent (PDE) to opsonize bacteria, and the phagocytic activity of peritoneal macrophages (PM). The subjects were 40 uremic patients followed for a mean period of 36 months and 40 normal women who underwent laparoscopy (controls).

Opsonic capacity for Staphylococcus epidermidis of undiluted PDE from CAPD patients with low peritonitis incidence (LPI) proved to be similar to that of 10% control serum. However, the capacity of effluent from patients with a high peritonitis incidence (HPI) was noticeably inferior. In these cases, IgG concentration in PDE was lower than in LPI patients.

There was a significant correlation between opsonization capacity for bacteria and IgG concentration values in PDE. We found inverse correlations between opsonic capacity of PDE and number of episodes of peritonitis.

Phagocytic capacity of PM from CAPD patients was similar to that of control PM when micro-organisms were preopsonized by control serum.

Treatment with intraperitoneal intmunoglobulin raised PDE opsonization capacity and lowered the incidence in those with previous HPI, thus demonstrating the importance of abnormal opsonization in CAPD peritonitis and the possibility of preventing infection by prophylaxis with intraperitoneal immunoglobulin. Intravenous immunoglobulin does not reduce the incidence of infection.
Extended use of a Glycerol-Containing Dialysate in Diabetic CAPD Patients
Authors: Matthys Erve , Dolkart Ralph , Lameire Norbert
Published: February 2020

Thirteen uremic diabetic patients were treated with CAPD, using solutions containing 1.4% and 2.5% glycerol. The total follow-up time was 237 patient months. Clinically, this dialysate was well tolerated. Biochemical follow-up demonstrated a slight increase in hematocrit and a stable control of blood urea, creatinine, electrolytes and acid-base parameters. There were no signs of hemolysis and hepatoxicity. Peritoneal ultrafiltration capacity and peritoneal creatinine clearance were well maintained over the whole follow-up period. There was no increase in the peritoneal protein loss with time. The daily blood-glucose profiles demonstrated remarkably stable levels; these were between 1 and 2 g/1 with a dose of intraperitoneally administrated crystalline insulin ranging between SO and 67 U per day. The one and two-year cumulative patient and technique survival rate were 91% and 76%, respectively. The peritonitis incidence was 1/10.7 patient months, but with an unusually high incidence of culture-negative peritonitis.
Survival Comparison of Adult Non-Diabetic Patients Treated with Either Hemodialysis Or CAPD for End-Stage Renal Failure
Authors: Posen Gerald , Arbus Gerald , Hutchinson Tom , Jeffery John
Published: February 2020

The authors studied all adult patients (15 years and over), other than those with primary diagnosis of diabetes mellitus, who were registered in the Canadian Renal Failure Register, and who had begun treatment with either hemodialysis or peritoneal dialysis. Survival was calculated only for those on hemodialysis or for those on peritoneal dialysis who changed to or continued on CAPD. The calculations were done for life and technique survival in three age groups. The age groups were: 15–44, 45–64, and 65 and over. In all age groups the survival until death was similar. The technique survival rates were higher in hemodialysis in the 15–44 group, similar in the 45–64 group, and initially lower in CAPD in the 65 and over group.

Previous studies and comparison (I, 2) of patient and technique survival in hemodialysis and CAPD have shown a poor technique survival in CAPD. Age-group analysis in the Australian Registry (2) demonstrated no difference in technique survival in different age groups, but patients over 64 were not studied separately either in Canada or other countries. This group represents 25% of our new patient population (3), and with an aging population their numbers can be expected to increase. Therefore we decided to study this group separately and to compare their technique and life survival results with the different treatment and different age groups.
Sexual and Marital Relationships and Dialysis the Patient's Viewpoint
Authors: Juliet Janis P. Stout , Kincey Auer John , Hillier Valerie F. , Gokal Ram , Gail Simon L. , Oliver Desmond
Published: February 2020

This study of 133 patients of both sexes on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) focusses on the patient's viewpoint of their satisfaction with their sexual relationships, and asks whether this had changed since commencement of treatment. Patients also were asked about their marital satisfaction and their partner's feelings in relation to their sexual relationship.

This study shows that about half the patients reported a significant deterioration in their satisfaction with sexual relationships since starting dialysis. This deterioration was significant regardless of age, sex or mode of treatment. Patients ex pressed concern about this deterioration and felt that their partners were similarly concerned. Patients aged less than 60 years and all patients on hemodialysis expressed significantly more concern than those over 60 and those on CAPD.

Satisfaction with marriage was reported as good on dialysis and this response was not related to the reported sexual dysfunction on treatment.

All members of the multidisciplinary renal team, especially the social worker, should ensure that dialysis patients and their partners have access to appropriate psychosexual counselling by a trained sex counsellor as part of the overall treatment and counselling of dialysis patients.
Limulus Lysate Study of Effluents from CAPD Patients
Authors: Cartmill T.D.I. , Tapson J.S. , Freeman R.
Published: February 2020

A micro method, Limulus lysate assay, has been used to determine the presence, or otherwise, of endotoxin in the emuents of various groups of CAPD patients. Endotoxin, a freely diffusable product of most gramnegative organisms was not detected in emuents of 11 asymptomatic trainers. Only 1/33 proven gram positive episodes of peritonitis and 1/21 patients with illnesses other than peritonitis were positive for endotoxin.

However only 7/10 proven cases of gram-negative peritonitis were positive for endotoxin. Thus, in its present state, the test is neither sensitive nor specific enough to be a reliable, rapid method of diagnosing gram-negative peritonitis. Only 1/24 cases of “culture-negative” peritonitis yielded a positive Limulus lysate test.
Sodium Thiosulfate Treatment of Soft -Tissue Calcifications in Patients with End-Stage Renal Disease
Authors: Yatzidis Hippocrates , Agroyannis Basil
Published: February 2020

Five patients on maintenance hemo dialysis for more than five years, who had tumoral calcifications, were treated by sodium thiosulfate for three to IS months. Four patients with periarticular and soft-tissue calcifications achieved regression of varying degrees and the motion of the adjacent joints was considerably improved. The fifth patient had calcification of penis; sodium thiosulfate produced early relief of symptoms and later complete disappearance of the calcification.
Six Years’ Experience of CAPD at One Centre: A Survey of Major Findings
Authors: Tranæus Anders , Heimbürger Olof , Lindholm Bengt , Bergström Jonas
Published: February 2020

This study summarizes the overall experience of the first six years of CAPD treatment at one centre, during which time all patients (n = 124) were selected, trained, and treated in a uniform way. Patient selection was largely influenced by a high transplantation activity. The patients had a high mean age, 54 years at start of CAPD, and there was a high proportion of diabetics, 26%.

Patient survival was 81% after two years and 60% after four years for all patients, and 100% after four years for non-diabetic patients < 50 years of age. Patient and technique survival was significantly superior in younger non-diabetics than in diabetics and in non-diabetics ≥ 60 years. Thirty-nine percent of transfers to other forms of dialysis were due to peritonitis. The main reason for a high early discontinuation rate was transplantation.

The mean treatment time in hospital was 27.7 d per patient year, one-third of which was attributable to peritonitis. The risk of developing peritonitis within the first year on CAPD was 55%.

During CAPD, serum urea remained unchanged, serum potassium, creatinine, and uric acid levels increased, and serum albumin levels decreased. These findings suggest that patients being treated with four 2 L exchanges Id, may not be sufficiently dialyzed as the residual renal function deteriorates, thereby increasing the risk of anorexia and subsequent malnutrition.
Beta-2 Microglobulin in Peritoneal Dialysis Patients: Serum Levels and Peritoneal Clearances
Authors: DiRaimondo Carol R. , McCarley Patricia , Stone William J.
Published: February 2020

Beta-2 microglobulin (B2M) is amyloidogenic in long-term hemodialysis patients, with amyloid deposition manifesting as lytic bone lesions, carpal tunnel syndrome, destructive arthropathies, tenosynovitis, and pathologic fractures. To study the behavior of this protein in the peritoneal dialysis population, serum levels of B2M from 14 chronic peritoneal dialysis (CPD) patients (4IPD, 10 CAPD) were compared to those of 15 chronic hemodialysis patients, and peritoneal clearances were measured in 9 CAPD patients. Standard cuprophan dialyzers were used for hemodialysis.

Serum B2M levels were significantly lower in the peritoneal dialysis group (mean ± SD 73.2 ± 20.9 mg/L) than in the hemodialysis group (100.3 ± 24.7 mg/L, p < .004). When CAPD patients alone were compared to the hemodialysis patients, lower serum B2M levels were again apparent, with mean 68.7 ± 16.4 mg/L (p ≤ .002). Mean serum B2M in IPD patients (84.6 ± 28.9 mg/L) did not differ statistically from either the CAPD or the hemodialysis group.

Peritoneal clearance of B2M, urea nitrogen, and creatinine over a 6 h exchange were obtained in 9 CAPD patients without peritonitis. Mean clearance (±SD) of B2M was 0.9 ± 0.4 ml/min/1.73 m2, urea nitrogen 5.3 ± 0.3 ml/min/1.73 m2, and creatinine 4.2 ± 0.8 ml/min/1.73 m2. Mean loss of B2M via the peritoneal cavity was 19.9 ± 6.6 mg/2 L-exchange/1.73 m2 (range 7.7 to 26.2 mg/2 L-exchange/1.73 m2).

Decreased serum B2M in peritoneal dialysis patients is consistent with increased clearance by the peritoneal membrane versus standard cellulosic hemodialysis membranes. Whether use of CPD rather than hemodialysis can prevent or even treat dialysis-associated amyloidosis (AB2M) remains speculative.
Peritoneal Macrophages in Short Dwell Time Effluent Show Diminished Phagocytosis
Authors: Bog Harm J. , Vlaanderen Klaag , Van Der Meulen Jan , De Veld Jog C. , Oe Liem P. , Beelen Robert H. J.
Published: February 2020

We investigated the effect of different i.p. dwell times of dialysis fluid on the composition and phagocytic capacity of the peritoneal cells. We examined dialysate after 1.5 and 15 h dwell time in 10 continuous cyclic peritoneal dialysis (CCPD) patients and after 8 h dwell time in 14 continuous ambulatory peritoneal dialysis (CAPD) patients. There was no significant difference in viability, composition, and Fc receptor positive cells among the peritoneal cells in the studied effluents of CCPD and CAPD patients. However, the yield of peritoneal cells and the phagocytic capacity of IgG-coated sheep red blood cells ([lgG]SRBC) by peritoneal macro phages in 1.5 h dwell time dialysate was significantly decreased when compared with 15 h dwell time dialysates. In addition, the total phagocytic capacity of peritoneal cells in 1.5 h dwell time dialysate is dramatically decreased when compared with the 15 h dwell time dialysate and 8 h dwell time dialysate of CAPD patients. These findings must be taken in consideration by performing three rapid exchanges after the diagnosis of a peritonitis.
Tenckhoff Catheter Penetrated by Aspergillus Fumigatus: A Case Report
Authors: Wegmann Frants , Heilesen Aina M. , Horn Thomas
Published: February 2020

A case of fungal penetration (AspergIllus fumigatus) of a Tenckhoff catheter in a 68-year-old female treated for five years with peritoneal dialysis is reported. Though histopathological and microbiological examination of the removed catheter revealed disseminated colonization, the patient presented no clinical signs of peritoneal infection, cultures of peritoneal fluid were negative, and dialysis procedures were without problems.
Can the Risk of Peritonitis be Predicted for New Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients?
Authors: Coles Gerald A. , Minors Susan J. , Horton Jeffrey K. , Fifield Richard , Davies Malcolm
Published: February 2020

Serum and overnight dialysate samples were obtained from 36 adult uraemic patients at the end of their continuous ambulatory peritoneal dialysis (CAPD) training. The samples were analysed for albumin, IgG, C3, and antistaphylococcal peptidoglycan antibody. None of the dialysate measurements correlated with the risk of peritonitis during up to one year's CAPD treatment.

Nineteen of the 36 patients were retested 6 to 20 months after starting CAPD. There were significant rises in serum C3 ( p < 0.02) and albumin ( p < 0.001) and a significant fall in dialysate IgG ( p < 0.02). Eight further patients were sampled at the end of training and three weeks later. They had a significant fall in dialysate IgG ( p < 0.05).

During CAPD training peritoneal permeability appears to be transiently increased. Analysis of overnight dialysate samples during training does not allow prediction of those at risk of subsequent peritonitis.
Fluconazole Therapy for Fungal Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report
Authors: Ahlmén J. , Edebo L. , Eriksson C. , Carlsson L. , Torgersen A.K.
Published: February 2020

Fluconazole proved effective in treating fungal peritonitis caused by Trichosporon cutaneum. Fluconazole seems to offer several advantages over other antifungal drugs in the treatment of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients.
Phosphatidylcholine Does Not Affect Peritoneal Transport of Intact Rabbits
Authors: Di Paolo Bruno , Chakrabarti Eva , Maher John F.
Published: February 2020

Ultrafiltration and solute transport during 60-min peritoneal dialyses of normal rabbits with intraperitoneal administration of phosphatidylcholine were compared to control values. The ultrafiltration rate of 0.27 mLIKglmin did not increase when phosphatidylcholine was added. This agent had no effect on the ultrafiltration coefficient, sodium mass transport or solute clearances. Previously reported beneficial results with this agent could be due to repletion of a deficiency or an effect of the organic solvent. More studies of safety and efficacy of phosphatidylcholine are warranted before widespread clinical use.
Bacterial Aggregation in Relation to Peritoneal Dialysis
Authors: Reid Gregor , Schwarz-Faulkner Susanne , McGroarty Jacqueline A. , Bruce Andrew W.
Published: February 2020

The ability of gram-positive cocci to aggregate and form biofilms at the exit site and on catheter surfaces in continuous ambulatory peritoneal dialysis (CAPD) has been associated with peritonitis. In the present study, 16 (80%) of 20 dialysate effluents from patients with staphylococcal peritonitis were found to contain aggregates of Staphylococcus epidermidis or S. aureus. Using an in vitro assay system, 20 (83%) of 24 pathogenic bacterial strains were found to aggregate in fresh dialysis solutions within 4 to 24 h at 37°C. Further studies with one strain, S. epidermidis 1938, showed increased aggregation when the bacteria were incubated in dialysate effluents compared to fresh dialysis solutions. Viability experiments showed that aggregated bacteria were less sensitive to the killing effects of fresh dialysis solutions and that dialysate effluents could support bacterial growth. The results suggest that attention be paid to aggregation as a potential mechanism used by bacteria in causation of peritonitis.
Recovery of HIV Antigen in Peritoneal Dialysis Fluid
Authors: Correa-Rotter Ricardo , Saldivar Sergio , Soto Luis E. , De Leon Samuel Ponce , Ojeda Francisco , Ruiz-Palacios Guillermo , Pena Jose Carlos
Published: February 2020

We investigated the presence of HIV antigen in dialysis fluid of patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), previously known to be infected with this virus. Sixteen adult patients and 6 adult volunteers were included in the study in 4 groups as follows: Group A: 3 patients on CAPD, previously known to be positive for serum HIV antibodies; Group B: 7 patients on CAPD, serum HIV negative; Group C: 6 AIDS patients without renal disease; and Group D: 6 healthy volunteers.

Of the 3 patients of Group A, the HIV-1 Ag was positive in dialysis fluid in only 2. In 1, serum Ab and Ag were present, while in the others only serum Ab was detected. The samples from Group B were all negative for the viral antigen in dialysis fluid.

We conclude that dialysis fluid of HIV-infected patients may contain the Ag and is therefore potentially infective. The presence of the HIV antigen was not constant, and was not related to antigenemia. It is possible that the presence of the Ag depends on local factors that influence viral replication or to alterations in the permeability of the peritoneal membrane. We discuss other possible factors that could influence the presence of viral Ag in peritoneal dialysis fluid.
Peritoneal Solute Clearances in Diabetics
Authors: Lee Hi Bahl , Park Min Sun , Chung Sung Hee , Lee Young Bae , Kim Kyung Soo , Hwang Seung Duk , Moon Chul
Published: February 2020

In order to examine solute transport across the peritoneal membrane and responsiveness of the peritoneal microcirculation to a vasodilator in diabetics on continuous ambulatory peritoneal dialysis (CAPD), we obtained peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in the drained dialysate (D PC), and percentage of peritoneal glucose absorption (% PGA) before and after nitroprusside (NP) addition to the dialysate in 13 diabetics (DM) and 13 nondiabetics (non-DM) matched for age, sex, body weight, and duration of CAPD.

Control (before NP) Curea, Ccr, D PC, and %PGA were not different between DM and non-DM. NP significantly enhanced Curea, Ccr, and D PC in both DM and non-DM. Curea, Ccr, D PC, and %PGA after NP were again not different between DM and non-DM.

The findings suggest that peritoneal solute clearances and responsiveness of the peritoneal microcirculation to NP in diabetics are not different from nondiabetics at the beginning of CAPD despite evidence for widespread vascular diseases in diabetic ESRD patients.
Baby Poop Peritonitis
Authors: Rodby R. A.
Published: February 2020

A 43-year-old black male with end-stage renal disease (ESRD) secondary to hypertension on continuous ambulatory peritoneal dialysis (CAPD) since
Host Defense Mechanisms in the Peritoneal Cavity of Continuous Ambulatory Peritoneal Dialysis Patients: First of Two Parts
Authors: Lewis Sharon , Holmes Clifford
Published: February 2020

This article provides a review of studies on peritoneal white blood cells (WBC) in CAPD patients. To some extent these studies support the concept that the peritoneal cavity of these patients contains adequate-functioning WBC that can provide effective antimicrobial defenses when they are studied in dialysate-free media. Commercially available dialysis solutions significantly impair WBC function. In some patients with high incidences of peritonitis, there appears to be reduced bactericidal capacity of their peritoneal macrophages. CAPD seems to contribute to a state of both macrophage and lymphocyte activation in the peritoneal cavity. The clinical consequences of this chronic activation are not known.
The Mesothelial Cells in CAPD Effluent and Their Relation to Peritonitis Incidence
Authors: Betjes Michiel G.H. , Bos Harry J. , Krediet Raymond T. , Arisz Lambertus
Published: February 2020

The total cell count and cell differentiation of the overnight peritoneal dialysis effluent (PDE) was analysed in 34 long-term CAPD patients. The mean percentage and yield of mesothelial cells were 3.1% and 0.17 × 106 per PDE. There was a significant lower percentage and yield of mesothelial cells in the PDE of patients with a peritonitis incidence (PI) of more than 2 episodes a year. Independent of dwell time, a positive correlation between the total yield of leucocytes and the yield of mesothelial cells was found. No relation between the amount of phospholipids in the PDE and the yield of mesothelial cells could be shown. Mesothelial cells in the PDE are probably reflecting the turn-over rate of a reactive mesothelium. Whether a low turn-over rate of the mesothelium is causing or is caused by a high PI needs further investigation.
Single -Dose Pefloxacin Pharmacokinetics and Metabolism in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Nikolaidis Paul , Walker Scott E. , Dombros Nicholas , Tourkantonis Achilleas , Paton Tom W. , Oreopoulos Dimitrios G.
Published: February 2020

Seven adult patients on continuous ambulatory peritoneal dialysis (CAPD) received one dose of pefloxacin, a novel quinolone antibiotic, orally and intravenously on two separate occasions to characterize the pharmacokinetics and metabolism of the drug. Concentrations of both pefloxacin and its active metabolite N-desmethylpefloxacin (norfloxacin) were measured in serum and dialysate by HPLC. Half-life, total body clearance and peritoneal clearance were determined. The overall elimination half-life was 19.9h. Relative to the IV dose the bioavailability following oral administration of pefloxacin was 76%. The mean serum and dialysate concentrations were similar up to 24 h after the oral or IV dose. After a 6 h dwell time the dialysate concentration of pefloxacin was 2.24 mg/L which is above the MICgo for most bacteria responsible for peritonitis in CAPD patients. The peritoneal clearance of pefloxacin averaged 2.5 mL/min. Serum concentrations of the metabolite norfloxacin were less than 0.5 mg/L during the 24 h study period.

We conclude that pefloxacin might be equally effective in the treatment of peritonitis of CAPD after oral or IV administration. Since the peritoneal clearance contributes insignificantly to the elimination of pefloxacin during CAPD, the proposed maintenance regimen of an oral or IV 400 mg dose/day seems to be a reasonable therapy for infections in CAPD patients.
A Method for Assaying Biofilm Capacity on Polyurethane-Coated Slides
Authors: Fessia Sandra L. , Griffin Mary J.
Published: February 2020

Isolates of coagulase-negative Staphylococci (CNS) were examined for their ability to form biofilms on polyurethane-coated slides. These slides provided a smooth plastic coating simulating polymeric plastic surfaces of medical grade catheter tubing. Slides were placed into plastic conical tubes containing tryptic soy broth inoculated with 106 bacteria per mL. The tubes were then incubated at 37° for 48 hours. After incubation, 1 of the slides was stained with a fluorescent acridine orange stain and the other with a safranin stain. The incubation tubes were also stained with safranin. Fortyeight percent of the 65 CNS isolates were found to form a biofilm using acridine orange staining. Forty percent of the 65 CNS isolates were found to form a biofilm using the safranin stain on slides, whereas only 34% were found to adhere on sides of plastic tubes. Increased sensitivity of the fluorescent stain was probably due to enhanced visualization of smaller numbers of bacteria on the plastic. This method using fluorescent stained plastic-coated slides was easier to visualize and interpret than the tube method.
Ciprofloxacin in the Treatment of Gram-Positive Bacterial Peritonitis in Patients Undergoing CAPD
Authors: Pérez-Fontán Miguel , Rosales Miguel , Fernández Fernando , Moncalián Javier , Fernández-Rivera Constatino , Alonso Angel , Valdés Francisco
Published: February 2020

Fluoroquinolones may be a good alternative for the treatment of bacterial peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). To test their efficiency against Gram-positive bacteria, we treatedwith intraperitoneal (i.p.) ciprofloxac in 30 episodes of Gram-positive bacterial peritonitis without manifest tunnel infection of the peritoneal catheters. Treatment was sustained for 5 days, then orally for 10 further days. Clinical and bacteriological responses were satisfactory in 25 cases, but resolution of infection was slow in 5 cases of Staphylococcus aureus. The minimal inhibitory and bactericidal concentrations were 0.06250.50 and 0.125-1.0 μg/mL respectively, lower than the plasma and dialysate concentrations of the drug. Side effects were negligible. We conclude that ciprofloxacin provides a good therapeutic alternative to more widely used antibiotics for the empirical treatment of peritonitis in patients undergoing CAPD. However, combinations of antibiotics may be necessary, in Staphylococcus aureus peritonitis.
Increased Salivary Concentration of Human Epidermal Growth Factor in Patients Undergoing CAPD
Authors: Dagogo-Jack Sam , Rodger R. Stuart C. , Aylor” Pat Kendall I
Published: February 2020

Epidermal growth factor (EGF) was measurea In the saliva of 36 patients with chronic renal failure (CRF) and 29 matched control subjects. Salivary EGF in controls was 0.65±0.009 nmol/L compared with 0.99±0.24 nmol/L in nondialyzed CRF patients, 1.15±0.23 in hemodialyzed patients and 1.96±0.25 (p < 0.01, Wilcoxon Rank Sum Test) in CAPO-treated patients. On Sephadex chromatography, the major peak of immunoreactive EGF from patient and control saliva samples coeluted with purified human EGF. We conclude that salivary concentrations of human EGF are significantly elevated in end-stage renal failure, particularly in patients treated by CAPO.
Prevalence of Hepatitis c Antibodies (HCV) in a Dialysis Population at One Center
Authors: Selgas Rafael , Martinez-Zapico Rosa , Bajo M. Auxiliadora , Romero Jose Ramon , Munoz Jesus , Rinon Carmen , Miranda Blanca , Miguel Jose Luis
Published: February 2020

Hepatitis C (HC) has been recently diagnosed by determination of specific antibodies that represent the former so-called non-A, non-B hepatitis.

We studied the prevalence of plasma HCV antibodies among 61 unselected patients on hemodialysis (HD) and 43 on continuous ambulatory peritoneal dialysis (CAPD). Plasma C-antibodies were determined through the ELISA test system. Transfusion policy was the same in both groups.

The prevalence of hepatitis C virus antibodies was significantly higher in hemodialysis patients than among those on CAPD. Time on dialysis, previous blood transfusions, and renal transplantation seem to increase the prevalence of C hepatitis antibodies among hemodialy sis patients. The effect of these parameters on CAPD was smaller. Understanding the reasons for these differences may help prevent this disease among dialysis patients.