bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical Aspects in Studying Peritoneal Morphology in Animal Models of Peritoneal Dialysis
Authors: Duman Soner , Şen Sait
Published: February 2020

Objective

Peritoneal biopsies are considered useful for gaining a better understanding of the pathophysiology of the peritoneum during experimental peritoneal dialysis (PD). Different peritoneal tissue samples (i.e., abdominal wall, liver, diaphragm, intestine, and omentum) may be used, but there can be artifacts due to peritoneal tissue processing.

Aim

To investigate differences in peritoneal membranes from different parts of the peritoneum, and also 2 different fixatives, in experimental PD and a peritonitis model in rats.

Methods

Peritoneal tissues from the anterior abdominal wall, liver, omentum, and intestine were taken from each of 3 groups of animals: sham, experimental PD, and peritonitis model. Tissue samples were immediately fixed with 4% formaldehyde and routinely processed for histological examination. Two parietal peritoneal tissue samples according to longitudinal and horizontal sections of anterior wall inner abdominal muscle were also taken. All samples were immediately fixed with 4% formaldehyde and B5 fixative (B5), and then routinely processed for histological examination.

Results

In all groups, histopathological findings were more commonly seen in the abdominal wall samples. There were no changes observed in peritoneal membranes other than those of anterior abdominal wall samples from both sham and PD model rats. However, there was a significant difference between anterior and posterior facets of liver in the peritonitis model. Furthermore, the antimesenteric site of intestinal peritoneum was less affected than the mesenteric site. There were no significant histopathological differences between B5 and 4% formaldehyde fixation ( p > 0.05).

Conclusion

Our results suggest that peritoneum obtained from the anterior abdominal wall is the most affected area and therefore the most suitable site to investigate peritoneal changes in the experimental rat PD model. There were no significant differences between fixation with 4% formaldehyde and B5 solution. Abdominal wall samples should be of the same direction of inner abdominal muscle, that is, horizontal sectioning should be used for measurements of the submesothelial area.
Quantitation of Markers of Protein Damage by Glycation, Oxidation, and Nitration in Peritoneal Dialysis
Authors: Rabbani Naila , Thornalley Paul J.
Published: February 2020

Proteolysis products of proteins damaged by glycation, oxidation, and nitration—glycated, oxidized, and nitrated amino acids (glycation, oxidation, and nitration free adducts)—are waste products normally excreted in urine and cleared in peritoneal dialysate. Glucose degradation products in peritoneal dialysis (PD) fluids may increase protein damage, giving rise to increased protein glycation, oxidation, and nitration adduct residues of proteins and increased flux of glycation, oxidation, and nitration free adducts. Increased protein damage has been linked to mortality in end-stage renal disease. Reliable quantitation of markers for adducts of protein glycation, oxidation, and nitration is required for mechanistic studies and for morbidity and mortality risk analysis in PD patients. We review the available analytical techniques for such quantitation. Stable isotopic dilution analysis with tandem mass spectrometry is the “gold standard.” This method needs to be applied further in the study of PD and to validate other techniques so that the effect of PD on the metabolism and clearance of damaged proteins and related products can be quantified, and so that best-practice fluid management can be established to minimize cardiovascular risk.
Is Subjective Global Assessment a Good Index of Nutrition in Peritoneal Dialysis Patients with Gastrointestinal Symptoms?
Authors: Li Yanjun , Dong Jie , Zuo Li
Published: February 2020

Objective

We investigated whether patients with gastrointestinal (GI) symptoms were prone to be diagnosed as malnourished by subjective global assessment (SGA) by simultaneously evaluating SGA and other indices of nutrition in a cross-sectional survey of peritoneal dialysis (PD) patients.

Patients and Method

From June 2006 to June 2007, 214 PD patients were involved in the study. We recorded results of a GI symptoms questionnaire (GSQ) and SGA. Other indices of nutrition included dietary intake, chemistry examination, anthropometry, handgrip strength, and lean body mass measured by creatinine kinetics.

Results

Mean age of the 214 PD patients enrolled in the study was 60.22 ± 14.02 years, and mean dialysis duration was 60.22 ± 14.02 months. Of the 214 patients, 56 (27.16%) were diagnosed as malnourished by SGA. The mean GSQ scores were 9.37 ± 1.71 (range: 8 – 17). There were 90 patients with GSQ scores of 8 (group 1), 80 patients with scores of 9 or 10 (group 2), 44 patients with scores of 11 or more (group 3). The prevalence of malnutrition diagnosed by SGA was significantly different in the three groups: 15.56% in group 1, 27.5% in group 2, and 45.45% in group 3 ( p = 0.02). However, we observed no difference between the three groups in mid-arm circumference, skinfold thickness (biceps, triceps, subscapular, and suprailiac), daily protein and energy intake, handgrip strength, lean body mass, and serum albumin and prealbumin levels ( p > 0.05).

Conclusions

Our results showed that the reliability of SGA in PD patients with GI symptoms remains worth exploring. These patients are possibly diagnosed as malnourished by SGA, although many other indices of nutrition are not necessarily bad.
Rapid Solute Transport in the Peritoneum: Physiologic and Clinical Consequences
Authors: Cueto–Manzano Alfonso M.
Published: February 2020

This review focuses on the physiologic and clinical consequences of rapid solute transport in the peritoneum. The concept, the current understanding of related factors, and the possible causes implicated in rapid solute transport are discussed first. Then, the consequences, with particular emphasis on mortality, are highlighted. Finally, based on recent advances and clinical studies, some strategies for the treatment of fast peritoneal transport are reviewed.
Carotid Intimal Thickness and Flow-Mediated Dilatation in Diabetic and Nondiabetic Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Prasad Narayan , Kumar Sudeep , Singh Anurag , Sinha Archana , Chawla Kamal , Gupta Amit , Sharma R.K. , Sinha Nakul , Kapoor Aditya
Published: February 2020

Objectives

We compared carotid intima media thickness (CIMT) and flow-mediated dilatation (FMD) between cases [end-stage renal disease patients (diabetic and nondiabetic) on peritoneal dialysis (PD)] and controls (diabetic and hypertensive patients with normal renal function) with the objective of identifying risk factors predicting atherosclerosis.

Methods

This cross-sectional study involved 124 subjects (62 cases, 62 controls). In both the case and control populations, we used B-mode ultrasonography to study CIMT and endothelium-dependent FMD, according to American College of Cardiology guidelines on brachial artery measurement. Pearson correlation was used to evaluate the correlation between CIMT and other variables.

Results

Compared with controls, cases had significantly higher systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglycerides, serum uric acid, inorganic phosphate, C-reactive protein, and parathyroid hormone, and significantly lower hemoglobin, calcium, and high-density lipoprotein. Compared with controls, cases showed significantly greater CIMT (0.60 ± 0.08 mm vs 0.54 ± 0.03 mm, p < 0.001) and significantly lower FMD (0.15 ± 0.08 cm vs 0.21 ± 0.04 cm, p = 0.02). Among cases, patients with diabetes had significantly greater CIMT (0.62 ± 0.08 mm vs 0.58 ± 0.07 mm, p = 0.05) than did patients without diabetes; FMD was similar in diabetic and nondiabetic patients on continuous ambulatory PD (0.16 ± 0.03 cm vs 0.18 ± 0.03 cm, p = 0.20).

Conclusions

Compared with controls, cases had significantly higher CIMT and lower FMD. Cases with diabetes had significantly higher CIMT than did cases without diabetes, but FMD was similar in diabetic and nondiabetic cases. Serum inorganic phosphate is an independent risk factor for atherosclerosis and was significantly correlated with CIMT. The noninvasive CIMT and FMD tests can be used to monitor atherosclerosis and endothelial dysfunction.
Patient Selection for Automated Peritoneal Dialysis: For Whom, When?
Authors: Liakopoulos Vassilios , Dombros Nicholas
Published: February 2020

The use of the various forms of automated peritoneal dialysis (APD) has increased considerably in the past few years. This increase has in part been driven by technology, through improved cycler design. Other contributing factors include better adjustment of APD to patient lifestyle, the flexibility that APD offers to patients, and the increased ability of APD to achieve adequacy and ultrafiltration targets. For high transporters and for patients unable to perform peritoneal dialysis (PD) on their own (for example, pediatric and elderly patients), APD is considered the most suitable PD modality. Furthermore, APD has been associated with improved compliance, lower intraperitoneal pressure, and lower incidences of peritonitis. On the other hand, concerns have been raised regarding increased complexity and cost, a more rapid decline in residual renal function, inadequate sodium removal, and disturbed sleep. Automated PD is an alternative to continuous ambulatory PD when a higher dialysis dose is needed, and it could be a reliable alternative for unplanned or urgent dialysis start. Other than beneficial results in high transporters, the medical advantages of APD remain controversial. Individual patient choice therefore remains the main indication for the application of APD, which should be made available to all patients starting PD.
Effect of Pre-Transplant Dialysis Modality on Kidney Transplantation Outcome
Authors: Caliskan Yasar , Yazici Halil , Gorgulu Numan , Yelken Berna , Emre Turker , Turkmen Aydin , Yildiz Alaattin , Aysuna Nilgun , Bozfakioglu Semra , Sever Mehmet Sukru
Published: February 2020

Background

The effect of pre-transplant dialysis modality on early graft function is a matter of debate. Although some authors deny the existence of a significant influence, others suggest that peritoneal dialysis (PD) affects early graft function favorably, possibly by contributing to a more physiologic water balance. In the present study, we evaluated the influence of pre-transplant dialysis modality on early and late graft function.

Patients and Methods

We studied 745 patients who underwent a first renal transplantation during 1983 – 2006, comparing the records of 44 PD patients [26 male; mean age: 26 ± 9 years (range: 8 – 56 years)] who received 36 living related and 8 cadaveric renal transplantations with those of a control group of 44 consecutive hemodialysis (HD) patients [26 male; mean age: 27 ± 11 years (range: 7 – 49 years)] for the index cases.

Results

The groups showed no significant differences in donor type, human leukocyte antigen matching, immunosuppressive protocols, and duration of dialysis. Also, neither group differed significantly with regard to incidence of delayed graft function, acute tubular necrosis, wound infection, systemic viral and bacterial infections, or acute rejection in the early post-transplant period. In the late post-transplant period, incidences of chronic rejection, graft failure, and malignancies were also similar. During the follow-up period, 3 patients in the PD group experienced acute rejection, 2 developed cytomegalovirus (CMV) disease, and 5 developed various other infections. In the HD group, 4 patients experienced acute rejection, 1 developed CMV disease, and 8 experienced other infections. Five patients in the PD group and one in the HD group died with functioning grafts ( p = 0.09). No differences were noted between the groups in the incidences of post-transplant cardiovascular complications, malignancies, and diabetes mellitus. In the PD group, 33 patients with functioning grafts are still being followed, 6 have returned to dialysis, and 5 have died. In the HD group, 38 patients with functioning grafts are still being followed, 5 have returned to dialysis, and 1 has died.

Conclusions

As a pre-transplant dialysis modality, neither HD nor PD affects the outcome of renal transplantation.
Treatment of Metabolic Syndrome in Peritoneal Dialysis Patients
Authors: Li Philip Kam-Tao , Kwan Bonnie Ching-Ha , Ko Gary Tin-Choi , Chow Kai-Ming , Leung Chi Bon , Szeto Cheuk-Chun
Published: February 2020

Metabolic syndrome (MetS) occurs in about 50% of peritoneal dialysis (PD) patients. It encompasses a cluster of major risk factors for cardiovascular diseases. A modified National Cholesterol Education Program Third Adult Treatment Panel guideline for the diagnosis of MetS in PD patients has been proposed. Preliminary data suggest that PD patients with MetS in our cohort have an increased risk of cardiovascular mortality. The proinflammatory effects of adipose tissue are one of the reasons for poor outcome in obese PD patients. Lifestyle modification, including appropriate dietary restriction and exercise, especially reduction of fat mass in obese patients, has been one of the major areas proposed for managing patients with MetS. Individual therapeutic trials are treating hyperglycemia, hypertension, and dyslipidemia in dialysis patients. Evidence in PD patients that interventions targeting MetS can improve outcomes is still lacking. Large-scale studies with data on the clinical outcome for MetS intervention in PD patients are needed.
Transition of the Adolescent Patient to the Adult Clinic
Authors: Alpay Harika
Published: February 2020

Transition is the purposeful, planned movement of adolescents and young adults with chronic and medical conditions from child-centered to adult-oriented health care systems. For patients with chronic diseases that have begun early in life and continued into adulthood, transition is a very important period requiring not only medical, but also psychological and social support, which should begin on the day of diagnosis. Lack of coordination between pediatric and adult units, resistance of the adolescents and their families, and lack of planning and institutional support are a few of the numerous hardships that are encountered while trying to sustain a successful transition. This article reviews the steps of transition and also solutions for the potential barriers to a successful transition.
Quality of Life in Children with End-Stage Renal Disease: Does Treatment Modality Matter?
Authors: Lai Wai-Ming
Published: February 2020

In children with end-stage renal disease (ESRD), health-related quality of life (HRQOL) is a useful and important clinical measure for monitoring the child's well-being and functional status. One of the commonly used generic HRQOL instruments in children is the Pediatric Quality of Life Inventory, because an ESRD-specific instrument for children is still lacking. In the limited studies of HRQOL in children with ESRD, a significant effect of ESRD is seen, with significantly lower HRQOL scores than are seen in healthy children. In future, a pediatric ESRD-specific instrument is needed to address differences in HRQOL between children on hemodialysis, on peritoneal dialysis, and with a kidney graft.
Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium
Authors: Lameire Norbert H. , De Paepe Marc , Vanholder Raymond , Verbanck Johan , Ringoir Severin
Published: February 2020

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country.

The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications.

Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases.

The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs.

After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment.

At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.
Stephen Rosenak M.D. (1900): The Father of the Peritoneal Catheter
Authors: McBride Pat , Rosenak Stephen
Published: February 2020

In this new section of the Bulletin, Pat McBride will describe the life and work of some of those pioneers who have been instrumental in the development of peritoneal dialysis. Mr. McBride, an experienced historian who is Director of Sales and Technical Education, Artificial Organs Division of Travenol Laboratories, Inc. has already written a successful history of hemodialysis (Genesis of the Artificial Kidney).

The Editor and the Editorial Board of the Bulletin feel fortunate that Mr. McBride has agreed to undertake this new section of the Bulletin and thank him for his efforts in preserving the history of peritoneal dialysis.

The readers of the Bulletin are encouraged to participate in this undertaking by passing on suitable information concerning the history of peritoneal dialysis and are invited, if they wish, to suggest individuals who, or events that, deserve recognition.

In this first issue, Mr. McBride describes the contributions of Dr. Stephen Rosenak one of the fathers of peritoneal dialysis.
The Importance of Patient Selection for Continuous Ambulatory Peritoneal Dialysis
Authors: Coward Robert A. , Yvonne Linda Uttley , Elaine Murray , Greenwood  , Mallick Neter P.
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) was used between May 1980 and May 1981 to treat 21 patients for a total of 8.2 “patient years”. On commencing CAPD, patients were also assessed according to our established criteria, as being suitable for home hemodialysis -Group I (independent) 13 patients, 62 patient months; or hospital hemodialysis Group II (dependent) eight patients, 36 patient months. Biochemical control was good in both groups. In Group II, peritonitis was more frequent and rehabilitation was poorer with more frequent and longer hospital admissions than in Group I. Selection of patients can therefore reduce the incidence of complications. Fourteen of the 27 episodes of peritonitis occurred in the ward during training or while the patients were hospitalized for other reasons indicating the risk of such training in busy general medical wards.
Cimetidine Disposition in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Paton Thomas W. , Manuel M. Arifie , Walker Scott E.
Published: February 2020

The disposition of cimetidine was studied following a single intrave nous dose of 300 mg over 10 minutes in six male patients with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD). The infusion of cimetidine and CAPD were initiated simultaneously. Cimetidine disappearance from plasma was biphasic with beta-phase ti varying from 6.1 to 7.4 hours. The total body clearance varied from 138 to 195 ml/min with a peritoneal clearance ranging from 1.9 to 4.0 ml/min. The total amount of cimetidine removed in the dialysate varied from 3.1 to 8.3 mg (1.2 to 2.7% of the dose administered) over 24 hours. This study demonstrates that very little cimetidine is removed by CAPD. We recommend that, to avoid toxicity, patients on CAPD should be given 200 mg cimetidine every 12 hours.
Clinical Observations on the Pathogenesis of Peritoneal Dialysate Eosinophilia
Authors: Steiner Robert W.
Published: February 2020

Dialysate eosinophilia was noted in three patients undergoing peritoneal dialysis. In all cases, this eosinophilia was asymptomatic, and the process resolved spontaneously after two to seven weeks. In two cases, dialysate IgE levels were measured and were not elevated. In the third case, a transient episode of antibiotic-responsive, culture-negative peritonitis resulted in temporary disappearance of eosinophils from the peritoneum. Idiopathic peritoneal dialysate eosinophilia is an apparently benign entity, which may arise via mechanisms distinct from those involved in infectious peritonitis. It does not seem that IgE, a potent eosinophilotactic agent, necessarily is involved in the development of this disorder.
Renal Transplantation in Diabetes Mellitus
Authors: Cardella Carl J. , Tam J Paul Y. W. , Walker Frank , DeVeber George A. , Cook Gerald T.
Published: February 2020

With increasing frequency, renal transplantation has been used to treat uremic diabetics. At this center, during 1981,28% of all cadaveric transplants were performed in diabetics. The one-year patient and graft survival in the 36 diabetics, who had such transplants in this unit (85% and 54% respectively) is lower than in non-diabetic cadaveric recipients, chiefly because of increased mortality and allograft rejection among the diabetics. A major cause of morbidity and mortality is severe progressive vascular disease. In spite of these limitations, nephrologists should consider renal transplantation early in uremic diabetics before they develop life-threatening or disabling complications. Successful transplantation appears to stabilize or improve the non-vascular complications and thus, enhance the quality of life for diabetics with end-stage renal disease.
Special Care of the Diabetic Patient on CAPD
Authors: Chisholm Lionel
Published: February 2020

We monitored the ocular status of 12 insulin-dependent diabetics on CAPD for up to 42 months. In 16 eyes of eight patients followed for six months or longer, the visual acuity remained unchanged in 13, while in three eyes, the visual acuity deteriorated. Factors influencing our observations are discussed.
Four Years’ Experience with Continuous Ambulatory Peritoneal Dialysis (CAPD) in the Elderly
Authors: Kaye Michael , Pajel Percival A. , Somerville Peter J.
Published: February 2020

Forty-four patients established on CAPD were followed for up to four years. They were divided into two groups: Those under 65 years of age, and those older and the response to treatment evaluated. No difference was found in biochemistry, complications, frequency of peritonitis or mortality between the two groups. Also, the proportion changing to another mode of dialysis was similar for each. We have concluded that age should not be considered a barrier to successful treatment of ESRD by CAPD.
Renal Osteodystrophy in Patients Maintained on CAPD for More than Three Years
Authors: Digenis George , Khanna Ramesh , Pierratos Andreas , Meema H. Erik , Rabinovich Sol , Petit Jean , Oreopoulos Dimitrios G.
Published: February 2020

Studies of renal osteodystrophy in patients maintained on CAPD for short periods have shown conflicting results. The present study reports on the status of renal osteodystrophy in 27 patients maintained on CAPD for over three years. Ten men and 17 women with a mean age of 49.5 years were on CAPD for a mean of 45 months. Dialysate calcium was 6 mg%. Oral dietary calcium intake for all the patients was low (= 500 mg/day). AI(OH)3’ Vit. D and/or 1,25(OH)2D3 were prescribed to maintain serum calcium and phosphorus at normal levels. Patients were divided into two groups according to the radiological findings at the beginning of treatment. Group A (10 patients) included those who had no subperiosteal resorption (SPR) and Group B (17 patients) those with SPR at the initiation of CAPD. In Group A, SPR grade remained normal in eight patients and progressed in two. In Group B, SPR remained unchanged or increased in 14 while it improved in the remaining three.
Mycobacterium Chelonei Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dial ysis (CAPD)
Authors: Poisson Michel , Beroniade Vincent , Falardeau Pierre , Vega Carlos , Morisset Richard
Published: February 2020

This paper describes a case of Mycobacterium chelonei peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). The patient probably acquired the infection from tap water. He presented with cloudy effluent, abdominal pain and systemic toxicity. Originally, gram stain, Ziehl-Neelsen stain, aerobic and anaerobic cultures were negative. One week later, culture grew an aerobic, fast growing, acid fast bacterium, which later was identified as Mycobacterium chelonei. The peritonitis was treated successfully with erythromycin and catheter removal. The diagnosis of tuberculous and non-tuberculous mycobacterial peritonitis during CAPD can be difficult. Compared to usual bacterial peritonitis associated with CAPD, everything in these cases proves to be nonspecific. Mycobacterial infection should be suspected in all episodes of culture-negative peritonitis especially those which do not respond to usual antimicrobial therapy.
Intraperitoneal Insulin Cannot Correct the Hyperlipidemia of CAPD
Authors: Beardsworth Stephen F. , Goldsmith Henry J. , Stanbridge Brent R.
Published: February 2020

We have investigated the effect of the administration of small doses of intraperitoneal insulin (mean 2.7 ± 1.45 u/L) on the hyperlipidemia associated with continuous ambulatory peritoneal dialysis (CAPD) in nine non-diabetic patients. Despite significant lowering of both fasting (6.21 ± 0.9 → 4.2 ± 0.5 mmoI/L) and postprandial (9.74 ± 1.1 → 7.4 ± 1.06 mmol/L) blood glucose levels, we saw no effect on serum total cholesterol, triglycerides or B lipoproteins.
Peritoneal Dialysis in Refractory Congestive Heart Failure PART II: Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Robson Michael , Boleswar Arie Biro , Schai Knobel George , Ravid Mordchai
Published: February 2020

Three patients with intractable congestive heart failure (CHF) resistant to all other therapy were treated for three, five and six months by continuous ambulatory peritoneal dialysis (CAPD). They lost eight to II kg in weight and had a marked improvement in symptoms of heart failure. Recurrent peritonitis precluded the continuation of CAPD and all three patients died within two weeks of stopping the treatment.
Nutritional Status of Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Heide Brigitte , Pierratos Andreas , Khanna Ramesh , Pettit Jean , Ogilvie Raymond , Harrison Joan , McNeil Kenneth , Siccion Zenaida , Oreopoulos Dimitrios G.
Published: February 2020

Nutritional follow-up of 20 CAPD patients for 18–24 months showed a decrease in total body nitrogen, increase in total body potassium and body weight, and a decrease in protein intake over time. There was no correlation between changes in TBN and the biochemical parameters measured. Serial dietetic assessments and measurements of total body nitrogen as well as adherence to an adequate protein intake will assist in the prevention of malnutrition in CAPD patients.
Principles of Abdominal Surgery in Patients on Intermittent Peritoneal Dialysis
Authors: Deitel Mervyn , Thompson Douglas A. , Moffat Fredrick L. , Karanicolas Stavros , Mycyk Taras R.
Published: February 2020

Abdominal operations were required in 21 patients on intermittent peritoneal dialysis (IPD) -13 elective, eight emergency. There was one death in the elective group (inguinal herniorrhaphy) and four deaths in the emergency group (three spontaneous colonic perforations and one strangulated ventral hernia). Wound complications occurred in seven patients. Wounds require secure, watertight closure to prevent dialysis leak. In elective abdominal surgery, IPD should be carried out shortly before operation to delay dialysis for a few days after operation and also to decrease platelet dysfunction. Hernias should be repaired electively. Constipation should be avoided. Preoperative transfusion for anemia is generally unnecessary. Drains should be avoided or removed before resumption of IPD. Postoperative IPD should be done with one-liter exchanges. In certain instances, transfer to hemodialysis is indicated.
Middle Molecules in Chronic Uremic Patients Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Fürst Jonas Bergström Hiroyuki Asaba Peter , Lindholm Bengt
Published: February 2020

Endogenous middle molecules (MM), which accumulate in uremia are more efficiently removed and better controlled by CAPD than by other forms of dialysis treatment. The generation rate of MM's in CAPD patients is closely related to protein intake and/or breakdown.
The Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis
Authors: Flynn C.T.
Published: February 2020

Insulin-dependent diabetics with renal failure have a relatively poor long-term survival. The basic issue, therefore, is quality of life. CAPD allows the patient to be independent. The procedure can be performed as well by the blind as by a sighted patient and thus is available to blind diabetics. Intraperitoneal insulin offers a safe, consistent and convenient control of the blood sugar. Our experience suggests that continuous ambulatory peritoneal dialysis is the dialytic treatment of choice for the majority of insulin-dependent diabetic patients.
Thyroid Function Tests in Uremic Patients on Maintenance Dialysis: A Comparison of CAPD and Hemodialysis
Authors: Tan Chaim Chary , Thysen Benjamin , Gatz Michael , Freeman Ruth , Alpert Bertram E.
Published: February 2020

Thyroid function tests were performed in nine clinically euthyroid, chronic-renal-failure (CRF) patients on continuous ambulatory peritoneal dialysis (CAPD), and the results were compared with similar tests performed on normal controls and eight patients on maintenance hemodialysis (HD). As reported earlier in untreated patients with CRF and those maintained on HD, our patients on CAPD had markedly reduced total tri-iodothyronine (T3) concentration. Levels of serum thyroxine (T4), and serum free T4 estimated by the microencapsulated antibody technique were reduced in both groups of patients but were in the hypothyroid range only in the HD group. However, in keeping with the clinically euthyroid status of these patients, thyroid stimulating hormone levels were within normal limits. Finally, both groups of patients had low normal reverse T3 levels. These data confirm the presence of abnormalities in in vivo thyroid function tests in patients with CRF maintained by different modes of dialysis. The significance and mechanism of these abnormalities remains speculative.
Peritonitis-related Deaths among CAPD Patients
Authors: Fenton S.S.A.
Published: February 2020

In 18 deaths related to peritonitis in CAPD patients over the period 1977 to 1982, the main clinical features included persistent low-grade fever and leukocytosis, with or without abdominal symptoms and signs. These deaths were not prevented by catheter removal, laparotomy with surgical drainage and prolonged antibiotic therapy. Conventional imaging techniques such as ultrasound, CA T scan and Gallium scans may not detect intra-abdominal abscesses in such patients. In this series the risk of dying during a peritonitis episode was 2.3%, namely one death for each 480 patient months of experience: it remained unchanged over the five year period of the study.
Cardiovascular Deaths among CAPD Patients
Authors: Wu George
Published: February 2020

Forty-four of the 508 CAPD patients in Toronto died of cardiovascular complications during the period september 1977 -October 1982. More than 80% of these patients had evidence of ischemic or hypertensive heart disease before commencement of CAPD. The survival of CAPD patients, who were free of cardiac problems before starting CAPD, was significantly better than those who had angina pectoris, myocardial infarction or cardiomegaly at the onset of CAPD. The de novo incidence of ischemic heart disease in patients between ages 40 and 59 (n = 70) was 8.8% at the end of the first year, and 15%() at the end of the second year. These figures were comparable to those reported for hemodialysis patients but worse than those in nonuremic patients with similar risk factors.

After starting CAPD, 68.2% of the initially hypertensive patients became normotensive without taking any medication, and 25.8%() became normotensive with a reduced dose of antihypertensive medications. There was no statistically significant difference between the mean fasting plasma cholesterol and triglyceride levels of patients with and those without coronary artery disease.
Changes in Left Ventricular Anatomy and Function on CAPD
Authors: Leenen Frans H.H. , Smith Donna L. , Khanna Ramesh , Oreopoulos Dimitrios G.
Published: February 2020

In 17 patients with end-stage renal disease, we evaluated the effects of treatment with CAPD on L V anatomy and function by M -mode echocardiography. All patients had a history of hypertension and had echocardiographic evidence of increased LV mass related to both concentric and eccentric hypertrophy. On CAPD, blood pressure returned to normal in a consistent manner. L V mass decreased in most (14/17) patients as a result of a decrease in both L V wall thickness and LV dimension. Initially four of the 17 patients had diminished LV function. On CAPD, LV function improved in three of these four and no patient showed deterioration.

These results indicate that CAPD improves L V hypertrophy and L V function by normalizing both pressure and volume overload.
Pathogenesis and Treatment of Back Pain in Peritoneal Dialysis Patients
Authors: Hamodraka-Mailis Angela
Published: February 2020

Back pain made a major contribution to dialysis failure in eight CAPD patients during a five-year period, We were able to collect history, physical examination and radiological data in five of them. Common factors associated with back pain were:

1) long-standing back problem (4 of 5),

2) presence of bone or degenerative disease involving the spine or extraspinal disease affecting the posture and,

3) abnormal spinal mechanics on physical examination.

It is recommended that the training program of patients on CAPD, who show these high-risk factors, incorporate a “custom-made” back exercise program and possibly these patients should wear lumbosacral supports.
The Sterile Weld: A New Method for Connection in Continuous Ambulatory Peritoneal Dialysis
Authors: Hamilton Robert W. , Disher Betty A. , Dillingham Genevieve A. , Nicholas Ann F.
Published: February 2020

Peritonitis due to contamination in the spiking step of CAPD bag exchange remains a persistent problem. We describe here the Sterile Connecting Device (SCD), an instrument which accomplishes bag exchanges by welding an extension tube from the dialysate bag to the patient administration set.
Increased use of Hypertonic Dialysate by CAPD Patients following Repeated Episodes of Peritonitis
Authors: Cole Craig H. , Prichard Sarah , Waddell Robert W.
Published: February 2020

Many investigators are concerned that in patients receiving long-term CAPD, repeated episodes of peritonitis may reduce the ultrafiltration capacity of the peritoneum. In our CAPD program, patients who had had no previous episodes of peritonitis used an average of 0.68 hypertonic exchanges per day, compared to 2.13 hypertonic exchanges required by patients who had had two or more episodes of peritonitis. When this phenomenon was examined in more detail, we found that the increase in the number of hypertonic exchanges could be explained by two factors. Daily urine output fell from an average of 585 ml in the peritonitis-free group to 284 ml in the group with recurrent peritonitis. The latter group needed more hypertonic exchanges to stay in fluid balance. Apparent fluid intake during a 64hour period was calculated in 13 CAPD patients. This increased from 3909 ml in those with no peritonitis to 6267 ml in those with two or more episodes of peritonitis. In a separate study, we measured drainage volume with a hypertonic exchange in 19 CAPD patients. There was no apparent relationship between drainage volume and the number of previous episodes of peritonitis or between drainage volume and the length of time on CAPD.

We conclude that there is increased use of hypertonic exchanges in CAPD patients with a history of frequent peritonitis but this can be explained by factors other than a decrease in the ultrafiltration capacity of the peritoneum.
Loss of Ultrafil Tration in Continuous Ambulatory Peritoneal Dialysis: A Role for Acetate
Authors: Faller Bernadette , Marichal Jean-Francois
Published: February 2020

A retrospective analysis of the ultra-filtration (UF) capacity of patients treated by continuous ambulatory peritoneal dialysis since 1978 showed that in all 31 patients using acetatebutTered dialysate the UF decreased whereas it decreased in only two (14%) of 14 patients using lactate dialysate. Prolonged exposure of the peritoneum to acetate dialysate seems to be responsible for this loss of UF.
Aluminum Hyoroxioe-Inouceo Osteomalacia, Encephalopathy ANO Hyperaluminemia in CAPO. Treatment with Oesferrioxamine
Authors: Bertholf Roger L. , Roman Jorge M. , Savory Sue Brown John , Wills Michael R.
Published: February 2020

We present the clinical course of a patient who has been treated with CAPD since 1979. He developed dialysis encephalopathy and fracturing osteomalacia, and was found to have a serum aluminum concentration of 560 μg/L. Treatment with desferrioxamine over a six month's period reduced his serum aluminum concentration to a non-toxic level, and his symptoms abated. One year after his initial encephalopathy this patient has a normal EEG, the bone fractures have healed, and serum aluminum concentration is 38 μg/ L. Apparently the hyperaluminemia was due to the ingestion of prescribed aluminum hydroxide.
Recurrent Hepatic Coma in a Chronic Hemooialysis Patient: Successful Treatment by CAPO
Authors: Segaert Marc F. , Carlier Bernard , Verbanck Johan
Published: February 2020

A hemodialysis patient developed hepatic cirrhosis with subsequent portal-systemic encephalopathy. Switching from hemodialysis to CAPD prevented the recurrent episodes of hepatic coma. This observation suggests that, in combined chronic renal and hepatic failure with portal-systemic encephalo pathy, CAPD may be the treatment of choice. This paper presents evidence to support this assumption.

Chronic hemodialysis patients frequently develop hepatitis B, which sometimes results in hepatic cirrhosis. Portal-systemic encephalopathy (PSE) may ensue. We describe a patient in whom mild PSE repeatedly progressed to full hepatic coma during hemodialysis sessions. Switching the patient from hemodialysis (HD) to continuous ambulatory peritoneal dialysis (CAPD) prevented the recurrent hepatic coma.
Fungal Peritonitis in Peritoneal Dialysis: Our Experience and Review of Treatments
Authors: Fabris Aldo , Biasioli Stefano , Borin Donata , Brendolan Alessandra , Chiaramonte Stefano , Feriani Mariano , Pisani Edmondo , Ronco Claudio , La Greca Giuseppe
Published: February 2020

From January 1975 to April 1982, 10 of our patients undergoing chronic peritoneal dialysis developed fungal peritonitis. Of six treated without removing the catheter two survived after intraperitoneal (IP) administration of imidazole derivatives, and four died despite combined IP and intravenous (IV) therapy. Of four patients treated by catheter removal, all survived, two without any additional therapy and two after IV antifungal treatment. Three of the deaths followed cardiac or cerebral accidents, while one was related to Candida sepsis.

Bacterial peritonitis is a frequent complication of peritoneal dialysis (FD). In addition fungal peritonitis has been reported with increasing frequency with the growing diffusion of FD, the subsequent increase in infectious episodes, the antibiotic treatment, which such complications require and the improvement in technique for mycological diagnosis.

This paper describes our experience with the clinical manifestations of fungal peritonitis and its treatment in 10 patients undergoing intennittent peritoneal dialysis (IFD) or continuous ambulatory peritoneal dialysis (CAFD).
Continuous Ambulatory Peritoneal Dialysis in South Africa -A Four-Year Experience
Authors: Parsoo I. , Seedat Y.K. , Naicker S. , Kallmeyer J.C.
Published: February 2020

This study describes our experience with continuous ambulatory peritoneal dialysis (CAPD) over a four year period, during which 88 patients were offered CAPD. It compares and contrasts the response to CAPD among four racial groups in Natal viz asiatics, blacks, coloureds and whites. Peritonitis -the major complication, occurred with an overall incidence of one episode every 4.41 patient months. CAPD remains a useful alternative therapy in developing countries where a high percentage of patients with chronic renal failure would be denied a chronic renal failure program because of lack of expertise in hemodialysis and/or renal transplantation, or limited financial resources.

Continuous ambulatory peritoneal dialysis (CAPD) was first described by Moncrief and Popovich (1) and, since its modification by Oreopoulos and his group (2), this technique has gained world wide usage. South Africa, like many developing countries has a high incidence of end-stage renal disease (ESRD) but because of lack of resources and economical problems, few patients with ESRD can be treated by dialysis or renal transplantation. CAPD affords a relatively simple and inexpensive form of therapy for these patients. At the present time about 200 patients are on CAPD in South Africa. Natal, the smallest of four provinces in South Africa, has a population of about five million, the majority being blacks. The minority groups include whites, asiatics and coloureds. There is only one chronic dialysis centre in Natal; situated in Durban, it serves the entire province including parts of the Transkei. This paper describes a four-year experience with CAPD in this mixed population and discusses problems unique to this situation.
Continuous Ambulatory Peritoneal Dialysis with Three-Liter Exchanges: A Prospective Study
Authors: Kim Donald , Khanna Ramesh , Wu George , Clayton Sheila , Oreopoulos Dimitrios G.
Published: February 2020

In a prospective study all new patients entering our CAPD program were dialyzed with three-liter exchanges during the first training day and continued with this volume if they tolerated it. Of 47 new patients, 17 (36%) (Group A) tolerated three-liter exchanges, whereas the remaining 30 (Group B) were treated with 4 x two-liter exchanges per day. Group A contained 14 men and three women with an average age of 47 years and a mean body surface area of 1.7 m2. Group B had 15 men and 15 women with an average age of 52 years and a mean body surface area of 1.6 m2. The average follow-up period was 6.4 and 7.1 months respectively. In Group A, eight pa. tients continued on three-liter CAPD, six were transplanted, and three were converted to two-liter exchanges because of penile and scrotal swelling, nausea and vomiting, and shortness of breath. The two groups showed no difference in biochemical and B.P. control. The 24-hour protein losses in the dialysate were also similar. The incidence of peritonitis in Group A was one episode every 55 patient months, significantly lower (p < 0.05) than that in Group B -one episode every 14 patient months.
Host Defense Mechanisms of the Peritoneal Cavity and Continuous Ambulatory Peritoneal Dialysis
Authors: Keane William F. , Peterson Phillip K.
Published: February 2020

Clinical and experimental data reviewed in this paper illustrate the perturbations of normal biological functions, which may accompany a major technological advance. There is a marked reduction in opsonic molecules, particularly IgG and C3, that occur after the instillation of large volumes of dialysate into the abdominal cavity. This greatly alters the normal balance in the peritoneal milieu and significantly impairs the normal function of phagocytic cells in the abdominal cavity. The “immunocompromised environment” produced is reflected in the high incidence of peritonitis in CAPD patients. Gram-positive organisms, particularly S. epidermidis, predominate. The higher incidence of gram-positive organisms in CAPD peritonitis probably reflects the more frequent exposure to gram-positive organisms during CAPD. These clinical data coupled with our experimental results suggest that the instillation of IgG locally in the abdominal cavity might enhance host defenses against peritonitis. This approach to prevention would represent a modern application of a treatment that was used extensively in the era before antibiotic therapy.
Evaluation of the Replaceable Peritoneal Catheter “Repl-A-Cath”: A Prospective Study
Authors: Cavagna Romano , Tessarin Cristina , Cerutti Mario , Casol Daniela
Published: February 2020

The authors evaluated Repl-A-Cath -a replaceable peritoneal catheter, over a three-year period. This device consists of a silicone “percutaneous tunnel”, through which a catheter is inserted into the peritoneal cavity. The catheter, which is hermetically sealed to the silastic tunnel, can be removed and replaced non-surgically if necessary. Because of its system of hermetical sealing, it has the same degree of bacteriological safety as other models in use. Among 31 ReplA-Cath's implanted in 27 patients (21 on CAPD, six on IPD), the incidence of complications was very low. The greatest advantage of this catheter is that it can be replaced in case of obstruction and poor dialysate drainage can be corrected without trauma.