bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors Responsible for Ultrafiltration Failure in Early Stages of Peritoneal Dialysis
Authors: Selgas Rafael , Bajo M.-Auxiliadora , Castro M.-José , Del Peso Gloria , Aguilera Abelardo , Fernández-Perpén Antonio , Cirugeda Antonio , Sánchez-Tomero José A.
Published: February 2020

Objective

To define risk factors for ultrafiltration failure (UFF) during early stages of peritoneal dialysis (PD).

Design

Retrospective analysis of a group of patients whose peritoneal function was prospectively followed.

Setting

A tertiary-care public university hospital.

Patients

Nineteen of 90 long-term PD patients required a peritoneal resting period to recover UF capacity: 8 had this requirement before the third year on PD (early, EUFF group) and 11 had a late requirement (LUFF group). The remaining 71 patients, those with stable peritoneal function over time, constituted the control group.

Main Outcome Measures

Peritoneal UF capacity under standard conditions (monthly) and small solute peritoneal transport (yearly).

Results

None of the conditions appearing at the start of PD or during the observation period could be definitely identified as the cause of UFF. There were no differences in characteristics between the EUFF group and the other two groups, except for the higher prevalence of diabetes in the EUFF group. Residual renal function (RRF) declined in all three groups during the first 2 years, with rapid loss during the third year in the EUFF group. This rapid loss in RRF was coincident with UFF. Peritoneal solute and water transport at baseline was similar in the three groups. After 2 years on PD, individuals in the EUFF group showed a significantly lower UF and higher creatinine mass transfer coefficient values than those in the LUFF group. Diabetic patients in the control group showed remarkable stability in UF capacity over time. During the second year on PD, requirement for increases in dialysate glucose concentration was 3.4 ± 0.5% in the LUFF group, but as high as 25.5 ± 24.2% in the EUFF group. The accumulated days of active peritonitis (APID, days with cloudy effluent) were similar for the three groups after 1, 2, and 3 years on PD. Interestingly, diabetic patients in the control group showed an APID index significantly lower than the overall EUFF group. Diabetics in the control group also had significantly lower APID versus nondiabetics in the control group ( p = 0.016).

Conclusions

Our findings suggest that certain patients develop early UFF type I. Diabetic state and a higher glucose requirement to obtain adequate UF suggest that glucose on both sides of the peritoneal membrane could be responsible. The mechanisms for this higher requirement remain to be elucidated. The identification of a larger cohort of these early UFF patients should lead to a better exploration of the primary pathogenic mechanisms.
High Peritoneal Permeability Predisposes to Hepatic Steatosis in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients Receiving Intraperitoneal Insulin
Authors: Nevalainen Pasi I. , Kallio Timo , Lahtela Jorma T. , Mustonen Jukka , Pasternack Amos I.
Published: February 2020

Objective

To evaluate hepatic fat accumulation in diabetic patients taking intraperitoneal or subcutaneous insulin treatment during continuous ambulatory peritoneal dialysis (CAPD).

Design

Cross-sectional study.

Setting

Tertiary-care university hospital.

Patients

We studied 16 patients with diabetic end-stage renal disease currently treated with CAPD. Median age was 42 years (range: 34 – 70 years), duration of diabetes was 27.5 years (range: 17 – 39 years), and duration of CAPD was 16.5 months (range: 2 – 59 months).

Outcome Measures

Ultrasound measures of liver steatotic area and thickness, peritoneal equilibration test (PET), weekly Kt/V urea, protein catabolic rate (PCR), hemoglobin A1c (HbA1c), lipoproteins, alanine aminotransferase, alkaline phosphatase, insulin dose, and dialysate glucose load.

Results

Focal hepatic fat accumulation was found. The location of steatosis was subcapsular; a negligible amount was periportal. Hepatic subcapsular steatosis was present in 7 of 8 patients taking insulin intraperitoneally and in 0 of 8 patients taking insulin subcutaneously. The maximal thickness of subcapsular steatosis correlated directly with peritoneal transport rate (2-hour dialysate-to-plasma creatinine ratio in PET, r = 0.80, p < 0.05) and inversely with PCR ( r = –0.82, p < 0.05). The area of the lesions correlated directly with body weight ( r = 0.80, p < 0.05) and inversely with weekly Kt/V urea ( r = –0.90, p < 0.01).

Conclusions

Intraperitoneal insulin, together with glucose-based peritoneal dialysate, induces hepatic subcapsular steatosis. The amount of hepatic subcapsular steatosis increases when peritoneal transfer rate and body weight are high.
Correlation of Intraperitoneal Antibiotic Pharmacokinetics and Peritoneal Membrane Transport Characteristics
Authors: Elwell Rowland J. , Bailie George R. , Manley Harold J.
Published: February 2020

Objective

To identify correlations between the pharmacokinetic variables that describe drug disposition in peritoneal dialysis (PD) patients and the measures used to assess dialysis adequacy.

Design and Methods

This retrospective study re-evaluated data collected during previous pharmacokinetic studies for intraperitoneally administered cefazolin, ceftazidime, and gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients, and intravenous cefazolin and tobramycin in automated PD patients. Pharmacokinetic variables were compared to creatinine clearance (CCr), Kt/V, and peritoneal equilibration test data using the Pearson product correlation coefficient ( r).

Results

Prominent correlations were found between renal CCr and renal Kt/V, with renal clearances of CAPD cefazolin and ceftazidime, and automated PD tobramycin and cefazolin ( r values ranged from 0.698 to 0.986; p < 0.05).

Conclusion

These findings support current peritonitis treatment recommendations that patients with residual renal function may require higher doses or more frequent drug administration.
Chronic Peritoneal Inflammation by Cyanate in Rats
Authors: Mun Kyo-Cheol , Yeo Mi-Young , Kim Sang-Pyo , Kim Hyun-Chul , Kwak Chun-Sik
Published: February 2020

Objective

During peritoneal dialysis, the peritoneum is exposed to waste products, including urea. Urea forms cyanate spontaneously at body temperature and pH, and cyanate carbamylates amino acids, peptides, and proteins. Cyanate may contribute to peritoneal injury with morphological changes in the peritoneum. To test this hypothesis, we injected cyanate into rats.

Methods

Experiments were performed in two groups of 7 rats each. In the cyanate group, each rat received 1 mL of 1.5 μmol/L potassium cyanate dissolved in 40 mmol/L sodium bicarbonate solution intraperitoneally each experiment day. In the control group, each rat received 1 mL of 1.5 μmol/L potassium bicarbonate instead of potassium cyanate. The rats in both groups were anesthetized and killed at the 85th day after the first injection. After formalin fixation, tissue samples from abdominal walls and livers were sliced, embedded in a standard manner, and stained with hematoxylin and eosin.

Results

Parietal peritoneum from rats in the cyanate group showed a mild increase in the number of fibroblasts, with collagen deposits, infiltration by mononuclear cells, vascular congestion, round-shaped transformation of mesothelial cells, widening of submesothelial spaces, and abundant denudation of mesothelial cells. The visceral peritoneum from rats in the cyanate group showed collagen deposits with fibroblastic proliferation.

Conclusions

Cyanate can induce chronic inflammation in the peritoneum, and exposure of the peritoneum to cyanate may contribute to peritoneal injury in patients being treated with peritoneal dialysis.
A Comparison between 1.36% and 3.86% Glucose Dialysis Solution for the Assessment of Peritoneal Membrane Function
Authors: Smit Watske , Langedijk Monique J. , Schouten Natalie , Van Den Berg Nicole , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Objective

To assess peritoneal membrane function with respect to fluid transport, parameters of low molecular weight solute transport, and estimations of the function of peritoneal water channels, comparing the results from a 1.36%/1.5% glucose solution with those from a 3.86%/4.25% solution in standardized peritoneal function tests.

Design

The study was performed in 40 stable continuous ambulatory peritoneal dialysis (CAPD) patients [median age 50 years (range: 22 – 74 years); duration of CAPD 9 months (range: 2 – 45 months)] who underwent two standard peritoneal permeability analyses (SPAs) within 1 month. One SPA used 1.36% glucose; the other, 3.86% glucose. Mass transfer area coefficients (MTACs) and dialysate-to-plasma (D/P) ratios were compared for the two solutions. Also, two different methods of estimating aquaporin-mediated water transport were compared: the sieving of sodium (3.86% glucose) and the difference in net ultrafiltration (ΔNUF), calculated as NUF 3.86% SPA – NUF 1.36% SPA.

Results

Median NUF in the 1.36% glucose SPA was –46 mL (range: –582 mL to 238 mL); in the 3.86% SPA, it was 554 mL (range: –274 mL to 1126 mL). The median difference in NUF for the two SPAs was 597 mL (range: 90 – 1320 mL). No difference between the two solutions was seen for the MTAC of creatinine (11.4 mL/min for 1.36% vs 12.0 mL/min for 3.86%) and absorption of glucose (64% vs 65%, respectively). Also, D/P creatinine was not different: 0.77 (1.36%) and 0.78 (3.86%). However, the ratio of dialysate glucose at 240 minutes and at 0 minutes (Dt/D0) was 0.34 (1.36%) and 0.24 (3.86%), p < 0.01. Values of D/P creatinine from the two glucose solutions were strongly correlated. The intra-individual differences were small and showed a random distribution. Patient transport category was minimally influenced by the tonicity of the dialysate. The minimum D/P Na+ (3.86%) was 0.884, and it was reached after 60 minutes. After correction for Na+ diffusion, D/P Na+ decreased to 0.849 after 120 minutes. The correlation coefficient between the diffusion-corrected D/P Na+ and the ΔNUF was 0.49, p < 0.01. An inverse relationship was present between MTAC creatinine and D/P Na+ ( p < 0.01) This correlation can be explained by the rapid disappearance of the osmotic gradient owing to a large vascular surface area. Such a correlation was not present between MTAC creatinine and ΔNUF.

Conclusions

We conclude that a standardized 4-hour peritoneal permeability test using 3.86%/4.25% glucose is the preferred method to assess peritoneal membrane function, including aquaporin-mediated water transport. The D/P Na+ after correction for Na+ diffusion is probably more useful for the assessment of aquaporin-mediated water transport than is ΔNUF obtained with 3.86%/ 4.25% and 1.36%/1.5% glucose-based dialysis solutions.
A Laparoscopic Approach under Local Anesthesia for Peritoneal Dialysis Access
Authors: Crabtree John H. , Fishman Arnold
Published: February 2020

Objective

Presented herein is a technical description of a time-proven laparoscopic approach to establishing successful long-term peritoneal dialysis access.

Design

Using a two-port technique, the peritoneal catheter is inserted through a paramedian port site while continuously monitoring the implant procedure with a laparoscope from a second port location. A long rectus sheath tunnel created with a nontrocar port device keeps the dialysis catheter oriented toward the pelvis. Helium abdominal insufflation enables full surgical laparoscopy under local anesthesia. Validation of the effectiveness of the technique is made by comparison to previous implantation experience using an open dissection method.

Patients

Laparoscopic implantation of peritoneal catheters was performed in 150 patients, and placement by open dissection was accomplished in 63 patients.

Main Outcome Measure

The incidence of complications and revision-free catheter survival between implantation methods were compared.

Results

Catheters implanted laparoscopically had a significantly lower incidence of flow dysfunction ( p < 0.05) and better survival ( p < 0.001) than those placed by open dissection.

Conclusions

Compared to implantation by open dissection, the laparoscopic approach provides the patient reduced perioperative discomfort. The procedure can be performed safely with the patient under local anesthesia on an ambulatory basis. Laparoscopic implantation significantly reduces the incidence of catheter flow dysfunction and permits simultaneous identification and correction of other problems that could complicate dialysis therapy.
Peritoneal Homocysteine Clearance is Inefficient in Peritoneal Dialysis Patients
Authors: Johnson David W. , Kay Troy D. , Vesey David A. , Isbel Nicole , Campbell Scott B. , Hawley Carmel M.
Published: February 2020

Objectives

To investigate the degree and the determinants of peritoneal homocysteine (Hcy) clearance and to compare measured Hcy clearance with the Hcy clearance predicted based on molecular weight (MW).

Design

Cross-sectional observational analysis.

Setting

Tertiary care institutional dialysis center.

Patients

Sixty-five stable peritoneal dialysis (PD) patients.

Outcome Measures

Fasting blood and 24-hour pooled dialysate effluents were collected for determination of peritoneal clearances of Hcy (CpHcy), urea (CpUr), and creatinine (CpCr). The dialysate-to-plasma creatinine ratio at 4 hours (D/P Cr 4 h) and levels of red cell folate, B12, ferritin, and C-reactive protein (CRP) were measured concurrently. Observed CpHcy was compared with predicted clearance, based on Hcy plasma protein binding and the relative molecular weights of Hcy, urea, and creatinine.

Results

Plasma concentrations of Hcy averaged 24.6 ± 1.1 μmol/L and were elevated above the upper limit of normal in 59 (91%) patients. The mean dialysate concentration of Hcy was 2.9 ± 0.3 μmol/L, equating to a daily peritoneal elimination of 34.6 ± 3.6 μmol. Observed CpHcy was closely approximated by predicted CpHcy (8.7 ± 0.6 L/week/1.73 m2 vs 9.0 ± 0.3 L/week/1.73 m2 respectively, p = 0.55). Patients maintained on automated PD ( n = 5) had a CpHcy similar to that of patients treated with continuous ambulatory peritoneal dialysis (8.9 ± 1.0 L/week/1.73 m2 vs 8.7 ± 0.6 L/week/1.73 m2, p = 0.92). The CpHcy was significantly correlated with C-reactive protein (CRP), D/P creatinine, CpUr, CpCr, and peritoneal protein loss, but not with plasma Hcy, albumin, B12, ferritin, age, dialysis duration, peritonitis episodes, or daily dialysate effluent volume. By multivariate analysis, the only variables that remained significant independent predictors of CpHcy were CRP and D/P Cr 4 h. High and high-average transporters had a higher CpHcy than low and low-average transporters (9.7 ± 0.8 L/week/1.73 m2 vs 7.0 ± 0.7 L/week/1.73 m2, p < 0.05), despite comparably elevated plasma Hcy concentrations [25.2 ± 1.5 μmol/L vs 23.4 ± 1.6 μmol/L, p = nonsignificant (NS)].

Conclusions

Elevated plasma concentrations of Hcy are not efficiently reduced by PD. The relatively low peritoneal clearance of Hcy is largely accounted for by a high degree of plasma protein binding and is significantly influenced by peritoneal membrane permeability.
Neoangiogenesis in the Peritoneal Membrane
Authors: Krediet Raymond T. , Zweers Machteld M. , Van Der Wal Allard C. , Struijk Dirk G.
Published: February 2020

Objective

This study reviews relevant publications on the peritoneal vasculature and tries to establish morphological–functional relationships.

Design

The design is a review article.

Results

Recent morphological studies in peritoneal dialysis (PD) patients have shown the presence of diabetiform neoangiogenesis in long-term peritoneal dialysis. The same abnormalities could be induced in rats administered a high glucose dialysis solution daily for 20 weeks. The animals showed functional abnormalities in peritoneal transport similar to those found in long-term PD patients. Evidence was obtained in patients that vascular endothelial growth factor could be involved in glucose-induced peritoneal neoangiogenesis.

Conclusions

Diabetiform peritoneal neoangiogenesis is an important pathogenetic factor in ultrafiltration failure in long-term peritoneal dialysis patients.
Strategies to Reduce Glucose Exposure in Peritoneal Dialysis Patients
Authors: Holmes Clifford J. , Shockley Ty R.
Published: February 2020

Glucose has been used successfully for more than two decades in peritoneal dialysis, and in this regard, must be considered a safe and effective osmotic agent. Recently, however, insight has been growing about the potential for metabolic and peritoneal effects arising from long-term exposure to high glucose concentrations—for example, hyperlipidemia and loss of peritoneal ultrafiltration. Clinical concerns over exposure to excessive glucose and glucose degradation products (GDPs) during peritoneal dialysis can be significantly ameliorated by the use of non-glucose-based peritoneal dialysis (PD) solutions, in combination with more biocompatible glucose-based formulations. Peritoneal exposure to GDPs can be reduced by using low-GDP-containing glucose formulations and non glucose solutions such as amino acids and icodextrin. Peritoneal glucose exposure, hyperosmolar stress, and carbohydrate absorption can be reduced by using a combination of icodextrin and amino acids.
Pre-Clinical Biocompatibility Testing of Peritoneal Dialysis Solutions
Authors: Holmes C.J.
Published: February 2020

Pre-clinical biocompatibility testing of peritoneal dialysis (PD) solutions has become an integral part of new solution development. The construction of a pre-clinical screening program for solution biocompatibility should take a hierarchical approach, starting with in vitro cell viability and function assays. The selection of cell types and assay systems for the in vitro studies should be broad enough to permit a balanced interpretation. Whenever possible, animal models are recommended for the next hierarchical level of testing, followed by human ex vivo study designs. Designs of the latter sort provide evidence that a new solution formulation is exerting an altered biological response in vivo; the response is not purely an in vitro artifact or restricted to a given animal species. This article discusses the various approaches available for biocompatibility testing during the pre-clinical phase of solution development, with an emphasis on the advantages and drawbacks of each method.
First In Vitro and In Vivo Experiences with Stay·Safe Balance, A pH-Neutral Solution in a Dual-Chambered Bag
Authors: Lage Cristina , Pischetsrieder Monika , Aufricht Christoph , Jörres Achim , Schilling Holger , Passlick–Deetjen Jutta
Published: February 2020

In addition to low pH and high osmolarity, glucose degradation products (GDPs) are considered to play a major role in the bioincompatibility of peritoneal dialysis fluids (PDFs). The formation of GDPs can be reduced by separating the glucose component of the solution (kept at very low pH) from the lactate component of the solution (kept at alkaline pH) during sterilization and storage. This development has been achieved by the use of a dual-chambered bag. Immediately before infusion, the seam between the two chambers is opened, and the contents are mixed. The result is a fluid with a more physiologic pH in the range 6.8 – 7.4.

Concentrations of 3-deoxyglucosone (3-DG), methyl-glyoxal (MG), acetaldehyde (AA), and formaldehyde (FA) in Stay·Safe Balance (Fresenius Medical Care, Bad Homburg, Germany) were remarkably reduced when compared to conventional PD solution [conventional PDF (1.5% glucose): 172 μmol/L, 6 μmol/L, 152 μmol/L, and 7 μmol/L respectively; Stay·Safe Balance (1.5% glucose): 42 μmolL, < 1 μmol/L, < 2 μmol/L, and < 3 μmol/L respectively; conventional PDF (4.25% glucose): 324 μmol/L, 10 μmol/L, 182 μmol/L, and 13 μmol/L respectively; Stay·Safe Balance (4.25% glucose): 60 μmol/L, < 1 μmol/L, < 2 μmol/L, and < 3 μmol/L respectively).

Human peritoneal mesothelial cells (HPMCs) were exposed to a control solution, a conventional PDF [CAPD 2, 1.5% glucose (Fresenius Medical Care, Bad Homburg, Germany)], and Stay·Safe Balance, either in a co-incubation model (24-hour PDF exposure) or in a pre-incubation model (30-min PDF exposure), followed by 24-hour recovery in culture medium. Interleukin-1β (IL-1β)–stimulated (1 ng/mL) IL-6 secretion from HPMCs was assessed by ELISA. Exposure of HPMCs to conventional PDF resulted in a significant reduction in IL-6 release, which was fully restored following exposure to Stay·Safe Balance. In addition to the short-term investigations, long-term in vitro studies were also carried out. All fluids had near-neutral pH and were changed every second day. After 1, 3, 5, 7, 10, and 13 days of exposure, cell viability was assessed. Whereas exposure to conventional PDF resulted in a significant reduction in HPMC viability after just 3 – 5 days, no significant toxicity of filter-sterilized or dual-chambered fluid was observed for up to 13 days.

An observational study with 9 patients suggested that the efficacy of Stay·Safe Balance is equivalent to that of conventional solution. However, even short-term treatment (8 ± 1 weeks) with this more biocompatible solution seems to improve mesothelial cell mass as indicated by a rise in cancer antigen 125 (CA125) from a baseline of 47 ± 37 U/ min to 172 ± 90 U/min.

Our data indicate that Stay·Safe Balance may help to better preserve peritoneal membrane cell function. An ongoing European multicenter study is expected to confirm these results.
Peritoneal Accumulation of Advanced Glycosylation End-Products in Diabetic Rats on Dialysis with Icodextrin
Authors: Lee Jeong Ho , Reddy Dheerendra K. , Saran Rajiv , Moore Harold L. , Twardowski Zbylut J. , Nolph Karl D. , Khanna Ramesh
Published: February 2020

Objective

To evaluate and compare the effects of glucose-based solutions to those of icodextrin with respect to peritoneal transport characteristics and formation of advanced glycosylation end-products (AGEs) in the peritoneal membrane in the diabetic rat model of peritoneal dialysis (PD).

Study Design

Thirty-three male Sprague–Dawley rats weighing between 275 – 300 g were divided into 5 groups: group C ( n = 6), control rats with catheter but not dialyzed; group D ( n = 5), diabetic rats with catheter but not dialyzed; group G ( n = 7), diabetic rats dialyzed with standard 2.5% glucose solution for daytime exchanges and 4.25% glucose solution for the overnight exchange; group H ( n = 8), diabetic rats dialyzed with standard 2.5% glucose solution for daytime exchanges and 7.5% icodextrin solution for overnight exchanges; group I ( n = 7), diabetic rats dialyzed with 7.5% icodextrin solution for all exchanges. Dialysis exchanges were performed three times daily with an instillation volume of 25 mL per exchange for a period of 12 weeks. Tissue sections were stained using a monoclonal anti-AGE antibody. One-hour peritoneal equilibration tests (PET) were performed every 4 weeks for comparison of transport characteristics.

Results

The level of immunostaining was lowest in group C and highest in group G. Significant differences were seen between group C and groups G, H, and I ( p < 0.001, p = 0.001, and p < 0.05 respectively). Significant differences were also found between group G and groups D and I ( p < 0.05 and p < 0.05 respectively). Over time, glucose concentration at the end of an exchange versus concentration at instillation (D/D0 glucose) decreased and dialysate-to-plasma ratio (D/P) of urea increased. Significant differences were found between groups C and H for D/D0 glucose (0.40 ± 0.01 vs 0.35 ± 0.01, p < 0.05); and between groups C and H for D/P urea (0.87 ± 0.03 vs 0.97 ± 0.02, p < 0.05).

Conclusions

These results suggest that AGE formation is lower with the use of peritoneal dialysis solution containing icodextrin than with glucose-based solutions. We conclude that the use of icodextrin may be helpful in slowing the deterioration of the peritoneal membrane, prolonging its use for dialysis.
The Influence of Demographic Factors and Modality on Loss of Residual Renal Function in Incident Peritoneal Dialysis Patients
Authors: Holley Jean L. , Aslam Nabeel , Bernardini Judith , Fried Linda , Piraino Beth
Published: February 2020

Objective

To determine whether gender, race, diabetes, peritoneal dialysis (PD) modality, and comorbid conditions influence loss of residual renal function (RRF).

Design

Retrospective study of incident PD patients, using database of prospectively collected demographic, laboratory, and clearance data.

Setting

Peritoneal Dialysis Registry of the University of Pittsburgh Medical Center.

Patients

The study included 184 continuous ambulatory PD and automated PD patients who had at least two 24-hour urine collections for glomerular filtration rate (GRF) between April 1991 and March 2000. 836 urine collections were analyzed.

Outcome Measures

Loss of RRF was defined as the slope of the decline in GFR as measured by the average of creatinine and urea clearances in 24-hour urine collections. Stepwise forward regression was used to identify demographic and laboratory factors associated with loss of GFR. Spearman correlations were used to assess the significance of associations.

Results

The median rate of decline of renal function was –0.17 mL/minute/month. Gender, race, diabetes, automated PD, peritoneal equilibration test, protein equivalent of nonprotein nitrogen appearance normalized to body surface area, and serum albumin did not predict loss of RRF. Cardiac disease was the only variable affecting decline of RRF ( p = 0.045).

Conclusion

Modality of PD and patient demographic factors do not contribute to the rate at which RRF is lost in incident PD patients. Additional study of the factors contributing to the decline and maintenance of RRF is needed.
Guidelines by An AD HOC European Committee on the Assessment of Growth and Nutrition Status in Children on Chronic Peritoneal Dialysis
Authors:   on behalf of the European Paediatric Peritoneal Dialysis Working Group, Coleman Janet E. , Edefonti Alberto , Watson Alan R.
Published: February 2020

If children are to thrive and grow on chronic peritoneal dialysis (CPD), close attention to their nutrition needs is required, with dietetic support being an essential part of the multidisciplinary team approach. This paper offers a practical approach to the assessment of growth and nutrition status in children on CPD under a combined medical and dietetic strategy.
Effective Treatment of Peritoneal Dialysis-Associated Peritonitis with Cefazolin and Ceftazidime in Children
Authors: Rusthoven Esther , Monnens Leo A.H. , Schröder Cornelis H.
Published: February 2020

Objective

To evaluate the use of the combination of cefazolin and ceftazidime for initial treatment of peritoneal dialysis (PD)-related peritonitis in pediatric patients.

Design

Retrospective nonrandomized study.

Setting

Pediatric dialysis units of the University Medical Center of Utrecht and Nijmegen, The Netherlands.

Patients

40 children (median age 5.4 years) who were treated with PD during the study period of 4.5 years.

Interventions

All 50 episodes of peritonitis that occurred during the study period were evaluated by review of medical records. Patients were given intraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L and cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were continued for 14 days.

Results

After identification of the causative microorganism, one of the antibiotics was discontinued in 34 cases, and the antibiotic schedule was adapted in 2 cases. All cases were initially cured within 3 days. In 5 cases (10%), there was a peritonitis with the same organism recurring within 2 weeks after completion of treatment. There were 4 cases of PD-related peritonitis caused by pseudomonas, all of which were cured.

Conclusions

The antibiotic combination of cefazolin and ceftazidime is effective for the initial therapy of PD-related peritonitis in children. The toxic complications of aminoglycosides are avoided with this combination.
Peritoneal Dialysis for Management of Pediatric Acute Renal Failure
Authors: Flynn Joseph T. , Kershaw David B. , Smoyer William E. , Brophy Patrick D. , McBryde Kevin D. , Bunchman Timothy E.
Published: February 2020

Background

While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention.

Design

Retrospective database review of children requiring PD for ARF over a 10-year period.

Setting

Pediatric intensive care unit at a tertiary-care referral center.

Patients

Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF.

Results

Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome ( 13 ), sepsis ( 10 ), nonrenal organ transplant ( 7 ), malignancy ( 3 ), and other ( 3 ). Mean duration of PD was 11 ± 13 days. Children with ARF were younger (30 ± 48 months vs 88 ± 68 months old, p < 0.0001) and smaller (11.9 ± 15.9 kg vs 28 ± 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease ( p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%.

Conclusions

Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.
Late Renal Transplant Failure: An Adverse Prognostic Factor at Initiation of Peritoneal Dialysis
Authors: Sasal Joanna , Naimark David , Klassen Judy , Shea Judy , Bargman Joanne M.
Published: February 2020

Background

Early renal transplant failure necessitating a return to dialysis has been shown to be a poor prognostic factor for survival. Little is known about the outcome of patients with late transplant failure returning to dialysis. It was our clinical impression that late transplant failure (>2 months) carries an increased morbidity and mortality risk in patients returning to dialysis.

Objective

To determine whether patients with a failed renal transplant have an outcome different to those on dialysis who have never received a kidney transplant.

Setting

Peritoneal dialysis (PD) unit in a teaching hospital.

Patients and Design

All failed renal transplant patients (fTx) in the Toronto Hospital Peritoneal Dialysis program between 1989 and 1996 were identified. This cohort of 42 fTx patients was compared with a cohort of randomly selected never-transplanted PD patients (non-Tx). The PD program was selected because of the availability of well-documented patient archival material. The non-Tx group was matched for age and presence of diabetes. Data were collected until retransplantation, change of dialysis modality or center, death, or until June 1998.

Results

There was no difference at initiation of PD between groups in serum albumin, residual renal function, or mean serum parathyroid hormone level. The mean low-density lipoprotein level was significantly higher in the fTx cohort. The duration of dialysis before Tx in fTx patients accounted for the increased total length of dialysis in fTx (mean 15 months). However, post-Tx the duration of PD was similar for both groups (30.7 months for fTx vs 31.6 months for non-Tx). The fTx group had a considerably worse outcome than the non-Tx group. The time to first peritonitis, subsequent episodes of peritonitis, catheter change, or transfer to hemodialysis occurred at a much faster rate in fTx patients. The most dramatic difference was in survival. There were 3 deaths in the non-Tx group and 12 in the fTx group ( p < 0.01). The mean age at time of death in the fTx group was 47.5 years. Deaths were due mainly to gram-negative peritonitis and cardiovascular disease.

Conclusions

W e conclude that late failed renal transplant patients starting dialysis are at increased risk of complications and have strikingly higher mortality rates than non-Tx patients. A previously failed kidney transplant can be considered an adverse prognostic factor for patients commencing PD; these patients need to be closely monitored. Although this study was limited to PD patients, the same principles likely apply to fTx patients returning to any form of renal replacement therapy.
Peritoneal Dialysis Case Forum
Authors: Burkart John M. , Piraino Beth , Prichard Sarah
Published: February 2020

Hypercalcemia in a Peritoneal Dialysis Patient
Acidosis Correction with a new 25 Mmol/L Bicarbonate/15 Mmol/L Lactate Peritoneal Dialysis Solution
Authors: Carrasco Alfonso Miguel , Rubio Maria Auxiliadora Bajo , Tomero Jose Antonio Sanchez , Girón Fernando Fernandez , Rico Miguel Gonzalez , Del Peso Gilsanz Gloria , Perpén Antonio Fernandez , Ramón Rafael Garcia , Bueno Isabel Frias , Tranæus Anders , Faict Dirk , Hopwood Alexandra
Published: February 2020

Objective

The aim of this study was to evaluate the effects of a combined 25 mmol/L bicarbonate/15 mmol/L lactate-based solution (Bic/Lac), compared to a 35 mmol/L lactate solution (Lac) — the most commonly used solution for patients in southern Europe — on the venous plasma bicarbonate level in patients treated with continuous ambulatory peritoneal dialysis (CAPD).

Design

This was a randomized, parallel, controlled, open-label study, with patients studied for a period of 3 months preceded by a 1-month baseline and followed by a 1-month follow-up. Patients used the 35 mmol/L lactate solution during baseline and follow-up periods.

Setting

Four Spanish nephrology centers.

Patients

Thirty-one (20 Bic/Lac, 11 Lac) well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) CAPD patients.

Interventions

Blood samples were taken for biochemistry tests at all visits. A physical examination was completed at baseline and month 3, and a medical update was completed after 1, 2, and 3 months, and at the follow-up visit. Adverse-event monitoring and notation of prescription changes were carried out continuously.

Main Outcome Measure

Effect on venous plasma bicarbonate level.

Results

Venous plasma bicarbonate rose by 3.1 mmol/L (confidence intervals 1.6 – 4.8), from a baseline level of 23.0 mmol/L during the treatment period in those patients treated with Bic/Lac ( p < 0.05 vs Lac). The number of acidotic patients (venous plasma bicarbonate < 24 mmol/L) was statistically significantly reduced at every treatment period visit in the Bic/Lac group ( p < 0.05). There were no adverse findings with respect to vital signs, physical examination, or clinical symptoms, apart from one death in the control group.

Conclusions

The new Bic/Lac solution allowed better correction of acid–base status than the lactate solution.
Emergence of Mupirocin-Resistant Staphylococcus Aureus in Chronic Peritoneal Dialysis Patients using Mupirocin Prophylaxis to Prevent Exit-Site Infection
Authors: Annigeri Rajeev , Conly John , Vas Stephen I. , Dedier Helen , Prakashan Kannam P. , Bargman Joanne M. , Jassal Vanita , Oreopoulos Dimitrios
Published: February 2020

Objective

To determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chronic peritoneal dialysis (CPD) patients after 4 years of prophylactic mupirocin application to the exit site, in a peritoneal dialysis unit.

Methods

Three swabs were collected from the nares, axillae/groin, and exit site, respectively, from 149 patients on CPD between May and July 2001. All swabs were cultured on solid selective agar (mannitol salt agar) and in mannitol salt broth. Staphylococcus aureus isolates were tested for methicillin resistance using oxacillin screening plates, and mupirocin resistance using E-test strips. Low-level MuRSA was defined as minimum inhibitory concentration (MIC) of 4 mg/mL or more, and high-level MuRSA as MIC of 256 mg/mL or more.

Results

Staphylococcus aureus was isolated from 26 (17%) patients (25 from nares/axilla/groin, and 1 from the exit site). High-level MuRSA was isolated from 4 patients (3% of the total study population; 15% of total SA isolates). No MRSA was detected. One patient with high-level MuRSA had peritonitis due to SA, resulting in treatment failure and catheter loss, soon after the swabs were collected for the study.

Conclusion

We report the emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in our unit. Our results may have significant implications for the future practice of prophylactic use of mupirocin by CPD patients to prevent exit-site infection.
Recovery of Renal Function in Black South African Patients with Malignant Hypertension: Superiority of Continuous Ambulatory Peritoneal Dialysis over Hemodialysis
Authors: Katz Ivor J. , Sofianou Lana , Butler Omar , Hopley Mark
Published: February 2020

Objective

To describe recovery of renal function (RC) in Black South African patients with primary malignant hypertension (MHT) and end-stage renal failure, according to the type of dialysis provided.

Design

A retrospective analysis of the records of 31 patients with MHT.

Setting

A university-based, large tertiary-care hospital and its community-based satellite continuous ambulatory peritoneal dialysis (CAPD) clinics.

Patients

Only patients with renal failure caused by MHT and who were on dialysis between January 1997 and June 2000. There were 11 patients on peritoneal dialysis (PD) that regained renal function; 11 patients on hemodialysis (HD), none of whom recovered renal function; and 9 patients on PD who did not recover renal function during the same time period.

Outcome Measures

The groups were investigated for variables that might predict RC.

Results

Peritoneal dialysis compared with HD was highly significant as an indicator of RC ( p < 0.0001), with 60% of patients on PD regaining renal function, versus 0% on HD. Median time to recovery was 300 (150 – 365) days. There was no significant difference in decline of mean arterial pressure (MAP) between the groups; MAP declined significantly in all groups ( p = 0.000 02). All groups received similar drug therapy. In the RC group, initial MAP, kidney size, and urine output tended to be higher and creatinine lower ( p = not significant). Dialysis adequacy was similar in the different groups.

Conclusions

This retrospective study suggests there may be benefit from PD as the primary form of dialysis when patients have MHT as a cause of their renal failure. Possible predictors of RC include blood pressure control, initial MAP, initial serum creatinine, initial urine output, and kidney size. Time should be allowed for RC before transplantation is undertaken. Prospective studies are needed to confirm the benefit of CAPD in patients with MHT.
Changes in Employment Status in End-Stage Renal Disease Patients during Their First Year of Dialysis
Authors:   The NECOSAD Study Group, Manen van Jeannette G. , Korevaar Johanna C. , Dekker Friedo W. , Reuselaars Margot C. , Boeschoten Elisabeth W. , Krediet Raymond T.
Published: February 2020

Objective

To assess employment status in new end-stage renal disease (ESRD) patients at the start of dialysis and after 1 year, and to determine whether demographic and clinical variables and physical and psychosocial functioning at the start of dialysis are risk factors for loss of employment after 1 year of dialysis.

Design

Prospective follow-up study in which 38 of 48 Dutch dialysis centers participate.

Patients

659 patients who had started on dialysis and who were between 18 and 65 years old were included. Patients were re-examined after 12 months.

Main Outcome Measures

Demographic data, physical and psychosocial functioning with the Short-Form Health Survey (SF-36), and data on employment status were obtained using questionnaires. Nephrologists provided the clinical data.

Results

At the start of dialysis, 35% of patients were employed, in contrast to 61% of the general Dutch population. Within 1 year, the proportion of employed patients decreased from 31% to 25% of hemodialysis patients, and from 48% to 40% of peritoneal dialysis patients. In patients who were working at the start of dialysis, independent risk factors for loss of work within 1 year were impaired physical and psychosocial functioning [odds ratio physical: 3.4, 95% confidence interval (%CI), 1.0 – 11.2; odds ratio psychosocial: 4.2, 95% CI, 1.2 – 14.2].

Conclusions

As the percentage of employed patients at the start of dialysis is about half the expected percent-age, loss of work is an important issue in both predialysis and dialysis patients. Improvements in physical and psychosocial functioning are potentially preventive of loss of work in patients who are employed when they start dialysis.
Clinical Outcome in Continuous Ambulatory Peritoneal Dialysis Patients is Not Influenced by High Peritoneal Transport Status
Authors: Park Hyeong Cheon , Kang Shin Wook , Choi Kyu Hun , Ha Sung Kyu , Han Dae Suk , Lee Ho Yung
Published: February 2020

♦ Objectives

We undertook this study to examine the influence of demographics, peritoneal membrane transport characteristics, nutrition indices, dialysis adequacy, and comorbid diseases on patient survival on continuous ambulatory peritoneal dialysis (CAPD), and to identify whether high peritoneal membrane transport is an independent risk factor for mortality on CAPD.

♦ Design

Our retrospective study was carried out in CAPD patients in a large tertiary care teaching hospital.

♦ Methods

Until December 2000, we followed 212 patients who started CAPD between 1994 and 1997 and who underwent a peritoneal equilibration test (PET) within 3 months of CAPD initiation.

♦ Results

By univariate analysis, comorbid diseases, old age, high peritoneal transport, and serum albumin predicted patient mortality. Independent predictors of mortality as determined by the Cox proportional hazard model included diabetes mellitus, cardiovascular disease, serum albumin, and old age. High peritoneal transport failed to independently influence mortality in our CAPD patients.
Interleukin-6 Levels Decrease in Effluent from Patients Dialyzed with Bicarbonate/Lactate–Based Peritoneal Dialysis Solutions
Authors: Cooker Laurinda A. , Luneburg Patricia , Holmes Clifford J. , Jones Suzanne , Topley Nicholas ,   on behalf of the Bicarbonate/Lactate Study Group, O'Donoghue D. , Frenken L. , Brown E. , Walls J. , Pedersen F.B. , Freese P. , Heimbürger O. , Gokal R. , Junor B. , Maiorca R. , Weiss L. , Farrington K. , Kristiensen J. , Ahlmén J. , Struijk D. , Brouwer R. , Ryckelynck J.P. , Williams J.D. , Hopwood A.M.
Published: February 2020

♦ Objective

Conventional lactate-buffered peritoneal dialysis (PD) solutions have several bioincompatible characteristics, including acidic pH, lactate buffer, and the presence of glucose degradation products (GDPs). These characteristics, along with inflammation, are believed to contribute to membrane dysfunction in peritoneal dialysis patients. A new PD solution containing a bicarbonate/ lactate buffer system with physiologic pH and low GDPs has shown improved biocompatibility in both in vitro and ex vivo studies. In the present study, the concentrations of cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), and vascular endothelial growth factor (VEGF), were measured in timed overnight effluents from PD patients continuously dialyzed with either lactate-based control solution (C) or bicarbonate/lactate–based solution (B/L) for 6 months.

♦ Methods

Effluents from 92 continuous ambulatory peritoneal dialysis (CAPD) patients were collected when the patients were entered into the study (baseline, all patients on C for more than 3 months), and at 3 and 6 months following randomization to C ( n = 31) or to B/L ( n = 61). Effluent samples were filtered, stored frozen, and then assayed for IL-6, TNFα, and VEGF by ELISA.

♦ Results

A significant decrease in effluent IL-6 was seen at 3 months and at 6 months in the B/L-treated patients. Levels of VEGF were significantly reduced at 3 months. No changes in the levels of IL-6 or VEGF were seen in the C-treated patients, and no changes in TNFα were seen in either group over time.

♦ Conclusions

Treatment with B/L is associated with decreased IL-6 synthesis and decreased VEGF secretion. The data suggest that the use of B/L solution is associated with reduced intraperitoneal inflammation and potential for angiogenesis. The use of B/L solution may, over time, help to restore peritoneal homeostasis and therefore preserve the function of the membrane in peritoneal dialysis.
Quality of Life of Elderly Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Trbojevic Jasna B. , Nesic Vidosava B. , Stojimirovic Biljana B.
Published: February 2020

Objective

The aim of the present study was to evaluate the impact of continuous ambulatory peritoneal dialysis (CAPD) on the lifestyle of elderly patients.

Patients and Methods

Aspects of health-related quality of life (QL) were studied in 48 patients (16 men, 32 women) in end-stage chronic renal failure (ESRF) undergoing CAPD at the Clinic of Nephrology, Clinical Centre of Serbia. The first group comprised 20 adult patients (8 men, 12 women; age range: 35 – 59 years). The second group consisted of 28 older adult patients (8 men, 20 women; age range: 65 – 75 years). Mean length of CAPD treatment was 5.2 years in the first group and 3.67 years in the second group. Fifteen QL variables were investigated: marital status, family relationships, working ability, sleep, tiredness, appetite, wound healing, hobby, sports, friendships, sexual activity, mood, travel, self management, and happiness.

Results

The results showed that, in the examined groups, marital status and relationships with family members weren't influenced at all by dialysis. In both groups, CAPD had a negative influence on ability to bear cold and to travel, but other life functions were not significantly affected. Elderly patients had a significantly worse appetite ( p = 0.03, Fisher test) and mood ( p = 0.045, Fisher test) than did younger adults. In other examined variables, no statistically significant differences were found between the groups.

Conclusions

Lack of large, statistically significant differences between the groups suggests that CAPD has an equal influence on quality of life in younger and older adult patients.