bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between fibrinogen level and its regulatory gene with Alzheimer’s disease and vascular dementia
Authors: Sun Yanan , Li Qi , Liu Wei , Zhang Benshu
Published: February 2020

Objective

Several investigations have shown that the level of fibrinogen (Fg) is associated with the susceptibility to dementia and is usually affected by polymorphisms in its gene. Our study aimed to investigate the relationship between Fg level and the fibrinogen β ( FGB) −148C/T gene polymorphism in patients with Alzheimer’s disease (AD) and vascular dementia (VaD).

Methods

The study included 64 AD patients, 72 VaD patients, and 56 healthy controls (HC). Plasma Fg level was detected by turbidimetry. Among the participants, 64 AD patients, 52 VaD patients, and 56 HC underwent FGB −148C/T polymorphism analysis using restriction fragment length polymorphism-PCR.

Results

Plasma Fg was significantly higher in AD and VaD groups than in HC. The AD and VaD patients with FGB −148 TT genotype had significantly higher plasma Fg than those with CC or CT genotypes. The distribution of CC and CT+TT genotypes differed in the three groups, with the frequency of CT+TT genotypes being higher in AD patients than in the HC group.

Conclusions

Plasma Fg level was significantly correlated with AD and VaD and related to the −148C/T polymorphism of FGB. The TT+CT genotypes and the distribution frequency of the T allele may be related to AD.
Exosomes: an important messenger in the asthma inflammatory microenvironment
Authors: Huang Feng , Jia Haoyuan , Zou Yingfen , Yao Yongliang , Deng Zhiyong
Published: February 2020

Asthma is a frequently diagnosed chronic pulmonary disease that is increasing in incidence. It is characterized by airway narrowing due to an immune response to allergens, infections, or air pollutants. Several types of cells participate in the initiation and development of asthma, including bronchial epithelial cells, smooth muscle cells, and immune cells (mast cells, T and B cells, and dendritic cells). Exosomes released in the asthmatic microenvironment exert a crucial function in intercellular signaling by transporting their contents, such as RNA, DNA, proteins, and lipid mediators, to recipient cells, which play key roles in the pathogenesis of asthma. In the present review, we summarize currently available information on the function of exosomes in the asthmatic microenvironment.
Optimum Volume of Freeway Corridors
Authors: Shojaat Siavash , Geistefeldt Justin , Wolshon Brian
Published: February 2020

Conventional methods to assess the quality of service on freeways are based on the comparison of a specific peak hour traffic demand to the capacity of the facility, which is usually measured at a single uniform bottleneck section. However, estimating the quality of service of one bottleneck section may not be sufficient to assess the performance of an entire freeway facility. A driver traveling along a freeway corridor may actually encounter multiple flow breakdowns at independent bottleneck sections, which affect the overall quality of service. This paper introduces a comprehensive approach that considers an entire freeway corridor as a system consisting of successive independent bottlenecks with different characteristics, and can be used to estimate the optimum sustainable volume. The methodology is based on the sustained flow index, which is defined as the product of traffic volume and the probability of survival at this volume. Optimum volumes of two real-world corridors are estimated based on the new derivations. The empirical results reveal that the optimum volume and the capacity of an entire corridor is less than those of its most restrictive bottleneck.
Mapping the Travels of Intersectionality Scholarship: A Citation Network Analysis
Authors: Moradi Bonnie , Parent Mike C. , Weis Alexandra S. , Ouch Staci , Broad Kendal L.
Published: February 2020

In this study, we conducted a citation network analysis of intersectionality scholarship. We aimed to elucidate content domains in this scholarship’s citation network. In addition, we explored a citation-based genealogy of this scholarship, attending to the representation of women of color identified in prior critical analyses of intersectionality scholarship as key but under-acknowledged contributors to intersectional thought and praxis. We used CitNetExplorer to analyze a network of 17,332 records and 60,132 citation links. The analysis yielded 17 clusters, with the five largest clusters focusing on (1) conceptualizing intersectionality theory, methodology, and analysis; (2) psychology, identity stigma, and multiple minority statuses; (3) sociology of gender inequality, labor markets, and organizations; (4) political science, political systems and policy, including in the European context; and (5) violence against women, gender and health, and health equity. Although some of the key women of color contributors to intersectional thought were among the most cited authors in the network, others were cited infrequently or not at all across the network and clusters. Taken together, the analyses revealed substantial and ongoing engagement with efforts to define and refine intersectionality as epistemology and methodology. However, the analyses pointed to the need for scholars to reengage with, cite, and follow the examples of the women of color who contributed to intersectional thought by actually doing intersectional praxis that directly advances social justice aims. Some of the smaller clusters in the citation network reflected content domains, such as environmental justice and community planning, ripe for such activist-scholar work. Online slides for instructors who want to use this article for teaching are available on PWQ's website at http://journals.sagepub.com/doi/suppl/10.1177/0361684320902408
Effects of bentonite nanoparticles inhalation on lung tissue and blood antioxidant indices in a rat model
Authors: Masoudi Fatemehsadat , Naghizadeh Ali , Zardast Mahmoud , Gholami Abdullah , Farrokhfall Khadijeh , Foadoddini Mohsen , Mehrpour Omid
Published: February 2020

Bentonite is an inorganic clay material that is often easily dispersed as fine particles by air and water circulation, and most people are exposed to different concentrations of bentonite particles. Therefore, the inhaled effects of bentonite nanoparticles (BNPs) were studied in Wistar rats. Seventy-five rats were divided into five groups of 15: four exposure groups (0.1, 0.5, 2, and 10 mg/m3 of BNPs) and one control group. The rats were exposed for 30, 60, and 90 days to BNPs for 5 days a week (6 h/day) in whole-body inhalation chambers. Blood samples were collected to measure the levels of antioxidant activity of the contents such as total antioxidant capacity (TAC) and malondialdehyde (MDA). X-ray diffraction and scanning electron microscopy were used to identify nanoparticles. The results showed no significant difference in the effect of nanoparticles on levels of TAC and MDA in the studied groups based on the concentrations of nanoparticles. However, the level of MDA increased significantly with extending exposure time; there was a significant increase in the level of MDA content 90 days postexposure compared to 30 days postexposure at concentrations of 0.5, 2, and 10 mg/m3. Histopathological examination showed that inhalation exposure of rats to BNPs led to different histopathologic responses in the lung tissue, such as inflammatory infiltration, granulomatous inflammation, acute neutrophilic reaction in the early stages, and lung fibrosis. At the lowest concentration, BNPs have low or no toxicity, and inhalation of these nanoparticles at low concentrations does not affect the levels of MDA and TAC content. However, increased concentration and exposure time caused correspondingly greater increases in MDA and more damage to lung tissue.
Hospice Utilization Among Residents in Long-Term Care Facilities
Authors: Xiong Beibei , Freeman Shannon , Banner Davina , Spirgiene Lina
Published: February 2020

Background:

Hospice care can improve quality of life for persons nearing end of life, yet little is known about utilization of hospice care among persons residing in long-term care facilities (LTCFs). Given the increasing number of deaths that occur in LTCFs, it is important to examine hospice care practices in LTCFs.

Aim:

The aim of the cross-sectional study was to describe residents who received hospice care in LTCFs and explore factors that can predict hospice use in LTCFs across Canada. This study included 185 715 residents aged 19 years or older in LTCFs in Canada in 2015.

Results:

Of all residents, 2.7% (n = 4973) received hospice care and 6.8% (n = 12 684) were profiled as having an end-stage disease. Among those who received hospice care, most were noted as end stage (89.5%) and had severe physical impairment (Activities of Daily Living Hierarchy Scale ≥ 5, 74.3%), mild-to-severe pain (Pain Scale ≥ 1, 76.0%), and moderate-to-severe health instability (Changes in Health, End-Stage Disease, Signs, and Symptoms Scale ≥3, 82.9%). Residents who received hospice care were in more severe and complex clinical conditions than those who did not receive hospice care.

Conclusion:

Only a small proportion of residents in LTCFs received hospice care. Further investigation of standardized assessment of terminal status is needed as accuracy of end-stage diagnosis continues to be challenging and criteria for hospice eligibility are narrow. Special attention should be paid to improve access to hospice care among residents with dementia or other progressive chronic diseases with severe and complex clinical needs.
Online Pro-Tobacco Marketing Exposure Is Associated With Dual Tobacco Product Use Among Underage US Students
Authors: Marion Hunter , Garner William , Estrada Alex , Moorer Christopher , Acosta-Velazquez Ixel
Published: February 2020

Purpose:

To understand the effect of pro-tobacco marketing on electronic cigarette and combustible cigarette dual use among US middle and high school students under 18 years of age.

Design:

Data were derived from the 2018 National Youth Tobacco Survey, an annual self-administered school-based cross-sectional survey.

Setting:

The survey was administered in public and private middle and high schools across the United States.

Participants:

The probability sample size was 15 238 middle and high school students with complete responses who were under 18 years of age during the study period.

Measures:

The study measured self-reported exposure to online combustible and electronic cigarette advertisements, dual use of combustible and electronic cigarettes during the past 30 days, exposure to the Real Cost antitobacco campaign advertisements, and other sociodemographic factors (eg, race/ethnicity, gender, and grade).

Analysis:

Logistic regressions were used to measure pro-tobacco marketing exposure and dual use as a function of pro-tobacco marketing exposure.

Results:

Descriptive analyses show that 59.0% of respondents were exposed to pro-tobacco online marketing, and 2.9% were dual users. Dual users (odds ratio [OR] = 1.73) and high school students (OR = 1.43) were more likely to report exposure to online pro-tobacco marketing.

Conclusions:

Findings indicate that a gap in electronic cigarette pro-tobacco marketing regulatory oversight may exist. Further policy action may be warranted to protect the public health of minors and other vulnerable populations who are most susceptible to pro-tobacco marketing.
Effect of Androgens on Anemia and Malnutrition in Renal Failure: Implications for Patients on Peritoneal Dialysis
Authors: Navarro Juan F. , Mora Carmen
Published: February 2020

Objective

To analyze the implications of the potential use of androgens in peritoneal dialysis patients, focusing on their effects on hematologic and nutritional parameters. This manuscript reviews the different compounds for clinical use, dosage schedules, adverse effects, and how therapy with androgens might be used to treat anemia and malnutrition in these dialysis patients.

Data Sources

Studies in the literature dealing with the effects of androgens on hematologic and nutritional parameters, and their role in uremic anemia and malnutrition.

Study Selection

Studies in which uremic patients received androgens as therapy for anemia or malnutrition.

Data Extraction

Data were abstracted from all of these studies.

Results

This review shows that androgens are anabolic substances that also have significant actions on erythropoiesis. A number of clinical studies in uremic patients have found that these compounds have beneficial effects on hematologic parameters and nutritional status, similarly to other therapies, such as recombinant human erythropoietin and recombinant human growth hormone, respectively.

Conclusions

Androgens have been shown to have a beneficial effect on anemia due to renal disease and on nutritional status in uremic patients. Further studies need to be done with larger groups of patients. Objectives for additional research are suggested.
Hyponatremia in Patients Undergoing CAPD: Role of Water Gain and/or Malnutrition
Authors: Zevallos Gonzalo , Oreopoulos Dimitrios G. , Halperin Mitchell L.
Published: February 2020

Background

Hyponatremia has a number of different causes; some may have serious untoward implications for patients undergoing chronic ambulatory peritoneal dialysis (CAPD).

Objective

To determine the pathophysiology of hyponatremia in patients on CAPD.

Methods

A retrospective analysis was carried out on 210 patients on CAPD. We selected patients with 2 – 4 consecutive periods when the plasma sodium concentration was ≤130 mmol/L and again when it was > 133 mmol/L. Exclusion criteria included hyperglycemia, orthostatic hypotension, edema, and inadequate records.

Results

An electrolyte-free water gain appeared to be the main cause of hyponatremia in only 1 of 5 patients because this was the only patient with a significant increase in body weight. In 1 patient, there was weight loss in the hyponatremic period, suggesting tissue catabolism was present. In 3 patients, there was neither weight gain nor evidence for a contracted extracellular fluid volume in the hyponatremic period, suggesting that intracellular potassium and phosphate loss could be the major mechanism for their hyponatremia.

Conclusion

When hyponatremia is due to a catabolic state, its management should aim to restore intracellular fluid composition ( i.e., to correct malnutrition).
Adsorption of Erythropoietin and Growth Hormone to Peritoneal Dialysis Bags and Tubing
Authors: Schröder Cornelis H. , Swinkels Leon M.J.W. , Reddingius Roel E. , Sweep Fred G.J. , Willems Hans L. , Monnens Leo A.H.
Published: February 2020

Objective

To study the adsorption of erythropoietin and growth hormone to dialysis bags and tubing.

Design

In vitro study in which radiolabeled erythropoietin and recombinant human growth hormone were added to small-volume (50- and 250-mL) dialysis bags. Recovery was measured after 15-minute dwells. Experiments were performed in triplicate.

Setting

University hospital.

Results

Adsorption of erythropoietin and growth hormone was less than 7%.

Conclusion

Adsorption of erythropoietin and recombinant human growth hormone to dialysis bags and tubing is minimal. This finding provides another argument in favor of intraperitoneal therapy in pediatric peritoneal dialysis.
Long-Term Capd Survival and Analysis of Mortality Risk Factors: 12-Year Experience of a Single Mexican Center
Authors: Cueto–Manzano Alfonso M. , Quintana–Piña Eduardo , Correa–Rotter Ricardo
Published: February 2020

Objective

To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program.

Design

Cohort study.

Setting

Tertiary care, teaching hospital located in Mexico City.

Patients

All patients from our CAPD program (1985 – 1997) were retrospectively studied.

Interventions

Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors.

Main Outcome Measures

End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997).

Results

627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (± SE) was 5.1 ± 0.6 years. In the univariate analysis, the following variables were associated ( p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 ± 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated ( p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors.

Conclusions

Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.
Diagnostic Value of Effluent Endotoxin Level in Gram-Negative Peritonitis in Capd Patients
Authors: Muhammed Khalifa Omar , Özener Çetin , Akoglu Emel
Published: February 2020

Objective

To evaluate the diagnostic usefulness of effluent endotoxin by Limulus amoebocyte lysate (LAL) assay in gram-negative peritonitis patients on continuous ambulatory peritoneal dialysis (CAPD) therapy.

Design

Prospective study with patients serving as their own controls. Standard microbiologic work up and endotoxin analysis of effluents (night dwell) were done during the pre- and posttreatment phases.

Setting

Specimens from three teaching hospitals were processed and tested at a common center. Patients were left for treatment at their respective centers without intervention.

Patients

32 clinical peritonitis and 40 infection-free CAPD patients were studied.

Results

75% ( n = 24) of cultures were positive: 41.6% ( n = 10) gram-negative and 58.4% ( n = 14) gram-positive bacteria. Effluents of pre- and posttreated gram-negative cultures had endotoxin levels of 1.53 ± 0.169 and 0.214 ± 0.085 endotoxin units (EU)/mL, respectively ( p < 0.0001); pre- and posttreated gram-positive levels of 0.102 ± 0.06 and 0.122 ± 0.052 EU/mL, respectively ( p > 0.05); pre- and posttreated culture-negative peritonitis levels of 0.110 ± 0.025 and 0.087 ± 0.031 EU/mL, respectively ( p > 0.05); peritonitis-free effluents contained 0.117 ± 0.079 EU/mL. The diagnostic specificity and the sensitivity of LAL assay were 100% and 98.2% respectively.

Conclusion

Where initial microbiological work-up cannot demonstrate a pathogen, effluent endotoxin determined by quantitative LAL assay is a useful marker for diagnosis and management, within safe time limits, of gram-negative peritonitis in CAPD patients.
Qt Dispersion and Signal-Averaged Electrocardiogram in Hemodialysis and Capd Patients
Authors: Yildiz Alaattin , Akkaya Vakur , Sahin Sevgi , Tükek Tufan , Besler Mine , Bozfakioglu Semra , Korkut Ferruh
Published: February 2020

Objective

The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls.

Setting

Controlled cross-sectional study in a tertiary- care setting.

Patients

28 HD (M/F 18/10; mean age 32 ± 9 years), 29 CAPD (M/F 17/12; mean age 34 ± 10 years), and 29 healthy controls (M/F 17/12; mean age 32 ± 8 years) were included.

Interventions

On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 μV, and RMS voltage (40 ms) were also measured.

Results

Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index ( r = 0.53, p = 0.004), but not in CAPD ( r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 ± 18 ms vs 49 ± 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 ± 15 ms and 104 ± 12 ms vs 95 ± 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 ± 12 ms vs 95 ± 8 ms, p < 0.001).

Conclusion

Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.
Aquaporins: Roles in Renal Function and Peritoneal Dialysis
Authors: Marples David
Published: February 2020

Aquaporin (AQP) water channels are important in the function of the kidney. Constitutively expressed AQP1 in the proximal tubule and descending limb is important in normal fluid absorption and in the counter-current multiplication system. The vasopressin-regulated shuttling of AQP2 is essential in antidiuresis and the regulation of water balance. Genetic damage to AQPs, or pathological changes in expression or function, impair renal water handling. The most striking examples of this involve disruption of AQP2 function, which can result in profound nephrogenic diabetes insipidus. Aquaporin 1 is present in capillaries and venules and appears to be important in peritoneal dialysis, where it appears to represent the “ultrasmall pores” of the three-pore model. Decreased expression or function of AQP1 may be responsible for some cases of ultrafiltration failure, but further evidence will be required to establish whether this is the case.
Does Enalapril Prevent Peritoneal Fibrosis Induced by Hypertonic (3.86%) Peritoneal Dialysis Solution?
Authors: Duman Soner , Günal Ali Ihsan , Sen Sait , Asçi Gülay , Özkahya Mehmet , Terzioglu Ender , Akçiçek Fehmi , Atabay Gürhun
Published: February 2020

Objective

Peritoneal fibrosis (PF) is one of the most serious causes of failure in continuous ambulatory peritoneal dialysis (PD). Although the underlying mechanism responsible for the genesis of PF is still unknown, transforming growth factor p (TGFβ1) has been shown to be associated with PF. Angiotensin converting enzyme inhibitors have been shown to prevent the stimulating effect of growth factors. The aim of the present study was to investigate the effect of enalapril on peritoneal function and morphology in a rat model of experimental PF.

Methods

Twenty-one albino Wistar rats were divided into three groups: ( 1 ) the control group (C) received 10 mL isotonic saline intraperitoneally (IP), ( 2 ) the dextrose (Dx) group 10 mL 3.86% dextrose PD solution IP, and ( 3 ) the enalapril-treated group (ENA) 10 cc 3.86% dextrose PD solution IP plus 100 mg/L enalapril in drinking water. After 4 weeks, a 1-hour peritoneal equilibration test was performed with 20 mL 2.27% dextrose PD solution. Dialysate-to-plasma urea ratio (D/P urea), glucose reabsorption (D1/D0 glucose), ultrafiltration (UF) volume, and levels of dialysate protein, TGFβ1, and cancer antigen 125 (CA125) were determined. The parietal peritoneum was evaluated histologically by light microscopy.

Results

Administration of enalapril resulted in preserved UF (-0.2 ± 0.7 mL vs 1.7 ± 0.3 mL, p < 0.05), protein loss (2.3 ± 0.5 g/L vs 1.6 ± 0.2 g/L, p > 0.05), and peritoneal thickness (77 ± 7 μ vs 38 ± 5 μ, p < 0.001). D/P urea increased significantly in the Dx group ( p < 0.05). Both higher levels of TGFβ1 (undetectable vs 298 ± 43 pg/mL, p < 0.001) and lower levels of CA125 in dialysate effluent (0.94 ± 0.5 U/L vs 0.11 ± 0.1 U/L, p > 0.05) were determined in the Dx group.

Conclusion

These findings show that peritoneal morphology and function tests were dramatically deranged in the Dx group. The same properties were partially preserved in the ENA group. The production of TGFβ1 was significantly reduced but peritoneal thickness was not completely inhibited. In conclusion, by inhibiting the production of TGFβ1, enalapril can preserve peritoneal histology, peritoneal function, and remodeling of mesothelial cells.
Relationship between Adequacy of Dialysis and Nutritional Status, and Their Impact on Patient Survival on Capd in Hong Kong
Authors: Lo Wai-Kei , Tong Kwok-Lung , Li Chun-Sang , Chan Tak-Mao , Wong Andrew K.M. , Ho Yiu-Wing , Cheung King-On , Kwan Tze-Hoi , Wong Kin-Shing , Ng Flora S.K. , Cheng Ignatius K.P.
Published: February 2020

Objective

Superior patient survival on continuous ambulatory peritoneal dialysis (CAPD) with 3 x 2-L exchanges has been reported from Hong Kong. This study examined the relationship between indices of dialysis adequacy and nutrition and patient survival on CAPD in Hong Kong.

Design

A cross-sectional study on prevalent CAPD patients. Patients were assessed for indices of dialysis adequacy and nutritional status with a composite nutritional index (CNI). Patients were then followed for 24 months. Survival data were analyzed according to adequacy indices and nutritional status.

Setting

All prevalent CAPD patients in nine dialysis centers in Hong Kong as of 1 April 1996.

Main Outcome Measure

Mortality.

Results

937 patients were assessed: 68.2% were using 3 x 2-L exchanges per day; mean age was 54.6 ± 13 years. Mean total Kt/V was 1.83 ± 0.42 and total creatinine clearance was 55.6 ± 19.5 L/week/1.73 m2. 19% of patients were moderately to severely malnourished according to the CNI. There was no significant correlation between indices of adequacy and serum albumin or CNI. The 1- and 2-year patient survival from the time of assessment was 90.9% and 79.8%. There was a trend toward better survival in patients with Kt/V greater than 2.0, but it was not statistically significant. Peritoneal Kt/V did not impact survival in anuric patients. Malnourished patients had poorer survival than patients who were better nourished ( p = 0.0259). After adjusting for age and diabetes, CNI was predictive of mortality but Kt/V and creatinine clearance were not.

Conclusions

This study demonstrates the importance of nutritional status over adequacy indices in predicting patient survival. There was a lack of correlation between nutritional status and conventional indices of dialysis adequacy.
Timing of Peritoneal Dialysis Catheter Removal after Pediatric Renal Transplantation
Authors: Arbeiter Klaus , Pichler Andrea , Muerwald Gabriele , Mueller Thomas , Bidmon Bettina , Balzar Egon , Ruffingshofer Dagmar , Greenbaum Laurence , Aufricht Christoph
Published: February 2020

Background

A peritoneal dialysis (PD) catheter is in place at the time of kidney transplantation in children receiving PD. Removal of the catheter eliminates the risk of catheter-related infections. However, the patient benefits from leaving the catheter in place if dialysis is necessary posttransplantation. There is currently no consensus on the proper timing of PD catheter removal after kidney transplantation in children.

Objective

To identify the risks and benefits of an indwelling PD catheter after renal transplantation in children.

Design

Retrospective single-center study of infectious complications and posttransplantation PD catheter use in 31 renal transplantations in 26 children.

Results

Peritoneal dialysis catheters were used postoperatively in 13 of the 31 transplantations. In 12 instances the catheter was needed during the first month after transplantation, and 2 of the patients involved did not have a catheter in place when needed. Six catheter-related infections occurred in 5 patients posttransplantation, with only 1 infection taking place within 1 month after transplantation.

Conclusion

Our data suggest that the need for catheter use occurs predominantly during the first month, while infectious complications usually happen later. This strongly suggests that PD catheters should not be removed until approximately 1 month after kidney transplantation.
Early Glycated Albumin, but Not Advanced Glycated Albumin, Methylglyoxal, or 3-Deoxyglucosone Increases the Expression of Pai-1 in Human Peritoneal Mesothelial Cells
Authors: Mandl–Weber Sonja , Haslinger Bettina , Schalkwijk Casper G. , Sitter Thomas
Published: February 2020

Objective

The continuous contact of glucose-containing peritoneal dialysis (PD) fluids with the peritoneum results in the intraperitoneal formation of early and advanced glycation end-products. This nonenzymatic glycation of proteins may cause morphological and functional alterations to the peritoneum, which may contribute to patient dropout from PD therapy. Because fibrinolytic system components have been demonstrated to play an important role in the balance of intraperitoneal generation and degradation of fibrin, we studied the effect of early and advanced glycated human serum albumin, methylglyoxal, and 3-deoxyglucosone on the synthesis of tissue-type plasminogen activator (tPA), as well as its specific inhibitor (PAI-1), in human peritoneal mesothelial cells (HPMC).

Methods

Antigen concentrations in the supernatants of cultured HPMC were measured by ELISA. Northern blot analysis was conducted for mRNA expression. Electrophoretic mobility shift assays were applied to demonstrate the involvement of the transcription factors nuclear factor kappa B (NF-κB) and activator protein-1 (AP-1) in signal transduction.

Results

Incubation of HPMC with early glycated albumin (GHSA) resulted in a time- and concentration-dependent increase in PAI-1 mRNA expression and antigen secretion. In contrast, no changes in PAI-1 synthesis occurred after stimulation with either the 1,2-dicarbonyl compounds methylglyoxal and 3-deoxyglucosone, or with late advanced glycation end-products. tPA synthesis was not affected by any of the tested components. Furthermore, HPMC exposed to GHSA induced NF-κB and AP-1 DNA binding activity, suggesting that GHSA-induced over-expression of PAI-1 is transcriptionally regulated by both transcription factors.

Conclusions

We conclude that Amadori modified glycated albumin upregulates PAI-1 synthesis in HPMC, possibly mediated through the activation of the transcription factors NF-κB and AP-1. The present data support the clinical relevance of the formation of glycated proteins and their involvement in pathological processes in PD patients. Thus, glycated albumin may contribute to an imbalance between intraperitoneal formation and degradation of fibrin that causes peritoneal structural alterations, with subsequent membrane failure.
The Relationship between Kt/VUrea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients
Authors:   for the NECOSAD Study Group, Jansen Maarten A.M. , Korevaar Johanna C. , Dekker Friedo W. , Jager Kitty J. , Boeschoten Elisabeth W. , Krediet Raymond T.
Published: February 2020

Objective

It is unknown whether a given level of urea clearance by the native kidneys provides better or similar control of uremia than the same level of urea clearance by continuous peritoneal dialysis (PD). More insight into possible differences between renal and peritoneal urea clearances is warranted. Therefore, we investigated the relationship between Kt/Vurea and protein equivalent of total nitrogen appearance normalized to body weight (nPNA), the relationship between urea clearance and creatinine appearance, and other nutritional parameters in PD patients without residual renal function, and in predialysis end-stage renal disease patients.

Patients

All patients participated in the Netherlands Cooperative Study on the Adequacy of Dialysis. This is a prospective cohort study of incident dialysis patients, in whom regular assessments of renal function are done. A group of 75 PD patients was identified at the first follow-up assessment in which their urine production was less than 100 mL/day. These patients were considered the anuric group. This group was compared with a control group of 97 predialysis patients studied 0 – 4 weeks before the start of dialysis treatment.

Results

Linear relationships were present between Kt/Vurea and nPNA, in both the predialysis patients and the anuric PD patients. A significant difference was present between the slopes of the two regression lines (0.40 vs 0.18, p = 0.007). When Kt/Vurea exceeded 1.3/week, a given level of Kt/Vurea was associated with a higher nPNA in predialysis than in anuric PD patients. Similar relationships were found between Kturea and PNA. Kturea was also significantly related to urine or dialysate creatinine appearance. A significant difference existed between the slopes of the regression lines in the two groups of patients ( p < 0.001). A weekly Kturea of 70 L was associated with a urine creatinine appearance of 11.0 mmol/day and a dialysate creatinine appearance of 8.4 mmol/day. Nutritional status measured with creatinine appearance and Subjective Global Assessment was better in the predialysis population, despite much lower values for Kt/Vurea in these patients.

Conclusions

The relationship between Kt/Vurea and nPNA in anuric PD patients is different from that in a predialysis population. It follows from our results that, when Kt/Vurea is above 1.3/week, a given level of Kt/Vurea is associated with a higher nPNA in predialysis than in anuric PD patients. This challenges the concept of equivalency between renal and peritoneal Kt/Vurea with respect to control of uremic morbidity.
Continuous Equilibration Peritoneal Dialysis (CEPD) in Hypercatabolic Renal FAILURE
Authors: Kontesis Antony Katirtzoglou Peter , George E Dora Myopoulou-Symvoulidis , Symvoulidis Digenis Alex , Komninos Zacharias
Published: February 2020

Continuous equilibration peritoneal dialysis (CEPD) is similar to continuous ambulatory peritoneal dialysis (CAPD) except that the patients are not ambulatory. CEPD was applied to five hypercatabolic and seven non-hypercatabolic patients with acute renal failure (ARF) or exacerbation of chronic renal failure (CRF). Serum potassium became normal within 24 hours of the initiation of CEPD, while the decrease and maintenance of blood urea and serum creatinine were not significantly different in the two groups. These results indicate that CEPD is effective in patients with hypercatabolic renal failure.
Chronic Dialysis in the Elderly: Intermittent Peritoneal Dialysis or Hemodialysis?
Authors: Gibor Abdul Marai Mauro Rathaus Yair , Bernheim Jacques
Published: February 2020

This study compared two groups of elderly patients -16 treated with IPD, and 31 treated with hemodialysis -HD. Predialysis conditions were assessed by means of a scoring system and the results were studied in terms of survival, causes of death, complications and laboratory parameters.

In the IPD group, survival was similar to the hemodialysis groups during the first 15 months but declined thereafter. IPD patients also required longer periods of hospitalizations. The causes of death were quite different: mainly cardiovascular in HD, and mainly related to peritonitis in IPD. Laboratory parameters were similar. Analysis of the scoring results showed that the patients selected for IPD had more cardiovascular disease and diabetes mellitus. In conclusion, the results of IPD in elderly patients are comparable to those of HD in the first year. The choice of “poor risk” patients for IPD may explain, in part, the inferior long-term results with this technique.
Effect of Indomethacin on the Peritoneum of Rabbits on Peritoneal Dialysis
Authors: Mileti Maurizio , Pietro Guiseppe Bufano , Franco Scaravonati , Carnevale Pecchini Guiseppe , Lanzarini Paolo
Published: February 2020

We studied the ultrastructural changes induced by intraperitoneal indomethacin on the visceral peritoneum of rabbits treated by peritoneal dialysis. We observed two outstanding effects: a) an increase in the number and size of endothelial vesicles and b) an almost complete disappearance of the endothelial intercellular spaces. The mechanisms of these changes are discussed.
Uremia and Host Resistance to Peritonitis in C.A.P.D-an Experimental Evaluation
Authors: Clarke Isabel A. , Ormrod Douglas J. , Miller Thomas E.
Published: February 2020

Peritonitis is an important complication of CAPD. Because uremia is believed to impair immunity, we sought to determine whether uremia per se predisposes patients on CAPD to peritoneal infection. Using an animal model of CAPD, we have evaluated the effect of severe uremia on host resistance to peritonitis. Intraperitoneal catheters were implanted in severely uremic and sham-operated non-uremic rats, which were then dialysed four times a day for two days. Alternatively, they were infused with dialysis fluid twice daily for eight days without drainage of the dialysate. Peritonitis was induced by direct inoculation of Escherichia coli; the bacteria in the peritoneal cavity and spleen were counted 24 hours after this challenge. Uremia did not impair resistance to experimentally induced peritonitis in either the dialysed or infused host.

Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly popular as a method for longteffil treatment of chronic renal failure. The major disadvantage is the risk of infection and peritonitis remains the single most important complication and reason for transfer of patients to another mode of therapy.

Uremia is believed to impair immunity and predispose patients to infection (1, 2). Hence the question arises: Are patients on CAPD predisposed to peritoneal infection by the uremia itself? We developed a model of chronic uremia in rats, which made possible studies uncomplicated by many variabies associated with the clinical management of uremic patients. This paper examines the contribution of uremia to the susceptibility of the dialysed host to peritonitis. In the rats, we found it difficult to maintain dialysis for longer than two days because of rapid blockage of catheters by fibrin and connective tissue. As a consequence, we employed two models: one carried out peritoneal dialysis for two days, and the other involved infusions of dialysate without drainage for a longer period. Uremic and sham-operated animals, either dialysed or infused without drainage, were compared with noffilal controls with respect to their ability to withstand an intraperitoneal challenge with viable Escherichia cali.
Improved Cell-Mediated Immunity in CAPD Patients as Compared to those on Hemodialysis
Authors: Giacchino Franca , Pozzato M. , Formica M. , Quarello F. , Piccoli G.
Published: February 2020

T -cell subsets were classified by monoclonal antibodies (OKT3 -peripheral mature T cells; OKT4 helper/inducer; OKT8 -cytotoxic/ suppressor) in CAPD and hemodialysis patients. Data were compared with in vivo assays of T cell function, such as DNCB and PPD skin tests.

Uremic patients had significant absolute lymphopenia; when the results were expressed as a percentage of OKT3+ cells, they did not differ from the controls. When they suffered from peritonitis, CAPD patients showed an increase in OKT8+ cells, but the ratio ocOKT4+ cells to OKT8+ cells showed no significant deviation from the normal population. On the other hand, CAPD patients showed a better response to DNCB and PPD antigens. In the hemodialysis patients there was a significant correlation between the negative response to the DNCB test and blood transfusion. There was no correlation between the immune response and the primary disease, or the nutritional status in either groups.
Evaluation of a Germicidal Device for Peritoneal Dialysis Connectors
Authors: Jensen William M. , Ahmad Suhail
Published: February 2020

Fifteen peritoneal-dialysis spike connectors were contaminated deliberately, either by handling (n = 12) or by a saline suspension of micro organisms (n = 3). The spikes were then subjected to ultraviolet light in a Germicidal System according to the manufacturer's instructions. Subsequent culture revealed that the device had sterilized the spikes contaminated by aqueous suspensions. In 25% of the tests, the spikes which were handled and contaminated by skin nor a had positive cultures. These results cast doubt on the efficacy of such a device.

Peritonitis, a major complication of peritoneal dialysis, is especially troublesome during continuous ambulatory peritoneal dialysis (CAPD). Here, the most common pathogens are skin flora (1), which is thought to be due to the frequent connections and disconnections needed in this method of treatment (1, 2). To reduce the incidence of contamination during the connecting procedure, Travenol Corporation has introduced a Gennicidal System (Model 5C-34–30). This system uses ultraviolet (UV) light to sterilize the connection between the patient line and the dialysate bag.

The present study was done to test the efficacy of this system by violating the recommended aseptic technique in a manner which would simulate patient non-compliance. We believe that testing with aqueous suspensions of bacteria is not an adequate challenge to the system because skin contact leaves oils and debris which may shield bacteria from the UV light (3,4).
Local Anesthetic -Bupiv Acaine Increases the Peritoneal Transport of Solutes. Part I: In Vivo Study
Authors: Breborowicz Andrzej , Knapowski Jan
Published: February 2020

A local anesthetic -bupivacaine was used in concentration 0.25 mmol/l in the dialysis fluid during peritoneal dialysis in rabbits. Bupivacaine increased the mean peritoneal clearance of urea by 33% and of inulin by 53%. The effect of the anesthetic persisted during next exchanges, performed without the drug. Bupivacaine given intraperitoneally, did not decrease blood pressure.

Peritoneal dialysis is used widely for treatment of renal failure (1). During the last few years, many attempts have been made to find a substance, which would increase the efficiency of peritoneal dialysis (2, 4). In the past we observed that procaine added to the fluid augments peritoneal solute clearance (5). Local anesthetics in the peritoneal cavity influence both the mesothelium and the vascular system. In the present study we used bupivacaine a long-acting, tissue-bound local anesthetic as the adjunct during peritoneal dialysis in rabbits.
A Cross Sectional Assessment of Serum Vitamin O ANO Trigl Ycerioe Concentrations in a CAPO Population
Authors: Nolph Karl D. , Ryan Leonor , Prowant Barbara , Twardowski Zbylut
Published: February 2020

A cross sectional analysis of 41 patients on continuous ambulatory peritoneal dialysis (CAPD) for six to 54 months (mean, 21.7) showed that 58.5% and 19.5% had low levels of 1,25-(OH)2 vitamin D and 25-OH vitamin D respectively. C-terminal and N-terminal parathyroid hormone (PTH) levels were elevated in 85 and 75%, respectively. N-terminal PTH correlated (r -0.31, p < 0.05) with serum inorganic phosphorus, but not with vitamin D levels. Triglyceride and cholesterol concentrations were elevated in 76% and 19%; HDL cholesterol was low in 37%. Except for PTH levels, none of the other above measurements correlated with time on CAPD. The findings suggest that most CAPD patients have low 1,25(OH)2 vitamin D and elevated PTH and triglyceride serum concentrations. More study should be made concerning the clinical significance of and proper therapeutic interventions in these circumstances.

Reduced serum concentrations of vitamin D metabolities and increased serum triglyceride concentrations have been described frequently in patients on continuous ambulatory peritoneal dialysis (CAPD) (1–4). In 41 patients in our CAPD program, we did a cross-sectional assessment of vitamin D and triglyceride levels to quantitate the frequency and severity of these problems. We correlated serum levels of vitamin D and triglyceride with time on CAPD and other variables.
Survey of Continuous Ambulatory Peritoneal Dialysis in the United Kingdom, 1982
Authors: Gokal Ram , Marsh Frank P.
Published: February 2020

Forty -one adult renal units undertaking continuous ambulatory peritoneal dialysis (CAPD) in the United Kingdom answered a questionnaire about available facilities and their own practices. The responses suggest that many units are struggling with unsatisfactory environmental facilities and inadequate staff. Working methods, diagnostic facilities and therapeutic policies varied considerably from unit to unit. We need more information about the influence of such variables on the results of CAPD and its complications, particularly peritonitis.

The use of CAPO for the management of end-stage renal failure in the United Kingdom has increased dramatically since its introduction in 1978 (I, 2). Although statistics from the European Dialysis and Transplant Association (EDT A) revealed a high technique failure rate and considerable morbidity from catheter and peritonitis problems (2, 3), individual units have reported better results (4, 5, 6). Discussion with nephrologists in the United Kingdom suggested that there were marked differences between renal units in the techniques used and the facilities available for the practice of CAPD, and that these might be reflected in the results of treatment. Therefore, we circulated a questionnaire to the 59 dialysis units in the United Kingdom requesting information concerning their facilities, practices, and the ways in which they diagnosed and managed CAPD-related infection in 1982. Replies were received from 52 units; of these six were not using CAPD and five others were pediatric centres. The questionnaires from the remaining 41 adult renal units were analysed for this report.
Massive Colonization ofan In-Dwelling Catheter by Penicillium Pinophilum without Peritonitis
Authors: Locci Romano , Marcello Romagnoni , Beccari Marcello , Faiolo Sergio , Granello Elisabetta , Lischetti Maria G. , Quaroni Sergio , Scalia Patrizia
Published: February 2020

This paper describes invasion of an indwelling peritoneal catheter by a fungus. This colonization by Penicillium pinophilum, whose identity was proved by isolation, mycological characterization and in situ examination by scanning electron microscopy, did not cause peritonitis. We have discussed possible causes of contamination and implications of the findings.

Fungi rarely are responsible for primary peritonitis in CAPD patients, though increasingly they are recognized as secondary agents (1). Mycetes so far isolated belong to the following genera: Aspergillus, Candida. Drechslera, Fusarium, Mucar, Rhodotorula and Trichosparan (2–10). Recently Pearson et al (II) described Penicillium peritonitis which appeared to have been induced by prolonged antibiotic therapy, following repeated episodes of bacterial peritonitis. A similar sequence was encountered after intestinal perforation (3).

In CAPD patients peritonitis caused by fungi does not differ from the more common bacterial peritonitis (3), though at first the clinical symptoms may be attenuated and effluent solution may be clear (6, 11). In some cases however such peritonitis can be particularly severe and persistent (12). In these circumstances the catheter should ∼ removed (2, 13, 14), because then the infection clears without specific antifungal therapy. Colonization of the in -dwelling device is associated with a poor prognosis (15). This report describes a patient with massive colonization of the exposed tract of the Tenckhoff peritoneal catheter with Penicillium without clinical symptoms of peritonitis or changes in the dialysate effluent.