bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective Use of Amino Acid Dialysate over four Weeks in CAPD Patients
Authors: Oren Arie , Wu George , Anderson G. Harvey , Marliss Errol , Khanna Ramesh , Tit Jean Pet , Mupas Lou , Rodella Helen , Brandes Lidia , Roncari Daniel A. , Kakis Gary , Harrison Joan , McNeil Kenneth , Oreopoulos Dimitrios G.
Published: February 2020

We studied the effectiveness, tolerance to, and beneficial metabolic effects of amino acid dialysate over an intermediate period in six CAPD patients. Two liters of 1% amino acid solution (Amino-Dianeal) were alternated with dialysate containing glucose. After four weeks there were significant increases in BUN (from 64 to 102 mg%), total body nitrogen (from 1333 to 1380 g), serum transferrin (from 175 to 222 mg%) and anion gap (from 15.1 to 17.3). Initially, there was a significant rise in HDL cholesterol, however, this was not sustained. No significant change was detected in total-body potassium, fasting serum albumin, triglyceride, insulin, glucagon, electrolytes, anthropometric measurements and daily ingestion of calories and proteins. During the study individual fasting, plasma amino acid levels showed significant increments in respect to histidine, tryptophan and glycine but alanine decreased. Several essential amino acids continued to show values below normal. Two hours after consumption of breakfast and concurrent infusion of the amino acid solution, the plasma levels of the amino acids in the dialysate peaked at emia, which develops in almost onehalf of the CAPD patients (7), and the significant weight gain observed in some of them. Furthermore, the daily losses of albumin and amino acids in the dialysate may induce protein malnutrition, especially if these losses are not replaced by an adequate daily protein intake. The presence of protein malnutrition in CAPD patients is indicated by the low serum albumin and total protein, and by the decrease in total body nitrogen over one year of CAPD (8).
In Vitro and in Vivo Studies of Erythropoiesis during Continuous Ambulatory Peritoneal Dialysis
Authors: Lamperi Silvano , Carozzi Silvia , Icardi Andrea
Published: February 2020

In order to understand the effect of CAPD on the anemia of chronic renal failure, we studied the behaviour of some hematological parameters and of the colony-formation capacity of bone marrow cells in in vitro cultures in patients undergoing this therapy.

Our studies showed a rise in hematocrit, hemoglobin and reticulocyte values, which showed a significant correlation with a recovery of the erythroid cell proliferative activity. Since serum erythropoietin levels do not change, the improvement of bone-marrow function appears to be due to a better clearance (by CAPD) of substances, which inhibit the response of bone marrow to the erythropoietin.
The Significance of Lipid Abnormalities in Patients Receiving Dialysis Therapy
Authors: Cattran Dan C.
Published: February 2020

The accelerated atherosclerosis seen in dialysis patients is multifactorial in origin. Abnormalities in lipid metabolism probably contribute to this premature vascular disease. Despite attempts to modify these abnormalities by dietary modifications, change in dialysis modalities, drug therapy and more recently exercise, the ideal approach has not yet been determined.
CAPO Raining Failures
Authors: Gutman Cathy , Clayton Sheila , Tattersal Susan
Published: February 2020

Thirty patients (5.5% of all patients who entered CAPD training in three Toronto Hospitals) failed CAPD training during the last five years. A categorization of these training failures revealed that in three patients (10%) were due to dialysis-related problems, and in 11 of them to concurrent medical problems ultimately contributing to training failure. Only in two of 30 (6.6%) failure was due primarily to inadequate intellectual ability.

In those situations where partners were responsible for carrying out the dialysis, the most common cause of failure was the inability of the partner to meet all of the other care needs beyond those of dialysis, mainly because the patients were very sick. Other reasons for spousal failure were fear of responsibility and outright spousal countermotivation.

Remaining categories of failure in patients were countermotivation (four or 13.3%), inability to adjust emotionally to life with CAPD (seven or 23.3%), physical impediments to carrying out CAPD (two or 6.6%) and severe psychiatric disturbance (one patient or 3.3%).
Clinical Observations on Renal Failure and Sexuality
Authors: Dailey Dennis M.
Published: February 2020

The renal failure patient is likely to experience a wide range of sex related concerns and/or serious sexual dysfunctions. This aspect of patient care is largely overlooked or avoided by health care professionals, usually because of attitude, knowledge, and skill deficits of the caregivers. This paper offers suggestions to prepare health professionals for competent intervention, in order that they may provide a more complete service to these patients and their partners.
Renal Osteodystrophy and the Status of Aluminum and Other Trace Metals in CAPD Patients: A Panel Review
Authors: Campese Vito , Easterling Ronald E. , Finkelstein Fred , Mattern William , Ogden David A. , Steiner Robert W. , Oreopoulos Dimitrios G.
Published: February 2020

Most reports indicate that in patients on CAPD, hyperparathyroid bone disease progresses, while osteomalacia improves. With 1.5g% Dianeal, and when dialysate Ca is 7mg%, peritoneal mass transfer of calcium is positive, i.e., it is absorbed from the solution, while with hypertonic solutions it is less positive or even negative. Daily phosphorus removal by CAPD is insufficient to control serum phosphorus, hence CAPD patients require phosphate binders and/or phosphate restriction. Peritoneal phosphorus removal is greater with hypertonic than with isotonic solutions.

In patients on CAPD, the loss of substantial amounts of D-binding protein and 25(OH)DJ into the dialysate, produces a gradual decrease in plasma 25(OH)D levels. Similarly, these patients have low 1,25(OH)D2 DJ levels and, hence, should receive vitamin D or its analogues.

Unlike hemodialysis, CAPD results in a significant removal of PTH, with a peritoneal clearance of 1.5 ml/min. However, despite an estimated daily loss of 13.5% of the circulating PTH, there probably is not a significant effect on plasma PTH levels, which usually respond to changes in serum Ca. Levels of the intact PTH molecule provide a better index of hyperparathyroidism than do levels of its COOH-terminal fragment.

With regard to investigation and treatment, one should measure serum ionic calcium rather than total calcium, even if the latter is corrected for total protein. The minimal dialysate calcium should be 7 mg/dl and for hypertonic solutions, perhaps it should be higher (7.5–8.0 mg%). Total serum calcium should be maintained at 10.2–10.7 mg/dl (ionized calcium of 5.1–5.5 mg/dl); adjunctive use of active forms of vitamin D and prevention of aluminum intoxication may prevent progressive bone disease in CAPD, and existing bone disease may heal.

Whereas there are enough data supporting the connection of aluminum toxicity and osteomalacia in hemodialysis patients, data concerning the incidence of osteomalacia and its relationship to aluminum in CAPD patients are scarce. Apparently CAPD removes aluminum more efficiently than hemodialysis. CAPD patients are less likely to develop osteomalacia because the dialysate aluminum content is low and these patients tend to require lower doses of phosphate binder.

There are no extensive studies on trace element deficiencies or excess in patients on CAPD. These patients may be more susceptible to deficiencies of trace elements which are protein bound. Desferoxamine may be effectively used for the treatment of patients with either aluminum or iron overload.
Peritoneal Mass Transfer in Patients on long Term CAPD
Authors: Selgas R. , Rodriguez-Carmona A. , Martinez M.E. , Perez-Fontan M. , Salinas M. , Escuin F. , Rinon C. , Martinez-Ara J. , Sanchez-Sicilia L.
Published: February 2020

Continuous contact of the peritoneum with the dialysis solution during CAPD and peritonitis may produce changes in the peritoneal masstransfer properties. In 35 patients who have been on CAPD for 1–34 months, we have studied the effect of time on CAPD, and peritonitis on mass transfer coefficients (MTC) of urea, creatinine, uric acid, inulin and parathormone (PTH). Even though the mean values of the whole group showed no statistically significant changes, in six patients, the MTCs of some solutes did show significant changes (increase or decrease).

Similarly peritonitis produced a varying effect on the MTC of some patients but they counteracted each other, hence the absence of significant effect in mean whole-group values.

We have concluded that the permeability of the human peritoneum is highly individual and, in some patients, mass transfer properties of the peritoneum should be assessed periodically in order to make appropriate adjustments in the dialysis schedule.
Computerized Tomography CT in the Diagnosis of Subcutaneous Leak Sites during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Twardowski Zbylut J. , Tully Richard J. , Nichols W. Kirt , Sunderrajan Sobha
Published: February 2020

Two patients receiving continuous ambulatory peritoneal dialysis (CAPD) presented with abdominal, and scrotal or vulvar edema. In both we suspected a dialysate leak, but the leak site could not be defined clinically. In one patient, a plain CT scan (without contrast in dialysate) revealed a small inguinal hernia and ruled out a pericatheter leak. In the other patient the route of fluid leakage could not be detected on a plain CT scan, or when images were taken immediately after contrast injection into dialysate, while the patient remained in the supine position on the CT table. Images taken two hours after contrast injection, with the patient ambulatory in the meantime, disclosed a leak through the tunnel of a previous peritoneal catheter. The diagnosis was confirmed at operation in both patients. Our experience suggests that when the diagnosis cannot be established clinically, CT scan may be useful to delineate a leak site.
Biocompatibility and Hydraulic Function of Tenckhoff and Life Cath@ Catheters
Authors: Ash Stephen R.
Published: February 2020

Different peritoneal catheters are compared in terms of their biocompatibility and in vivo functional characteristics.
Outcomes of CAPD and IPD Therapy at Manhattan Kidney Center, 1979–83
Authors: Ira Norman Deane , Herman C. , Garvey Michael A. , Wineman Robert J.
Published: February 2020

The study undertaken by Dr. Norman Deane of Disparate Patient Groups undergoing CAPD and IPD found the interval between peritonitis was higher for IPD patients. Duration for hospitalization for peritonitis was similar for both therapies. Total hospitalization was greater for IPD patients. The primary cause of death for the CAPD patient was GI related and for IPD, cardiovascular. Survival of the CAPD group was similar to that of the in-center hemodialysis patient survival. Survival of the IPD group was inferior to that of CAPD due to the presence of greater co-morbid conditions. Finally, survival of patients aged 55 years or older on either therapy was similar.

The purpose of the study was to evaluate the outcomes of patients using continuous ambulatory peritoneal dialysis (CAPD) and intennittent peritoneal dialysis (IPD) therapies over the last 4 years.
Comparison of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis for Diabetics
Authors: Mejia Gonzalo , Zimmerman Stephen W.
Published: February 2020

To determine the relative efficacy of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) we compared all diabetic patients starting these treatments between April 1978 and August 1983. There were 37 HD patients and 34 CAPD patients who were comparable in age and degree of systemic disease. In the CAPD group survival was 81% at one and three years, and in the HD group 76% and 400/() at one and three years (P < 0.05) respectively. Initially CAPD patients spent more days in the hospital for catheter placement and training but subsequently had fewer hospital days. Infections other than peritonitis and catheter related were more frequent in HD (P < .05) patients, as were access repairs (P < .05). Also we compared at one year 12 patients on CAPD to eight patients on HD. Although they were comparable in all respects at the start of therapy, at the end of follow-up (24 ± 3 mo HD, 27 ± 3.5 mo CAPD) all CAPD patients remained on CAPD while only three remained on HD. Also HD patients had spent more than twice as many hospital days/patient months as did CAPD patients (P < .01). We have concluded that CAPD compares favorably with HD as a renal replacement therapy for diabetic patients at our institution.

In the last decade increasing numbers of diabetic patients with end-stage renal disease (ESRD) have been accepted for various types of renal replacement therapy (1–17). Of these, hemodialysis (HD) has been carried out for the longest period and although results have improved, the mortality rates in diabetics are still higher than in nondiabetic populations (14–16). Continuous ambulatory peritoneal dialysis (CAPD) is a new and reportedly efficacious therapy for diabetic patients with ESRD. While some studies have suggested that CAPD has an advantage over HD, definite proof is lacking because many reports (1,2,7) included patients who were transferred from one form of dialysis to another or were started on dialysis after a renal transplant. Furthermore, few studies have compared CAPD with hemodialysis in the same institution. For these reasons at our affiliated institutions we did a retrospective study, which compared HD and CAPD as the primary form of therapy for ESRD due to diabetic nephropathy.
Patient's Self Assessment of Stressors and Adjustment to Home Hemodialysis and CAPD
Authors: Kline Stepben A. , Burton Howard J. , De-Nour A. Kaplan , Bolley Hildo
Published: February 2020

We studied adaptability to the stresses of bome bemodialysis and CAPD programs by asking patients (143 on bemodialysis; 53 on CAPD) to assess particular treatment -associated stressors. A 14-item questionnaire was constructed to measure areas in which the patients felt stress and the intensity of the stress. Also we used a self-rating scale to obtain information about both the patient's overall and bis or ber physical wellbeing. The majority of patients complained of physical weakness and an inability to sleep. This paper outlines stressors for each treatment modality, and based on patient self-assessment concludes that the two modes of treatment are comparable.
Surgical Complications during Continuous Ambulatory Peritoneal Dialysis
Authors: Valenti Giovanni , Cresseri Donata , Luisa Maria , Enzo Bianchi , Lorenz Corghi Marc , Buccianti Gherardo
Published: February 2020

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two.

From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.
Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Developing Country
Authors: Dominguez Jorge , Gonzalez Gladys , Figueroa Lenin , Mendez Jose
Published: February 2020

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months.

Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%).

Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy.

The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses.

Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.
Estimating Rates of Recurrent Peritonitis for Patients on CAPO
Authors: Vonesh Edward F.
Published: February 2020

Recurrent peritonitis is a major complication of Continuous Ambulatory Peritoneal Dialysis (CAPD). As a therapy for patients with end stage renal disease, CAPD entails a continuous interaction between patient and various medical devices. The assumptions one makes regarding this interaction play an essential role when estimating the rate of recurrent peritonitis for a given patient population.

Assuming that each patient has a constant rate of peritonitis, two models for evaluating the risk of recurrent peritonitis are considered. One model, the Poisson probability model, applies when the rate of peritonitis is the same from patient to patient. When this occurs, the frequency of peritoneal infections will be randomly distributed among patients (Corey, 1981). A second model, the negative binomial probability model, applies when the rate of peritonitis varies from one patient to another. In this event, the distribution of peritoneal infections will differ from patient to patient. The poisson model would be applicable when, for example, patients behave similarly with respect to their interactions with the medical devices and with potential risk factors. The negative binomial model, on the other hand, makes allowances for patient differences both in terms of their handling of routine exchanges and in their exposure to various risk factors.

This paper provides methods for estimating the mean peritonitis rate under each model. In addition, “survival” curve estimates depicting the probability of remaining peritonitis free (i.e. “surviving”) over time are provided. It is shown, using data from a multi-center clinical trial, that the risk of peritonitis is best described in terms of survival curves rather than the mean peritonitis rate. For both models, the mean peritonitis rate was found to be 0.85 episodes per year. However, under the negative binomial model, the one-year survival rate, expressed as the percentage of patients remaining free of peritonitis, is 52% as compared with only 42% under the Poisson model. Moreover, the negative binomial model provided a significantly better fit to the observed frequency of peritonitis. These findings suggest that the negative binomial model provides a more realistic and accurate portrayal of the risk of peritonitis and that this risk is not nearly as high as would otherwise be indicated by a Poisson analysis.
Successful Use of Continuous Ambulatory Peritoneal Dialysis in Refractory Heart Failure
Authors: Kim Donald , Khanna Ramesh , Wu George , Fountas Panos , Druck Maurice , Oreopoulos Dimitrios G.
Published: February 2020

Four patients with end-stage heart failure, massive ascites refractory to medical interventions and a variable degree of renal failure were treated successfuly with CAPD for eight to 24 months. The New York Heart Association functional class improved in all four. In two patients, who presented initially with signs and symptoms mainly of right-sided heart failure, ejection fraction improved. Each day dialysis achieved a significant degree of ultrafiltration and a negative sodium balance. We propose that CAPD is an alternative therapeutic modality in patients with severe heart failure refractory to the conventional medical treatment.

The advent of potent diuretics and preload and afterload reducing agents has had a major impact in the treatment of refractory congestive heart failure. Recently, captopril, an angiotensinconverting enzyme inhibitor, has been used with major benefit in some patients (I). However, some patients still do not respond to these treatments and their management presents a major therapeutic challenge. Furthermore, overzealous therapy with diuretics may lead to intravascular volume depletion resulting in hypotension, azotemia and electrolyte disturbances which further complicate their management.

In the past, intermittent peritoneal dialysis (IPD) or hemodialysis (HD) has been used to remove fluid from patients with intractable edema due to heart failure (2 7). But the benefit is only transient and fluid accumulates again, requiring repeated sessions of acute dialysis. However, hypotension is a frequent complication during either form of acute dialysis especially in hemodynamically unstable patients due to rapid removal of large amounts of fluid from intravascular space.

Continuous ambulatory peritoneal dialysis (CAPD), whose main characteristic is the slow continuous removal of sodium and water, offers obvious advantages in patients with intractable heart failure.

This paper describes our experience of four patients with intractable heart failure who have been treated with CAPD for eight to 24 months.
A New Approach for Catheter Placement and Care in CAPD
Authors: Henao Jorge , Mejia Gonzalo , Arbelaez Mario , Sus Alvaro , Arango Jorge L. , Aramburo Olga , Sanchez Julieta
Published: February 2020

Between April 1981 and December 1984, 54 double-cuff straight Tenckhoff catheters were inserted in 50 patients. This paper describes our experience with a new approach for catheter placement and care. It is based on a) ambulatory insertion by nephrologists; b) no flushing, heparinization or cycling; c) “break-in” delayed for two weeks and performed with regular two-liter bags; dialysis and d) ambulatory training carried out over 7–10 days. The actuarial survival rates of the catheters were 98% at 12 months and 80% at 24 and 36 months. Catheter failure was seen in six patients, three were due to peritonitis, two to tunnel infection and one to outflow obstruction caused by peritoneal adhesions. We conclude that this approach is feasible, safe, cheap and affordable and probably will produce less complications than other methods.

Our nephrology section started a CAPD program in early 1981 but limited financial resources led us to devise a simplified and affordable protocol for catheter placement and care and for patient training and follow-up. Thus, we provide ambulatory catheter placement followed by two weeks without any type of peritoneal dialysis or catheter flushing. After this period, patients are trained as outpatients for seven to 10 days. This paper reports our experience with this approach.
Appendicitis Perforata in CAPD Patients -Report of Two Cases
Authors: Vogt Konstantin , Hess Bernhard , Baumgartner Dieter , Maass Dirk , Keusch Gerald , Binswanger Ulrich
Published: February 2020

Two patients on CAPD had peritonitis due to perforated appendicitis. Both presented with diffuse painful peritonitis with nausea, fever and prostration. There was blood leukocytosis with a shift to the left. The peritonitis did not respond to antibiotic therapy. The diagnosis was made after 8 and 18 days respectively by exploratory laparotomy. Both patients had a gangrenous perforated appendix surrounded by abscess. Both patients had uncomplicated recovery after appendectomy, drainage, removal of the Tenckhoff catheter with discontinuation of CAPD and change to hemodialysis. Our experience suggests that a perforated appendix might be recognized early in a patient with apparent fecal peritonitis in whom other more common causes (e.g. diverticulosis/ diverticulitis) have been ruled out, or when he presents with severe symptoms and a low peritoneal white cell count.

Perforated appendicitis leading to fecal peritonitis is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Among 85 patients treated with CAPD since 1978 for a total of 1062 patient months, we observed two such cases. Although CAPD now is established as a kidney replacement treatment and appendicitis is a common condition, we know of no other report of perforated appendicitis during CAPD. Therefore we describe our experience with two such patients, treated with CAPD for 14 and 5 months, respectively. The diagnostic and therapeutic implications are discussed in the context of other forms of fecal peritonitis, mainly due to colonic perforation, secondary to diverticular disease. This report emphasizes the need for a high level of suspicion that the peritonitis may be related to bowel disease, especially when it does not respond quickly to standard treatment.
Arterial Calcifications in Patients Undergoing Chronic Peritoneal Dialysis: Incidence, Progression and Regression
Authors: Meema H. Erik , Oreopoulos Dimitrios G.
Published: February 2020

The authors graded radiologically detectable arterial calcification (A.C.) in 168 patients with end-stage renal disease treated with peritoneal dialysis; 41 of them had diabetes mellitus (DM). Comparison of DM and nondiabetic (ND) patients showed that during an average dialysis period of more than two years, the incidence of A.C. increased from 37% before dialysis to 45% at the last examination in the ND patients, and from 90% to 100% in DM patients. Both prevalence and progression of A.C. were significantly higher in DM patients (P < 0.001 and <0.05 respectively). Regressions of A.C., unrelated to parathyroidectomy or renal transplantation, were observed in 5 ND and 4 DM patients. This 9% incidence of regressions should encourage further investigations to detect the factors responsible because severe A.C. sometimes is associated with gangrene and other complications.

Although numerous publications on radiologic changes in renal osteodystrophy include descriptions of arterial calcifications (A. C.), only a few have focused on the latter (1–4). Furthermore, none have looked at the relative proportions of diabetic (DM) and non-diabetic (ND) patients with A.C. and chronic renal failure. The main purpose of this paper is to make such a comparison.
Deterioration of Peripheral Nerve Function during Continuous Ambulatory Peritoneal Dialysis
Authors: Lindholm Bengt , Tegner Richard
Published: February 2020

Peripheral neuropathy during CAPD, was investigated in 27 nondiabetic patients at the start of CAPD and after a mean of 24 months on CAPD with measurements of nerve conduction velocity (NCV) and vibratory perception threshold (VT). The clinical signs of neuropathy were quantified according to a fixed protocol. During the study period, motor NCV decreased 7% in the median nerve, and 9% in the peroneal nerve (p < 0.05); VT increased 45% in the hand (p < 0.01), and 135% on the foot (p < 0.001); and the clinical status improved in five and deteriorated in 14 patients (NS). We conclude (1) that the neuropathy may deteriorate during CAPD, although it remains mild in most instances, and (2) that the most characteristic finding is a markedly impaired vibratory sensitivity.
Special Studies from the NIH USA CAPD Registry
Authors: Nolph Karl D. , Cutler Sidney J. , Steinberg Seth M. , Novak Joel W.
Published: February 2020

Recent studies from the USA CAPD Registry include: cohort studies related to year of training, the impact of center size, the impact of descriptive characteristics of therapy that were not previously available, and identification of additional risk factors that predispose to transfer. The results indicate decreasing rates of peritonitis, exit site tunnel infection, and hospitalization for CAPD complications in the more recently trained patients. Center size has no major impact on outcomes. There may be a reduced risk of peritonitis with the addition of insulin to peritoneal dialysis solutions. Factors such as training year, distance from center, use of a partner, activity status, visual status, exchange volume, exchange frequency and exchange type, may influence outcomes and must be considered in studies of complication rates.
Biofilm and Foreign Body Infection the Significance to Capd-Associated Peritonitis
Authors: Holmes Clifford J. , Evans Rosemary
Published: February 2020

Microbial colonization of indwelling and implantable medical devices and prostheses is known to precede the formation of an adherent biofilm, such as is found on peritoneal catheters during CAPD. Micro-organismderived exopolysaccharides within the biofilm matrix seem to confer unique biological properties on this material, such as enhanced resistance to host defenses and antimicrobial agents. It has been proposed that an adherent biofilm is a major contributing factor in the development of foreign-body infections, including CAPD peritonitis. The source of organisms which lead to biofilm formation on peritoneal catheters is unknown but may include “seeding” at the time of surgical placement and migration from the subcutaneous tunnel via the inner cuff.

Strategies to inhibit biofilm development in industrial systems usually involve physical destruction of the biofilm and the use of biocides. Clinical success has been achieved by antimicrobial agents impregnated into or coated onto susceptible devices. Microbial adhesion to inanimate surfaces is a complex and multifaceted event. Continued research in this area, however, should increase our understanding of the factors involved underlying foreignbody infection.
Peritoneal Catheter Survival in Children
Authors: Hymes Leonard C. , Clowers Bertha , Mitchell Carolyn , Warshaw Barry L.
Published: February 2020

In children undergoing CAPD or CCPD, the authors compared two techniques for peritoneal catheter insertion by analyzing the probabilities for overall catheter survival, catheter outflow failure and peritonitis. Between January 1980 and December 1982, catheters were installed with a slightly arcuate subcutaneous tunnel with a predominantly transverse orientation. After December 1982 catheters were implanted with a straight subcutaneous tunnel directed caudally toward the pelvis. We found that a catheter directed toward the pelvis was associated with improved overall survival. Adoption of this technique greatly reduced outflow obstruction, the leading cause of catheter failure before 1983. However, the orientation of the extraperitoneal catheter segment did not appear to influence the overall risk for peritonitis.
Rupture of the Spleen: A Complication of Continuous Ambulatory Peritoneal Dialysis
Authors: De Los Santos C. Abaete , Von Eye Osvaldo , Vila Domingos d’ A , Mottin Claudio Cora
Published: February 2020

A 44-year-old woman on CAPD for 20 months presented with severe intraperitoneal bleeding secondary to rupture of the spleen. On the day of the accident displacement of the Tenckhoff catheter to the left upper quadrant of the abdomen was detected by X-ray. We believe this dislodgement caused the rupture either by direct trauma or erosion of the organ. This complication of CAPD has not been described before.

There are no previous reports of rupture of an abdominal organ during chronic peritoneal dialysis. However massive intraperitoneal hemorrhage in CAPD has been described secondary to abdominal wall erosion by the Tenckhoff catheter. We believe that rupture of the spleen in the present case was due to trauma and/or erosion induced by a displaced Tenckhoff catheter.
Renal Osteodystrophy in Patients on Continuous Ambulatory Peritoneal Dialysis: A Five Year Study
Authors: Rahman Rabihur , Heaton Alexander , Goodship Timothy H.J. , Stuart R. , Rodger C. , Tapson Leslie John S. , Ellis Sellars Hew A. , Wilkinson Robert , Ward Michael K.
Published: February 2020

The clinical, biochemical, radiological and histopathological data related to renal osteodystrophy were extracted from the computer records of 81 patients who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for more than two years. Paired bone histopathology was available in 45 of these patients.

The majority maintained normal serum ionised and total calcium concentrations, while mean serum phosphate concentration ranged from 1.68 to 1.80 mmol/l. Serum parathyroid hormone concentrations fell significantly in those with high values at the start of CAPD. Five patients underwent parathyroidectomy. Mean serum aluminium concentrations were higher than normal healthy controls and the levels rose further after the addition of aluminium-containing phosphate binders (ACPB).

Of the patients with histological evidence of secondary hyperparathyroidism, 82% showed improvement on repeat biopsy. Nine, who had no evidence of osteitis fibrosa at the beginning of CAPD, remained free of bone disease during the study period. Osteomalacia was present in two patients at the onset of CAPD and developed in three more, two of them after parathyroidectomy. Except for one patient, all those with osteomalacia improved after the addition of alfacalcidol and continuation of CAPD. This last patient died with evidence of aluminium deposition in his bones.

We conclude that when used as clinically indicated, CAPD, with the addition of calcium carbonate, phosphate binders and alfacalcidol, achieves good control of renal osteo dystrophy in the majority of patients.
Plasma Vitamin-A Levels in Children on CAPD
Authors: Parrott Keith A. , Stockberger Roxy A. , Alexander Steven R. , Miller Lorraine T. , Leklem James E. , JenkinsJ Randall D.
Published: February 2020

Accumulation of vitamin A in patients with renal failure was first described in the 1940's. This study reports dietary intake and plasma concentration of vitamin A in children undergoing CAPD. Dialysate loss of vitamin A was also evaluated. Eight children (mean age 12 years) were studied who had been on CAPD from nine months to five years. Vitamin supplements were discontinued for three weeks before the study and a three-day dietary record was obtained.

Mean plasma vitamin A concentration was 617 μg/dl with a range of 342 to 1051 μg/dl. No vitamin A was detected in the dialysate. Mean dietary intake was 944 retinol equivalents per day, which is equivalent to a mean per cent RDA of 125. Dietary vitamin A ranged from 62 to 262% of the RDA.

Not only should these patients avoid supplements containing vitamin A but the individual should monitor dietary intake of vitamin A and avoid intake in excess of the RDA.
Peritoneal Catheters and Exit -Site Practices: Current Recommendations
Authors: Oreopoulos Dimitrios G. , Baird G. , Khanna Ramesh , Lum Gary M. , Matthews Raymond , Paulsen Kevin , Twardowski Zbylut J. , Vas Stephen I.
Published: February 2020

The peritoneal catheter is the CAPD patient's lifeline. Advancement in catheter technology has made it possible to access the peritoneal cavity safely over extended periods. Infection at the exit site is still a problem, solution to which is being extensively researched. Successful outcome of catheter in an individual depends upon meticulous adherence to the guidelines provided here, which is a compilation of extensive experience of several large centers.
Relationship of Adherent Bacterial Biofilms to Peritonitis in Chronic Ambulatory Peritoneal Dialysis
Authors: Oasgupta Mrinal K. , Bettcher Kelvin B. , Ulan Raymond A. , Burns Valorie , Lam Kan , Oossetor John B. , Costerton J. William
Published: February 2020

To examine the relationship of the formation of biofilm (adherent bacterial microcolonies) to recurrent peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPO) we examined the surfaces of 25 recovered Tenckhoff (T) catheters by scanning electron microscopy (SEM) and microbiological examination of scrapings. Twelve catheters had been removed after successful transplantation; the patients had not been dialyzed for three months and had no evidence of peritonitis during that period (control group), and only seven had experienced peritonitis (I or 2 episodes) before transplantation. All 13 patients in the study group had experienced repeated episodes of peritonitis (range 3–13, average, 5.6). We detected no significant differences between the control and study groups with respect to the percentage of catheter-surface covered by biofilm, or the proportion of catheter segments whose scrapings yielded positive bacterial cultures. It is concluded that large areas of the T catheters of CAPO patients are colonized by bacterial biofilms but only active dialysis predisposes to recurrent peritonitis.
Routine Daily Surveillance Cultures in the Management of C.A.P.D. Patients
Authors: Williams Peter S. , Hendy Michael S. , Ackrill Peter
Published: February 2020

The authors collected 3876 daily specimens of dialysate for bacteriological culture from II patients on CAPD over a period of 155 patient treatment months. During the trial period, there were 30-culture positive episodes of peritonitis. In 16 ( 530;”) of the episodes there was a latent interval of 72 hours or less between the presence of organisms in the dialysate and the clinical onset of peritonitis. However, 153 positive cultures were unrelated to ari episode of peritonitis. Most asymptomatic positive cultures, therefore, do not progress to peritonitis. There were eight episodes of “recurrent” peritonitis. In six of these, although initially the dialysate was rendered sterile and the patient asymptomatic by antibiotics the pathogenic organism was isolated again from dialysate on more than one occasion, during continued antibiotic administration. In six of these cases, a second episode of peritonitis due to the same organism recurred within 20 days of discontinuing antibiotics suggesting that most episodes of “recurrent” peritonitis represent treatment failure, rather than reinfection.
Possible Heparin-Inouceo Subcutaneous Necrosis in a CAPO Patient
Authors: Somerville Peter J. , O'Brien Elizabeth , Kaye Michael
Published: February 2020

A patient developed subcutaneous necrosis of the tissue of the anterior abdominal wall while carrying out continuous ambulatory peritoneal dialysis (CAPD). This necrosis was preceded by a leak of heparin-containing dialysate into the area. We believe this represents an example of the entity -heparin-induced subcutaneous necrosis. After reviewing the appropriate literature, we have concluded that intraperitoneal heparin should be used with caution in CAPD patients, who are at risk for leakage and heparin necrosis, i.e. those who are diabetic, elderly, obese, and receiving broad spectrum antibiotics.
Delayed Laceration of Intestinal Wall by the Permanent T enckhoff Peritoneal Catheter
Authors: Haj Mahmud , Kristal Batya , Shasha Shaul M.
Published: February 2020

Two patients with delayed laceration of intestinal wall by long-standing Tenckhoff peritoneal catheter for continuous ambulatory peritoneal dialysis (CAPD) are described. The laceration was due to the formation of a decubitus ulcer by prolonged pressure of the catheter on the intestinal wall. If not treated surgically, this may cause perforation with fecal peritonitis and intestinal obstruction.
IntraperitonealInsulin: A Protocol for Administration during CAPD and Review of Published Protocols
Authors: Beardsworth S. F. , Ahmad R. , Terry E. , Karim K.
Published: February 2020

For many diabetics in end-stage renal failure, the initial therapy they receive will be continuous ambulatory peritoneal dialysis (CAPD) together with i.p. insulin. To date, all published protocols rely on empirical dosages based upon predialysis insulin requirements. A practical regimen for the institution of i.p. insulin administration during CAPD is described. The only endpoints used to determine insulin dosage were fasting plasma glucose 5 to 10 mmol/L and 2 h postprandial plasma glucose 8 to 15 mmol/L. An initial protocol related to body weight, dextrose content, volume, and timing of dialysate was based on a retrospective analysis of the results in our first 10 patients. Subsequently, a prospective assessment in an additional 22 patients confirmed the effectiveness of the regimen. The following protocol is recommended for the institution of i.p. insulin therapy in patients undergoing CAPD: Preprandial exchanges 1.36% dextrose-0.175 U/L dialysate/kg body weight 3.86% dextrose-0.25 U/L/kg Overnight exchanges 1.36% dextrose-0.1 U/L/kg 3.86% dextrose-0.15 U/L/kg Further adjustment of insulin dosage is then made on the basis of four hourly plasma glucose profiles. Self-monitoring of capillary blood glucose is recommended.
Natural History of Exit-Site Infection (ESI) in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Abraham Georgi , Savin Evgeije , Ayiomamitis Anthony , Izatt Sharron , Vas Stephen I. , Mathews Raymond E. , Oreopoulos Dimitrios G.
Published: February 2020

One hundred and thirty-one patients were started on continuous ambulatory peritoneal dialysis (CAPD) between January 1984 and June 1987. They ranged in age from 14 to 82 years (mean 52.8). Sixty patients (1914 patient months) developed 133 episodes of exit-site infection (ESI), an incidence of one episode per 14.4 patient months. Sixty-six episodes were purulent and 67 were nonpurulent (redness, crust, or serous discharge). In diminishing order of frequency, the bacteria isolated were Staph. aureus, Staph. epidermidis, Pseudomonas, and diphtheroids. The probability for remaining free of ESI was 54% at one year and 22% at three years. Factors like single or double-cuff catheters, diabetes, and sex did not influence the development of ESI. Recurrence was common especially in purulent ESI, and medical or surgical treatment did not eradicate the infection. Patients with purulent ESI had a higher incidence of peritonitis than those with no ESI-one episode per 8.1 patient months vs. one episode per 20.9 patient months. In the ESI group, of the 154 catheters implanted, 24 (15.6%) were removed; five were lost without ESI (3%). The main cause leading to catheter removal in the ESI group were Staph. aureus and Pseudomonas infections. Peritonitis following ESI was not necessarily due to the organisms isolated from the ESI.
Acquired Cystic Disease of the Kidney in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Rodriguez-Perez1 Jose Carlos , Vega Nicanor , Camaño Tomas , Fernandez Ana , Plaza Celia , Palop Leocadia , Gragera Francisco
Published: February 2020

Acquired Cystic Disease of the Kidney (ACDK) has been increasingly noted in patients with long-standing renal failure and in those treated with dialysis. We assessed the prevalence of different patterns of cysts in 48 randomly selected patients treated with CAPD (23.1 ± 16.0 months). Only 3 patients had been previously treated with hemodialysis. All patients underwent renal ultrasonography (US) and nine underwent computerized tomography (CT). In 22 patients no cysts were found. The other 24 patients were Included In three different groups. Group 1: Cysts that predominate In the renal cortex from 0.3 to 3.0 cm In diameter: 14 patients. Group 2: Cysts less than 0.3 cm in diameter (granular-microcystic pattern): 4 patients. Group 3: SolItary cysts 1 to 3: 6 patients.

US and CT are relIable and sensitive enough to detect cysts even smaller than 0.3 cm in diameter. The incidence of patients with renal cysts increases with the duration of CAPD. Cysts less than 0.3 cm In diameter (Group 2) could correspond to an initial stage of Group 1 cysts or to a new aspect of ACDK. Group 1 and Group 2 cysts were predominant In male patients, while Isolated renal cysts were more frequent in females.
Effect of Various Factors on Peritoneal Lymphatic Flow in Rabbits
Authors: Breborowicz Andrzej , Rodela Helen , Oreopoulos D.G.
Published: February 2020

Peritoneallymphatic flow in normal and uremic rabbits was measured by estimation of the disappearance of the radiolabelled 1311–albumin from the peritoneal cavity.

The results show that lymph flow rate from the peritoneal cavity is not steady and depends on dialysate volume, its tonicity, and protein content. During peritoneal dialysis, peritoneal lymphatic flow is lower at the beginning of an exchange. Peritoneal lymphatic drainage is higher in uremic rabbits compared to normal controls.
Absorption of Recombinant Human Growth Hormone (rhGH) following Intraperitoneal Instillation
Authors: Fine Richard N. , Fine Shawney E. , Sherman Barry M.
Published: February 2020

Recombinant human growth hormone (rhGH) was instilled intra peritoneally (i.p.) in six children undergoing continuous cycling peritoneal dialysis {CCPD). Immediate absorption was noted with either 0.250 mg/kg, 0.125 mg/kg, or 0.050 mg/kg of rhGH. Peak serum growth hormone {GH) levels occurred 4 and 8 h following i.p. administration, and the serum GH levels had returned to baseline values at 24 h. In one patient, a higher dosage demonstrated adequate absorption, whereas the lower dosage produced a flat absorption curve. These data indicate that daily i.p. administration of rhGH could be utilized in clinical trials directed toward improving the growth velocity of children undergoing CCPD.
Comparative Pharmacokinetics of Recombinant Erythropoietin Administered by the Intravenous, Subcutaneous, and Intraperitoneal Routes in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients
Authors: Boelaert Johan R. , Schurgers Mario L. , Matthys Erve G. , Belpaire Frans M. , Daneels Roger F. , De Cre Mireille J. , Bogaert Marc G.
Published: February 2020

The single dose pharmacokinetics of recombinant human erythropoietin (r-HuEPO) were compared in six continuous ambulatory peritoneal dialysis (CAPD) patients after intravenous (i.v.), subcutaneous (s.c.), and intraperitoneal (i.p.) administration of 300 U/kg. Intravenous administration gave results close to those obtained in hemodialysis patients, with a half-life of 11.2 h and a volume of distribution of 5.0% of body weight. After subcutaneous administration, the serum concentration rose slowly to plateau between 24 and 36 h, the area under the serum concentration vs. time curve from 6 to 72 h being 18.2% of that after intravenous administration. After intraperitoneal administration, the serum concentration was even lower, the area under the curve from 0 to 24 h was between 2.5 and 3.6% of that after intravenous administration, and 80% of the administered dose was recovered in the first peritoneal effluent after a 4- h dwell time.
Metabolism of D-Lactate in the Dog and in Man
Authors: Fine Adrian
Published: February 2020

Peritoneal fluid contains equimolar amounts of D and L isomers of lactate. Controversy exists as to whether D-Iactate is metabolized as effectively as the L isomer. D and L-Iactate were infused into the portal circulation of dogs and net hepatic uptake of both isomers measured by A-V sampling, blood flows being measured by flow probes. Hepatic extractions of both isomers were not significantly different. In three patients on intermittent peritoneal dialysis (IPD), and three patients on continuous ambulatory peritoneal dialysis (CAPD), arterial D-Iactate was less than 15% of the concentration of Llactate at the end of treatment. In conclusion, D-Iactate is metabolized as effectively as L-Iactate.