bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Impaired Transcellular Water Transport Contribute to Net Ultrafiltration Failure during CAPD?
Authors: Monquil Margje C.J. , Imholz Alexander L.T. , Struijk Dirk G. , Krediet Raymond T.
Published: February 2020

Objectives

To assess the contribution of transcellular water transport in net ultrafiltration failure during continuous ambulatory peritoneal dialysis (CAPD).

Design

Retrospective.

Setting

Renal Unit, Academic Medical Center, Amsterdam.

Patients

One group of 6 patients with clinical severe ultrafiltration loss and a group of 10 stable CAPD patients without ultrafiltration problems.

Intervention

In all patients, two peritoneal permeability tests were done within one week, using glucose 1.36% dialysate on one day and glucose 3.86% on the other day. Dextran 70 was used as a volume marker.

Results

The difference in net ultrafiltration between 3.86% glucose and 1.36% glucose dialysate was 569±51 mL (control) and 153±1 03 mL (poor ultrafiltration group; p < 0.005). The dialysatelplasma (DIP) concentration ratios increased in both groups with glucose 1.36%. When using 3.86% glucose, the DIP ratio decreased in the control group with a median minimum value one hour after completion of inflow. It is possible that sieving of sodium was due to transcellular water transport by crystalloid osmosis during the hypertonic dwell, as a dissociation between the transport of water and sodium is unlikely to occur in transport through the much larger intercellular pores. The DIP sodium ratio after one hour was related to the mass transfer area coefficient (MTC) of creatinine and the percentage of glucose absorption in the control group. No decrease in DIP ratio was found in the poor ultrafiltration group. This suggests impairment of transcellular water transport. No significant differences were present between both groups with regard to MTC creatinine (10.2 and 14.0 mL/min), glucose absorption (71% and 71%), effective lymphatic absorption rate (1.34 and 1.01 mL/min), and residual volume (248 and 178 mL). Only 1 patient in the ultrafiltration loss group continued with CAPD. The others had to be transferred to hemodialysis; 1 of them developed sclerosing peritonitis.

Conclusion

The sieving of sodium during CAPD may be caused by transcellular water transport. Deficient sieving as assessed by the absence of a decreased DIP ratio after one hour of a hypertonic dwell suggests impairment of transcellular water transport. This is asso ciated with severe ultrafiltration failure. It indicates that failure of transcellular water transport, possibly by glycosylation of specific proteins on the cell membrane, may be considered one of the causes of ultrafiltration failure during CAPD.
Subcutaneous Epoetin Beta in Renal Anemia: An Open Multicenter Dose Titration Study of Patients on Continuous Peritoneal Dialysis
Authors: Bárány Peter , Clyne Naomi , Hylander Britta , Johansson Ann-C. , Simonsen Ole , Larsson Rutger , Frisenette-Fich Carsten , Svensson Birgitta , Helmers Claes
Published: February 2020

Objective

To establish dose requirements (target hemoglobin >100 g/L) and safety of subcutaneously administered epoetin beta.

Design

Open multicenter study.

Patients

Forty-five anemic patients (21 female, 24 male; mean age 55 years; range 20 79 years) who had been on continuous peritoneal dialysis for 1-157 months (mean 24 months). Thirty patients required blood transfusions during the year prior to the study. Mean hemoglobin concentration pretreatment was 75 g/L (range 57 –89 g/L).

Intervention

After a pretreatment period of two weeks, 60 IU kg-1 week-1 divided into three weekly doses of epoetin beta was administered subcutaneously. The dose was increased by 60 IU kg-1 week-1 after ten weeks, and when necessary, every fourth week in patients with hemoglobin levels below 100 g/L.

Main Outcome Measures

Hemoglobin concentration. Analysis of factors affecting the response to epoetin beta. Safety of epoetin beta.

Results

Thirty-eight of the 45 patients completed six months and 21 patients completed one year in the study. Twenty-six patients reached hemoglobin 100 g/L within six months and 8 patients did later on. The mean hemoglobin concentration after three months was 93 g/L (range 64 –144 g/L) and after six months was 99 g/L (range 59 –130 g/L; mean epoetin beta dose 1221U kg-1 week-I). During the second six-month period of the study, hemoglobin levels were stable in most patients. After one year, the mean hemoglobin was 110 g/L (range 84 –153 g/L) and the mean epoetin beta dose was 1071U kg-1 week-l. Prolonged correction time and impaired response to epoetin were observed in patients with infections or hemorrhages and in patients with low hemoglobin concentration before starting epoetin treatment. Iron deficiency was controlled by iron supplementation, either orally or, in 10 patients, intravenously. Increased blood pressure, requiring intensified antihypertensive treatment, was observed in 13 patients.

Conclusions

Continuous peritoneal dialysis patients with moderate anemia (Hb 75 –90 g/L) and without complicating disorders can be managed with subcutane0usdoses of ep0etin<1201U kg-lweek-l. Theepoetin beta dose should be adjusted after the first month of treatment since most patients required higher doses than the initial 60 IU kg-1 week-l.
Effect of Oral Calcidiol Treatment on Its Serum Levels and Peritoneal Losses
Authors: Martinez María E. , Del Campo Maria T. , Sánchez-Cabezudo Maria J. , Balaguer Gloria , Rodriguez-Carmona Ana , Selgas Rafael
Published: February 2020

Objectives

To evaluate calcidiol serum levels in a group of continuous ambulatory peritoneal dialysis (CAPO) patients and the effect of oral calcidiol treatment on serum levels and peritoneal losses.

Study design

Twenty patients (13 female, 7 male) were studied for 12 –60 months. Their ages ranged 22 72 years (mean 46±15). Serum calcidiol, total protein and urea were determined at baseline and after the administration per os of 0.133 mcg/day of calcidiol for 10 days. At the same time, calcidiol and total protein were measured in peritoneal effluent at baseline and at 5,10, and 40 days after starting this treatment.

Results

A significant and direct correlation between the calcidiol dialysis/plasma ratio and the peritoneal protein losses was found, both before and 40 days after calcidiol administration when calcidiol serum levels were the lowest. As calcidiol serum levels rose to the normal range in the course of the study, peritoneal losses of this metabolite increased slightly and correlated with calcidiol serum levels and urea mass transfer coefficient (MTC); the significant correlation between calcidiol serum levels and peritoneal protein losses disappeared.

Conclusions

When serum calcidiol levels are low, calcidiol peritoneal losses in patients on CAPO correlate with protein peritoneal losses. However, when serum calcidiollevels rise, the calcidiol peritoneal losses correlate with calcidiol serum levels and urea MTC, and not with protein peritoneal losses.
Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable CAPD
Authors: Pannekeet Marja M. , Zemel Désirée , Koomen Ger C.M. , Struijk Dick G. , Krediet Raymond T.
Published: February 2020

Objective

To investigate whether dialysate concentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue.

Design

We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation.

Setting

CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam.

Patients

Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied.

Results

All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur.

Conclusions

Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in CAPD
Authors: Gokal Ram , Mistry Chandra D. , Peers Elizabeth M. ,   The MIDAS Study Group
Published: February 2020

Objective

To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS).

Design

Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients.

Setting

Eleven CAPD units in U.K. teaching hospitals.

Patients

A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study.

Intervention

Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently).

Main Outcome Measures

The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy.

Results

Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patient year, respectively.

During study

There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patient year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01).

Conclusions

Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
Ysis Prescription and Peritoneal Membrane Transport Characteristics on Nutritional Status
Authors: Burkart John M.
Published: February 2020

These data suggest that dialysis dose is one of the major determinants of protein and energy intake in PD patients and that higher doses of dialysis tend to improve outcome. The data also suggest that with a long time on PD the peritoneal membrane probably has some underlying histological changes that preclude it from optimally responding to injury and may predispose it to irreversible damage. A possible early finding in this case is an increase in peritoneal transport in patients whose transport was initially stable. Peritoneal membrane transport properties are an important determinant of not only dialysis dose, but also nutritional status via both direct and indirect means. It is therefore important to identify the individual patient's peritoneal membrane transport characteristics. These transport characteristics may change over time. High transporters on CAPD represent a unique challenge. They have ultrafiltration problems and a tendency toward protein malnutrition presumably due to increased dialysate protein losses while on CAPD. One must consider that malnutrition in a rapid transporter may be due to the fact that the patient is on the wrong PD therapy. A change to NIPD may rectify some of the biochemical parameters, but these patients may not always improve. Reasons for this occasional lack of improvement are multifactorial, but emphasize our need to look at each patient as an individual and not focus only on laboratory parameters.
Bioelectrical Impedance Analysis and Dual Energy X-Ray Absorptiometry to Monitor Nutritional Status
Authors: Stall Sharon , Ginsberg Nancy S. , Lynn Robert I. , Zabetakis Paul M.
Published: February 2020

There exists an imperative to monitor changes in body composition in all dialysis patients on a regular basis to avoid overt malnutrition. In this regard, the absolute measurement of the fat-free mass assessment may not be as crucial as the serial measurement of fat-free mass with the same modality. A significant difference in measured fat and fat-free mass should be expected if different techniques are employed. Therefore, when attempting to monitor patients over time or to assess the effects of changes in therapeutic regimens, a single methodology should be employed. Our data validate the use of BIA in the stable PD patient, indicating that BIA can predict the DXA results. Considering the ease with which

BIA measurements can be obtained and the lack of dependency on operator interpretation, BIA is an ideal technique for use in the clinical setting. The applicability of this technique for use in monitoring longitudinal changes in body composition has, in fact, been well established (25,30,31). BIA appears to be an excellent method for routine fat-free mass measurement in dialysis patients. In as much as malnutrition continues to remain a significant problem in PD patients, measuring and monitoring body composition is strongly recommended.
Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable Capd
Authors: Pannekeet Marja M. , Zemel Désirée , Koomen Ger C.M. , Struijk Dick G. , Krediet Raymond T.
Published: February 2020

Objective

To investigate whether dialysateconcentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue.

Design

We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation.

Setting

CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam.

Patients

Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied.

Results

All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur.

Conclusions

Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
Fractional Urea Clearance Estimates Using Two Anthropometric Formulas in Continuous Peritoneal Dialysis: Sex, Height, and Body Composition Differences
Authors: Tzamaloukas Antonios H. , Dombros Nicholas V. , Murata Glen H. , Nicolopoulou Nicoletta , Dimitriadis Athanasios , Kakavas John , Malhotra S Deepak , Antoniou Stavros , Balaskas Elias V. , Voudiklaris Sonia
Published: February 2020

Objective

To compare estimates of urea volume (V) and KT/V obtained by the Watson and Hume anthropometric formulas, and to identify the similarities and differences between these estimates.

Design

Theoretical analysis applying wide variations in the determinants of anthropometric V (age, height, weight) in hypothetical women and men. Analysis of urea kinetic studies performed in patients on continuous peritoneal dialysis (CPD).

Setting

Four dialysis units in Albuquerque, two in Athens, and two in Thessaloniki.

Participants

Three hundred and two CPD patients who had 440 urea kinetic studies.

Intervention

Standard urea clearance was performed by 24-hour collections of urine and drained dialysate followed by blood sampling. V was estimated by both the Watson and Hume formulas.

Main Outcome Measures

Estimates of V and KT/V were compared separately in women and men by Student's t-test, linear regression, and limits of agreement (mean difference±2 SD). The agreement of the KT/V estimates was also tested by the kappa ratio using a value of 1.70 weekly as the lowest acceptable KT/V.

Results

The theoretical analysis indicated important disagreement only in extreme variations from the ordinary in height and, to a lesser extent, weight. Differences due to height variation were pronounced only in hypothetical women. CPD patient findings were as follows: in women, Watson V and weekly KT/V were 30.4±4.4 L and 2.10±0.61, respectively. Corresponding Hume estimates were 30.3±5.4 L and 2.12±0.66, respectively. Corresponding estimates for men were 40.5±5.7 L and 1.92±0.57 (Watson) plus 41.4±5.6 L and 1.88±0.57 (Hume), respectively. By linear regression, KT/VHume = -0.083 + 1.052 (KT/Vw8tson), r = 0.961 (women); and KT/VHume = -0.026 + 0.992 (KT/Vwatson), r = 0.985 (men). Limits of agreement were -1.41 L and 2.10 L for V, and -0.15 and 0.14 weekly for KT/V. In 94.3% of the cases, KT/Vw8tson and KT/VHume agreed (both >1.70 or both <1.70 weekly). Kappa ratio was 0.875 (excellent agreement). The concordant and discordant groups differed in height and degree of obesity, in agreement with the theoretical analysis.

Conclusion

The Watson and Hume formulas provide similar estimates of V and KT/V in CPD patients. Differences may be noted only if women's height or, to a lesser extent, both sexes’ weight is at a great variance with the ordinary values.
Comparison of Measured and Predicted Creatinine Excretion is An Unreliable Index of Compliance in Pd Patients
Authors: Blake Peter G. , Spanner Evelyn , McMurray Susan , Lindsay Robert M. , Ferguson Evelyn
Published: February 2020

Objective

To evaluate the use of the ratio of measured to predicted creatinine excretion as an index of compliance in peritoneal dialysis (PD) patients.

Design

A prospective analysis.

Setting

Academic teaching hospital dialysis unit.

Patients

Forty-three patients on PD.

Measurements

Creatinine excretion in daily dialysate and urine collections was measured on one occasion in 10 patients and on two occasions in 33 patients, and, after adding an estimate for extrarenal creatinine degradation, was divided by predicted creatinine excretion to give a creatinine excretion ratio, which has been proposed as an index of compliance with exchanges in PD patients. Values above 1.24 have been suggested to indicate non-compliance. Lean body mass was also estimated from creatinine excretion.

Results

The mean creatinine excretion ratio was 1.12, and 30% of patients had a value above 1.3. Only one patient admitted noncompliance. Studies on four consecutive days of guaranteed compliance in 7 patients with high ratios showed that creatinine excretion remained constant, suggesting that the patients were high creatinine producers rather than noncompliant. Creatinine excretion was stable when measured at intervals of days, but over months it tended to change markedly in many patients. Lean body mass estimations using creatinine excretion were low in most patients.

Conclusion

Comparison of measured and predicted creatinine excretion is not a reliable indicator of noncompliance because many compliant patients consistently excrete more creatinine than predicted. The standard formulas were not validated in dialysis patients and underestimate creatinine excretion significantly in many PD patients. Existing estimates in the literature of non-compliance, using this methodology, may not be accurate. Better methods of detecting this problem are required.
Igg Subclasses in Capd Patients
Authors: Krediet Raymond T. , Koomen Ger C.M. , Vlug Arjen , Struijk Dirk G. , Buis Barbara , Van Olden Rudolf W. , Imholz Alexander L.T.
Published: February 2020

Objective

To make a comparison of serum levels of immunoglobulin G (lgG) subclasses in adult continuous ambulatory peritoneal dialysis (CAPD) patients with those in age-and sex-matched hemodialysis patients and healthy volunteers, and to analyze the contribution of removal of these proteins in peritoneal effluent to their plasma values.

Design

A cross-sectional study.

Setting

A renal unit of a university hospital.

Patients

Twenty-three CAPD patients, 21 hemodialysis patients, and 21 healthy volunteers. Peritoneal transport studies were done in 8 of the 23 CAPD patients.

Methods

IgG subclasses were measured in serum by nephelometry. For the peritoneal transport studies an ELISA method on ethylenediamine tetracetic acid plasma was used. The same method was used in seven-to ten-fold concentrated peritoneal dialysate.

Results

CAPD patients had lower IgG2 and IgG4 1evels than hemodialysis patients and healthy volunteers (p < 0.01). lgG2 values below 1.5 glL were present in 43% of the CAPD patients (p < 0.001 compared to healthy volunteers). Peritonitis incidence was not different between CAPD patients with low or normal IgG2 plasma levels. Peritoneal clearance of IgG3 was lower than that of the other subclasses. Evidence was obtained for a depressed synthesis of IgG2 and IgG4 in CAPD patients. The hypothesis that interleukin-2 may be involved in the low synthesis rate of IgG2 is discussed.

Conclusion

Low serum IgG2 and IgG4 1evels are present in stable, adult CAPD patients. These were not caused by increased peritonealloss, but by decreased synthesis.
Prescription and Assessment of Tidal Peritoneal Dialysis Delivery with a Specific Equilibration Test
Authors: Edefonti Alberto , Picca Marina , Consalvo Geltrude , Ghio Luciana , Damiani Beatrice , Dal Col Augusta , Galato Raffaele
Published: February 2020

Objective

To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery.

Design

In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (DIP) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables.

Setting

Dialysis unit of a pediatric nephrology department and patients’ homes.

Patients

Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD.

Interventions

Dialysate and blood sample collections.

Main Outcome Measures

DIP ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15–,30–,60, and 120-minute PETtimes, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances.

Results

Correlation coefficients between PET -derived and total TPD dialysate-derived DIP ratios, and those between PET -derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. DIP ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the DIP ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances) -that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea.

Conclusion

The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the DIP ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.
Continuous Peritoneal Dialysis in Heavyweight Individuals: Urea and Creatinine Clearances
Authors: Tzamaloukas Antonios H. , Dimitriadis Athanasios , Murata Glen H. , Nicolopoulou Nicoletta , Malhotra Deepak , Balaskas Elias V. , Kakavas John , Antoniou Stavros , Dombros Nicholas V. , Batzili Elleni , Voudiklari Sonia
Published: February 2020

Objective

To study whether or not continuous peritoneal dialysis (CPD) can provide acceptable levels of normalized urea and creatinine clearance in heavyweight individuals.

Design

Retrospective analysis of urea and creatinine clearance studies.

Setting

CPD patients followed in four dialysis units in Albuquerque, two dialysis units in Thessaloniki, and two dialysis units in Athens.

Participants

One hundred and ninety-nine patients on CPD with 266 clearance determinations between 1991 and 1995.

Interventions

The heavyweight group consisted of 22 patients (24 clearance studies) weighing 100 kg or more (109.0±8.7 kg) at the time of the clearance study. All subjects were obese. The reference group consisted of 177 CPD subjects (242 clearance studies)ofnormal weight (68.7±12.2 kg). Urea fractional clearance (KT/V) and normalized creatinine clearance (Ccr) were compared between the heavyweight and the reference groups.

Main Outcome Measures

The lowest acceptable weekly levels were set at 1.70 for KT/V and 54.4 L/1. 73 m2 for Ccr.

Results

Weekly KT/V was 1.75±0.41 in the heavyweight group and 1.94±0.52 in the reference group (p = 0.047). Corresponding weekly Ccr levels were 64.0±24.3 and 77.6±40.3 L/1.73 m2, respectively (p = 0.021). In the heavyweight group, 13 studies (54.2%) had acceptable KT/V values compared to 160 studies (66.1 %) in the reference group (NS). Corresponding values for acceptable Ccr were 17 (70.8%) and 165 (68.2%), respectively (NS). Drain volume was 12.96±4.40 L/24 hours in the heavyweight group and 9.63±2.58 L/24 hours in the reference group (p = 0.001). High daily exchange volume was delivered by a combination of daily continuous ambulatory peritoneal dialysis (CAPD) and nocturnal automated peritoneal dialysis (APD) in 13116 heavyweight studies. This combination was tolerated better than any other method of delivering a large daily exchange volume.

Conclusion

Although normalized urea and creatinine clearances are lower in obese, heavyweight individuals than in lean CPD subjects with lower weight, approximately equal percentages of these two groups achieve acceptable clearance levels. However, heavyweight individuals require larger-than-usual daily exchange volumes. The preferred way to deliver these large dialysate volumes is a combination of daily CAPD and nocturnal APD.
Accuracy Or Bias in Nurses’ Ratings of Patient Compliance: A Comparison of Treatment Modality
Authors: Edelman Robin , Eitel Patricia , Wadhwa Nand K. , Friend Ronald , Suh Heesuck , Howell Nancy , Cabralda Thelma , Jao Erlinda , Aprile-Forlenza Suzanne
Published: February 2020

Objective

The study examined the accuracy of nurses’ assessments of patient compliance and identified factors influencing these assessments, including possible biases.

Design

Nurses’ assessments of compliance, lab serum levels of dietary compliance, and interdialytic weight gain (IWG) were collected and compared to each other. End-stage renal disease (ESRD) patients on peritoneal dialysis (PD) and hemodialysis (HD) were compared on these measures and their compliance.

Setting

The study was conducted at the tertiary care university hospital at Stony Brook.

Patients

Data were collected for 62 ESRD patients (38 male, 24 female; mean age 54 years). The sample consisted of 26 HD and 36 PD patients.

Interventions

Nurses rated patients’ compliance with fluid restrictions (HD patients only) and overall dietary compliance, as well as individual indicators of compliance including protein, potassium, and phosphorus compliance on a 7 -point rating scale. Interdialytic weight gain, dietary (serum BUN and K levels), and medication compliance were recorded from charts for a 3-month period for each patient.

Main Outcome Measures

The main outcome measures were the correlations between nurses’ ratings of compliance and medical compliance data and the regression coefficients, which indicate the relative importance of each of the factors that nurses use to make their compliance ratings.

Results

Nurses’ ratings for patients in both treatment modalities were highly correlated with the medical data for measures of fluid (r = 0.66, p < 0.001), potassium (r = 0.36, p < 0.01), and phosphorus (r = 0.36 p < 0.01). A regression analysis indicates that potassium (β = 0.48, p < 0.001), phosphorus (β = 0.19, p < 0.05), and protein (β = 0.31, p < 0.01) all significantly contributed to nurses’ assessments of patients’ overallcompliance. However, nurses’ ratings of education levels for patients in both treatment modalities were not associated with phosphorus (r = 0.07, p < 0.61), protein (r = 0.18, p < 0.23), or potassium (r = 0.03, p < 0.85) measures. Finally, regressions revealed that nurses used personal knowledge of the patients when rating noncompliant patients (β = 0.49, p < 0.05) but not when rating compliant patients (β = 0.05, p < 0.75).

Conclusions

Nurses rely heavily on medical records to rate patients’ compliance and to make accurate assessments. Nurses also use several individual indicators (lab values and IWG) to rate overall dietary compliance, suggesting a thorough assessment. While assessments are not biased by personal factors such as nurses’ perceptions of patients’ education levels, nurses do rely on personal knowledge when rating noncompliant patients.
Nasal Carriage and Peritonitis by Staphylococcus Aureus in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Study
Authors: Wanten Geert J.A. , Van Oost Peter , Schneeberger Peter M. , Koolen Marianne I.
Published: February 2020

Objective

To establish whether or not patients on continuous ambulatory peritoneal dialysis (CAPD) using current infection control measures who are nasal carriers of Staphylococcus aureus are at risk for the development of S. aureus peritonitis.

Design

A prospective 22-month study analyzing nasal and ski nlnasal (i.e., nasal and/orexit-site)carrier status for S. aureusand peritonitis episodes. Nasal swab cultures for S. aureus were taken with 1 to 3-month intervals; swab cultures from the catheter exit site were taken only when infection was suspected.

Setting

Renal unit, tertiary-care center.

Patients

All patients on CAPD at our center that could be observed during at least 2 months.

Interventions

None.

Main Outcome Measures

Nasal and skinlnasal carrier status, occurrence of peritonitis.

Results

Of 54 enrolled patients, 31 (57%) were nasal carriers for S. aureus: 6 of these 31 developed S. aureus peritonitis as opposed to none of 23 non-carriers (p = 0.03). The S. aureus peritonitis rate in 28 skin/nasal carriers was increased when compared to non-carriers (p = 0.02), but there was no difference between chronic and intermittent skin/nasal carriers (p = 0.63).

Conclusions

In our population, nasal carriers are at increas ed risk for the development of S. aureusperitonitis. Further studies should evaluate the effect of eradication of nasal carriage of S. aureus and the effect of additional preventive hygienic measures on the occurrence of peritonitis by S. aureus.
Epidemiologic and Demographic Aspects of Peritoneal Dialysis in Mexico
Authors: Su-Hernández Lilia , Abascal-Macías Antonio , Méndez-Bueno Francisco Javier , Paniagua Ramon , Amato Dante
Published: February 2020

Objective

To assess some epidemiological and demographic aspects of peritoneal dialysis (PD) at the Instituto Mexicano del Seguro Social (IMSS), the major institution of social security in Mexico, that provides health care services for 57% of the Mexican population at the time of the study.

Study Design

A cross-sectional analysis of data about patients under peritoneal dialysis in 1992.

Data Sources

A national survey containing demographic data, dialysis modality, type of catheter, peritonitis and death rates, and questions on costs, medical staff, and physical facilities for PD in all of the hospitals of the IMSS.

Results

All hospitals returned the information re quested. Intermittent peritoneal dialysis (IPD) was performed in 19 hospitals, continuous ambulatory peritoneal dialysis (CAPD) in 11, and both modalities in 90. In 61 hospitals, a special area was designed for PD; in the rest of them, beds from general internal medicine departments were used. All hospitals had a head for the PD programs; overall, teams had 240 physicians and 765 nurses for IPD, and 182 physicians and 313 nurses for CAPD. CAPD prescription was four 2-L bags/day. For IPD, patients were hospitalized once a week and received 28 manually performed exchanges of 2– L bags; the mean time of hospitalization was 2.7 days, and 878 beds were used. The number of patients receiving PD was 7785, with a prevalence of 199.6 per million population. Ofthem, 4011 were on IPD and 3774 on CAPD; 54% of the patients were males. IPD patients’ mean age was 49 ± 17 yr, and that of CAPD patients’ was 42 ± 17 yr (NS). Diabetic nephropathy was the most frequent cause of ESRD (44%). Infection was the most important complication detected. Rates of peritonitis were 0.5/patient/yr on IPD and 0.8/patient/yr on CAPD. Annual mortality rates without stratification for specific causes were 34% in IPD and 17% in CAPD. Mortality rates may have been influenced by malnutrition and cardiovascular complications of diabetes, but specific causes of death were not investigated. All of the PD programs costs were covered by the institution. The cost per patient was not calculated, but IPD is known to be more expensive, due to its higher hospitalization rate.

Conclusion

In spite of its higher cost and mortality, the institutions still use IPD, notso much on medical basis, but as the only alternative available for patients with adverse environmental, social, educational, and economic conditions for CAPD or HD.
Variability in Creatinine Clearance (Ccr) and Ktn Due to Different Methods of Calculating Volume and Ccr
Authors: Low Chai Luan , Bailie George R , Rasmussen Ray , Eisele George
Published: February 2020

Objective

This study aimed to compare the correlations between KTN and creatinine clearance (Ccr) calculated by different methods and to determine and compare the correlations between KTN and Ccr.

Design

Nonrandomized, retrospective analysis of data.

Setting

Continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic in a teaching hospital.

Patients

All patients were included for analysis if the data collection was complete for the calculations of KTN and Ccr using five different methods.

Interventions

Volume of distribution for urea (V) was estimated by four methods: Watson nomogram, ideal body weight (IBW), actual body weight, and total body surface area. Ccr was determined by five methods: Dialysate Ccr was calculated by creatinine (Cr) uncorrected and corrected for the presence of glucose; urinary Ccr was calculated using urinary Cr alone and the average urinary clearance of urea and Cr; and by the Cockcroft and Gault method.

Main Outcome Measures

Correlations between KTN and Ccr.

Results

Sixty-three data sets were collected from 52 CAPD patients. The correlations between weekly KTN and Ccr normalized to 1.73 m2 body surface area were found to be highly variable from one method to another (r2 = 0.012 -0.494). For obese patients (20% above IBW), KTN values obtained were more variable using the Watson nomogram compared to the IBW and BSA methods.

Conclusion

KT/V calculated using the Watson nomogram and the Ccr determined using average of urinary urea and creatinine clearance gave the best correlation (r2 = 0.49).
Pharmacokinetics of Once-Daily Ip Gentamicin in Capd Patients
Authors: Low Chai Luan , Bailie George R. , Evans Anne , Eisele George , Venezia Richard A.
Published: February 2020

Objective

This study aimed to investigate the pharmacokinetic characteristics of once-daily intraperitoneal (IP) gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Prospective, nonrandomized, open study.

Setting

CAPD outpatient clinic in a teaching hospital.

Patients

Ten volunteer CAPD patients without peritonitis.

Interventions

Each patient received a single IP dose of 0.6 mg/kg of gentamicin. Blood and dialysate samples were collected at 0,0.5,1, 2, 3,6 (end of first dwell), and 24 hours after the administration of IP gentamicin. Any urine produced over the 24hour study period was also collected. The dialysate concentration/time data were fitted to a monoexponential curve for all patients.

Results

The bioavailability was 56±11% over a six hour dwell. The mean serum elimination half-life (t1/2) was 35.8 hours. The volume of distribution was 0.23±0.08 L/kg. Equilibration of gentamicin across the peritoneal membrane was rapid, with a t½ equilibration of 4.5 hours. The peritoneal clearance was 5.74±1.5 mL/min. Patients with residual renal function had significantly higher systemic gentamicin clearances (7.36±1.46 mL/min) than those of anuric patients (4.76±1.08 mL/min, p < 0.024).

Conclusion

Currently recommended doses of oncedaily IP gentamicin for the treatment of peritonitis may not produce the desired therapeutic serum and dialysate concentrations over 24 hours for effective treatment of peritonitis.
Reviews and Original Articles
Authors: Keane William F. , Alexander Steven R. , Bailie George R. , Boeschoten Elizabeth , Gokal Raman , Golper Thomas A. , Holmes Clifford J. , Huang Chiu-Ching , Kawaguchi Yoshindo , Piraino Beth , Riella Miguel , Schaefer Franz , Vas Stephen
Published: February 2020

The recommendations provided in this document represent a distillation of various experiences, as well as data obtained from published studies in the setting of substantial changes in antibiotic sensitivity. It is hoped that this revised compilation will provide a basis upon which future developments and advances can be made in the therapeutic approach to infectious complications of peritoneal dialysis.
24-Hour Dialysate Collection for Determination of Peritoneal Membrane Transport Characteristics: Longitudinal Follow-Up Data for the Dialysis Adequacy and Transport Test (Datt)
Authors: Rocco Michael V. , Jordan Jean R. , Burkart John M.
Published: February 2020

Objective

To determine the ability of the dialysis adequacy and transport test (DATT) to monitor changes in peritoneal transport characteristics over time.

Setting

University-based peritoneal dialysis program.

Patients

One hundred patients on continuous ambulatory peritoneal dialysis who underwent 226 simultaneous DATTs and peritoneal equilibration tests (PET).

Methods

Retrospective analysis of DA TT and PET data.

Results

The mean 24-hour dialysate-to-plasma creatinine (cr) concentration ratio (DIP cr) from the DATT was 0.70±0.10, and the mean four-hour DIP crfrorn the PET was 0.68 ± 0.10. The correlation coefficient between the fourhour and 24-hour DIP cr was 0.81, and the standard error of estimate was 0.065. The mean (±SD) difference between the four-hour and 24-hour DIP cr was 0.023 ± 0.061. Fifty eight patients had two or more sequential DA TTs and PETs. For these 94sets of sequential DATTs and PETs, the mean (±SD) difference between the change in the four-hour DIP cr and the change in the 24-hour DIP cr was 0.020 ± 0.024, and the standard error of estimate was 0.064. In 17 patients a change in dwell volume from 2.0 L to 2.5 L occurred between the first and second measures of peritoneal membrane transport characteristics. The mean (±SD) difference between the change in the four-hour DIP cr and the change in the 24-hour DIP cr was 0.036 ± 0.055, and the standard error of estimate was 0.087.

Conclusion

The DATT can be used to monitor for changes in peritoneal transport over time. It should not be used in patients receiving cycler therapy or in patients whose dwell times and dextrose concentrations vary markedly from day to day.
Efficacy of Recombinant Human Erythropoietin Administered Subcutaneously to Capd Patients Once Weekly
Authors: Frifelt Jens J. , Tvedegaard Erling , Bruun Kirsten , Steffensen Gudrun , Cintin Christina , Breddam Marianne , Dominguez Helena , Jørgensen Jørgen D.
Published: February 2020

Objective

The purpose of the present study was to compare the dosage requirements of recombinant human erythropoietin (rHuEPO) administered subcutaneously (SC) either one or three times weekly.

Design

A randomized, prospective study. .Setting: The patients were recruited from two university hospitals and five county hospitals.

Patients

Thirty-three anemic patients on continuous ambulatory peritoneal dialysis (CAPD) treatment for endstage renal failure completed the study.

Interventions

Initially, all were treated with rHuEPOSC three times a week until hemoglobin blood levels (Hb) remained constant between 105 and 121 g/L for three months. Following randomization, 17 patients continued the same treatment schedule (group A), while 16 patients received the same dose, but administered only once weekly for three months (group B).

Main Outcome Measures

The Hb levels and rHuEPO doses at the start and at the end of the three-month study period.

Results

In group A the median Hb at randomization was 118 g/L (109 -119) (25 -75 percentiles) and, after three months, was 113 g/L (106 -119) (p = 0.13), while in group B the median Hb was 114g/L (108–119) and 114 g/L (106 -120), respectively (p = 0.50). In group A the weekly dose of rHuEPO remained virtually unchanged during the study period, 65 (55 -86) and 66.3 (55 -95) U/kg/week, respectively, while in group B it was increased from 60.2 (46–88) to 77 (60 90) U/kg/week. The 22% increase (p = 0.03) took place during the last two weeks.

Conclusions

Our findings indicate that a once-weekly SC dosing regimen of rHuEPO in anemic CAPD patients was equally effective in maintaining a stable hemoglobin level as a thrice-weekly dosing regimen.
Interleukin-10, Interferon Gamma, Interleukin-2, and Soluble Interleukin-2 Receptor Alpha Detected during Peritonitis in the Dialysate and Serum of Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Lu Ying , Hylander Britta , Brauner Annelie
Published: February 2020

Objective

To analyze interleukin (IL)-10, interferon gamma (IFN-y), IL-2, and soluble IL-2 receptor alpha (sIL2Rα) in the dialysate and serum of patients on continuous ambulatory peritoneal dialysis (CAPD).

Design and Patients

Samples from dialysate bags were collected during the initial month of dialysis. During peritonitis, samples were collected from the first three bags on the day of admittance to the hospital and from the night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. .Results: IL-10 was detected in all dialysate samples except one on the first day of infection, with a peak median level of 50 pg/mL and a slow decrease thereafter. In serum the median levels never exceeded detectable levels. Patients infected with Escherichia coli or Staphylococcus aureus had higher IL-10 levels in dialysate on day 3 as compared to the remaining patients (p < 0.05). If the catheter had to be drawn, because of persistent cloudy dialysate, the IL-10 levels remained elevated for a longer time (p<0.05). IFN-y and IL-2were detected only in the dialysate of patients infected with either S. aureusor S. epidermidis. Only one serum sample showed increased IFN-y. SIL-2Rα was found in all the serum and dialysis samples from the first day of infection. Contrary to the analyzed cytokines, the receptor showed several fold higher levels in serum as compared to the dialysate. During the infection the receptor levels in the dialysate increased, while they remained stationary in the serum, indicating a local production.

Conclusion

This is the first time IL-10 has been demonstrated in the dialysate during peritonitis in CAPD patients. In view of its role as a suppressor of the immune and inflammatory responses, it is a potentially important observation, which might have clinical implications in the future.
A New Self-Locating Peritoneal Catheter
Authors: Di Paolo Nicola , Petrini Giovanni , Garosi Guido , Buoncristiani Umberto , Brardi Simone , Monaci Giulio
Published: February 2020

Objective

Peritoneal catheters often become dislocated, and this may lead to malfunction. Since it is not usually possible to bring them back into their correct position, they must be replaced. With the aim of preventing this complication, we designed a new catheter.

Design

The new catheter has the same form as the Tenckhoff catheter except for a small increase in external diameter of the last 2 cm, made possible by the high specific weight of a small12-g tungsten cylinder incorporated in the Silasticat the abdominal end. The new catheter may be inserted by a percutaneous technique.

Setting

University hospitals of Sienaand Perugia, Italy.

Patients

In the last three years, 32 of these catheters have been implanted for a total experience of 468 patientmonths. Their position was checked on insertion and every two months thereafter by radiography; 26 Tenckhoff catheters (415 patient-months) were studied at the same time. Insertion was performed surgically and by a percutaneous method. The frequency of cuff extrusion, exit-site infections, leakage, and peritoneal infection were noted, together with peritoneal function, which was evaluated by KTN and weekly creatinine clearance one month after catheter insertion; the tests were repeated when dislocation occurred and at the end of the trial.

Results

No dislocations occurred with the self-locating catheters, whereas nine dislocations occurred in control patients (p = 0.0003). There were no significant differences with respect to controls for cuff extrusion, exit-site infections, leakage, peritoneal infection, and peritoneal function.

Conclusions

The presence of a small weight at the catheter tip prevents displacement completely, keeping the intraperitoneal part of the catheter in place.