bluuebunny/crossref_metadata_2025 huggingface dataset:
The Biology of the Mesothelium during Peritoneal Dialysis
Authors: Hjelle J. Thomas , Miller-Hjelle Marcia A. , Dobbie James W.
Published: February 2020

Substantial derangements of mesothelial biology are observed during experimental simulations of dialysis conditions, inferred from the content of human dialysis effluent and visualized by microscopy of human mesothelial biopsies. Canosmotically active solutions be made biocompatible with the osmoregulatory system of the mesothelium? Can the contributions of the mesothelium to host defenses against inflammation and/or infection be supported during CAPD? Do underlying metabolic derangements present in various kidney diseases and end-stage renal disease, regardless of cause, require customized CAPD protocols and solutions? Use of dialysis solutions less directly toxic to the mesothelium is a necessary step toward some day manipulating peritoneal biology by pharmacological and therapeutic modalities.
An Elevated Ratio of Measured to Predicted Creatinine Production in Capd Patients is Not a Sensitive Predictor of Noncompliance with the Dialysis Prescription
Authors: Burkart John M. , Bleyer Anthony J. , Jordan Jean R. , Zeigler Nancy C.
Published: February 2020

Objective

To determine the effect a period of “intentional noncompliance” in stable continuous ambulatory peritoneal dialysis (CAPD) patients has on the ratio of measured to predicted creatinine generation.

Design

Prospective study that compares baseline to noncompliant periods in individual CAPD patients.

Patients

Nine chronic, stable CAPD patients.

Study Design

At baseline, measured creatinine production and adequacy parameters (KT/V, creatinine clearance, lean body mass, and protein equivalent of nitrogen appearance) were calculated from 24-hour collections of dialysate and urine while patients were performing their routine dialysis prescriptions. After three days of intentional noncompliance (one less exchange/day) the patients repeated their 24-hour collections, again performing their routine number of exchanges. Measured creatinine production and adequacy parameters were again calculated. Predicted creatinine production for each patient was calculated from standard equations. All parameters at baseline were compared to corresponding parameters after intentional noncompliance.

Results

In all patients, except one where there was no change, there was a statistically significant increase in not only the ratio of measured to predicted creatinine production but also all other parameters.

Conclusion

As suspected by previous investigators, this study suggests that one cause of an elevated ratio of measured to predicted creatinine production may be a recent period of noncompliance with the patient's dialysis prescription. However, these data suggest that an isolated ratio of measured to predicted creatinine generation is not a sensitive predictor of noncompliance with the peritoneal dialysis prescription.
Capd Viability: A Long-Term Comparison with Hemodialysis
Authors: Maiorca Rosario , Cancarini Giovanni C. , Zubani Roberto , Camerini Corrado , Manili Luigi , Brunori Giulio , Movilli Ezio
Published: February 2020

Objective

To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD).

Design

Retrospective study of patients of our institution starting dialysis between January 1,1981, and December 31, 1993, and surviving for at least 2 months.

Patients

Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD).

Main Outcomes Studied

Cox -adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time.

Results

Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 -1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (“technique success”) was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients ≥75 years.

Conclusion

CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.
The Japanese National Registry Data on Pediatric Capd Patients: A Ten-Year Experience a Report of the Study Group of Pediatric Pd Conference
Authors: Honda Masataka , Litaka Kikuo , Kawaguchi Hiroshi , Hoshii Sakurako , Akashi Shunji , Kohsaka Takao , Tuzuki Kazuo , Yamaoka Kanji , Yoshikawa Norishige , Karashima Sinnyo , Itoh Yuhei , Hatae Ken
Published: February 2020

Objective

Over the past 10 years, we have collected data on pediatric patients less than 16 years of age from the National Registry of CAPD (continuous ambulatory peritoneal dialysis). We present our experience with this population.

Design

The database details the patient number, age, weight, height, outcome, cause of death, reason for terminating CAPD therapy, peritonitis, and catheter survival.

Patients

Of the 434 patients (239 males, 195 females), 37 patients (8.5%) were under 1 year of age and 164 patients (37.8%) were under 6 years of age. About half of the patients were less than 20 kg in weight, clearly indicating that CAPD was the treatment of choice in young children. The duration on CAPD for these patients was less than 2 years for 233 patients (54%), and was 5 years or more in 48 patients (11%).

Results

The outcome of the total patient population of 434 as of M ay, 1991, is as follows 229 patients (52.8%) were being successfully treated with CAPD, 47 patients (10.8%) died, and 78 patients (18.0%) received a kidney transplantation. The patient survival rate was 85.6% at 3 years and 81.7% at 5 years. The technique survival rate was 74.9% at 3 years and 63.5% at 5 years. The rate of peritonitis was one episode over 28.6 patient-months. The mean catheter duration was 1.68 years. Peritonitis rate, catheter survival rate, and the rate of tunnel infection were worse in children less than 6 years of age than in older children.

Conclusion

The excellent patient and technique survival rates indicate that CAPD is an effective treatment for children with end-stage renal disease in Japan. The high infection rates in younger children indicate that extra careful management is needed for this young age group.
Rapid Decline of Residual Renal Function in Patients on Automated Peritoneal Dialysis
Authors: Hiroshige Kinya , Yuu Kougi , Soejima Masasuke , Takasugi Masayuki , Kuroiwa Akio
Published: February 2020

Objective

To determine the effect of peritoneal dialysis modalities such as nightly intermittent peritoneal dialysis (NIPD), continuous cyclic peritoneal dialysis (CCPD), and continuous ambulatory peritoneal dialysis (CAPD) on residual renal function.

Design

A six-month prospective, nonrandomized comparison study.

Setting

Outpatient CAPD unit of a university hospital.

Participants

Eighteen end-stage renal disease patients treated by peritoneal dialysis (8 by NIPD, 5 by CCPD, and 5 by CAPD).

Interventions

Samples from the total dialysate, blood, and 24hour urine collection were obtained monthly.

Measurements

Urea, creatinine, and beta2-microglobulin concentrations were measured. Renal and peritoneal clearances of each substance and KT/V urea were calculated. Residual renal function (RRF) was estimated by renal creatinine clearance (RCcr).

Results

No significant differences in age, sex, and primary renal disease among the three groups were noted. In all groups, anemic and hypertensive states were controlled identically, and mean weekly total (renal + peritoneal) KT/V urea (over 2.1/wk) and total creatinine clearance (over 60 L/wk/1.73 m2) were maintained during the whole experimental period. Starting mean RCcr was near 4.0 mL/min/1.73 m2 in all groups. Thereafter, a rapid and significant decline in RRF was demonstrated on NIPD and CCPD. The declining rates of RCcr values at 6 months after starting NIPD and CCPD were -0.29 and -0.34 mL/min/month, respectively, which were much greater than those of CAPD (+0.01 mL/min/month).

Conclusion

Because of a possibly characteristic progressive loss of RRF in automated peritoneal dialysis (APD), strict regular assessment of RRF should be performed from the start of APD.
In Search of the Ideal V
Authors: Tzamaloukas Antonios H.
Published: February 2020

The ideal normalization parameter for urea and creatinine clearance is not yet known. The best current practices are to normalize urea clearance by anthropometric V, corrected for certain conditions such as edema, and creatinine clearance by BSA. Normalization parameters should be calculated using the actual weight. In addition, the ideal weight also should be used in underweight individuals.
Neither Size Nor Weight Predicts Survival in Peritoneal Dialysis Patients
Authors: Fried Linda , Bernardini Judy , Piraino Beth
Published: February 2020

Objective

To determine if patient size or weight at the start of PO influences patient or technique survival.

Design

A prospective cohort study of adult PO patients.

Setting

A university and a Veterans Administration outpatient dialysis unit.

Patients

343 adults patients with 660 years on PO enrolled from 1979 to 1995.

Main Outcome Measures

Patient survival (censoring for transplant, 60 days post -transfer to hemodialysis, and end of study) and technique survival (censoring for death, transplant, or end of the study) for patients as grouped by weight (≤ 64 kg vs. >64 kg or ≤82.7 kg vs. > 82.7 kg) or BSA (≤2.0 m2 vs >2.0 m2).

Results

Patient survival was 86.3% at one year, 77.0% at two years, 65.2% at three years, and 56.9% at 4 years. Technique survival was 84.9% at one year, 77.5% at two years, 63.5% at three years, and 58.3% at four years. The patient and technique survival curves were not significantly different for patients as grouped by weight or BSA. Using Cox proportional hazards model, age, diabetes, peritonitis rate, and albumin at the start of PO were independent predictors of patient survival, but BSA and weight were not. The only predictor of technique survival was the peritonitis rate. Larger patients had higher initial albumins, which may indicate better nutritional status that may offset the risk of underdialysis.

Conclusions

Large patients do as well as smaller patients on PO. Size alone should not preclude patients from PO.
Peritoneal Mesothelium in Vitro: An Electrophysiologic Study
Authors: Simon Marek
Published: February 2020

Objective

In vitro electrophysiologic characterization of the peritoneal mesothelium as a barrier for ion transport during peritoneal dialysis.

Design

Experiments were performed on rat's mesentery and diaphragm. Electrophysiologic parameters of the isolated tissue were assessed in the modified Ussing system.

Results

We have shown that there are significant differences between electrophysiological parameters of the parietal and visceral peritoneum. The value of the potential difference across the parietal mesothelium lining the abdominal part of the diaphragm (PDmpt) was 0.26 ± 0.03 mV (mean ± SEM), with a positive charge recorded from the apical side of the mesothelium. Electrical resistance of the mesothelial monolayer (Am t) was mAp t = 13.6 ± 1.3 Ω.cm and 1.4±0.2 Ω.cm for the tissue isolated from the diaphragm and mesentery, respectively. Both the mechanical and chemical procedures used for the preparation of the peritoneal membrane model from the diaphragm have been shown to produce similar values of electrophysiological parameters.

Conclusion

The electrophysiologic approach presented here may be a useful tool for studies of highly permeable biological membranes such as the peritoneal mesothelium. The mesothelial tissue isolated from the rat diaphragm has been shown to be a suitable model for electrophysiologic studies of the peritoneum as assessed by the values of the PDmpt and Ampt parameters.
Solute Clearance Approach to Adequacy of Peritoneal Dialysis
Authors: Burkart John M. , Schreiber Martin , Korbet Stephen M. , Churchill David N. , Hamburger Richard J. , Moran John , Soderbloom Robert , Nolph Karl D.
Published: February 2020

To investigate the effect of dialysis prescription on patient outcome for peritoneal dialysis patients, the relationship between total solute clearance and the relative risk of death has been investigated. Preliminary studies have suggested that more clearance is better and that patient outcome is predicted by total solute clearance. The recently published Canada-U.S.A. (CANUSA) multicenter study, evaluating adequacy of dialysis and nutrition in peritoneal dialysis patients, has further defined this relationship. Although these publications allow us to establish guidelines for the treatment of peritoneal dialysis patients, they also define the limitations of our knowledge and raise new questions.

In this article we review our current knowledge regarding the predicted value of total solute clearance with patient outcome and nutritional status. Furthermore, we attempt to outline a practical approach for optimizing total solute clearance in peritoneal dialysis patients.

Based on a review of the published literature and clinical recommendations, we feel that the minimal target total solute clearance for continuous forms of peritoneal dialysis is a weekly total KTN > 2.0 and/or a weekly total creatinine clearance >60 L/week/1.73 m2. For intermittent therapies, a weekly total KTN > 2.2 and/or a weekly total creatinine clearance >70 L/week/1.73 m2 is recommended.
Ultrastructure, Distribution, and Density of Lamellar Bodies in Human Peritoneum
Authors: Dobbie James W. , Anderson James D.
Published: February 2020

Objective

To determine the ultrastructure, relative density, and location of lamellar bodies in the various regions, structures, cells, and intercellular matrix in normal human peritoneum; to carry out engineering analysis of the role of lamellar structures in serosal lubricancy and deduce what effect this system may have on the process of peritoneal dialysis.

Design

Five samples of normal human parietal peritoneum obtained at elective operation were fixed in a tannic acid-glutaraldehyde mixture and submitted to examination by transmission electron microscopy. Detailed analysis using reconstruction of serial electron micrographs and tracings of montages were employed in determining location, disposition, density, and geometric patterns of lamellar bodies in all levels of the peritoneal membrane.

Results

Lamellar profiles were found in greatest density enmeshed in surface microvilli and in mesothelial cytoplasm. Lamellar bodies were frequently observed capping the external portion of mesothelial junctional complexes, and within intercellular junctions. Lamellar bodies were also encountered in macrophages, both in the peritoneal cavity and submesothelial tissue, and also in fibroblasts. Lamellar bodies were present in low density in the matrix ground substance of submesothelial connective tissue, in blood vessel walls between smooth muscle, in endothelial cell cytoplasm, and in vascular lumina.

Conclusion

Three-dimensional analysis of lamellae on mesothelial surfaces indicates that an arrangement of constantly changing microscopic spheres and cylinders would act as “ball and roller bearings” among the microvilli for the lubrication of opposing surfaces. The entrapment offluid in lamellar bubbles, which in normal peritoneum fill the microvillous layer, would, if maintained in peritoneal dialysis, constitute a stagnant layer of considerable stability and inertia.
Osmotic Conductance of the Peritoneum in Capd Patients with Permanent Loss of Ultrafiltration Capacity
Authors: Waniewski Jacek , Heimbürger Olof , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Objective

To compare the effectiveness of osmotic pressure in the induction of fluid flow during continuous ambulatory peritoneal dialysis (CAPD) in patients with permanent loss of ultrafiltration capacity (UFC) and clinically stable patients.

Design

Estimation of osmotic conductance in individual CAPD patients using data from single CAPD dwell studies.

Patients

Twenty clinically stable CAPD patients with normal ultrafiltration rate (NUR group); 8 CAPD patients with permanent UFC loss due to high diffusion rate for small solutes [high diffusion rate (HDR) group]; 3 CAPD patients with permanent loss of UFC dueto high absorption rate (HAR) of peritoneal dialysate (HAR group).

Design

Six-hour dwell studies were carried out in each patient using 2 L of Dianeal 3.86% dialysis fluid. Dialysate volume and the peritoneal absorption rate were measured using radioiodinated serum albumin as a marker. The dialysate volume over dwell-time curves were examined using three mathematical models of fluid transport for solutions with a crystalloid osmotic agent: model P, based on a phenomenologically derived exponential function of time; model OS, based on the linear relationship between the rate of net volume change (Qv) to the difference of osmolality in dialysate and blood; and model G, based on the linear relationship between Qv and the difference of glucose concentration in dialysate and blood.

Results

All three models provided an accurate description of the measured dialysate volume over time curves. The osmotic conductance, defined as the coefficient of proportionality between the rate of ultrafiltration and the osmolality (or, alternatively, glucose) gradient between dialysate and blood plasma, was 30% lower in the HDR group than in the NUR group, but close to the normal value in the HAR group.

Conclusion

In the HDR group the changes in the peritoneal membrane, which resulted in the increased diffusion rate of small solutes, also yielded a decrease of osmotic conductance. In contrast, the changes in the membrane in the HAR group, which resulted in increased peritoneal absorption, did not change the osmotic con ductance or the solute diffusion rate. The detailed pathophysiological mechanisms for these two different types of UFC loss failure are still unknown.
L-Cysteine Improves Growth of Human Peritoneal Mesothelial Cells In Vitro
Authors: Bird Stephen D. , Legge Michael , Walker Robert J.
Published: February 2020

Objective

To improve the growth characteristics of human peritoneal mesothelial cells (HPMC).

Design

The effect of commonly used agents, L-cysteine and epidermal growth factor (EGF), added individually (“single”) or mixed with hydrocortisone and apo-transferrin (“admixture”) in the culture medium (M199) on cultured HPMC, was investigated. Methods: Growth agents were added to M199 medium along with 2% fetal bovine serum and L-glutamine. Growth was determined by the analysis of thymidine ([methyl-3H] thymidine) incorporation into deoxyribonucleic acid, total cell protein, and by cell counts. Morphology was assessed by phase contrast light microscopy and scanning electron microscopy.

Results

HPMC exposed to L-cysteine 0.25 x 10–3 mol/L (30 μg/mL) exhibited significantly improved attachment and growth. Attached cells appeared flat and well spread out shortly after seeding, and produced a tight polygonal monolayer in 14 days, in contrast to the growth of HPMC in control M199 medium, which failed to reach confluence. After an initial lag period in cell growth, EGF (0.01 μg/mL) produced a greater increase in cell growth than L-cysteine did; however, this was associated with changes in HPMC morphology. During the growth period (14 days), EGF-stimulated HPMC appeared distorted and irregular compared to L-cysteine-treated cells, which had the characteristic tight “cobblestone” appearance.

Conclusion

L-cysteine improved cell attachment with preservation of the characteristic morphology of HPMC. Epidermal growth factor improved cell growth but produced changes in morphology. The addition of L-cysteine to the culture medium has an important cell growth enhancement role due to the improved cell attachment and cell viability.
Abdominal Cocoon: An Animal Model for a Complication of Peritoneal Dialysis
Authors: Levine Seymour , Saltzman Arthur
Published: February 2020

Objective

The purpose of this work was to develop an animal model of sclerosing encapsulating peritonitis, a complication of continuous ambulatory peritoneal dialysis in which the intestines are conglomerated into an ovoid cocoonlike structure.

Design

Toward this end, rats were injected with a chemical irritant (household bleach) intraperitoneally. One week later, before the resultant peritonitis could cause adhesions, 10 or 25 mL of fresh whole rat blood was injected into the peritoneal cavity. Two weeks later, the effect of the treatments was evaluated by macroscopic and microscopic study.

Results

The irritant caused a chemical peritonitis. The subsequently injected blood clotted on the surfaces of the inflamed intestines, and contraction of the clot (syneresis) was responsible for bringing the intestinal loops together. This conglomeration was made permanent by the fibrosis evoked by the chemical peritonitis. The end result was an ovoid encapsulated mass of intestines and other viscera.

Conclusion

An animal model for an abdominal cocoon has been produced. It can be used for studies of the pathogenesis and prevention of this complication of peritoneal dialysis.
The Study of Outcomes for Capd versus Hemodialysis Patients
Authors: Port Friedrich K. , Wolfe Robert A. , Bloembergen Wendy E. , Held Philip J. , Young Eric W.
Published: February 2020

Objective

To discuss potential reasons for reported differences in the results of several recent studies comparing mortality risk among continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis patients, and to assess the role of statistical methods and study design.

Data Sources

Recent published reports comparing mortality risk among patients treated with CAPD and hemodialysis.

Conclusions

Differences in study design, study populations, sample size, data collection, and availability of data likely account in part for the differences in available study results. The Cox model is a valuable tool, particularly for observational studies. Observed outcome differences for CAPD and hemodialysis patients may be due to either the dialytic modality itself or other factors such as differences in patient selection, practice patterns, dialysis dose, patient compliance, etc. Relative mortality rates for hemodialysis and CAPD patients may vary by country, as these factors may differ internationally. A randomized clinical trial is necessary to best determine the effect of the modality itself.
Low Calcium Dialysate and Hyperparathyroidism
Authors: Duncan Rachel , Cochrane Tracey , Bhalla Carol , Michael Jonathan , Richards Nicholas Talbot , Adu Dwomoa
Published: February 2020

A low calcium dialysate reduces hypercalcemia from calcium-containing phosphate binders and makes phosphate control possible without the use of aluminum salts. We asked whether this might, however, lead to hyperparathyroidism. We prospectively studied serum concentrations of parathyroid hormone levels (by an immunoreactive intact molecule assay) in 173 patients on continuous ambulatory peritoneal dialysis (CAPD) who were started on a low calcium dialysate (Ca2+ 1.25 or 1.00 mmol/L) because of hypercalcemia. Median follow-up was 13.2 months (range 1 -28). Initial serum parathyroid hormone was [median (range)]: 70 (5 -1043) ng/L pre low calcium dialysate, and this rose to 130(5 -914) ng/LatO 6 months; 130 (5 -1030) ng/Lat 6 -12 months; 170 (170 1400) ng/L at 12 -18 months; and 130 (5 -1200) ng/L at 18 24 months (p = 0.0006). Twenty-two patients required a parathyroidectomy because of a sustained rise in parathyroid hormone that was not responsive to alfacalcidol and hypercalcemia. Initial serum parathyroid hormone was significantly higher in these patients at 359 (5 1073) ng/L as compared to a level of 69.5 (6 1147) ng/L in patients who did not have a parathyroidectomy (p = 0.0009). There was a significant sustained fall in mean serum corrected calcium from 2.77 (2.37 3.51) mmol/L to 2.53 (1.39 3.20) mmol/L at three months (p = 0.0006), a nonsignificant rise in mean serum alkaline phosphate from 179 (47 -1858) mmol/L to 191 (55 -1821) mmol/L (p = 0.15), and a fall in mean serum phosphate levels from 1.87 (0.59–3.18) mmol/L to 1.68 (0.45–3.6) mmol/L (p = 0.76). Our data suggest that the benefits of a low calcium dialysate in CAPD patients are balanced by an increased risk of hyperparathyroidism, and that this risk is higher in patients with an initially high serum parathyroid hormone level.
The Ethics of Infant Dialysis
Authors: Bunchman Timothy E.
Published: February 2020

The proper treatment of an infant with end-stage renal disease depends upon a number of factors including parental willingness to take on the task, experience of the health-care team, local and regional resources, and society's willingness to accept this support as a standard of care. Whereas the abilityto keep infants aliveon peritoneal dialysis (PD) is obtainable, it is not without physical, financial, as well as emotional cost. In order for a family to agree to take on such a task, an understanding of the risks and long-term prognosis should be offered. This “informed consent” is difficult to obtain in such a highly charged situation when emotions often dictate choice independently of logic. Long-term outcome of infants on PD has improved over time, yet is still fraught with complications. Options of treatment or nontreatment are explored.
Acute Peritoneal Dialysis Access in Infant Renal Failure
Authors: Bunchman Timothy E.
Published: February 2020

Rapid onset of acute peritoneal dialysis (PD) in the infant population is, in part, dependent upon equipment availability. From March 1991 until June 1995, over 200 children at the University of Michigan have undergone dialysis for acute renal failure. Of these children, 29 infants (mean±SEM) (age 4.5±1.3 months; weight 4.8±0.5 kg) have had placement of an acute 5 French Cook PD catheter for dialysis. Complications including inadequate inflow in one case, bleeding in one case, and accidental removal in one case were infrequent. Duration of the placed catheters was 9.9±2.7 days, without the problems associated with chronic placement of a stiff catheter. Onset of dialysis occurred within minutes due to rapid access. We conclude that the placement of a 5 French Cook acute PD catheter for acute PD in the infant population is easily performed with minimal risk. Moreover, this allows for more rapid onset of PD when conditions mandate this need.
Home Health and Respite Care
Authors: Watson Alan R.
Published: February 2020

Families with a child on chronic peritoneal dialysis have to assume a significant burden of care, which can result in stress and potential complications. Adequate preparation of the child and family with appropriate information in many forms is essential. We describe a homevisiting strategy using the named nurse, dietitian, and social worker, which also includes liaison with nurseries, schools, community nurses, and primary care physicians. Respite care is provided by an occasional evening babysitting service and increasing use of daytime support from a home care nurse. The holiday support strategy includes a holiday caravan for families in addition to an organized holiday for children alone. A parents’ support group has provided valuable feedback on quality-of care issues.
Body Composition of Children on Capd
Authors: Stefanidis Constantinos , Siapera Dimitra , Papadopoulou Alexandra , Michelis Kyriakos
Published: February 2020

Our objectives were to estimate the body composition of children on continuous ambulatory peritoneal dialysis (CAPD), assess the fat-free mass (FFM) by bioelectrical impedance (BIA) and skinfold anthropometry (SF), and determine the effect of various parameters of the nutritional status and adequacy of dialysis on body composition. The design was a noninterventional retrospective clinical trial.

The percent of fat ranged from 10% to 25% (15±2), when it was calculated from SF, and was from 9% to 32% (18±2) when it was calculated from BIA. There was a significant correlation between the percent of fat calculated by SF and by BIA (r = 0.94, p < 0.0001 with limits of agreement 4.16 to 1.37 and -0.40 to -3.19). The water content of FFM ranged from 70%-79% (74±1). There was a weak but significant correlation (r = 0.64, p = 0.016) between protein catabolic rate (PCR) and KT/V (V = 60% of weight). This correlation became more significant (r = 0.83, p = 0.0007) when the V of KT/V was calculated from BIA.

The prediction of body composition with the use of bioelectrical impedance is a simple and reliable technique. Serial measurements of BIA might be an important tool for the assessment of the nutritional intervention.
Measurement of Hydrostatic Intraperitoneal Pressure: A Necessary Routine Test in Peritoneal Dialysis
Authors: Durand Pierre-Yves , Chanliau Jacques , Gambéroni Joel , Hestin Dominique , Kessler Michele
Published: February 2020

This paper summarizes our clinical studies on hydrostatic intraperitoneal pressure (IPP), showing the interest of this measurement in routine clinical practice.

IPP can easily be measured routinely by a simple an d safe method: the measure of the column of dialysate in the peritoneal dialysis (PD) line before drainage, with point 0 located on the midaxillary line. The normal value is 12±2 cm of water (cm H2O) with an intraperitoneal volume (IPV) of 2 L, with linear increases of 2.2 cm H2O for each additional liter.

IPP must be measured to estimate the tolerance of IPV: the maximal permissible IPV is reached for an IPP of 18 cm H2O, squaring with a decrease of 200/0 in vital capacity and sometimes arising before clinical symptomatology. However, IPP measured at rest could not predict PD mechanical complications (hernias, dialysis leakages, hemorrhoids, etc.), which are more dependent on parietal previous history or predisposition.

IPP is significantly higher during the first three days after peritoneal catheter implantation (17±3 cm H2O) than during the 12 following days (10±4 cm H2O). It is recommended to postpone the start of PD until after catheter implantation, and patients should remain supine for the first three days.

On the other hand, IPP strongly reduces the overall ultrafiltration (UF) volume: an increase of 1 cm H2O in IPP caused a decrease of 70 mL in global UF after two hours. Therefore, IPP should be measured in diagnosis of losses of UF. However, UF loss during peritonitis is not due to an increase of IPP.
Theoretical Analysis of Osmotic Agents in Peritoneal Dialysis. What Size is An Ideal Osmotic Agent?
Authors: Rippe Bengt , Zakaria El Rasheid , Carlsson Ola
Published: February 2020

In this article the difference between osmotic fluid flow (ultrafiltration) as driven by osmotic pressure and diffusion through thin leaky membranes is discussed. It is pointed out that water transport induced by osmosis is fundamentally different from the process of water diffusion. Applying modern hydrodynamic pore theory, the molar solute concentration and the solute concentration in grams per 100 mL, exerting the same initial transmembrane osmotic pressure as a 1% glucose solution, was investigated as a function of solute molecular weight (MW). It was then assumed, based on experimental data, that the major pathway responsible for the peritoneal osmotic barrier characteristics is represented by pores of radius ~47 å. With increasing solute radius, the osmotic reflection coefficient (σ) and, hence, the osmotic efficiency per mole of solute will increase. However, simultaneously, the molar concentration per unit solute weight will decrease. The balance point between these two events apparently occurs at a solute MW of approximately 1 kCa. An additional advantage of using solutes of high MW as osmotic agents during peritoneal dialysis (PC), rather than increased osmotic efficiency per se, lies in the fact that large solutes, due to their low peritoneal diffusion capacity, will maintain a sustained rate of ultrafiltration (osmosis) over a prolonged period. To illustrate this, we have performed computer simulations of peritoneal fluid transport according to the three-pore model of peritoneal permselectivity. According to these simulations, 4% of an 800 Ca polymer solution (+50 mmol/ L above isotonicity) will produce the same cumulative amount of intraperitoneal fluid volume ultrafiltered (UF) during 360 -400 minutes as 4% of a 2 kCa polymer solution (+20 mmol/L) or 6.5% of a 10 kCa polymer solution (+6.5 mmol/L) having the same electrolyte concentration as dialysis solutions conventionally used for PC. Similar cumulative UF volumes (during 400 minutes) can be obtained by a 2.5% glycerol (+272 mmol/L) or a 3.2% glucose-containing dialysis solution (+177 mmol/L) with conventional electrolyte composition.
Effect of Different Buffers on the Biocompatibility of Capd Solutions
Authors: Schambye Hans Thalsgård
Published: February 2020

Commercially available solutions for continuous ambulatory peritoneal dialysis (CAPO) affect the viability and function of the cells in the peritoneal cavity. The low biocompatibility of the solutions may be caused by a low pH, hyperosmolality, high glucose content, and lack of potassium, glutamine, and other components essential for normal cellular functions. The nature of the buffer employed is also important for the cytotoxicity of the solutions. Lactate, the most frequently used buffer, has been shown to inhibit cellular functions important for the peritoneal defense system including phagocytosis, bacterial killing, and secretion of cytokines. It is generally believed that the cytotoxicity of lactate is caused by lowering of intracellular pH and impairment of metabolism due to changed redox potentials. However, the cytotoxicity of lactate is highly dependent upon the pH of the solutions, indicating that passive or active diffusion across the cell membrane is determining the effects of lactate. Bicarbonate has been heavily advocated as an alternative buffer because it is the most important naturally occurring buffer in plasma and it enables a pH of approximately 7.4 in the solutions. However, due to sedimentation of calcium carbonate (CaCO3) and production of toxic glucose metabolites it is difficult to prepare and store bicarbonate-based solutions. Moreover, investigations have revealed that even bicarbonate-based solutions are not optimal regarding biocompatibility, presumably due to a paradoxical intracellular acidification caused by influx of carbon dioxide (CO2). More recently, the effect of other buffers such as pyruvate and histidine have been examined. Especially pyruvate is a promising new buffer candidate.

Conventional CAPD solutions based on lactate have been shown to impair a wide variety of cell functions important for the peritoneal host defense. Apart from the influence of hyperosmolality, high glucose concentration, lack of potassium, glutamine, and other factors, this seems to be due to the combination of low pH and high lactate concentration. Presumably, lactate carries protons across the membrane, which results in intracellular acidification and increased intracellular lactate concentration, both of which may impair cell metabolism and function.

Bicarbonate-based solutions are less toxic than lactate-based solutions -primarily attributable to the higher pH. However, experiments performed by our group have indicated that bicarbonate concentrations that are too high may also affect cell function, and that a solution containing both bicarbonate and lactate may be superior. However, further studies are needed to fully elucidate this problem.

Pyruvate seems to be a promising new buffer candidate with lower toxicity than lactate solutions at identical pH and glucose content. Comparison of pyruvate, lactate, and bicarbonate solutions regarding cytotoxicity and especially intracellular acidification will hopefully shed new light on the toxic properties of these solutions.
Normalization of Protein Equivalent of Nitrogen Appearance and Dialytic Adequacy in Capd
Authors: Virga Giovambattista , Viglino Giusto , Gandolfo Carmen , Aloi Elisabetta , Cavalli Pier Luigi
Published: February 2020

Caloric-proteic malnutrition is frequently encountered in peritoneal dialysis and is associated with an increased risk of morbidity and mortality. Our paper aims to assess any greater reliability of protein equivalent of nitrogen appearance (PNA) normalization to desirable body weight (dBW) compared to actual body weight (aBW) and resulting implications for the relationship between dialytic adequacy and protein intake in continuous ambulatory peritoneal dialysis (CAPD).

We studied 36 patients on CAPD, 24 male and 12 female (aged 66.6±10.2 years, 24±29 months on dialysis), collecting dialysate and urine over 24 hours (126 samples) to calculate the PNA according to Randerson and the total weekly KT N. The total body muscle mass (TBMM) was calculated by anthropometry and the dBW according to Metropolitan Life Insurance tables. Finally, PNA was normalized to aBW (aPNA, g/kg/day) and to dBW (dPNA, g/kg/day).

Average aBW proved to be higher than dBW (66.0±11.1 vs 59.8±6.9 kg, p < 0.0001) and aPNA lower than dPNA (0.96±0.31 vs 1.08±0.3 g/kg/day, p < 0.005). Compared to aPNA, dPNA correlates better with both blood urea nitrogen (BUN) (R2 = 0.702 vs 0.614) and KT/V (R2 = 0.348 vs 0.306). The TBMM is higher in the group with dPNA ≥ 1.0 vs < 1.0 g/kg/day (25.5±0.6 vs 23. 1±0. 7 kg, p < 0.02) while, paradoxically, it is lower in patients with aPNA≥ 1.0 vs < 1.0 g/kg/day (22.8±0.8 vs 25.4±0.6 kg, p < 0.01). The KT/V of the patients with dPNA < 0.8,0.8–1.2 and > 1.2 g/kg/day proved to be different (1.52±0.06 vs 1.80±0.03 vs 2.04±0.04, p < 0.005). On analysis of the linear regression, dPNA = 1.0 and 1.2 g/kg/day corresponds to KT/V values of 1.7 and 2.05, respectively.

We consider dPNA to be more suitable then aPNA for the correct assessment of protein intake, and a weekly KT/V of 1.7 2.05 as being sufficient to guarantee satisfactory dPNA.
Lipoprotein (a) Levels in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Guindeo Carmen , Vega Nicanor , Fernandez Ana M. , Palop Leocadia , Aguilar Jose A. , Moreda Andres , Cia Pedro
Published: February 2020

Most researchers have found increases of lipoprotein (a) [Lp(a)] in uremic patients, as well as in those undergo ng hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mechanisms for this increase remain unclear. We studied 71 patients undergoing CAPD, 48 me n and 23 women. According to the time spent on CAPD, the patients were divided into three groups: group 0: 29 patients at the starting off point of dialysis treatment; group I: 22 patients with an average stay of 15.2 months; group II: 20 patients with an average stay of 69.3 months on CAPD. We have only observed significant increases of Lp(a) levels in those patients initiating the dialysis, but no significant differences are found in the other groups undergoing CAPD for longer periods when compared to the control group. We found no significant relation between Lp(a) levels and peritoneal protein loss, and not with absorption of glucose from the dialysate either. We have found a positive and significant correlation between Lp(a) levels and urinary protein loss (r = 0.41; p < 0.001). It is possible that an element associated with proteinuria might have an effect on the metabolism of Lp(a) in CAPD patients.
Increased Serum Level of Total Homocysteine in Capd Patients despite Fish Oil Therapy
Authors: Holdt Birgit , Korten Gero , Knippel Monika , Lehmann Jochen K. , Claus Renate , Holtz Manfred , Hausmann Stefan
Published: February 2020

It has been shown that serum total homocysteine (HC) is a risk factor for vascular disease which characterizes endothelial damage. The incidence of vascular disease is increased in continuous ambulatory peritoneal dialysis (CAPD) patients. Our aim was to investigate: (1) whether concentration of HC correlates with atherosclerotic and inflammatory events, and (2) if fish oil therapy can retard the disturbance in lipid metabolism which promotes atherosclerosis. Fourteen patients with various degrees of impaired peritoneal clearance and lipid metabolism were observed. In all patients the serum HC was elevated. Seven patients were treated with fish oil for three months. The results indicate an average increase of HC (+18%), total cholesterol (+6.6%), aggregation of erythrocytes (+9%), and an average decrease of dialysate-to-plasma creatinine (DIP) ratio (-7%), deformability of erythrocytes (-8%), and normalization of elevated soluble interleukin2 receptor (sIL-2R) values. Regression analysis of all data demonstrated a significant correlation between HC and parameters of lipid metabolism and hemorheology. There were no significant correlations between HC and peritoneal function and serum cytokine levels. We conclude that the treatment in CAPD patients with fish oil did not improve the lipid metabolism disturbances in atherosclerosis and peritoneal function. Elevated HC confirms the progression of the disease.
Endocrinology and Pd: Optimal Treatment of Anemia in Peritoneal Dialysis Patients
Authors: Bárány Peter
Published: February 2020

The optimal treatment of anemia in peritoneal dialysis is given by subcutaneous administration of epoetin. The optimal dosing frequency is in most patients 2 -3 injections per week, but in responsive patients once a week may be enough during the maintenance phase. Both before starting and during epoetin treatment it is necessary to monitor for factors causing hyporesponsiveness. The epoetin dose is adjusted monthly aiming at an increase in Hb concentration of 10 g/L per month. Further studies are required to define the optimal target Hb concentration. Iron supplements should be administered routinely. Parenteral iron may be used liberally when oral supplements are ineffective or inconvenient.

In the initial three-month period of peritoneal dialysis a marked increase in Hb concentration is common, and if epoetin treatment is necessary low starting doses will be sufficient. In patients with moderate anemia, adequate iron stores and iron availability, and no significant comorbidity, low starting doses are recommended (50 75 U kg-1 week-1). Patients with severe anemia or with comorbidity usually require higher doses and may be started with 75 150 kg-1 week-1. Hypertension is the principal adverse effect of epoetin treatment in patients with chronic renal failure, but it is usually easily controlled by fluid control and/or increased antihypertensive medication.
Subcutaneous and Intraperitoneal Insulin Therapy in Diabetic Patients on Capd
Authors: Nevalainen Pasi I. , Lahtela Jorma T. , Mustonen Jukka , Pasternack Amos
Published: February 2020

We evaluated in a cross-over manner the consequences of subcutaneously and intraperitoneally given insulin on glucose control, insulin sensitivity, and serum lipids in 8 type I diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). The patients were treated with both subcutaneous and intraperitoneal insulin for at least three months. After each period, metabolic studies were performed.

Despite significantly improved glycemic control (Hb A^ 10.00±0.38% after subcutaneous and 8.40±0.36% after intraperitoneal insulin, p = 0.01), serum lipids showed unfavorable changes. High-density lipoprotein (HDL)-cholesterol was significantly lower (1.28±0.18 mmol/L vs 0.88±0.06 mmol/L, p = 0.03) and low-density lipoprotein (LDL)/HDL-cholesterol ratio was higher (p = 0.025) during intraperitoneal insulin. Total cholesterol, LDL-cholesterol, and triglycerides were higher during intraperitoneal insulin administration. Severe hypoglycemic episodes were more common during subcutaneous than intraperitoneal insulin.

It is concluded that, although intraperitoneal insulin administration offers significantly better glycemic control and insulin sensitivity than subcutaneous insulin, the effect on serum lipids is more disadvantageous possibly via a direct effect of insulin on the liver.
Does Calcitriol Therapy Improve Muscle Function in Uremic Patients?
Authors: Wanic-Kossowska Maria , Grzegorzewska Alicja , Plotast Hanna , Bombicki Krzysztof
Published: February 2020

The purpose of the present study is to investigate whether calcitriol therapy in uremic patients undergoing dialysis treatment can improve muscle function. In 8 uremic patients [2 on continuous ambulatory peritoneal dialysis (CAPD), 6 on hemodialysis (HD) treatment], calcitriol (Calcitriol, Roche) was given in the dose of 1 μg/ day for 15 months. At the beginning of therapy and every month, the following parameters in serum were determined: creatinine (Cr), calcium (Ca), phosphate (P), and parathyroid hormone (PTH). At the beginning and at the end of treatment, quantitative electromyography (EMG) was performed.

We observed a slight increase of serum Cr during 15 months of treatment in 4 patients. Serum Ca, P, and PTH did not change significantly. The EMG revealed abnormal polyphasic motor nerve unit potentials of brief durations, a decrease in the amplitude, and fibrillation potentials. The EMG findings did not change significantly after calcitriol therapy, but all patients on physical examinations exhibited the disappearance of clinical manifestations of uremic myopathy.

In conclusion, our findings suggest that vitamin D deficiency is one of the causes of uremic myopathy and a careful treatment with calcitriol can diminish muscle weakness in uremic patients.
Significance, Epidemiology, and Prevention of Peritoneal Dialysis Catheter Infections
Authors: Burkart John M.
Published: February 2020

Catheter infections are a major cause of morbidity, catheter loss, and transfer to hemodialysis. These infections are mainly due to S. aureus. To date, treatment is less than optimal. Therefore, the primary goal should be prevention of catheter infections. Prevention is based on improving catheter design and implantation technique while using careful exit-site care. Prophylaxis with antimicrobials such as intranasal mupirocin or the use of silverimpregnated catheters appears promising as a way to reduce the risk of developing S. aureus infections. To optimize patient outcome, one must focus on these preventive measures.
Comparisons of Y-Set Disconnect System (Ultraset) versus Conventional Spike System in Uremic Patients on Capd: Outcome and Cost Analysis
Authors: Li Philip Kam Tao , Chan Tak Hin , So Wing Yee , Wang Angela Y.M. , Leung Chi Bon , Lai Kar Neng
Published: February 2020

We conducted a single-blind, prospective randomized study on the use of the V -set disconnect system (Uttraset) (U) versus the conventional (C) spike system to assess the peritonitis rate, exit-site infection (ESt), clinical outcome, the resulting hospitalization rate, and recurrent costs. Forty new end-stage renal failure patients admitted to the dialysis program were recruited into the study and 20 each were randomly allocated to the U and C systems. They were studied for a period of 12 months. The mean number of days required to train patients for the U and C systems were 8.6 and 9.8 days, respectively. The peritonitis rates for the U and C systems were one episode every 17 and 11.4 patient-months, respectively. The ESI rates for the U and C systems were one episode every 26.4 and 21.6 patient-months, respectively. Four catheters were removed due to fungal peritonitis (three with the C system and one with the U system). As related to peritonitis, patients on the C system required 57 hospital-days while those on the U system required 28 days per year. On cost analysis, the extra cost required for the U system can be offset by the other expenses incurred for events related to more infections on the C system.

It is concluded that for the similar cumulative costs required for the patients on the two systems, the Y-set disconnect has a better morbidity profile than the conventional spike system.