bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vitro Biocompatibility of a Heat -Sterilized, Low Toxic, and Less Acidic Fluid for Peritoneal Dialysis
Authors: Wieslander Anders P. , Deppisch Reinhold , Svensson Eva , Forsbäck Gunita , Speidel Rose , Rippe Bengt
Published: February 2020

Objective

The aim of this study was to investigate a peritoneal dialysis (PD) fluid (PD-Bio), produced with the intention of reducing the amount of glucose degradation products and to increase the final pH. The heat sterilization of the fluid was performed with the glucose separated from the electrolytes. After sterilization the two solutions were combined.

Methods

The in vitro biocompatibility of PD-Bio was measured as the inhibition of cell growth of a cultured fibroblast cell line and as the stimulated release of interleukin-1β from cultured human mononuclear cells. The glucose degradation products were measured as UV absorbance at 228 nm or 284 nm and the concentration of aldehydes was estimated with high-performance liquid chromatography and gas chromatography.

Results

Our results demonstrate that in comparison to conventional PD fluids the pH of PD-Bio was increased, to about 6.5. Due to less contaminating glucose degradation products in PD-Bio, basal cytotoxicity was significantly decreased for both 1.5% and 4% glucose-containing fluids, and the stimulated release of interleukin-1β was normalized compared to sterile filtered controls with the same pH. UV absorbance measured at 228 nm was decreased, whereas the absorbance at 284 nm was equal to that of a conventional fluid. In PD-Bio the concentrations of formaldehyde, acetaldehyde, methylglyoxal, and 2-furaldehyde were found to be below the detection limit, whereas glyoxal was present in the same and 5hydroxymethylfurfural (5-HMF) in higher concentrations than in conventionally produced PD fluid.

Conclusions

The results demonstrate that it is possible to improve biocompatibility of PD fluids by simply changing the way the fluid is produced.
Highlights of ISPD 1995
Authors: Nolph Karl D.
Published: February 2020

New ideas and innovations continue to emerge in the field of peritoneal dialysis. I believe that by converging experts from around the world and sharing our knowledge, we will advance our efforts to develop new applications that will enhance the safety and efficacy of peritoneal dialysis.
Which Catheter is the Best Buy?
Authors: Piraino Beth
Published: February 2020

Good but not perfect results can be obtained with many types of catheters. Convincing data demonstrating superiority of one catheter over another are not available. What is the comparative cost of these catheters? The straight Tenckhoff catheter remains the least expensive at $42.50 (Quinton Instrument Company). Until a large randomized trial is done demonstrating a clear superiority of another catheter, we will continue to use the straight double-cuff Tenckhoff catheter.
Stability of Drug Additives to Peritoneal Dialysate
Authors: Bailie George R. , Kane Michael P.
Published: February 2020

Objective

The primary literature was reviewed to determine the stability of drug additives in peritoneal dialysis solutions.

Data Sources

A MEDLINE search and retrieval, covering the period 1981 to 1994, was undertaken to identify relevant original literature. Additional references were identified from citations within the original literature. Non-English literature was excluded unless an English abstract was provided.

Study Selection

Forty-nine studies were identified. Of these, 24 were directly related to drug stability, 13 were related to the clinical use of the drug additives but included no stability data, and 12 examined other, nonstability aspects of in vitroactivity of antibiotics, additives, or drug adsorption in peritoneal dialysis bags and tubing.

Data Extraction

Data included concentrations of drug additives and dialysate solutions, duration and temperatures of storage conditions, types of assay, and whether they were stability-indicating.

Results

Stability was defined as the duration of time that the drug concentration remained at 90% or more of the original concentration. Stability was examined under a large variety of conditions. Thirty-one drugs were identified from 20 manuscripts as single-drug additives. Most beta-Iactams were stable for 1 –2 weeks in a refrigerator and for several days at room temperature. Aminoglycosides were stable for 1 –2 days at room temperature. Glycopeptides were stable for several weeks refrigerated or at room temperature. Prolonged storage at room temperature resulted in instability of cefotaxime, ceftazidime, ceftriaxone, and miconazole. Eleven drugs were identified from seven manuscripts as drug combination studies and showed similar stability as single agents. Dialysate concentration appeared to have minimal effect on stability.

Conclusions

Drug additives in peritoneal dialysate, singly or combined, should be avoided unless data are available to support their stability. Additives should be made as close as possible to the time of the exchange. Alternatively, additives should be stored refrigerated, then warmed prior to use. The practice of preparing numerous bags at one time should be avoided. Finally, stability data do not indicate sterile integrity of the dialysate.
Peritoneal Dialysis Access: Prospective Randomized Comparison of the Swan Neck and Tenckhoffcatheters
Authors: Eklund Björn H. , Honkanen Eero O. , Kala Aino-Riitta , Kyllönen Lauri E.
Published: February 2020

Objective

To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit -site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective randomized trial.

Setting

CAPD unit in one university hospital, serving a population of 1.2 million.

Patients

Forty consecutive patients requiring their first dialysis catheter for future CAPD were randomized to receive either a two-cuff permanently bent Swan neck catheter or a two-cuff straight Tenckhoff catheter. The skin exit was downward-directed in the Swan neck group and upward-directed in the Tenckhoff group.

Results

Dialysate leak, catheter migration, or tunnel infection did not occur in any of the patients. Three outer cuff extrusions needing cuff shaving occurred, all in the Tenckhoffgroup(p =0.1). No significant differences could be demonstrated in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections.

Conclusion

Catheter configuration did not influence the catheter-related mechanical or infectious complications, and equally good results were obtained with both catheter types studied.
Insertion of a Straight Peritoneal Catheter in an Arcuate Subcutaneous Tunnel by a Tunneler: Long Term Experience
Authors: Favazza Antonio , Petri Roberto , Montanaro Domenico , Boscutti Giuliano , Bresadola Fabrizio , Mioni Giuseppe
Published: February 2020

Objective

This study describes the results of the insertion of a straight Tenckhoff peritoneal catheter (PC) in an arcuate, caudally concave tunnel using a tunneler designed by the authors. It has a semicircular shape and a bending radius of 4.5 cm.

Setting

A hospital renal unit.

Patients

From June 1988 to February 1994, 112 straight Tenckhoff PCs, 62 with one deep cuff (single-cuff PC) and 50 with two cuffs (double-cuff PC), were inserted as first catheters in 112 patients (mean age 62±13 years), who underwent continuous ambulatory peritoneal dialysis (CAPD). The follow-up was 1099 months (mean 18±13 months)forsingle-cuff PC sand 1264 months (mean 25±15 months) for double-cuff PCs, respectively.

Interventions

After intraperitoneal placement of the PCs by median laparotomy, a 180° arc bend tunnel, with both external and peritoneal exits directed downwards, was created by means of the tunneler.

Results

The rate of exit-site infection (ESI) was 0.27 episodes/year (epis/year). The probability of remaining ESI-free was 76%, 60%, and 55% at 1, 2, and 3 years. The rate of tunnel infection (TI) was 0.046 epis/year. The incidence of the double-cuff PC-related ESI and TI tended to be lower than the incidence observed with the singlecuff PC. Episodes of peritonitis were 60 (0.30 epis/year), where 6 were subsequent to ESI and/or TI. Two PCs were lost due to ESI, 3 due to TI, and 11 due to peritonitis. Drainage failure, due to displacement of the PC caused by straightening, involved 3 PCs; 2 were lost. PC survival was 92%, 82%, and 74% at 1, 2 and 3 years, respectively.

Conclusions

By an easily used semicircular tunneler, the standard straight Tenckhoff PC can be stably positioned in an arcuate tunnel with both inner and outer exits directed downwards. This tunnel shape, as already suggested by some authors, appears to be an effective technical solution to reducing the PC-related complication rates.
Why are Reported Relative Mortality Risks for Capd and Hd So Variable? (Inadequacies of the Cox Proportional Hazards Model)
Authors: Nolph Karl D.
Published: February 2020

The relative risks of death for CAPD and HD reported in the literature and at recent meetings most likely reflect case-mix differences and varying percentages of adequately dialyzed patients within the compared populations. A prospective randomized comparison of CAPD and HD patients will be unlikely because of the expense. Therefore, we should attempt to improve the way that both CAPD and HD are practiced. There is no conclusive evidence that the choice of CAPD or HD per se yields a specific modality advantage for survival.
Elevated Llpoprotein(A) and Fibrinogen Serum Levels Increase the Cardiovascular Risk in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Bartens Werner , Nauck Matthias , Schollmeyer Peter , Wanner Christoph
Published: February 2020

Objective

To analyze the relationship between lipoprotein(a) [Lp(a)] and fibrinogen as potential cardiovascular risk factors in patients on continuous ambulatory peritoneal dialysis (CAPD).

Patients

A total of 47 uremic patients receiving CAPD, 21 with coronary artery disease (CAD), 26 without CAD.

Measurements

Lp(a) levels were determined by an immunoradiometric assay. Since Lp(a) serum concentrations vary depending on the size, apoprotein(a) [apo(a)] isoforms were determined (Westernblot). Fibrinogen was quantified according to Clauss.

Results

The mean Lp(a) serum concentration was 43 ± 5 mg/dL (SEM) (median 33 mg/dL) in CAPD patients and 21 ± 2 mg/dL (8 mg/dL) in controls (p < 0.01). Patients with low molecular weight apo(a) isoforms exhibited substantially elevated Lp(a) levels when compared with patients with high molecular isoforms (p < 0.01). In addition, we found elevated fibrinogen levels in the CAPD patients (538 ± 61 mg/dL) compared with healthy controls (288 ± 46 mg/dL). Twenty-one CAPD patients (45%) were suffering from CAD. Patients with CAD had higher Lp(a) levels (54 ± 5 mg/dL vs 34 ± 4 mg/dL) as well as higher fibrinogen concentrations (628 ± 59 mg/dL vs 459 ± 46 mg/dL). Furthermore, a positive correlation between the fibrinogen levels and the Lp(a) serum concentration was observed (r = 0.45, p = 0.01).

Conclusion

We suggest that elevated Lp(a) levels are influenced by the allelic variation of the apo(a) isoform. In addition to the typical dyslipidemia found in CAPD patients, high levels of Lp(a) and fibrinogen may contribute to the elevated risk of coronary artery disease and other cardiovascular complications.
Fusarium Peritonitis in a Child on Peritoneal Dialysis: Case Report and Review of the Literature
Authors: Flynn Joseph T. , Meislich Debrah , Kaiser Bruce A. , Polinsky Martin S. , Baluarte H. Jorge
Published: February 2020

Objective

To review various aspects of the management of peritonitis due to Fusarium, a soil mold which infrequently causes infections in humans.

Data Sources

A case of Fusarium peritonitis in a child on chronic peritoneal dialysis (PD) is presented. The child developed Fusarium peritonitis 2 weeks after an episode of bacterial peritonitis. His Tenckhoff catheter was removed, and he was maintained on hemodialysis while receiving intravenous amphotericin. Following 2 weeks of treatment with amphotericin, he was successfully returned to PD. A literature review of all previously reported cases of Fusarium peritonitis was then conducted to determine features common to infections caused by Fusarium. Emphasis was also placed on unique characteristics of the organism that may affect patient management, as well as patient characteristics that may increase the risk for infection by Fusarium.

Results

Fusarium may cause infection inimmuno suppressed individuals, such as cancer patients or patients on chronic PD. The organism has a propensity to attach to foreign bodies such as intravascular and intraperitoneal catheters. Therefore, successful treatment of infections caused by Fusarium may require catheter removal in addition to systemic antifungal therapy.

Conclusions

This report presents the first known case of Fusarium peritonitis in a child. In view of the difficulties posed by this unusual organism, optimal therapy of Fusarium peritonitis should consist of immediate catheter removal and treatment with systemic antifungal drugs.
Treatment Modality Selection in 150 Consecutive Patients Starting Esrd Therapy
Authors: Prichard Sarah S.
Published: February 2020

Objective

The purpose of this study was to assess the reasons for treatment modality selection between hemodialysis (HD) and peritoneal dialysis (PD) in 150 consecutive patients in a single center.

Design

This study is a retrospective study using chart review as the data collection method.

Setting

A single tertiary care university teaching hospital.

Patients

One hundred and fifty consecutive patients starting end-stage renal disease (ESRD) therapy at the Royal Victoria Hospital in Montreal were assessed. Their treatment modality at 6 weeks after starting dialysis was recorded as their treatment modality. Patients transplanted or who died prior to that 6 week period were excluded.

Main Outcome Measures

The treatment modality, that is, either HD or PD, at 6 weeks after the initiation of ESRD was the modality assigned to the patient.

Results

One hundred and fifty patients started ESRD therapy of whom 83 went to HD and 67 to PD. Thirty-one patients were directed to HD, including 20 for social reasons, 3 with ostomies, and 6 with unsuitable abdomens. Fourteen patients were directed to PD, including 10 with severe cardiovascular disease, 3 with no vascular access, and one for geographical reasons. Of 31 diabetics who were encouraged to do PD, 17 went to PD and 14 to HD (10 for social reasons, 3 refused PD, and one with an inappropriate abdomen). Seventy-four patients were initially eligible for either PD or HD. Fifty percent (37) went to PD and 50% to HD. Of those going to HD, 15 went to self-care HD, of whom 7 had prior exposure to HD. Eleven were not informed regarding PD. There was no gender preference for PD versus HD.

Conclusion

We conclude that among informed patients, if given a choice of treatment modality, the majority will choose self-care dialysis including continuous ambulatory peritoneal dialysis (CAPD) or selfcare HD.
Erythropoietin Treatment Decreases Cardiovascular Morbidity and Mortality in Capd Patients
Authors: Bajo Maria Auxiliadora , Selgas Rafael , Castro Maria Jose , Jiménez Carlos , Fernández-Reyes Maria Jose , Del Peso Gloria , De Alvaro Fernando , Sanchez-Sicilia Luis
Published: February 2020

Objective

To analyze the effects of recombinant human erythropoietin (rHuEPO) therapy on cardiovascular (CV) morbidity and mortality among continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Retrospective comparative study.

Setting

CAPD unit in a university hospital.

Patients

Forty-two patients on rHuEPO treatment for at least one year were compared with an rHuEPO nonuser group of 113 patients. Subcutaneous rHuEPO doses were adjusted to a hemoglobin objective level of 10.5 -13.5 g/ dL. Fifty-seven patients were considered as high cardiovascular risk (HCVR), 17 in the rHuEPO group and 40 in the rHuEPO nonuser group. Ninety-eight patients were classified as low cardiovascular risk (LCVR), 25 of whom were in the rHuEPO group.

Results

The incidence of cardiovascular morbidity was more frequent in the rHuEPO nonuser than in the rHuEPO user group (40% vs 22%) and in HCVR than in LCVR patients (59.6% vs 20.4%). By multiple logistic regression analysis, the best model to explain the development of cardiovascular morbidity comprises rHuEPO treatment, CV risk, and age. In the rHuEPO user group, HCVR and LCVR patients did not show significant differences in survival, while in the rHuEPO nonuser group, HCVR patients had a lower survival rate than LCVR patients (p = 0.0003). Cox proportional hazards model revealed that LCVR patients had an excellent prognosis compared with HCVR patients in the rHuEPO nonuser group, but this difference disappeared in the rHuEPO user group.

Conclusion

These data show a beneficial effect of rHuEPO treatment on cardiovascular morbidity and mortality in CAPD patients, evidenced by the elimination of the correlation between prior cardiovascular risk and subsequent mortality.
Fibrinogen and Fibrinolytic Activity in Capd Patients with Atherosclerosis and Its Correlation with Serum Albumin
Authors: Kim Kyung Jo , Yang Won Seck , Kim Soon Bae , Lee Sang Koo , Park Jung Sik
Published: February 2020

Objective

It has been suggested that hypoalbuminemia in dialysis patients leads to a hypercoagulable state, however, the relationship between serum albumin and fibrinogen or fibrinolytic activity has not been well-documented. The aim of this study was to investigate the changes of fibrinogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), and lipid levels in continuous ambulatory peritoneal dialysis (CAPD) patients with atherosclerosis, and the relationship between those factors and serum albumin.

Design

A cross-sectional study.

Setting

A university hospital.

Patients

Twenty CAPD patients with atherosclerosis, 49 CAPD patients without atherosclerosis, and 33 normal controls were included. Presence of atherosclerosis was determined by positive results in a stress thallium singlephoton emission computed tomography or an ankle brachial index less than 0.9. Coronary angiography and/ or Doppler ultrasound of extremities were followed for the patients with positive results to confirm atherosclerotic cardiovascular disease.

Main outcome measures

tPA and PAI-1 levels were determined with ELISA method, and fibrinogen with thrombin time method. Serum albumin and lipids were also measured.

Results

Serum albumin and HDL -cholesterol levels were significantly lower, and the ratio of total cholesterol/ HDL was significantly higher, in CAPD patients than in normal controls. CAPD patients with atherosclerosis had significantly higher fibrinogen, tPA, and PAI-levels than other groups. tPA was an independent predictor of atherosclerotic vascular disease in CAPD patients in stepwise logistic regression analysis. Serum albumin level was inversely correlated with fibrinogen (r = -0.28; p < 0.05) in CAPD patients, but not with tPA or PAI-1 levels. PAI-1 level was correlated with tPA (r = 0.37; p < 0.01) and triglycerides (r = 0.32; p < 0.05).

Conclusions

Association of high levels of fibrinogen and PAI-1 with lipid disorders may be of importance in the development of atherosclerosis in CAPD patients. Hypoalbuminemia may contribute to atherosclerosis via increased synthesis of fibrinogen.
Adequate Dialysis? Measurement of Ktn in a Pediatric Peritoneal Dialysis Population
Authors: Walk Twiggy L.M. , Schröder Cornelis H. , Reddingius Roel E. , Lelivelt Marga , Monnens Leo A.H. , Willems Hans L.
Published: February 2020

Objective

To measure the urea and creatinine kinetics in a pediatric population

Patients and Methods

In 19 children treated with peritoneal dialysis (PD) KT/V, urea and creatinine clearances (Ccr) were measured. Thirteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 6 on nightly intermittent peritoneal dialysis (NIPD).

Results

Mean KT/V per week was 2.31 ±0.78 and mean creatinine clearance 74 ±47 L/week/1. 73 m2. There was no difference in dialytic KT/V between patients treated with CAPD and NIPD (1.75 ±0.21 vs 1.76 ±0.50). The correlation between KT/V urea and creatinine clearance was 0.9 (p<0.001). There was a clear relationship of these parameters with residual renal function, but not with age or blood urea level. A weak positive correlation was found with serum albumin and protein intake.

Conclusions

Mean KT/V in this patient group was higher than the values reported for most adult patient groups. Residual renal function considerably contributes to this high KT/V. It is not clearly defined which KT/ V should be aimed for, since criteria for adequate dialysis are multifactorially determined and therefore difficult to interpret.
Chronic Administration of Iron Dextran into the Peritoneal Cavity of Rats
Authors: Park Sang-Eun , Twardowski Zbylut J. , Moore Harold L. , Khanna Ramesh , Nolph Karl D.
Published: February 2020

Objective

To determine the influence of chronic iron dextran administrations into the peritoneal cavity of rats on function and anatomy of the peritoneal membrane, as well as on erythropoiesis and serum iron.

Design

Prospective randomized animal study.

Setting

Animallaboratory. Animals: 36 Sprague-Dawley rats.

Interventions

The rats were divided into three groups (n = 12). The animals were given standard 1.5% Dianeal (control group) or 1.5% Dianeal containing iron dextran in a concentration of 2 mg/L [Iow-dose group (LDG)] or 10 mg/L [high-dose group (HDG)].

Main outcome measures

On the 8th day, at 3 months, and at 6 months a 2-hour peritoneal equilibration test (PET) and blood tests including hematocrit, serum iron, and total iron-binding capacity (TIBC) were done. After the final PET at 6 months, the peritoneal membrane was evaluated by gross inspection and by light microscopy.

Results

Hematocrit and serum iron levels increased only in the HDG and LDG. Peritoneal transport of small solutes decreased significantly in the HDG compared to baseline. All cases of the HDG group revealed peritoneal adhesions and fibrosis around the peritoneal catheter as well as massive iron deposits on the peritoneum. Similar but less pronounced changes were found in the LDG.

Conclusions

These findings suggest an efficient absorption of iron from the peritoneal cavity of rats, however, dialysate iron dextran concentrations of 2 mg/L or greater are toxic to the peritoneal membrane. Therefore, future studies should be performed to determine the minimal effective and nontoxic iron dextran concentrations for intraperitoneal administration.
Insulin Stimulates the Activity of Na+/K+-Atpase in Human Peritoneal Mesothelial Cells
Authors: Witowski Janusz , Breborowicz Andrzej , Topley Nicholas , Martis Leo , Knapowski Jan , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To assess the effect of insulin on the Na+/ K+-ATPase expression and activity in human peritoneal mesothelial cells (HPMC).

Methods

HPMC were isolated from the omental tissue of non-uremic patients, grown to confluence and rendered quiescent by serum deprivation for 24 hours. The activity of Na+/K+-ATPase was determined by measuring the ouabain-sensitive86Rb uptake. To assess whether the effect of insulin was related to changes in [Na+]i the sodium influx was measured with 22Na and the activity of Na+/K+ -A TPase was assessed in the presence of amiloride. Expression of Na+/K+ -A TPaseα1’ α2 and β1-subunit mRNAs was determined by RT/PCR.

Results

Exposure of HPMC to insulin resulted in a time and dose-dependent increase in the Na+/K+-ATPase activity. After 60 minutes the ouabain-sensitive 86Rb up take (cpm/104 cells) was increased from 6650±796 in control cells to 9763±1212 in HPMC exposed to 100 mU/ mL insulin (1.5-fold increase; n=4, P<0.05). In addition, incubation of HPMC with 100 mU/mL insulin resulted in a time-dependent increase in the 22Na influx. Pre-exposure of HPMC to 1 mM amiloride reduced the activity of Na+/K+-A TPase but did not block the stimulatory effect of insulin. RT/PCR analysis revealed that HPMC constitutively expressed α1 and β1-subunit mRNAs while the α2-subunit mRNA was barely detectable. Exposure of HPMC to insulin for up to 24 hours was not associated with any changes in the expression of either α1’ α2 or B1-subunit.

Conclusion

Insulin stimulates the Na+/K+-ATPase activity in HPMC in a time and dose-dependent manner. This effect appears to mediated by an increase in [Na+]i and is not related to alterations in Na+/K+-ATPase subunit mRNAs expression.
Peritoneal Catheters and Exit-Site Practices toward Optimum Peritoneal Access: 1998 Update
Authors: Gokal Ram , Alexander Steven , Ash Stephen , Chen Tzen W. , Danielson Anders , Holmes Cliff , Joffe Preben , Moncrief Jack , Nichols Kirt , Piraino Beth , Prowant Barbara , Slingeneyer Alain , Stegmayr Bernd , Twardowski Zbylut , Vas Stephen
Published: February 2020

The peritoneal catheter is the PD patient's lifeline. Advances in catheter knowledge have made it possible to obtain access to the peritoneal cavity safely and to maintain access over an extended period of time. Catheter-related infections remain a major problem, solutions for which are being actively researched. Nevertheless, the successful outcome of a catheter is very much dependent on meticulous care and attention to detail. Adherence to the principles of catheter insertion and subsequent management and care remain the cornerstone of successful PD access. The guidelines provided in this publication represent a consensus view based on studies from the literature and opinions of experts in this field; it is hoped that implementation of these guidelines will improve catheter-related outcomes and, therefore, enhance patient care.
Hyperleptinemia in Patients with End-Stage Renal Disease Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Dagogo-Jack Samuel , Ovalle Fernando , Landt Michael , Gearing Barbara , Coyne Daniel W.
Published: February 2020

Objective

To determine whether the increased plasma leptin levels reported in hemodialyzed patients is a feature of end-stage renal disease or an artifact of hemodialysis, we studied plasma levels in patients treated exclusively by continuous ambulatory peritoneal dialysis (CAPD).

Design

Prospective comparison of end points in CAPD patients and matched healthy subjects.

Setting

Tertiary care institutional dialysis center.

Participants

Fifty-six healthy subjects, age 50.8 ± 2.3 years, body mass index (BMI) 27.7 ± 1.3 kg/m2, recruited through public announcement, and 36 patients with end-stage renal disease, age 51.0 ± 2.4 yr, BM128.2 ± 1.3 kg/m2, enrolled in a CAPD treatment program.

Intervention

Four exchanges of CAPD per day, using 2.0, 2.5, or 3.0 L of dialysate over a period of 1 -96 months (median 22 mth).

Main Outcome Measures

The primary outcome measure was plasma leptin concentration. Secondary measures included plasma glucose, insulin, C-peptide, and cortisol concentrations; and residual renal function and dialysis adequacy (Kt/V).

Results

Plasma leptin levels in CAPD patients were 27.1 -490 ng/mL(women)and 1.3 -355 ng/mL(men); the levels in healthy subjects were 2.0 84.7 ng/mL (women) and 1.8 -55.4 ng/mL (men). The mean leptin levels were 5-fold higher among CAPD-treated men than control men (49.9 ± 18.4 vs 9.8 ± 2.5 ng/mL, p < 0.001) and 7.5-fold higher among CAPD-treated women than control women (220 ± 28.1 vs 29.3 ± 3.7 ng/mL, p < 0.0001). Female gender and BMI were the strongest predictors of hyperleptinemia in CAPD patients.

Conclusion

These results indicate that hyperleptinemia is a feature of terminal renal failure, not an artifact of hemodialysis.
Risk Factors for Developing Peritonitis Caused by Micro-Organisms of Enteral Origin in Peritoneal Dialysis Patients
Authors: Caravaca Francisco , Ruiz-Calero Rosa , Dominguez Carmen
Published: February 2020

Objective

To investigate the risk factors associated with the development of peritonitis caused by enteral bacteria in peritoneal dialysis patients, including the prescription of gastric acid inhibitors as a potential risk factor.

Design

Retrospective single-center study.

Setting

Tertiary university hospital.

Patients an d Main Outcome Measures

Fifty-five patients who entered into our continuous ambulatory peritoneal dialysis (CAPD) program during the last 6 years were included. Multiple logistic regression analysis was used to establish the best determinants over the development of at least one episode of enteric peritonitis. The predictive variables included in the model were: age, gender, diabetic versus nondiabetic, polycystic versus nonpolycystic kidney diseases, history of constipation, presence or absence of moderate/severe malnutrition, peritoneal transport characteristics, peritoneal protein losses, rate of exit-site infections, rate of total peritonitis, intestinal abnormalities, and treatment with inhibitors of gastric acid secretion.

Results

The total number of peritonitis episodes during the studied period was 88, which clustered in 34 of 55 patients. Fourteen (16%) were caused by enteric microorganisms in 10 patients: Escherichia coli (6), Klebsiella sp (2), Enterobacter sp (1), and Enterococcus sp (5). Nine of 10 patients who developed enteric peritonitis were on gastric acid inhibitors (3 patients on omeprazole and 6 patients on H2-antagonists), while 15 of 45 patients who did not develop enteric peritonitis were on gastric acid inhibitors (all of them on H2-blockers). There were temporal relationships between the start of gastric acid inhibitors and the development of enteric peritonitis in 6 of 9 patients who were on this medication. Four of 10 patients who developed enteric peritonitis had diverticulosis. Ten of 45 patients who did not develop enteric peritonitis had been diagnosed with diverticulosis of the colon or sigmoid prior to entry to CAPD. The unique patient who was not on gastric acid inhibitors and developed enteric peritonitis, had been diagnosed with chronic atrophic gastritis with achlorhydria. By multiple logistic regression analysis, the treatment with gastric acid inhibitors was the only independent variable that entered into the best predictive equation over the development of enteric peritonitis (Iog likelihood ratio = -26.077, odds ratio = 18; 95% CI odds ratio: 2 - 155).

Conclusion

Gastric acid inhibitors may increase the risk for developing enteric peritonitis in peritoneal dialysis patients.
Autonomic Function in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Jassal Sarbjit V. , Allen Judith A. , Douglas James F. , Stout Robert w.
Published: February 2020

Objective

To investigate sympathetic function in the peripheries of patients on chronic ambulatory peritoneal dialysis (CAPD) using noninvasive techniques.

Design

Comparison of peripheral blood flowresponses in sympathetic vasoconstrictor reflexes in CAPD patients and matched control subjects.

Setting

Tertiary care hospital and research institution.

Patients

Twenty-three clinically stable CAPD patients and 23 control subjects matched for age, sex, and drug therapy.

Main Outcome Measures

Sympathetic activity assessed from the reductions in hand and foot blood flow induced by a deep breath and by body surface cooling. Cardiac autonomic activity measured by the changes in heart rate produced by deep breathing, a Valsalva maneuver, and standing from lying.

Results

A deep breath induced mean decreases in hand blood flow of 65.1% in the patients and 82.8% in their matched controls. Corresponding reductions in the foot were 46.0% and 70.0%. Body surface cooling reduced mean hand blood flow by 50.3% in the patients an d 71.8% in the control subjects. Corresponding values in the foot were 26.7% and 43.6%. The differences in response between the patients and their matched control subjects were all significant (p < 0.01). Cardiac autonomic function assessed by standard tests of heart rate variability was significantly impaired in the patients compared with the control subjects in two of the three tests used (p < 0.001).

Conclusions

Cardiovascular autonomic impairment can affect the peripheral circulation as well as the heart in patients on dialysis, and this may have implications for cardiovascular homeostasis.
The Effect of Antibiotic Prophylaxis on the Healing of Exit Sites of Peritoneal Dialysis Catheters in Rats
Authors: Pecoits-Filho Roberto F.S. , Twardowski Zbylut J. , Khanna Ramesh , Kim Yong-Lim , Goel Sharad , Moore Harold
Published: February 2020

Objective

To evaluate the influence of intraperitoneal (IP) antibiotic (AB) prophylaxis on the quality of healing and infection rates of exit sites in peritoneal dialysis catheters.

Study Design

Twenty-one Sprague-Dawley rats were dialyzed 3 times per day for 6 weeks. Dianeal solution containing AB was used for all the rats during the first 5 days. The animals were randomized on the sixth day into three groups: group A (AB-free after randomization), group B (AB for 3 weeks), and group C (AB during 6 weeks). Scores were given to each exit site according to the observation. Mean scores from each group were compared in an attempt to find significant differences between the groups. Dialysate and exit-site drainage samples were taken weekly for microbiology.

Results

Eight episodes of peritonitis were diagnosed, six in group A and two in group B. The most common bacteria causing peritonitis were gram-negative rods. The mean scores were not significantly different between groups C and B throughout the study, even after the discontinuation of the prophylaxis. Group A, when compared to the other two groups, had significantly higher scores after the second week and throughout the rest of the study.

Conclusion

Intraperitoneal antibiotic prophylaxis for 3 weeks after catheter implantation is an effective way to prevent early colonization of exit sites, providing a better healing quality and lower incidence of catheter-related infection. Although the extension of the prophylaxis for 6 weeks seems to be beneficial, it was not statistically proven in this study.
The Italian Registry of Pediatric Chronic Peritoneal Dialysis: A Ten-Year Experience with Chronic Peritoneal Dialysis Catheters
Authors: Rinaldi Stefano , Sera Francesco , Verrina Enrico , Edefonti Alberto , Perfumo Francesco , Sorino Palma , Zacchello Graziella , Andreetta Barbara , Ardissino Gianluigi , Bassi Sergio , Capasso Giovanni , Caringella Domenica A. , Gianoglio Bruno , Gusmano Rosanna , Rizzoni Gianfranco
Published: February 2020

Objective

To analyze the data from 347 peritoneal catheters implanted in 249 pediatric patients aged ≤ 15 years at start of chronic peritoneal dialysis (CPD).

Design

Restrospective study of the data collected between 1986 and 1995, in 20 dialysis centers, from the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Data collection for each pediatric catheter included: catheter type, site and technique of insertion, complications, duration, and reason for removal or replacement.

Results

Fifty catheters were inserted in patients under 2 years of age, 50 in patients aged 2 5 years and 247 in patients over 5 years of age. Catheter types included 307 (88.5%) Tenckhoff (286 double cuff, 21 single cuff) and 40 (11.5%), double-cuff, Valli-type catheters. All catheters were surgically implanted and omentectomy was performed in 83.5% of cases; the entry-site was in the midline in 136 cases (39.2%) and paramedian in 211 (60.8%). During 6076 CPD months we observed 274 catheter related complications: 182 catheter infections (exit-site and/or tunnel infection), 23 leakages, 19 obstructions, 19 cuff-extrusions, 14 dislocations, 6 hemoperitoneum, 10 other (incidence of one complication every 21.8 dialysis months). A significant reduction of catheter-related complications occurred in the last five years, compared with the first 5 years. One hundred and six catheters were removed due to catheter-related causes: infection (83 cases), obstruction (11), dislocation (4), outer-cuff extrusion (3), leakage (2), bowel incarceration (2), and bowel infarction (1). Catheter survival was 72.2% at 12 months, 52.3% at 24 months, 32.8% at 36 months, and 25.7% at 48 months. Significantly lower catheter survival was found in younger children (0 2 years) compared with two other age groups (2 5 years, and > 5 years). No significant correlation was found between catheter survival and catheter entry-site (midline vs paramedian).

Conclusions

Catheter-related infections were confirmed to be the most common complication and most frequent cause of peritoneal catheter removal. In addition, catheter survival rate was worse in younger children, indicating that more effort should be made to improve peritoneal catheter survival particularly in this age group.
Dimensional Impact of Social Capital on Financial Performance of SMEs
Authors: Dar Ishaq Ahmad , Mishra Mridula
Published: February 2020

In emerging economies, small and medium enterprises (SMEs) contribute a sizeable proportion of exports and manufacturing output, and millions of people are provided employment. Entrepreneurs and these small firms are influenced by many contextual factors in their operations. Social capital factors, both formal and informal social networks, are considered influential to their performance. This study uses regression analysis to study the impact of social capital dimensions on financial performance of SMEs. Primary data were collected through survey of SMEs of India. It was found that out of five social capital dimensions only four dimensions, such as complicity, status, social relations and personal relations, positively impact the financial performance of SMEs, whereas one dimension ‘Interlinking and family support’ had no significant impact on financial performance of SMEs. The implications of these findings are discussed.
W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design
Authors: Rosenberg Sebastian , Hickie Ian
Published: February 2020

Objective:

To consider the changing profile of Australia’s mental health workforce and the implications, particularly for specialist psychiatry services.

Method:

We analyse data from a national collection that describes changes in the workforce over a decade, to 2017–2018.

Results:

While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia’s response to complex mental illness, are under enormous pressure.

Conclusion:

The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.
No country for older men: ageing male suicide in New Zealand
Authors: Barak Yoram , Cheung Gary , Fortune Sarah , Glue Paul
Published: February 2020

Objective:

Suicide rates increase in late life. There is, however, a gap in understanding suicide in the very old. We aimed to underscore the evidence for high rates of death by suicide in the oldest-old men (age 85+) in New Zealand and to provide a conjectural discussion about factors driving these rates.

Method:

Provisional suicide data were obtained from the New Zealand Coronial Services website for the period 2011–2019. Yearly suicide rates for those aged 85+ were plotted over time. Mean suicide rates were calculated for three youth and young adult male cohorts, identified by the Coroner as having very high rates, and compared with the 85+ age cohort.

Results:

Between 2011 and 2019, rates of death by suicide of older males remained consistently high never overlapping female suicide rates. Mean suicide deaths/100,000 population for all four age cohorts were comparable; 15–19 years: 23.5; 20–24 years: 29.0; 25–29 years: 27.0; 85+ years: 27.9.

Conclusions:

Deaths by suicide are very high for older males. In addition to established risk factors, psychosocial adversity as reflected by loneliness, poverty and shift to residential care may be major reasons for the high suicide rates. Research to inform about this vulnerable population and prevention are urgently needed.
Feline abdominal ultrasonography: What’s normal? What’s abnormal? The pancreas
Authors: Griffin Sally
Published: February 2020

Practical relevance:

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease.

Clinical challenges:

Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging.

Aim:

This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material.

Equipment:

Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience.

Evidence base:

Information provided in this article is drawn from the published literature and the author’s own clinical experience.
Feline skull injuries: Treatment goals and recommended approaches
Authors: Rizkallal Cristina , Lafuente Pilar
Published: February 2020

Practical relevance:

Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice.

Clinical approach:

Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient’s ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries.

Treatment goals and techniques:

A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal’s oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain.

Aim:

This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.
Congenital anomalies in the offspring of women with total hip replacement: a nationwide register study in Finland
Authors: Kuitunen Ilari , Eskelinen Antti , Skyttä Eerik T , Huhtala Heini , Artama Miia
Published: February 2020

Background:

Few previous studies have analysed the possible teratogenic effect of maternal total hip replacement (THR) on congenital anomalies. The aim of this study was to estimate the risk of major congenital anomalies in the offspring of women with THR. Furthermore, we compared the risks based on type of implant (metal-on-metal [MoM]/non-MoM).

Methods:

The study population for this register-based cohort study was gathered from six Finnish national registers. All fertile-aged females who underwent THR from 1980 to 2007 and three reference females for each THR patient without THR were selected. THR operation day was the start of the follow-up for both groups. Information on pregnancies, induced abortions (IA) and congenital anomalies was gathered for the years 1987–2007 and the proportions of congenital anomalies were compared.

Results:

In the THR group, 2429 women had 256 pregnancies, 205 (80.1%) deliveries and 51 (19.9%) IAs. In the reference group, 7276 women had 1670 pregnancies, 1443 (86.4%) deliveries and 236 (13.6%) IAs. There was no difference in the incidence of major anomalies between the THR (3.5%, n = 9) and the reference group (3.6%, n = 60), p = 0.91. In the THR group, there was no difference in the risk of major anomalies between the patients with a MoM-THR (10.5%, 2/19) and those with a non-MoM (2.9%, 7/241) (OR 3.93, 95% confidence interval 0.76–20.2; p = 0.13).

Conclusions:

Reassuringly, maternal THR does not appear to increase the risk of major congenital anomalies or pregnancies ending due to suspected foetal anomalies. Studies with larger study populations are needed to further assess the risk of anomalies in the offspring of women having MoM-THR.
Identifying the Impacts of Acne: A Delphi Survey of Patients and Clinicians
Authors: Tan Jerry , Frey Marc P. , Thiboutot Diane , Layton Alison , Eady Anne
Published: February 2020

Background

Acne can adversely impact those affected in multiple dimensions. The purpose of this study was to determine the most prominent impacts identified by acne patients and by clinicians.

Methods

Independent Delphi surveys for acne patients and clinicians were conducted to achieve consensus regarding acne impacts within each group. Acne patients were recruited from outpatient clinics of authors (AL, JT, and DT). The first phase involved qualitative responses, where emergent themes were identified and used to generate items for 2 subsequent phases.

Results

The qualitative phase generated 64 items in 3 themes: psychological, sociological, and treatment related. These items were independently ranked in importance by patients and by clinicians. Consensus for importance was achieved for 34 items by patients and 43 by clinicians. Patient-identified highest ranked items were being self-conscious, feeling unattractive, feeling uncomfortable in own skin, unattractive to others, would not want pictures taken, envious of people with clear skin, and time/effort spent concealing scarring; while clinicians identified feeling unattractive.

Conclusions

We identify acne impacts within psychological, sociological, and treatment-related domains by acne patients and clinicians. Further, we establish discrepancies between patients and clinicians regarding the impact of acne. This provides evidence for the importance of establishing patient-reported outcomes.