bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison between DOQI and Canadian Guidelines for Peritoneal Dialysis
Authors: Blake Peter G.
Published: February 2020

The recently published Canadian Society of Nephrology (CSN) Guidelines for Peritoneal Dialysis Adequacy differ in a number of ways from the United States National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) guidelines on the same topic. The three main differences are ( 1 ) the CSN targets are the same for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), whereas the DOQI targets are higher for APD; ( 2 ) the CSN guidelines have a lower creatinine clearance (CCr) target of 50 L/wk for low and low-average transporters compared to 60 L/wk for high and high-average transporters, but no such distinction is made by DOQI; and ( 3 ) the CSN has set lower limit targets as well as preferred targets for Kt/V and CCr.

Other differences are that the CSN recommendations do not give Kt/V the same primacy over CCr that DOQI does. Also, the CSN recommendations give greater emphasis to the risks associated with high transport status.

This review looks at the reasons for these differences and demonstrates that some are due to information that has become available since the publication of the DOQI guidelines. However, it is emphasized that, when recommendations are predominantly opinion- rather than evidence-based, geographic and economic factors may also account for differences.
Production and Regulation of Matrix Metalloproteinases and Their Inhibitors by Human Peritoneal Mesothelial Cells
Authors: Martin John , Yung Susan , Robson Rachel L. , Steadman Robert , Davies Malcolm
Published: February 2020

Objective

Human peritoneal mesothelial cells (HPMC) are likely to be involved in maintenance of the peritoneal membrane. We determined whether these cells were able to synthesize the matrix degrading enzymes, matrix metalloproteinases (MMPs), likely to be responsible for the breakdown of this membrane, and whether this secretion could be modulated by cytokines involved in the inflammatory response.

Design

MMP activity in conditioned medium of growth-arrested HPMC was measured by zymography. Cultures were incubated in the presence and absence of the cytokines transforming growth factor-beta (TGFβ) and interleukin (IL)-1β in order to determine the effects of these cytokines on this process. The mRNA for these MMPs, together with that of their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), was also examined by reverse transcriptase polymerase chain reaction (RT-PCR).

Results

HPMC were shown to constitutively secrete the metalloproteinases MMP-2 and MMP-3 in vitro. In response to the proinflammatory cytokine IL-1β, the protein and mRNA for MMP-9 was induced, while secretion of MMP-2 was unaltered. Similarly, the mRNA for MMP-3 was also increased relative to actin following the addition of IL-1β. TGFβ was shown to slightly induce the secretion of MMP-2 together with the mRNA for TIMP I, TIMP II, and, to a greater extent, TIMP III. Used peritoneal dialysate was also shown to induce MMP-9 secretion, and this effect was blocked by the co-incubation of IL-1 receptor antagonist. The secretion of enzyme activity was shown to be from the apical surface of the cells.

Conclusion

HPMC have the ability to control the accumulation of extracellular matrix by secreting the matrix degrading molecules MMP-2, MMP-3, and MMP-9. In addition, the secretion of these enzymes, together with that of their inhibitors (TIMPs) is regulated by the cytokines IL-1β and TGFβ. This process is likely to be important in both the normal maintenance of the integrity of the peritoneal membrane and in the changes that occur following prolonged peritoneal dialysis.
Prevention of Peritonitis in Children on Peritoneal Dialysis
Authors: Verrina Enrico , Honda Masataka , Warady Bradley A. , Piraino Beth
Published: February 2020

We reviewed methods of preventing peritonitis in children. A considerable body of evidence indicates that peritonitis rates are lowest with the use of a double-cuffed catheter, with a downward directed tunnel, placed by an experienced surgeon. Evidence in adults, but lacking in children, suggests that exit-site mupirocin will lower Staphylococcus aureus exit-site infections and thus peritonitis rates. The risk of peritonitis due to contamination can be diminished by the avoidance of spiking and by the provision of a long training period. Catheter removal and replacement for catheter-related peritonitis may be done simultaneously in certain circumstances and is useful in decreasing the risk of recurrent peritonitis. Antibiotic prophylaxis at the time of catheter insertion, for contamination, during dialysate leaks, and for invasive procedures appears to be useful in diminishing peritonitis risk.
Advanced Glycosylation End-Products in Diabetic Rats on Peritoneal Dialysis Using Various Solutions
Authors: Lee Jeong H. , Reddy Dheerendra K. , Saran Rajiv , Moore Harold L. , Twardowski Zbylut J. , Nolph Karl D. , Khanna Ramesh
Published: February 2020

Objective

To evaluate and compare the effects of glucose-based solutions to those of icodextrin with respect to peritoneal transport characteristics and advanced glycosylation end-product (AGE) formation in the peritoneal membrane in a diabetic rat model of peritoneal dialysis (PD).

Design

Thirty-three male Sprague–Dawley rats weighing between 275 – 300 g were divided into five groups: group C ( n = 6), control rats implanted with a catheter but not dialyzed; group D ( n = 5), diabetic rats implanted with a catheter but not dialyzed; group G ( n = 7), diabetic rats implanted with a catheter and dialyzed with standard 2.5% glucose solution for daytime exchanges and 4.25% glucose solution for overnight exchanges; group H ( n = 8), diabetic rats implanted with a catheter and dialyzed with standard 2.5% glucose solution for daytime exchanges and 7.5% icodextrin solution for overnight exchanges; group I ( n = 7), diabetic rats implanted with a catheter and dialyzed with 7.5% icodextrin solution for all exchanges. Dialysis exchanges (25 mL per exchange) were performed three times daily for a period of 12 weeks. Tissue sections were stained using a monoclonal anti-AGE antibody. One-hour peritoneal equilibration tests (PET) were performed every 4 weeks for comparison of transport characteristics.

Results

The level of immunostaining was lowest in group C and highest in group G. Significant differences in immunostaining were seen between group C and group G ( p < 0.001), group C and group H ( p = 0.001), and group C and group I ( p < 0.05). Significant differences were also found between group G and group D ( p < 0.05), and between group G and group I ( p < 0.05). Over time, the ratio of glucose concentration after 1 hour to glucose concentration at instillation (D/D0) decreased and the dialysate-to-plasma ratio (D/P) of urea increased. Significant differences in D/D0 glucose and D/P urea were found between group C and group H (D/D0: 0.40 ± 0.01 vs 0.35 ± 0.01, p < 0.05; D/P urea: 0.87 ± 0.03 vs 0.97 ± 0.02, p < 0.05).

Conclusions

These results suggest that AGE formation is lower with the use of peritoneal dialysis solution containing icodextrin than with glucose-based solution. We conclude that use of icodextrin may help to slow the deterioration of the peritoneal membrane, prolonging its use for dialysis.
Iron Absorption after Single Pharmacological Oral Iron Loading Test in Patients on Chronic Peritoneal Dialysis and in Healthy Volunteers
Authors: Bastani Bahar , Islam Shah , Boroujerdi Nasser
Published: February 2020

Objective

Oral iron is poorly absorbed in chronic dialysis patients. We tested the hypothesis that a superpharmacologic dose of iron sulfate (260 mg elemental iron) administered on an empty stomach results in significant iron absorption in these patients.

Design

A prospective open controlled trial.

Setting

Outpatient department of a university hospital.

Patients

Nine stable chronic peritoneal dialysis (PD) patients and seven normal control subjects.

Method

All subjects ingested a single dose of 4 tablets of iron sulfate (260 mg elemental iron total) in the morning while fasting.

Outcome Measures

Serum iron concentrations at baseline, and at 2 and 4 hours after the oral dose were compared between the two groups.

Results

The control group showed a significant rise in mean [± standard error (SE)] serum iron concentration, from a baseline value of 76.5 ± 7 μg/dL to 191 ± 10.5 μg/dL at 2 hours and to 190 ± 24 μg/dL at 4 hours. This result represents a percentage rise of 164% ± 32% at 2 hours and 152% ± 28.5% at 4 hours. In the PD patients, a significant rise in serum iron concentration was also seen, from a baseline value of 64 ± 8 μg/dL to 130 ± 3 μg/dL at 2 hours and 111 ± 18 μg/dL at 4 hours. This result represents a percentage rise of 105% ± 29% at 2 hours and 77% ± 23.5% at 4 hours. However, the absolute change in serum iron concentration in PD patients at 2 and 4 hours was approximately equal to 50% of the change in control subjects at those time points. None of the PD patients experienced gastrointestinal side effects; 4 control subjects experienced mild side effects.

Conclusion

Despite impaired oral iron absorption in chronic dialysis patients, a large pharmacologic dose given orally can result in significant iron absorption and may prove to be a more efficient means of oral iron supplementation therapy in these patients.
Is Absorption of High-Dose Oral Iron Sufficient in Peritoneal Dialysis Patients?
Authors: Dittrich Elisabeth , Puttinger Heidi , Schneider Barbara , Hörl Walter H. , Haag–Weber Marianne , Vychytil Andreas
Published: February 2020

Objective

Iron supplementation plays a major role in erythropoietin-treated end-stage renal disease patients. For peritoneal dialysis (PD) patients, oral iron substitution is more convenient than intravenous therapy. However, disturbed iron absorption and adverse effects may be limiting factors for oral treatment. Nevertheless, we compared the response to a high-dose and low-dose oral iron absorption test between PD patients and healthy control subjects.

Patients and Interventions

In 34 PD patients and 15 healthy control subjects, blood samples were taken at baseline as well as 2, 4, and 8 hours after oral intake of 4 tablets iron sulfate (105 mg elemental iron per tablet). In a subgroup of 6 PD patients and 6 control subjects, the oral iron absorption test was repeated using 1 tablet iron sulfate.

Results

There was no significant difference in the increase in serum iron during the test between the two groups. As known for healthy subjects, iron absorption was significantly better in PD patients with absolute iron deficiency compared to those with functional iron deficiency. Iron-repleted PD patients showed the lowest iron absorption, indicating that a high dose of oral iron did not overwhelm the ability of the bowel tract to reject unneeded iron. Increasing the oral iron dose from 1 to 4 tablets was followed by a better response in a small subgroup of PD patients compared to control subjects. Side effects such as nausea and vomiting occurred more frequently during high-dose oral iron in control subjects than in PD patients (20% vs 8.8%).

Conclusion

High-dose oral iron is well absorbed in iron-depleted PD patients. This kind of oral iron therapy should be considered in some subgroups of PD patients with iron deficiency, particularly in those patients with poor vascularization of arm veins or intolerance to intravenous iron preparations.
Is Obesity a Favorable Prognostic Factor in Peritoneal Dialysis Patients?
Authors: Johnson David W. , Herzig Karen A. , Purdie David M. , Chang Wendy , Brown Allison M. , Rigby Russell J. , Campbell Scott B. , Nicol David L. , Hawley Carmel M.
Published: February 2020

Objective

To determine the influence of an elevated body mass index (BMI) on cardiovascular outcomes and survival in peritoneal dialysis (PD) patients.

Design

Prospective, observational study of a prevalent PD cohort at a single center.

Setting

Tertiary care institutional dialysis center.

Patients

The study included all patients with a BMI of at least 20 who had been receiving PD for at least 1 month as of 31 January 1996 ( n = 43). Patients were classified as overweight [BMI > 27.5; mean ± standard error of mean (SEM): 32.1 ± 1.1; n = 14] or normal weight (BMI 20 – 27.5; mean ± SEM: 23.8 ± 0.4; n = 29).

Outcome Measures

Patient survival and adverse cardiovascular events (myocardial infarction, congestive cardiac failure, cerebrovascular accident, and symptomatic peripheral vascular disease) were recorded over a 3-year period.

Results

At baseline, no significant differences were seen between the groups in clinical, biochemical, nutritional, or echocardiographic parameters, except for a lower dietary protein intake (0.97 ± 0.10 g/kg/day vs 1.44 ± 0.10 g/ kg/day, p = 0.004) and a higher proportion of well-nourished patients by subjective global assessment (100% vs 72%, p < 0.05) in the overweight group. After 3 years of follow-up, 29% of overweight patients and 69% of normal-weight patients had died ( p < 0.05). Using a Cox proportional hazards model, a BMI greater than 27.5 was shown to be an independent positive predictor of patient survival, with an adjusted hazard ratio (HR) of 0.09 [95% confidence interval (CI): 0.01 – 0.85; p < 0.05]. However, being overweight did not significantly influence myocardial infarction-free survival (adjusted HR: 0.33; 95% CI: 0.07 – 1.48; p = 0.15) or combined adverse cardiovascular event-free survival (adjusted HR: 0.67; 95% CI: 0.23 – 1.93; p = 0.46).

Conclusions

Obesity conferred a significant survival advantage in our PD population. Obese patients should therefore not be discouraged from receiving PD purely on the basis of BMI. Moreover, maintaining a higher-than-average BMI to preserve “nutritional reserve” may help to reduce the mortality and morbidity rates associated with PD.
Chlamydia Pneumoniae DNA in Peripheral Blood Mononuclear Cells in Peritoneal Dialysis Patients
Authors: Iliescu Eduard A. , Fiebig Marnie F. , Morton Alexander R. , Sankar–Mistry Perin
Published: February 2020

Objective

The aim of the present study was to examine the association between infection with Chlamydia pneumoniae and symptomatic atherosclerosis in peritoneal dialysis (PD) patients.

Design

Cross-sectional study.

Setting

Peritoneal Dialysis Unit of Kingston General Hospital.

Patients

Fifty-five prevalent PD patients.

Outcome Measures

( 1 ) Infection with C. pneumoniae diagnosed by detection of DNA in peripheral blood mono-nuclear cells (PBMCs) using polymerase chain reaction. ( 2 ) Symptomatic atherosclerosis involving the coronary, cerebral, or peripheral circulation.

Results

The DNA of C. pneumoniae was detected in PBMCs in 33 patients (60.0%). Atherosclerosis was present in 16 of 33 (48%) PBMC C. pneumoniae DNA–positive patients, and in 10 of 22 (45%) PBMC C. pneumoniae DNA–negative patients ( p = 0.83). Using multiple logistic regression and controlling for a number of known cardiovascular risk factors, PBMC C. pneumoniae DNA status was not predictive of atherosclerosis. The only significant independent predictors of atherosclerosis were diabetes and age.

Conclusions

In prevalent PD patients, a high prevalence of symptomatic atherosclerosis and of Chlamydia pneumoniae DNA in PBMCs were seen; however, the results of the present study do not support the presence of an association between infection with C. pneumoniae and atherosclerosis.
Evaluation of Several Saccharides as Osmotic Agent for Peritoneal Dialysate
Authors: Tomo Tadashi , Shibata Tetsuo , Nasu Masaru , Shibata Kouji , Izumi Giichi , Sofue Katuyoshi
Published: February 2020

Objective

The carbonyl group of glucose reacts nonenzymatically with the amino group of protein to form advanced glycosylation end-products (AGEs). AGEs are found in the peritoneum of continuous ambulatory peritoneal dialysis patients, and this AGE formation is suspected to be one of the causes of impaired peritoneal function. In order to control AGE formation in the peritoneum, AGE formation and ultrafiltration in rats were examined with peritoneal dialysates using as osmotic agents saccharides that lack a carbonyl group, the saccharic acid lactobionate [molecular weight (MW) 358.30], the sugar alcohol maltitol (MW 344.32), and the nonreducing sugar nistose (MW 666.58).

Design

Bovine serum albumin (BSA) (25 mg/mL) was incubated with 18, 36, and 72 mg/mL maltitol, lactobionate, nistose, and glucose at 37°C. After 3 or 6 weeks, amounts of furosine and N-(carboxymethyl) lysine were measured. A 20-mL intraperitoneal injection of a lactate-based dialysate (osmotic pressure 388 mOsm/kg) containing 4.34% maltitol, 4.52% lactobionate, or 8.4% nistose was given to Sprague–Dawley rats and, after 2, 4, or 6 hours, the quantity of effluent and levels of urea nitrogen and creatinine in the effluent and in serum were measured.

Results

No increases in furosine or N-(carboxymethyl) lysine were seen with maltitol, lactobionate, or nistose after 3 and 6 weeks of incubation with BSA; AGE formation was not observed. In the study in rats, the quantity of abdominal fluid after a 6-hour dwell was nistose > lactobionate > maltitol > glucose. No differences in dialysate-to-plasma ratios for urea nitrogen or creatinine were seen in any group.

Conclusions

AGE formation in peritoneal tissue might be controlled by using saccharides with a modified carbonyl group as osmotic agents for peritoneal dialysates. Nistose is considered to yield the most efficient dialysis.
Icodextrin Effluent Leads to a Greater Proliferation than Glucose Effluent of Human Mesothelial Cells Studied Ex Vivo
Authors: Bajo M.-Auxiliadora , Selgas Rafael , Castro M.-Angeles , Del Peso Gloria , Díaz Cándido , Sánchez-Tomero Jose A. , de Castro Mercedes Fernandez , Alvarez Vicente , Corbí Angel
Published: February 2020

Objective

To compare the effect of glucose (Glu) and icodextrin (Ico) dialysate on in vitro culture of mesothelial cells (MC) from peritoneal dialysis (PD) patients.

Design

Prospective, controlled comparative study on the effects of two PD solutions.

Setting

A tertiary-care public university hospital.

Patients

Sixteen PD patients regularly using Glu dialysate were asked to collect an 8-hour dwell peritoneal effluent on 2 different days, with an interval shorter than 7 days. In the first collection, 2.27% Glu solution and in the last, 7.5% Ico solution was infused. Human MC were isolated from the nocturnal peritoneal effluent bags and grown ex vivo.

Main Outcome Measures

Mesothelial cell proliferative capacity ex vivo.

Results

Mesothelial cells were present in all patient dialysates except that of a single patient's Glu dialysate. The number of MC drained was similar with both solutions. After the initial culture reached confluence, MC were identified in 14 and 12 patients receiving Ico and Glu, respectively. However, in 1 patient using Ico and in 2 using Glu, the MC count at this stage was so low that further subculture could not be performed. Cells from Ico-derived solutions exhibited a higher degree of proliferation than cells from Glu-derived solutions. The morphology of MC was also different. Cells from drained effluent were typical in 11 patients using Glu solution in contrast with 14 patients using Ico. At confluence, the percentages of typical appearance were 50% and 92.9% ( p < 0.05) in Glu and Ico respectively.

Conclusions

Mesothelial cells taken from icodextrin effluent show a greater proliferation ex vivo than those taken from glucose effluent.
Characteristics of Peripheral and Peritoneal White Blood Cells in Children with Chronic Renal Failure, Dialyzed or Not
Authors: Bouts Antonia H.M. , Out Theo A. , Schröder Cornelis H. , Monnens Leo A.H. , Nauta Jeroen , Krediet Raymond T. , Davin Jean-Claude
Published: February 2020

Objective

To explore further the mechanisms leading to immune deficiency in chronic renal failure and the role of dialysis treatment in these mechanisms.

Design

Cross-sectional and longitudinal analysis.

Patients

We studied 39 children treated with peritoneal dialysis (PD), 23 children treated with hemodialysis (HD), 33 children not yet dialyzed [chronic renal failure (CRF)], and 27 healthy children. Peritoneal cells were also obtained from PD children for analysis.

Methods

White blood cells (WBCs) were isolated from blood and peritoneal dialysis effluent by centrifugation. The number of CD2+, CD4+, and CD8+ T cells, B cells, and natural killer cells were measured by flow cytometry.

Results

The total peripheral blood lymphocyte count was lower in PD children (2.6 x 109/L), HD children (2.1 x 109/L), and CRF children (2.0 x 109/L) compared with healthy children (3.1 x 109/L, p < 0.05). The B lymphocyte count was also lower in PD children (0.34x109/L), HD children (0.22 x 109/L), and CRF children (0.33 x 109/L) compared with healthy children (0.52 x 109/L, p < 0.01). Numbers of CD4+ T cells were not different, but numbers of CD8+ T cells were lower in PD children (0.56 x 109/L), HD children (0.63 x 109/L), and CRF children (0.53 x 109/L) compared with healthy children (0.77 x 109/L, p < 0.05). The count of natural killer cells was lower in PD children (0.21 x 109/L), HD children (0.17 x 109/L), and CRF children (0.18 x 109/L) compared with healthy children (0.50 x 109/L, p < 0.0001). The CD4/CD8 ratio of lymphocytes in peritoneal effluent was 0.8 versus 1.9 in peripheral blood ( p < 0.001). The CD2/CD19 ratio was not different. The cell subsets remained stable during the first year of PD treatment. The CD2/CD19 ratio in peritoneal effluent was higher in children with a peritonitis incidence ≥ 1 per year.

Conclusions

The reduced numbers of B lymphocytes, CD8+ T cells, and natural killer cells found in CRF children, dialyzed or not, may favor the frequent occurrence of infections.
Advantages of Tidal Peritoneal Dialysis
Authors: Agrawal Alok , Nolph Karl D.
Published: February 2020

Tidal peritoneal dialysis (TPD) was introduced in 1990 in the hopes of improving dialysis efficiency. Studies comparing low dialysate flow rates show that tidal peritoneal dialysis has no clearance advantage over intermittent peritoneal dialysis (IPD). With high dialysate flow rates, TPD may be superior or similar to IPD in efficacy, but it is expensive because of the high volumes of dialysis solution used. However, it provides better fluid flow mechanics and more comfort to the patient owing to fewer alarms and less pain during inflow and outflow.
Biological Significance of Reducing Glucose Degradation Products in Peritoneal Dialysis Fluids
Authors: Wieslander Anders , Linden Torbjörn , Musi Barbara , Carlsson Ola , Deppisch Reinhold
Published: February 2020

Carbohydrates are not stable when exposed to energy; they degrade into new molecules. In peritoneal dialysis (PD) fluids, degradation of glucose occurs during the heat sterilization procedure. The biological consequences of this degradation are side effects such as impaired proliferation and impaired host defense mechanisms, demonstrated in vitro for a great variety of cells.

Several highly toxic compounds—such as formaldehyde and 3-deoxyglucosone—have been identified in PD fluids. Carbonyl compounds, apart from being cytotoxic, are also well-known promoters of irreversible advanced glycation end-products (AGEs), which might participate in the long-term remodeling of the peritoneal membrane.

Various approaches can be used to reduce the formation of glucose degradation products (GDPs) during heat sterilization. Some examples are shortening the sterilization time, lowering the pH, removing catalyzing substances, and increasing glucose concentration. The latter three factors are employed in the multi-compartment bag with a separate chamber containing pure glucose at high concentration and low pH.

Gambrosol trio, a PD fluid produced in this way, shows reduced cytotoxicity, normalized host defense reactions, less AGE formation, and reduced concentrations of formaldehyde and 3-deoxyglucosone. Moreover, in the clinical situation, the fluid turns out to be more biocompatible for the patient, causing less mesothelial cell damage, which in the long term could lead to a more intact peritoneal membrane.

Conclusion

Glucose degradation products in heat-sterilized fluids for peritoneal dialysis are cytotoxic, promote AGE formation, and cause negative side effects for the patient. Using improved and well-controlled manufacturing processes, it is possible to produce sterile PD fluids with glucose as the osmotic agent but without the negative side effects related to GDPs.
Structural and Functional Alterations of the Peritoneum after Prolonged Exposure to Dialysis Solutions: Role of Aminoguanidine
Authors: Lee Eun Ah , Oh Jong Hoon , Lee Hyun Ah , Kim Sung Il , Park Eung Woo , Park Kyung Bae , Park Min Sun
Published: February 2020

Objective

The effect of long-term use of high glucose dialysate on peritoneal structure and function, and its relation with accumulation of advanced glycosylation end-product (AGE) in the peritoneum was investigated in this study.

Methods

Dialysates with 4.25% glucose were injected into the peritoneal cavity of normal rats for 12 weeks without (PD, n = 7) and with (1 g/L, PD+AG, n = 7) aminoguanidine in their drinking water. Rats not having intraperitoneal (IP) injection served as control ( n = 9). After 12 weeks of IP injection, a 2-hour peritoneal equilibration test (PET) was performed using 30 mL 4.25% glucose dialysate. Intraperitoneal volume (IPV), dialysate-to-plasma urea ratio at 2 hours (D2/P2), the ratio of dialysate glucose at 2 hours to initial dialysate glucose (D2/D0), and the peritoneal fluid absorption rate (Qa) were evaluated. After the PET, samples of the parietal peritoneum were taken for hematoxylin and eosin (H&E) staining and immunohistochemical staining for AGE.

Results

The IPV and D2/D0 glucose were significantly lower and Qa and D2/P2 urea significantly higher in the PD group than in the control group. Aminoguanidine reversed in part the changes in IPV and D2/P2 urea in the PD group; it had no effect on Qa and D2/D0 glucose. The H&E staining showed a linear mesothelial lining with negligible cells and capillaries in the narrow submesothelial space in the control group. Mesothelial denudation and submesothelial infiltration of monocytes and capillary formation were observed in the PD group. Mesothelial denudation was relatively intact in the PD+AG group compared with the PD group. Submesothelial monocyte infiltration and capillary formation in the PD+AG group were not as prominent as in the PD group. Positive AGE staining was found in the submesothelial space, vascular walls, and endomysium in the PD group, while it was markedly attenuated in PD+AG group and negligible in the control group.

Conclusion

Long-term use of high glucose solutions induced peritoneal AGE accumulation and mesothelial denudation, and increased peritoneal permeability and peritoneal fluid absorption rate. Inhibition of peritoneal AGE accumulation prevented those functional and structural damages to the peritoneum.
A New Titanium Fiber Mesh-Cuffed Peritoneal Dialysis Catheter: Evaluation and Comparison with a Dacron-Cuffed Tenckhoff Catheter in Goats
Authors: Walboomers Frank , Paquay Yvonne C.G.J. , Jansen John A.
Published: February 2020

Objective

We report the development of a new peritoneal dialysis catheter. The purpose of the current study was to evaluate tissue response to this catheter.

Design

In our catheter design, the catheter's cuffs are made from sintered titanium fiber mesh instead of the common Dacron material. The catheters were implanted in goats. During the study period, the catheter exit sites were observed once every 2 weeks. After 14 weeks, the catheters and surrounding tissues were processed for histology and analyzed.

Results

We observed that catheters with titanium cuffs performed significantly better, compared with a commercial catheter design. Histology showed that titanium fibers evoked a lesser inflammatory response compared with Dacron fibers. In addition, the capsule surrounding the titanium cuff was significantly thinner.

Conclusions

Supported by the obtained results, we conclude that the use of Dacron velour for anchorage of percutaneous catheters has to be reconsidered. Titanium fiber mesh has a great potential for application in percutaneous catheters.
Polymicrobial Outbreak of Intermittent Peritoneal Dialysis Peritonitis during External Wall Renovation at a Dialysis Center
Authors: Cheng Vincent C.C. , Lo Wai Kei , Woo Patrick C.Y. , Chan Shiu Bing , Cheng Suk Wai , Ho Melissa , Yuen Kwok Yung
Published: February 2020

Objective

To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients.

Design

An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis.

Setting

Renal dialysis center.

Patients

Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed.

Interventions

Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count.

Main Outcome Measures

The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions.

Results

The causative organisms included Acinetobacter baumanii ( 6 ), Stenotrophomonas maltophilia ( 2 ), Pseudomonas aeruginosa ( 1 ), Candida albicans ( 1 ), C. tropicalis ( 1 ), Enterococcus ( 3 ), and Enterobacteriaceae ( 2 ). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis.

Conclusion

In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation.
A Comparison of Quality of Life of Patients on Automated and Continuous Ambulatory Peritoneal Dialysis
Authors: de Wit G. Ardine , Merkus Maruschka P. , Krediet Raymond T. , De Charro Frank Th.
Published: February 2020

Objective

Data on health-related quality of life (HRQOL) of automated peritoneal dialysis (APD) patients are scarce. The objectives of this study were ( 1 ) to explore HRQOL of APD patients and compare it with HRQOL of continuous ambulatory peritoneal dialysis (CAPD) patients and a general population sample, and ( 2 ) to study the relationship between HRQOL assessment outcomes and background variables.

Design

Home interviews of APD and CAPD patients. HRQOL, social-demographic, clinical, and treatment-related background data were collected at the interview and from patient charts. Multiple regression analysis and logistic regression analysis were used to study the relationship of HRQOL assessment outcomes with background variables.

Setting

Sixteen Dutch dialysis centers.

Patients

Convenience sample of 37 APD patients and 59 CAPD patients matched for total time on dialysis.

Main Outcome Measures

Four HRQOL instruments: Short-Form 36, EuroQol EQ-5D, Standard Gamble, and Time Trade Off.

Results

Physical functioning of both APD and CAPD patients was impaired compared with the general population; mental functioning was not different. In multivariate analyses, the mental health of APD patients was found to be better than that of CAPD patients. In addition, APD patients were less anxious and depressed than CAPD patients. With respect to physical aspects of HRQOL and role-functioning, no differences were observed between APD and CAPD patients. Other variables to explain HRQOL assessment outcomes were age, the number of comorbid diseases, and primary kidney disease.

Conclusions

HRQOL of APD patients is at least equal to HRQOL of CAPD patients.
Trends in CAPD Technique Failure: Canada, 1981–1997
Authors: Schaubel Douglas E. , Blake Peter G. , Fenton Stanley S.A.
Published: February 2020

Objective

Although important enhancements to continuous ambulatory peritoneal dialysis (CAPD) have occurred since its inception, few studies have explicitly evaluated trends over time in CAPD technique failure rates. To assist in quantifying the net benefit of improvements to CAPD for patient outcomes, we examined trends in technique failure rates among Canadian CAPD patients.

Patients

Patients initiating renal replacement therapy on CAPD ( n = 7110) between 1981 and 1997.

Main Outcome Measures

Technique failure ( i.e., switch to hemodialysis).

Results

Total follow-up was 12 831 patient-years (pt-yr). There were 1976 technique failures, for a crude CAPD failure rate of 154.0/1000 pt-yr. Technique failure rate ratios (RR) estimated using Poisson regression and adjusted for age, gender, race, province, primary renal diagnosis, and follow-up time, were significantly reduced for the 1990–93 [RR = 0.75, 95% confidence interval (CI) = (0.68, 0.83)], 1994–95 [RR = 0.83, CI (0.75, 0.93)], and 1996–97 [RR = 0.78, CI (0.70, 0.87)] calendar periods relative to 1981–89 (RR = 1, reference). Among cause-specific technique failure rates, the greatest improvement was observed for peritonitis-attributable technique failure, with RR = 0.46, CI (0.41, 0.50) for 1990–97 relative to 1981–89. However, rates of technique failure due to inadequate dialysis were significantly elevated for the 1990–97 period [RR = 1.68, CI (1.44, 1.96)].

Conclusions

The collection of more detailed data on practice patterns would enable future studies to elucidate the cause-and-effect relationship between CAPD descriptors and technique failure, and hence assist in clinical decision-making.
Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD
Authors: Kent James R. , Almond Michael K. , Dhillon Soraya
Published: February 2020

Background

Azithromycin is an azalide antibiotic with a similar antibacterial spectrum to erythromycin but with greater gram-negative activity. Azithromycin displays a favorable pharmacokinetic profile, with improved absorption and higher sustained tissue concentrations compared with erythromycin. This results in a prolonged elimination half-life, suggesting a potential for treating continuous ambulatory peritoneal dialysis (CAPD) peritonitis.

Objective

This study aimed to define the potential role of azithromycin in treating CAPD peritonitis.

Design

The pharmacokinetics and peritoneal dialysis (PD) clearance of azithromycin were studied following a single 500-mg oral dose of azithromycin. Blood and dialysate samples were taken over a 10-day period and assayed using high-pressure liquid chromatography.

Setting

The study took place within the Renal Unit at Southend Hospital NHS Trust, a district general hospital in the United Kingdom.

Patients

Eight patients with oliguric end-stage renal failure without peritonitis maintained on CAPD (3 x 2 L/day).

Results

Peak plasma concentrations occurred at 2 -3 hours with 0.35 - 1.35 mg/mL (mean 0.75). The mean elimination half-life was 84.55 hrs, and plasma clearance was 21.93 L/hour. This compares with values of greater than 40 hours and 40.8 L/hour reported in healthy volunteers. After 8 hours, the mean dialysate concentration was 0.07 mg/mL; PD clearance was 0.06 L/hr.

Conclusion

Azithromycin is not substantially removed by CAPD in the absence of peritonitis and cannot be recommended for widespread use in this setting at present. However, the successful use of azithromycin in CAPD peritonitis, due possibly to an intracellular drug transport mechanism, has been reported. Future research should address this possibility.
Intravenous Vancomycin Pharmacokinetics in Automated Peritoneal Dialysis Patients
Authors: Manley Harold J. , Bailie George R. , Frye Reginald F. , McGoldrick M. Donald
Published: February 2020

The pharmacokinetics of intravenous (IV) vancomycin was studied in automated peritoneal dialysis (APD) patients who received a single IV dose of vancomycin (15 mg/kg total body weight). Dialysate samples were collected at the beginning, middle, and end of dwells 1 – 3 (on-cycler), and at the end of dwells 4 and 5 (off-cycler), for a 24-hour period. Blood samples were collected at the beginning, middle, and end of dwells 1 – 3 (on-cycler), and at the end of dwell 5 (off-cycler) for a 24-hr period. Pharmacokinetics parameters were calculated assuming a one-compartment model. Glomerular filtration rate (GFR) and vancomycin clearance (Cl) values were normalized to 1.73 m2. Ten patients [4 males, 6 females; 47.4 ± 9.9 years of age (mean ± SD)] who had received PD for a median 3.5 months (range 2 – 66 months) were studied. Dwell times were 2.3 ± 0.1 hours on cycler and 7.3 ± 0.1 hours off cycler. Vancomycin half-life was significantly different on-cycler than off-cycler (11.6 ± 5.2 hr vs 62.8 ± 33.0 hr; p < 0.001). Vancomycin total Cl (ClT) was 7.4 ± 2.0 mL/min. Renal Cl (ClR) and PD Cl (ClPD) accounted for 23.6% and 28.0% of ClT, respectively. ClR correlated with GFR (ClR = 0.90 GFR – 1.01; r2 = 0.79; p = 0.008). Mean vancomycin serum and dialysate end-of-dwell concentrations were above minimum inhibitory concentration of susceptible organisms (5 mg/mL) for the first cycler and the second ambulatory exchanges only.

The results of this study suggest that, to provide adequate concentrations for susceptible organisms over a 24-hour period, current intermittent vancomycin dosing recommendations for PD-related peritonitis need to be changed to 35 mg/kg intraperitoneally on day 1, then 15 mg/kg IP thereafter ( i.e., once daily) in APD patients.
Impact of Dialysis Adequacy on Cardiac Function in Pediatric CAPD Patients
Authors: Bakkaloąlu Sevcan A. , Ekim Mesiha , Koçak Gülendam , Atalay Semra , Tümer Necmiye
Published: February 2020

Background

Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies.

Objective

To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD).

Design

Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital.

Patients

Eighteen children, aged 13.3 ± 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study.

Main Outcome Measures

Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group.

Results

Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects ( p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 ± 0.71 and mean TCCr was 58 ± 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions ( p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V ( p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI ( r = 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr ( r = -0.555 and r = -0.520) were detected.

Conclusion

These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic findings and dialysis adequacy indices suggest that adequate dialysis has a beneficial effect on cardiac function via effective removal of toxic substances.
Pediatric Peritoneal Dialysis Training: Characteristics and Impact on Peritonitis Rates
Authors: Holloway Margaret , Mujais Salim , Kandert Marianne , Warady Bradley A.
Published: February 2020

Objective

Peritonitis is the leading cause of technique failure in pediatric patients on peritoneal dialysis. A survey was developed to determine what impact, if any, training practices and staffing patterns have on peritonitis rates in pediatric patients.

Design

A survey developed by the International Society for Peritoneal Dialysis Advisory Committee on Peritonitis Management in Pediatric Patients.

Patients

The survey was distributed to 168 centers and was completed by 76 (45%) centers. A total of 597 children younger than 21 years of age received peritoneal dialysis in these centers.

Results

The peritonitis rate was significantly lower (1 episode/19.9 months vs 1 episode/13.5 months; p < 0.05) in programs characterized by larger patient numbers (≥ 15 patients vs < 15 patients) and longer training time dedicated to theory and practical/technical skills ( p < 0.01).

Conclusion

Peritoneal dialysis training is an important factor that influences the rate of peritonitis. The results of this survey reinforce the value of the time committed to this effort.
Effects of Two Simplified Methods of Dialysate Sampling on Estimations of Adequacy Indices in Automated Peritoneal Dialysis
Authors: Rodríguez–Carmona Ana , Pérez–Fontán Miguel
Published: February 2020

Objective

To assess the effects of two simplified methods of dialysate sampling on the estimation of adequacy markers in automated peritoneal dialysis (APD).

Design

Cross-sectional noninterventional study.

Setting

Tertiary-care hospital.

Patients

Forty-nine patients undergoing standard APD therapy (36 nontidal, 13 tidal with low reserve volume).

Intervention

We estimated creatinine clearance (CCr), Kt/V urea, sodium removal, and peritoneal protein loss using two simplified methods. We calculated separate diurnal and nocturnal adequacies. Nocturnal concentrations of urea, creatinine, sodium, and proteins were extrapolated from dialysate samples taken after the first (method A) or the last (method B) cycle of the night. For the reference method, we estimated adequacy from a complete 24-hour dialysate collection.

Results

Spearman correlations versus the reference method were, for CCr, 0.82 for method A and 0.87 for method B; and for Kt/V, 0.78 (A) and 0.72 (B). Method A overestimated CCr by 19.6% (4.5 L/week)(median values) and Kt/V by 8.8% (0.12). Method B overestimated CCr by 5.0% (1.7 L/week) and Kt/V by 4.4% (0.06). Both methods estimated sodium removal accurately, but estimated protein loss poorly. Tidal APD was associated with a clear overestimation of adequacy indices with both methods. In fact, when only nontidal patients were considered, method B slightly underestimated CCr and Kt/V.

Conclusions

In APD, estimation of nocturnal adequacy from dialysate samples taken after the first cycle is inaccurate. Estimation from samples taken after the last cycle yields suboptimal but acceptable results; the deviation is small and the dose of dialysis delivered to the patients is not overestimated.
Patient and Technique Survival on Capd in Turkey
Authors:   for The Turkish Multicenter Peritoneal Dialysis Study Group (TULIP), Utaş Cengiz
Published: February 2020

Objective

To analyze the status of continuous ambulatory peritoneal dialysis (CAPD) in 12 centers in Turkey.

Design

Retrospective study of CAPD technique and patient outcome.

Setting

University hospital renal units.

Patients

334 patients [205 males (61%), 129 (39%) females; mean age 42.2 ± 13.8 years; mean follow-up time 23.5 ± 18.3 months] beginning CAPD between March 1992 and December 1999, and having a minimum follow-up of 3 months.

Outcome Measure

Patient survival, technique survival, and duration of hospitalization.

Results

Mean weekly Kt/V urea was 1.9 ± 0.8, weekly creatinine clearance was 62.9 ± 8.5 L/1.73 m2, and mean serum albumin level was 3.7 ± 0.6 g/dL. 93 patients (28%) were withdrawn from peritoneal dialysis due to death (12.6%), transplantation (3.9%), transfer to hemodialysis (8.7%), patient failure to adapt (1.5%), and other reasons (1.2%). The major causes of death were cardiovascular disease (60%), infection (19%), malignancy (2%), and others (19%). Cox proportional hazard model analysis indicated age, serum albumin levels, comorbidity, and functional status affected survival and hospitalization ( p < 0.05), whereas gender and Kt/V did not ( p > 0.05). Estimation of patient survival by Kaplan–Meier analysis showed 94.2%, 88.6%, 84.5%, and 68.9% at 1, 2, 3, and 5 years respectively. Technique survival estimate by Kaplan–Meier analysis was 96.6%, 91.1%, 90.4%, and 77.4% at 1, 2, 3, and 5 years respectively.

Conclusion

Peritoneal dialysis is an acceptable method of renal replacement therapy in Turkey. There is controversy regarding the usefulness of Kt/V in predicting mortality and morbidity.
High Glucose Dialysis Solutions Increase Synthesis of Vascular Endothelial Growth Factors by Peritoneal Vascular Endothelial Cells
Authors: Seo Moon Jeong , Oh Suk Joong , Kim Sung Il , Cho Kye Won , Jo Inho , Schaub Thomas , Schilling Holger , Passlick–Deetjen Jutta , Han Dong Choel
Published: February 2020

♦ Objective

Increased peritoneal vasculature has been reported in long-term peritoneal dialysis (PD), and vascular endothelial growth factors (VEGFs) have been found in dialysate. High concentrations of glucose or lactate, glucose degradation products (GDPs), and low pH of dialysis solutions are all possible factors in increased peritoneal VEGF synthesis. In this study, we investigated the effects of high glucose dialysis solutions on VEGF synthesis by peritoneal vascular endothelial cells (PVECs).

♦ Methods

The PVECs were isolated from rat omentum and were incubated for 4 hours in three different culture media [M199 media (control), conventional dialysis solutions containing 4.25% glucose diluted with an equal volume of M199 media (HGD), and M199 media containing 118 mmol/L mannitol as an osmolar control (mannitol)]. Levels of VEGF protein in the culture supernatant were measured by ELISA, and mRNA expression was determined by Northern blot analysis. Data are presented as percent of control.

♦ Results

After incubation for 4 hours, the number of cells did not differ between the 3 groups. Levels of VEGF in culture supernatant were significantly higher in the HGD group (124% ± 19%, p = 0.006) as compared with the control and mannitol (85% ± 10%) groups. The mRNA expression of VEGF appeared to be higher in the HGD group (128% ± 49%) than in the control and mannitol (94% ± 18%) groups.

♦ Conclusion

High glucose dialysis solutions increased VEGF synthesis by PVECs. The relationship between VEGF synthesis by PVECs and neovascularization of the peritoneum observed in long-term peritoneal dialysis patients has to be studied further.