bluuebunny/crossref_metadata_2025 huggingface dataset:
Pituitary Adrenal Responsiveness to Corticotropin-Releasing Hormone in Chronic Uremic Patients
Authors: Siamopoulos Kostas C. , Dardamanis Mathew , Kyriaki Despina , Pappas Michael , Sferopoulos George , Alevisou Vasiliki
Published: February 2020

We investigated the effect of exogenous ovine corticotropin-releasing hormone (oCRH) on plasma levels of adrenocorticotropic hormone (ACTH) and cortisol in 24 chronic renal failure patients: 8 nondialysis (NDCRF), 8 on hemodialysis (HD), and 8 on continuous ambulatory peritoneal dialysis (CAPD). In all groups the acute administration of oCRH caused a further increase (less pronounced in NDCRF patients) in the already elevated levels of cortisol. Following oCRH administration, plasma ACTH rose significantly in CAPD patients, but there was a blunted response of the hormone in the NDCRF and HD groups. The patterns of the ACTH and cortisol response in the last two groups, resemble those observed in chronic stress. We conclude that the hypothalamic-pituitary-adrenal axis in chronic uremic patients, retains the ability to respond to exogenous oCRH. Patients on CAPD, however, display a better, identical to normal response, which can be due to less chronic stress andlor to the more effective clearance of uremic toxins.
Lymphoma-Mimicking Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Vlahakos Demetrios , Rudders Richard , Simon Gertrude , Canzanello Vincent J.
Published: February 2020

Cloudy dialysate in a patient on continuous ambulatory peritoneal dialysis (CAPD) most commonly reflects an increased number of leukocytes secondary to bacterial peritonitis. In the absence of infection, increased quantities of eosinophils, red blood cells, fibrin, or chyle may produce cloudy dialysate in these patients. We report the case of a CAPD patient presenting with cloudy dialysate and symptoms suggestive of bacterial peritonitis. Analysis of the dialysate revealed no microorganisms. The turbidity of the dialysate was related to an increased number of atypical lymphocytes consistent with a B cell lymphoma. Peritoneal dialysis continued uneventfully despite neoplastic disease within the peritoneum. It is recommended that malignant involvement of the peritoneum be added to the differential diagnosis of cloudy dialysate occurring in CAPD patients.
Peritoneal Calcification in a Peritoneal Dialysis Patient: A Case Report
Authors: Francis David M. A. , Busmanis Inny , Becker Gavin
Published: February 2020

A case of peritoneal calcification in a 44-year-old female treated with peritoneal dialysis for 13 years is reported. The patient, who had secondary hyperparathyroidism and had suffered repeated episodes of catheter-related peritonitis, presented with intraperitoneal bleeding and underwent laparotomy and excision of some of the calcified peritoneal plaques. She remains well on peritoneal dialysis 1 year later with occasional mild intraperitoneal bleeding and reduced peritoneal filtration.
Is Intraperitoneal Tobramycin Ototoxic in CAPD Patients?
Authors: Nikolaidis Paul , Vas Stephen , Lawson Victor , Kennedy-Vosu Lorraine , Bernard April , Abraham Georgi , Izatt Sharon , Khanna Sudhir , Bargman Joanne M. , Oreopoulos Dimitrios G.
Published: February 2020

In 40 CAPD patients treated for peritonitis, the authors did a prospective study of ototoxic effects of intraperitoneal tobramycin. They evaluated cochlear function in pure-tone threshold audiograms over a range of frequencies from 250–10, 000 Hz, in the speech-reception threshold test and in the speech-discrimination test. These tests were performed within 48 hours of initiation of tobramycin treatment and within 2 or 3 weeks of the drug's discontinuation. With the aminoglycoside doses used in this study, no statistical difference between the mean baseline and mean follow-up hearing levels was seen in these 40 patients. However, according to the standard criteria of ototoxicity, the hearing in 10 of 40 patients (25%) deteriorated after tobramycin, while it improved in seven patients (17.5%). In the remaining 23 (57.5%), hearing remained stable. With respect to the risk factors for ototoxicity such as advanced age, increased duration of treatment, elevated plasma aminoglycoside levels, concomitant treatment with other ototoxic drugs, pre-existing hearing loss, renal dysfunction and hyperthermia, no statistically significant difference was demonstrated between the patients with deteriorated, stable or improved hearing. The results of this study do not confirm that tobramycin given intraperitoneally to CAPD patients produces auditory toxicity. The hearing deterioration observed in 10 patients may be due to synergistic factors. The improvement observed in 7 patients could not be explained.
Morphology of Peritoneal Dialysis Catheter Tunnel : Macroscopy and Light Microscopy
Authors: Twardowski Zbylut J. , Dobbie James W. , Moore Harold L. , Nichols W. Kirt , DeSpain John D. , Anderson Philip C. , Khanna Ramesh , Nolph Karl D. , LoyS Tim S.
Published: February 2020

There is scanty knowledge of the morphology of peritoneal dialysis catheter tunnels in humans, even though such knowledge may impact on peritoneal catheter design, implantation and postimplantation care. Past descriptions of catheter tunnels are based mainly on data from animal experiments. Based on these data, it has been assumed that epidermal spreading is inhibited by collagen fibers ingrown into the cuff. Our preliminary investigation indicated that this may not be the case in humans and led us to study catheter tunnel morphology in more detail. Eighteen catheter tunnels (2 -Smm of tissue around the catheters) were removed in 17 peritoneal dialysis patients. The catheters were inserted 30 to 2013 days prior to removal (median 366 days). The catheters were removed electively or because of infectious or noninfectious complications. Contrary to the observations in animals, in only 1 case did epithelium extend to the cuff with only a minimal amount of granulation tissue present at the end of a 9 mm long sinus tract. In the remaining cases, the leading edge of the epithelium always met granulation tissue 1 −14 mm from the exit, and the cuffs were found 8 33 mm from the exit. In tunnels older than 197 days, dense fibrous tissue was ingrown into the cuffs, and a dense fibrous capsule surrounded the cuff. The uninfected intercuff segment formed a pseudosheath, indistinguishable from a tendon sheath or synovial membrane. Infection in the catheter tunnel propagates through the part of the cuff adjacent to the tubing inside the capsule, suggesting that the cuff per sedoes not constitute a major barrier for spreading infection. This observation, by exclusion, infers that the beneficial role of an external cuff in decreasing exit infections is by providing firm anchorage of the catheter resulting in restriction of its piston like movement and thereby minimizing trauma and inward conveyance of outer sinus tract flora.
Acquired Renal Cystic Disease and Its Complications in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Ishikawa Isao
Published: February 2020

Purpose

To determine whether there is any difference in the prevalence of acquired cystic disease and malignancy of the kidney in patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis.

Data Identification

Relevant studies published from January 1983 to June 1991 were identified by manual search and MEDLINE search.

Study Selection

We reviewed the studies in which acquired renal cystic disease and/or renal cell carcinoma developed in patients on CAPD.

Data Extraction

Details of the prevalence of acquired cystic disease and renal malignancy as a complication of acquired cysts in CAPD patients were tabulated with the duration of treatment.

Results

Acquired cystic disease was observed in 195 of 425CAPD patients(41.1%), which is comparable to the prevalence of 47.1% (520/1103) seen in hemodialysis patients. The overall prevalence of renal cell carcinoma accompanying acquired cystic disease in this series of CAPD patients was 2 of 375 (0.4%), which is comparable to the prevalence of 1.5% (17/1103) in hemodialysis patients. So far, eight other instances of renal cell carcinoma complicating acquired cystic disease in CAPD patients were described as case reports. Retroperitoneal bleeding due to the rupture of acquired cysts has been reported on a few occasions.

Conclusion

In this review no differences were detected in the prevalence or severity of acquired renal cystic disease in patients treated with CAPD as compared with those on hemodialysis. Therefore, the incidence of complications associated with acquired cysts may also be the same for the two treatment modalities, although reports on such complications are rare.
The Pharmacokinetics of a Single Dose of Calcitriol Administered Subcutaneously in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Selgas Rafael , Martinez Maria-E. , Miranda Blanca , Baja Maria-Auxiliadara , Ramera Jase-Raman , Ausejo Monica , Sanchez-Cabezudo Maria-J. , Lapez-Revuelta Katia , Sanchez-Sicilia Luis
Published: February 2020

Objectives

To evaluate the kinetics of calcitriol (1,25(OH)2D3) administered subcutaneously.

Study Design

Calcitriol kinetics and efficacy after subcutaneous administration were studied in 13 CAPD patients with varying degrees of increased plasma levels of parathyroid hormone (i-PTH). A single dose of 2 μg of calcitriol was administered subcutaneously, and its serum levels at baseline and after 1,2,6,12, and 24 hours were determined. Plasma ionized calcium and i-PTH were also determined at these periods.

Results

Serum calcitriol levels reached peak levels of 60 and 70 pg/mL at 1 and 2 hours after administration, respectively. These levels decreased thereafter, but remained above baseline values during 24 hours. The mean value of the area under the curve (AUC) was 809±226 pg/mL/hour. Plasma i-PTH levels showed a slight decrease after 1 and 2 hours, returning to baselime levels after this period. Plasma ionized calcium did not show significant changes during the study. A slight pain at the site of injection was mentioned by some patients.

Conclusions

The subcutaneous route for calcitriol administration achieves theoretically adequate plasma levels in continuous ambulatory peritoneal dialysis (CAPD) patients. This is important when paremteral administration of calcitriol is considered in the treatment of secondary hyperparathyroidism.
Short Term Clinical Study with Bicarbonate-Containing Peritoneal Dialysis Solution
Authors: Feriani Mariano , Dissegna Daniela , La Greca Giuseppe , Passlick-Deetjen Jutta
Published: February 2020

Objective

The evaluation of the efficacy, adequacy, clinical tolerance, and safety of a new bicarbonate continuous ambulatory peritoneal dialysis (CAPD) solution.

Design and Patients

A 6–week cross-over clinical study in 6 stable CAPD patients was performed. After a control period (2 weeks) with a standard CAPD solution (lactate, 35 mmol/L), a two-chamber bag containing 34 mmol/L of bicarbonate was used for 4 weeks. A breakable valve divided the two chambers, one containing bicarbonate and the other calcium. The two solutions were mixed just before use, thus avoiding the calcium and magnesium carbonate precipitation.

Results

No differences between control and study periods were found for blood urea nitrogen, creatinine, total proteins, albumin, total and ionized calcium, phosphate, sodium, potassium, chlorine, and hemoglobin. Blood bicarbonate significantly increased from 21.25±2.02 to 23.36±1.15 (p<0.05) during the study. The peritoneal equilibration tests for urea nitrogen, creatinine, proteins, sodium, potassium, and glucose were slightly reduced during bicarbonate dialysate, but this effect was compensated for by a slight increase of ultrafiltration, thus keeping peritoneal clearances constant. Residual renal function did not change during the study. No side effects occurred during the bicarbonate period.

Conclusion

A CAPD bicarbonate solution is effective in uremic acidosis correction, does not affect dialysis adequacy, is safe, and well tolerated.
The Role of Sympathetic Dysfunction in Blood Pressure Regulation in Uremic Patients Treated by Continuous Ambulatory Peritoneal Dialysis
Authors: Jankovic Nikola , Varlaj-Knobloch Vesna , Pavlovic Draško , Milutinovic Slobodan
Published: February 2020

The role of autonomic nervous system dysfunction In the regulation of arterial blood pressure In 4 male and 10 female uremic patients, age 35–65 years (57±9 years), treated by continuous ambulatory peritoneal dialysis (CAPO) for 6–40 months (20±12 months), was studied. The integrity of the entire autonomic reflex arc was checked using Valsalva's test and the orthostasis challenge test in parallel, efferent sympathetic function was tested with the handgrip test.

A significantly decreased Valsalva ratio was found In 7 patients (50%), and it was normal in only 2 patients (14%). The handgrip test was subnormal in 5 patients (36%) and abnormal In 7 patients (50%). On the contrary, the orthostatic challenge test showed normal compensatory reaction in 10 patients (72%). The evaluation of three autonomic tests showed combined (afferent + efferent) lesion In 6 patients (43%), predominant afferent lesion In 3 patients (21 %), and In 3 patients predominant efferent lesion. In 2 patients (14%) there was no end-organ response.

Despite significant autonomic nervous system dysfunction In uremics on CAPO, as demonstrated by these results, blood pressure regulation In the supine and up right position was adequate In most patients (72%), indicating a relatively greater role of other blood pressure-regulating factors.
Removal of Phosphorus by Peritoneal Dialysis
Authors: Delmez James A.
Published: February 2020

Substantial evidence exists that peritoneal dialysis, as currently practiced, cannot alone remove adequate amounts of phosphorus in well-nourished patients. Current efforts should address the possibility of developing improved nontoxic oral phosphorus binders and/or different compositions of dialysate fluid.
Transperitoneal Calcium Mass Transfer using Dialv Sate with a Low Calcium Concentration (1.0 mM)
Authors: Weinreich Thomas , Colombi A. , Echterhoff H.H. , Mielke G. , Nebel M. , Ziegelmayer C. , Passlick-Deetjen J.
Published: February 2020

Lower dialysate calcium concentrations were recently proposed to overcome the risk of hypercalcemia In continuous ambulatory peritoneal dialysis (CAPD) patients on calcium containing phosphate binders and/or vitamin D metabolites using the standard dialysate calcium concentration (sCa) of 1.75 mM.

To assess transperitoneal calcium mass transfer (CaMT) in CAPD patients using a dialysate with a low calcium concentration (LCa, 1.00 mM), 18 stable patients were randomly allocated to receive either LCa or SCa. CaMT was assessed over 4 hours using 2L dialysate bags with three different dialysate glucose concentrations (1.5%, 2.3%, 4.25%). Total serum calcium (tCa), Ionized calcium (iCa), and the exact dialysate volume were measured before and after the 4-hour dwell. A sample of the drained dialysate was obtained to measure the dialysate calcium concentration.

The tCa and iCa levels were not significantly different In both groups prior to and did not change throughout the test. CaMT (median/range) was .0.64 mmol/exchange (0.35 –1.29 mmol/exchange) using LCa with 1.5% glucose compared to 0.23 mmol (.0.18 -0.87 mmol) with SCa (p<0.0001). CaMT was negatively correlated to ICa and ultrafiltration volume [4.25%: LCa -1.22 (.0.84 -1.9); SCa .0.43 (-1.35 -0.13); p<0.001].

In summary, LCa results in a loss of calcium into the dialysate even at low ultrafiltration volumes and serum ICa levels. This might facilitate the prevention and therapy of renal osteodystrophy with calclum-containing phosphate binders and calcitriol. However, patients using LCa must be carefully monitored for calcium homeostasis and bone turnover.
Well-Informed Patients with End-Stage Renal Disease Prefer Peritoneal Dialysis to Hemodialysis
Authors: Ahlmén Jarl , Carlsson Lisbeth , Schönborg Christina
Published: February 2020

One hundred and one azotemic patients, from March 1988 to March 1992, expected to be in need of active treatment of uremia within the next 6 months, were invited to four information meetings concerning conservative treatment of uremia, hemodialysis, peritoneal dialysis, and transplantation. Eighty-three percent of the invited patients attended. Another 13 started active treatment of uremia after receiving individualized information. At the end of the observation period, 37 of 97 patients had chosen continuous ambulatory peritoneal dialysis (CAPD), and 23 hemodialysis. Twenty-nine had not yet decided which mode of active treatment of uremia they wanted, and 4 patients had died.

Patients choosing CAPD had a mean age of 52 years, compared to 59 years for those choosing hemodialysis. Thirty-six of 37 patients who had chosen CAPD and 19 of 23 patients who had chosen hemodialysis had started treatment. The cumulative patient and technique survival at 12 months for CAPD was 92% and 66%, and for hemodialysis 700/0 and 70%, respectively.

The patients were asked to give their views on their choice of active treatment of uremia and the information meetings once they had started treatment. Eighty-six percent of the patients did not want to change their chosen therapy, and 88% of the patients found the Information provided adequate.

When patients with renal insufficiency are given adequate Information, the majority prefer peritoneal dialysis to hemodialysis and are very satisfied with their choice.
Urea Kinetics and Nitrogen Appearance Rates in Diabetic Patients on Peritoneal Dialysis
Authors: Prowant Barbara F. , Bernardini Judith Y. , Bernardini Judith , Piraino Beth
Published: February 2020

Objective

We compared the relationship of protein intake (as measured by protein nitrogen appearance) and dialysis delivery in insulin-dependent diabetic (IDDM) and nondiabetic patients.

Design

One to two 24-hour dialysate and urine collections were obtained in 20 diabetic patients and 42 nondiabetic patients. The protein equivalent of nitrogen appearance (PNA) was calculated by the Randerson formula. KTN was determined using V obtained by the Watson formula. PNA was normalized using three different methods to determine body weight: first, by normal or ideal body weight according to the Metropolitan Table (nPNA); second, by standard body weight according to the NHANES Table (sPNA); and third, by V/0.58 (vPNA).

Results

The mean PNA was not different in diabetics and nondiabetics (53±21 g/day vs 60±14 g/day), nor was weekly KTN (2.1 ±0.6 vs 2.1 ±0.6). Mean normalized PNA was not different in IDDM versus non-DM regardless of the method. KTN correlated with nPNA in IDDM (r = 0.54, p = 0.002 and non-DM, r = 0.31, p = 0.03), and with vPNA in IDDM (r = 0.73, p < 0.00001, and non-DM, r = 0.45, p = 0.0009). KTN also correlated with sPNA in IDDM (r = 0.57, p = 0.001), but not in non-DM (r = 0.25, p = 0.08). The slope for normalized PNA versus KTN was steeper for IDDM than for non-DM.

Conclusion

KTN and PNA are more closely correlated in IDDM patients than in non-DM patients. Thus it is extremely important that IDDM patients receive an adequate level of dialysis.
Nasogastric Tube Feeding in Infants on Peritoneal Dialysis
Authors: Warady Bradley A. , Weis Lynette , Johnson Leslie
Published: February 2020

Enteral nutritional support is an important component of the care provided to infants receiving long-term peritoneal dialysis. In the majority of published experiences on this subject, the use of the nasogastric tube has facilitated the provision of required calorie and protein intake and resulted in an improved patient outcome. Advantages of the nasogastric route of nutritional support include the ease of administration, while recurrent emesis remains the most troublesome and frequent shortterm complication associated with its use. Impaired oralmotor development may also result from nonoral feeding and should be addressed throughout the course of tube feeding.

The outcome of infants with ESRD receiving CPD has markedly improved since the introduction of NG feedings as a regular component of dialysis patient care. While complications associated with NG feedings have been documented, the benefits associated with this route of nutritional supplementation have been great. Currently, an increasing number of infants/ young children on CPD are receiving supplemental nutrition with the use of the gastrostomy tube/button (31). However, the risks associated with this route of therapy in the CPD population, especially in terms of infection, are as yet not well defined (32). Once the risk/benefit ratio of gastrostomy tube/button placement is determined, future efforts should be directed towards better defining how the two routes of enteral nutritional support (e.g., NG tube, gastrostomy tube/button) may best complement one another.
Impaired Initial Cell Reaction in Capd-Related Peritonitis
Authors: Koopmans Julia G. , Boeschoten Elisabeth W. , Pannekeet Marja M. , Betjes Michiel G.H. , Zemel Désirée , Kuijper Ed J. , Krediet Raymond T.
Published: February 2020

Our objective was to determine the incidence of peritonitis episodes with an impaired initial cell reaction (IICR: neutrophil number <100 x 1 061L) over a period often years, and to find possible explanations for this unusual presentation of peritonitis. A retrospective review of the files of continuous ambulatory peritoneal dialysis (CAPD) patients included in the CAPD program between 1984 and 1993 was done. Analysis of cytokine and prostanoid patterns during four peritonitis episodes with an IICR was compared to 12 episodes with a normal initial cell reaction (NICR). Dialysate cell numbers and immunoeffector characteristics of peritoneal cells were compared in 7 IICR patients in a stable situation and a control group of 70 stable CAPD patients. The setting was a CAPD unit in the Academic Medical Center in Amsterdam. Thirty-five CAPD patients who had one or more peritonitis episodes with an IICR and a control group of 249 CAPD patients were included in the study.

The incidence of peritonitis with an IICR was 6%. These episodes occurred more than once in 51% of the patients who presented with IICR. In 72% the cell reaction was only delayed: a cell number exceeding 100 x 1 061L was reached later. Staphylococcus aureus was significantly more frequently the causative microorganism compared to all peritonitis episodes (PE) that occurred during the study period. Patients with IICR had lower dialysate cell counts in a stable situation, compared to a control group (p < 0.01). This was caused by a lower number of macro-phages and CD4 positive lymphocytes. The phagocytosis capacity of the macrophages appeared to be normal. In a comparison of four PE with an IICR and 12 episodes with an NICR, the tumor necrosis factor-α (TNF-α) response was similar and occurred on day 1, also pointing to normally functioning macrophages. However, the maximal appearance rates of interleukin-6 (IL-6) and IL-8 occurred later in the episodes with IICR compared to NICR (day 2 vs day 1, p < 0.05). No differences were found in vasodilating prostaglandins, mesothelial cell markers (cancer antigen 125, phospholipids, hyaluronan), and mesothelial cell numbers in the stable situation nor during peritonitis.

Peritonitis can present as abdominal pain in the absence of a cloudy dialysate. In some of the patients this presentation occurred more than once. This impaired, most often delayed, cell reaction was associated with a delayed secondary cytokine response. As IL-6 and IL-8 can be synthesized by mesothelial cells, this suggests an impaired functioning mesothelium. This could not be confirmed, however, by a lower number of mesothelial cells in effluent or lower dialysate levels of mesothelial cell markers.
Calculation of 6-Hour Dip Creatinine Ratio from the 4-Hour Peritoneal Equilibration Test. The Effect of Dwell Duration on the Results
Authors: Mehrotra Rajnish , Khanna Ramesh , Yang Thomas C.K. , Kathuria Pranay , Moore Harold L. , Prowant Barbara F. , Nolph Karl D. , Twardowski Zbylut J.
Published: February 2020

Objectives

Since the introduction of the peritoneal equilibration test (PET), the 4-hour dialysatelplasma creatinine (DIP Cr) has been used by several authors for determining continuous ambulatory peritoneal dialysis (CAPD) prescriptions. However, the results have been unsatisfactory because the 4-hr DIP Cr does not accurately reflect the DIP Cr in 24-hr collections. The PET and the 24-hr dialysate collections differ in the duration of dwell and the tonicity and volume of dialysate, all of which influence the equilibrated DIP Cr. It can be assumed that the DIP Cr in 24-hr collections in these patients is closer to a 6-hr DIP Cr. Because a 6hr PET is inconvenient, we developed a mathematical model to calculate the 5 and 6-hr DIP using the results of a standard PET.

Design

In a retrospective analysis, DIP Cr ratios in 24-hr collections and DIP Cr ratios calculated from a mathematical formula were correlated. Using a mathematical model, the data collected fit an exponential relation of the type DIP = a(1 -e-t/τ). The values of a and τ are unique for a given patient and were determined using a nonlinear regression technique. The formula performed well on our published data -the true and predicted 6-hr DIP Cr being 0.696 and 0.71, respectively.

Setting

The University Hospital and Clinics, Dalton Cardiovascular Research Center and Dialysis Clinic, Inc., Columbia, Missouri.

Patients

All CAPD patients on four 2-L exchangeslday at the time of the 24-hr collections were included.

Interventions

None.

Main Outcome Measures

Closeness of 4-hr and 6-hr DIP Cr values to those of 24-hr ratios.

Results

The study group comprised 74 patients (age, mean ± SEM: 56.4 ± 1.8 yr) with 80 PETs and 145 (24-hr) collections. The interval between the two tests was 8. 3 ± 0.9 months (0 48.7 months). The median 24-hr DIP Cr of 0.760 did not differ significantly from the predicted median 6-hr DIP Cr of 0.755. A subgroup analysis, based on transport type, showed that this relationship was most precise in the high-average transporters. The predicted 6hr DIP Cr was within 100;0 of the 24-hr DIP Cr in 48% of patients and within 20% in 77% of patients. The margin of error was greatest in the low transporters.

Conclusions

To conclude, the 4-hr DIP Cr from a PET cannot be used interchangeably with the DIP Cr in the 24-hr dialysate collections, hence, the clearances calculated thereof will be inaccurate. Using the proposed model, it is feasible to use the 4 -hr PET results to obtain 5 and 6 -hr DIP Cr values. In our study, using this model, the extrapolated 6-hr DIP Cr is similar to the DIP Cr in 24-hr dialysate collections only in the high-average transporters. Hence, the best way to determine clearances in peritoneal dialysis patients is still by collecting 24-hr dialysates.
Reduced Glucose Degradation Products in Bicarbonate/Lactate-Buffered Peritoneal Dialysis Solutions Produced in Two-Chambered Bags
Authors: Cooker Laurinda A. , Luneburg Patricia , Faict Dirk , Choo Carolyn , Holmes Clifford J.
Published: February 2020

Objectives

The aims of the current study were: (1) to determine the effects of peritoneal dialysis (PD) solutions at different glucose concentrations on the growth of cultured cells; (2) to determine whether a bicarbonate/ lactate-based solution, as a result of the configuration of its components during heat sterilization in a two-chambered bag, was lower in glucose degradation products than a corresponding lactate-based PD solution; and (3) to determine whether lower glucose degradation corresponded to a decreased inhibition of cell growth.

Design

Growth inhibition of cells exposed to lactatebased PD solutions at three different glucose concentrations was determined. Bicarbonate/lactate-based and lactate-based solutions at high glucose concentration (3.86%) were further analyzed for presence of glucose degradation products and inhibition of cell growth.

Methods

Cell growth was determined by neutral red uptake, measured by optical density at 540 nm. Glucose degradation to acetaldehyde or fructose was determined by gas chromatographymass spectroscopy and highperformance liquid chromatography.

Results

Only 3.86% glucose lactate-based PD solution caused significant inhibition of cell growth (p < 0.05). The heat-sterilized, bicarbonate/lactate-based solution (3.86% glucose) had lower levels of fructose and acetaldehyde than a conventional heat-sterilized, lactatebased solution with the same glucose concentration. Growth of cultured cells exposed to the bicarbonate/ lactate-based solution was significantly improved (p < 0.05) over growth in the conventional solution.

Conclusions

The bicarbonate/lactate-based solutions, manufactured and heat-sterilized in two-chambered bags, were lower in glucose degradation products than the corresponding lactate-based PD solutions, and demonstrated improvedin vitrobiocompatibility as measured by the growth of cultured cells.
Safety and Efficacy of Total Dose Iron Dextran Administration in Patients on Home Renal Replacement Therapies
Authors: Sloand James A. , Shelly Mark A. , Erenstone Anne L. , Schiff Melissa J. , Talley Thomas E. , Dhakal Madhavendra P.
Published: February 2020

Objective

To determine the safety and efficacy of intravenous total dose iron (TDI) replacement in patients treated with home renal replacement therapy.

Design

Prospective open-label study on end points in the population studied.

Setting

Institutional outpatient home dialysis program.

Patients

The study included 20 end-stage renal disease (ESRD) patients, performing chronic peritoneal or home hemodialysis, with iron deficiency defined as ferritin < 100 ng/mL and/or an iron saturation < 20%.

Intervention

The total dose of iron dextran was calculated and infused at a rate not exceeding 6 mg/min. Hemoglobin, hematocrit, iron studies, and liver function tests (LFTs) were obtained before and 3 to 4 weeks after TDI infusion. Hematocrit of patients failing to achieve an increase in Hct over this period was re-examined 2 to 4 weeks later looking for a delayed response.

Main Outcome Measures

Primary end points for efficacy were changes in Hct, ferritin, and iron saturation. Toxicity was measured as reported immediate and delayed symptoms and elevated transaminases and/or alkaline phosphatase levels.

Results

A median iron dose of 1000 mg (range, 325 1500 mg) was administered. The infusions were generally well tolerated. Clinical adverse effects were seen in 2 patients weighing less than 50 kg. No increase in LFT results was seen. Hematocrit increased 2.2% (95% CI, 0.5% -3.9%) from 29.0% to 31.2% (p = 0.01) within 4 weeks of infusion. Significant increases also occurred in iron saturation (from 13% to 22%, p = 0.001) and ferritin (from 234 to 305 ng/mL, p = 0.008). Among the 9 patients who did not respond with a significant increase in Hct, 2 had a delayed response, increasing the overall response from 63% at 4 weeks to 71 %,8 weeks after TDI.lnadequate erythropoietin dosing and low-grade infectious/inflammatory disorders may have contributed to a poor response in several patients.

Conclusion

Total dose iron is a safe and effective means of restoring iron and erythropoietic response in ESRD patients weighing more than 50 kg who receive their renal replacement therapy at home.
Mast Cell Histamine-Induced Calcium Transients in Cultured Human Peritoneal Mesothelial Cells
Authors: Bird Stephen D. , Walker Robert J.
Published: February 2020

Objective

Peritoneal inflammation results from a complex interplay of events initiated by macrophage activity in response to infection, with the stimulation of mesothelial cell cytokine release amplifying the recruitment of blood-borne defense cells to the site of injury. Resident peritoneal mast cells may add to this complexity with mast cell derived cytokines released during this cascade. This study examined the influence of histamine, a mast cell derived inflammatory mediator, on the initial activation of human peritoneal mesothelial cells (HPMC) by intracellular free calcium (Cai2+) mobilization, and changes to the actin cytoskeleton.

Design

HPMC signal transduction was examined in response to histamine (1.0 mmol/L) compared to fetal bovine serum (FBS) (0.1 %) and 4-br-A23187 (1.0 μmol/L). Intracellular free calcium was measured in fura-2 loaded cells with and without external calcium (Ca2ex+t), or Ca2ex+t with verapamil (100 μmol/L). Following treatment with agonists, HPMC actin cytoskeleton was stained using direct immunocytochemistry.

Results

HPMC responded to histamine with a twofold transient rise in Cai2+ which returned to the baseline, in contrast with FBS and A23187–induced Cai2+ transients, which returned to elevated resting values. In the absence of Ca2ex+t’ all agents produced a calcium transient indicative of calcium release from intracellular stores. Histamine induced calcium -dependent changes to the cytoskeleton and cellular organization, including increased actin stress fibers.

Conclusion

Histamine produced large specific receptor-mediated calcium transients in HPMC, which included components of calcium release from intracellular stores and receptor -mediated calcium influx processes. The observed response to histamine raises the possibility that histamine derived from resident mast cells may modulate mesothelial cell function, in part by calciumdependent pathways, and influence the performance of the peritoneal membrane during peritoneal dialysis.
The Standard Peritoneal Permeability Analysis in the Rabbit: A Longitudinal Model for Peritoneal Dialysis
Authors: Zweers Machteld M. , Douma Caroline E. , De Waart Dirk R. , Van Der Wardt Anton B. , Ho-Dac-Pannekeet Marja M. , Krediet Raymond T. , Struijk Dirk G.
Published: February 2020

Objective

The development of an experimental peritoneal dialysis (PD) model in rabbits to investigate peritoneal transport characteristics during a longitudinal follow-up and to assess normal values of these peritoneal transport parameters.

Design

Peritoneal transport parameters were determined in conscious, unrestrained rabbits by standard peritoneal permeability analysis adjusted for rabbits (SPAR). In this test a 1-hour dwell with 3.86% glucose dialysate is used. Dextran 70 (1 g/L) was added to the dialysate to allow calculation of fluid kinetics. Dialysate samples were taken before, 10, and 40 minutes after instillation and at the end of the dwell. Blood was drawn at the end of the dwell.

Experimental Animals

Eighteen female New Zealand White rabbits (2565 g) were included for catheter implantation. SPARs were performed in 15 animals; the other 3 were excluded due to complications.

Main Outcome

The mass transfer area coefficients (MTACs) of the low molecular weight solutes urea (MTACurea) and creatinine (MTACcr) were calculated. The clearances of albumin (Clalb) and IgG (ClIgG), glucose absorption, and fluid transport were computed. Coefficients of intraindividual variation (Vc) were calculated for these parameters.

Results

The main complications were catheter obstruction and/or dislocation. Five rabbits underwent uncomplicated PD during a 4-week period. Fifteen SPARs in 15 stable rabbits were performed and analyzed to obtain normal values. Means and standard deviations of the transport parameters were as follows: MTACurea 2.24 ± 0.57 mL/min, MTACcr 1.61 ± 0.30 mL/min, Clalb 52.9 ± 17.2 μL/min, ClIgG 44.5 ± 22.9 μL/min. The transcapillary ultrafiltration rate was 0.66 ± 0.13 mL/min and the lymphatic absorption rate 0.47 ± 0.26 mL/min. The parameters of solute transport were upscaled to those in humans using two different methods. MTACs of low molecular weight solutes in rabbits and patients were of the same order of magnitude, but the clearance of albumin was approximately four times higher in rabbits than in patients, and that of IgG eight times. In all rabbits sieving of sodium was observed. The dialysate/plasma (D/P) of sodium decreased to a minimum at 40 min ( p < 0.003 vs the initial value), followed by a rise to 60 min. The minimal value was 0.884 ± 0.002. The coefficients of variation calculated on 7 rabbits that underwent two or more SPARs were similar to those assessed from the patient data. This indicates stability of the model and reproducibility of the SPAR.

Conclusion

The conscious rabbit model for PD can be used for repeated studies on peritoneal transport.
Changes in Volume of Peritoneal Mesothelial Cells Exposed to Osmotic Stress
Authors: Breborowicz Andrzej , Polubinska Alicja , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To evaluate changes in volume of mesothelial cells exposed to hypertonic medium and the role of volume regulatory mechanisms in adaptation to hyperosmolality.

Design

Experiments were performed on primary cultures of human peritoneal mesothelial cells. Cell volume was estimated by measuring equilibrated (intracellular/ extracellular space) 14C-urea in cellular water. Cells in monolayers were exposed to hyperosmotic media and changes in cellular water or intracellular uptake of 3H-proline were measured.

Results

Exposure of mesothelial cell monolayers to hyperosmotic media reduced the cell volume; the effect was proportional to the osmolality of the medium. Volume of cells exposed to medium supplemented with glucose (180 mmol/L) decreased by 26%, p < 0.001, after 30 minutes’ incubation. Prolonged exposure of mesothelial cells to hyperosmotic medium resulted in gradual recovery, after initial decline, of their volume. Intracellular uptake of amino acid 3H-proline increased after 240 minutes’ exposure of the mesothelial cells to medium supplemented with glucose (90 mmol/L) (+40%, p < 0.05). When cells cultured for 7 days in medium supplemented with glucose (45 mmol/L) were exposed to medium with low glucose content (5 mmol/L) their volume increased by 17%, p < 0.05.

Conclusion

Mesothelial cells shrink after exposure to hypertonic medium. Increased intracellular uptake of amino acids may be one of the regulatory mechanisms that ensure subsequent volume increase in these cells. Mesothelial cells chronically exposed to hypertonic medium swell after transfer to a medium with physiologic osmolality.
Survival and Complications of 225 Catheters Used in Continuous Ambulatory Peritoneal Dialysis: One-Center Experience in Northern Greece
Authors: Balaskas Elias V. , Ikonomopoulos Dimitrios , Sioulis Athanasios , Dombros Nicholas , Kassimatis Efstratios , Bamichas Gerasimos , Katsara Ioanna , Tourkantonis Achilleas
Published: February 2020

This study reports our experience with permanent peritoneal catheters. From July 1983 until December 1997, 225 catheters were implanted surgically in 207 patients (120 males, 87 females) with mean age of 58 ± 16 years (range: 2 -82 years), and a mean duration of continuous peritoneal dialysis (CAPD) of 21.9 ± 21.3 months (range: 1 145 months). Two hundred and seventeen catheters were used in 199 patients suffering from end-stage renal disease (ESRD), and 8 catheters in 8 patients with end-stage heart failure resistant to medical therapy. One patient used 3 catheters and 16 patients used 2 catheters.

The catheters used were: Tenckhoff, 2; Oreopoulos Zellerman-1 (OZ-1), 10; OZ-2, 205; and OZ-pediatric, 8. All catheters were implanted by the same surgical team, through a paramedian incision under local anesthesia. By life table analysis, the actuarial survival rates at 1 year, 2 years, 3 years, and 5 years were 97%, 92%, 87%, and 82% respectively for all catheters. The catheter-related complications were: 5 obstructions, 2 dislodgments, 13 dialysate leaks (6 early; 7 late), 90 exit-site/tunnel infections (in 56 patients), 2 cuff extrusions, and 37 hernias (in 31 patients). Eighteen catheters were replaced for persistent peritonitis (15 cases), dislodgment (1 case), obstruction (1 case), and accidental shortening (1 case).

The total observation period was 4526 patient-months. The overall incidence of peritonitis was one episode per 15 patient-months, and of exit-site/tunnel infections was one episode per 50 patient-months, with a significant improvement during the last years. We conclude that OZ catheters implanted surgically through a paramedian incision have a very high survival rate and a low complication rate.
Continuous Ambulatory Peritoneal Dialysis in High-Risk Patients: Patients with Cardiovascular Diseases -Role of the Nurse
Authors: Lambert Marie-Christine Z. , Schilling Holger
Published: February 2020

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis -induced effects on the heart. With continuous peritoneal dialysis (CAPO) some of the cardiovascular complications are ameliorated owing to slow ultrafiltration and absence of an arteriovenous fistula. CAPO might be concluded to be the preferable option in patients with cardiovascular disease, but a few disadvantages, such as hyperlipidemia and hyperinsulinemia, also exist. Nurses also play an important role in the therapeutic success and outcomes of these patients.
Nutritional Status of Korean Peritoneal Dialysis Patients
Authors: Chung Sung Hee , Na Myung Hee , Lee Sui Hyung , Park Sung Ja , Chu Won Seck , Lee Hi Bahl
Published: February 2020

Objectives

To assess the nutritional status of Korean peritoneal dialysis (PD) patients and to compare with data from Western literature, and to elucidate independent factors determining nutritional status and death.

Design

Cross-sectional single-center study.

Setting

Kidney Center, Soon Chun Hyang University Hospital.

Materials

Ninety-eight CAPD patients were included. Of these, 54 patients were male, 32 patients were diabetic, mean age was 47.9 :i: 13.1 years, and mean duration of CAPD was 22.3 :i: 21.6 months. The patients were followed until death, transfer to hemodialysis (HD) or other units, transplantation, or until 3 years had elapsed after the first evaluation.

Methods

Nutritional status was assessed by subjective global assessment (SGA), biochemical and anthropometric measurements, fat-free edema-free (FFEF) body mass by creatinine (Cr) kinetics, protein equivalent of total nitrogen appearance (PNA), and urea kinetic studies.

Results

By SGA score, 53.1% of patients were classified as normal, 44.9% with mild-to-moderate malnutrition, and 2% with severe malnutrition. Patients with malnutrition were significantly older and had higher peritonitis rates, lower serum albumin (Alb), blood urea nitrogen (BUN), serum Cr, FFEF body mass, mid arm muscle circumference, and PNA (p < 0.05). On stepwise multiple regression analysis, the SGA score was negatively correlated with age and peritonitis rate (p < 0.01). At the end of the 3-year follow-up period, 11 patients were still on CAPD, 26 had died, 51 had transferred to HD and 5 to other units, 3 patients had been transplanted, and 2 patients were lost to follow-up. Patients who died during follow-up were older and had higher peritonitis rates and lower total serum protein, Alb, Cr, and FFEF body mass when compared to those who survived (p < 0.05). Independent predictors of death were age, peritonitis rate, and serum Alb (p < 0.01).

Conclusion

Malnutrition was as common in Korean PD patients as reported in the Western literature. Our data suggests that, to prevent malnutrition and early death, it is important to reduce the peritonitis rate, to improve protein intake, and to prescribe an adequate dose of peritoneal dialysis.
Investigating the effect of different bonding areas on the lateral resistance of polyurethane-mixed ballast using the discrete element method
Authors: Ling Xing , Xiao Hong , Jin Feng
Published: February 2020

In order to investigate the characteristics of the lateral resistance of the polyurethane-mixed ballast with different bonding areas, a sleeper–ballast model was established using the discrete element method. The lateral resistance of the polyurethane-mixed ballast with single and combined bonding modes was analyzed. The results show that the lateral resistance increases with the increase of the bonding depth of the shoulder ballast. After the bonding depth of the crib ballast and the base ballast reaches 5 cm and 15 cm below the bottom of the sleeper, respectively, there is no significant development of the lateral resistance. The lateral resistance cannot be improved efficiently by bonding the slope ballast. The combined bonding of the crib ballast and the base ballast is an effective method to improve the lateral resistance. With the gradual failure of the bonding contact points between the sleeper and the ballast, the average value of the lateral resistance decreases linearly and the lateral resistance presents a greater randomness under the more complex bonding mode.
Real-time comprehensive toxicology testing in the clinical management of accidental pediatric capecitabine ingestion
Authors: Gintjee Thomas J , Goodnough Robert , Li Kai , Badea Adina , Lynch Kara L , Garcia Eddie , Repplinger Daniel
Published: February 2020

Introduction

Capecitabine is an orally bioavailable prodrug of the chemotherapeutic agent, fluorouracil. Fluorouracil is converted to several active metabolites that induce a cytotoxic effect. Capecitabine toxicity can be life-threatening with a delayed presentation from ingestion. An oral antidote, uridine triacetate, exists but requires the administration of 20 total doses over a course of five days.

Case report

In this report, we describe a case where timely coordination with a clinical toxicology laboratory was utilized to drive clinical decision making and management. Two children were brought to the emergency department shortly after suspected capecitabine ingestion.

Management and outcome

Patients were admitted to the hospital and started on uridine triacetate. Real-time comprehensive toxicology testing of the children’s blood was used to rule out capecitabine toxicity and prevent several unnecessary days of hospitalization and doses of antidote. Patients were discharged safely.

Discussion

Real-time comprehensive toxicology testing on a patient’s blood may be a valuable resource in ruling out or confirming toxic exposure in accidental pediatric ingestion of chemotherapeutic agents like capecitabine when performed in a timely manner.
Money: An Integrated Review and Synthesis From a Psychological Perspective
Authors: Wang Xijing , Chen Zhansheng , Krumhuber Eva G.
Published: February 2020

Many empirical studies have demonstrated the psychological effects of various aspects of money, including the aspiration for money, mere thoughts about money, possession of money, and placement of people in economic contexts. Although multiple aspects of money and varied methodologies have been focused on and implemented, the underlying mechanisms of the empirical findings from these seemingly isolated areas significantly overlap. In this article, we operationalize money as a broad concept and take a novel approach by providing an integrated review of the literature and identifying five major streams of mechanisms: (a) self-focused behavior; (b) inhibited other-oriented behavior; (c) favoring of a self–other distinction; (d) money’s relationship with self-esteem and self-efficacy; and (e) goal pursuit, objectification, outcome maximization, and unethicality. Moreover, we propose a unified psychological perspective for the future—money as an embodiment of social distinction—which could potentially account for past findings and generate future work.