bluuebunny/crossref_metadata_2025 huggingface dataset:
The Cytotoxicity of Continuous Ambulatory Peritoneal Dialysis Solutions with Different Bicarbonate/Lactate Ratios
Authors: Schambye Hans Thalsgård , Pedersen Fritz Bangsgaard , Christensen Hanne Knoldsborg , Berthelsen Henrik , Wang Palle
Published: February 2020

Five different bicarbonate-based continuous ambulatory peritoneal dialysis (CAPD) solutions (pH: 7.0-7.4; bicarbonate: 10-27 mM; lactate: 20.8–0.7 mM) were produced in order to examine the cytotoxic effects of the different compositions. The migratory capacity of normal human polymorphonuclear (PMN) granulocytes after exposure to the solutions was used as a cytotoxicity assay.

All the tested solutions reduced cellular function compared to a standard cell culture medium, but considerable differences between the solutions were observed.

The optimal Conditions for the PMN migration were at a pH of 7.0 and at bicarbonate and lactate concentrations of 20 mM and 12.5 mM, respectively. Bicarbonate concentrations of more than 25 mM were associated with reduced cellular function as were lactate concentrations of more than 15 mM.

The most advantageous CAPD solution regarding cytotoxicity towards normal human PMN's is a combination of a lactate and bicarbonate-based solution, which has a bicarbonate concentration of approximately 20 mM, a lactate concentration of 12.5 mM, and a pH of approximately 7.2.
Urea Kinetics and Clinical Features of Long Term Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Kumano Kazuo , Takagi Yutaka , Yokota Shinji , Shimura Satoru , Sakai Tadasu
Published: February 2020

The purpose of this study was to assess urea kinetic modeling (UKM) as a marker for adequate dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. UKM was conducted on 19 anuric patients on CAPD for more than 2 years. Serum β2-microglobulin (β2M) was also measured as a marker of large molecular weight substances. Patient clinical conditions were evaluated by the doctors and patients as well. The patients were thus asked to complete a questionnaire on uremic symptoms an d daily activities. A comparison was made in urea kinetics and biochemical parameters based on clinical assessment scores. Patient and doctor scores showed a close correlation (r=0.69) and were correlated to days of hospitalization. The peritonitis rate was significantly higher in the “not doing well” group. No correlation could be found between indexes of UKM or β2M plasma level and clinical assessment scores. A signlficant correlation was noted between serum albumin concentration and doctor scores (r=0.52). It was thus concluded that UKM was not a good indicator of the adequacy of dialysis for CAPD, but serum albumin was. However, clinical symptoms and signs are more important than biochemical parameters for assessing adequacy.
Gastroparesis: An Important Cause of Hospitalization in Continuous Ambulatory Peritoneal Dialysis Patients and the Role of Erythromycin
Authors: Gallar P. , Oliet A. , Vigil A. , Ortega O. , Guijo G.
Published: February 2020

Gastroparesls Is a disabling complication In diabetic patients. It has been reported as the second most frequent cause of hospitalization In diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). We analyzed Infectious and noninfectious complications In our CAPD patients. We Included 31 patients (12 diabetics and 19 nondiabetics) with an average time on CAPD of 14±7 months. The Incidence of peritonitis was 1.68 episodes/patient/year In diabetics and 0.84 tn nondiabetics. Nine (75%) diabetic patients had peritonitis, 5 (42%) had vomiting, and 4 (33%) had Ischemic heart disease. The hospitalization Index (days/year) was greater In diabetics: 11.83± 11.36 versus 4.16±8.84 In nondiabetics (p<0.05). Vomiting was the first cause of admission in diabetics. We were unable to control severe gastroparesls with cisapride and metoclopramide in 4 patients. Erythromycin, 100 mg/2-L bag of dialysate, improved symptoms In all of them.

We concluded that gastroparesls Is an Important cause of morbidity In CAPD patients. Intraperitoneal erythromycin can Improve symptoms If other prokinetic drugs fail.
Computerized Management of Peritoneal Dialysis
Authors: Mandolfo Salvatore , Corradi Bruno , Malberti Fabio , Imbasciati Enrico
Published: February 2020

The importance of the evaluation of dialytic adequacy is well known In peritoneal dialysis. It is necessary to be able to quantify and Individualize the substitution treatment.

In 15 patients we compared five quantitative approaches by using original software: Teehan's dialysis index (D1); Dlaz-Buxo's liters/week (LW); Keshavlah's the quantity of dialysis prescribed (wKt/V); and Boen and Twardowskl's weekly creatinine clearance (WC). All patients were treated by continuous ambulatory peritoneal dialysis (CAPD) according to the peritoneal equilibration test (PET).

Peritoneal solute clearances for urea, creatinine, uric acid, and phosphorus were adequate, but there was disagreement between adequacy indexes. According to the D1, 40% of our patients were underdialyzed, 33% were adequate, and 27% received excessive dialytic dose, while according to LW and wKt/V, about 50% were adequate, 100/0 underdialyzed, and 40% received excessive doses. According to WC, 74% were overdialyzed and 26% were adequate. In two patients only (13%) all the Indexes Indicated underdialysis.

We think that the D1 is too severe an adequacy Index, probably because residual renal clearances have a great weight In the formula, while WC may lead to an overestimate of the actual dose of therapy in patients with significant residual renal clearance.

Prospective, randomized and clinical studies are needed to better assess the optimal Index for Individualization of targeted peritoneal dialysis prescription.
Psychiatric and Psychosocial Status of Elderly Patients Undergoing Dialysis
Authors: Iordanidis Pantazis , Alivanis Polichronis , Lakovidis Apostolos , Dombros Nicholas , Tsagalidis Ioannis , Balaskas Elias , Derveniotis Vasilis , Lerodiakonou Charalambos , Tourkantonis Achilles
Published: February 2020

We Investigated the psychiatric and psychosocial status of 31 elderly (age >65 years) end-stage renal disease patients undergoing hemodialysis (HO) (17 patients) and continuous ambulatory peritoneal dialysis (CAPO) (14 patients). There was no difference between the two groups In terms of age (67.3:1:.2.3 and 68.5:1:.4.3 In HO and CAPO groups, respectively), duration of dialysis treatment, and biochemical profile. The psychiatric and psychosocial status of the patients was assessed using the standardized psychiatric Interview (SPI), Hamilton's depression scale (HRS-O), and a questionnaire for the evaluation of the psychosocial Impact of the method of treatment. Sixteen of 31 patients presented with psychiatric morbidity (9 mild, 5 moderate, 2 severe). However, there was no significant relationship between psychiatric morbidity and method of dialysis (HO or CAPO). The mean values of SPI (21.47:1:.16.38 and 17.14:1:.13) and HRS-O (20.91:1:.17.33 and 15.41:1:.13.13) scores for the HO and CAPO groups, respectively, did not differ significantly. The analysis of the results of the questionnaire regarding the Impact of the method of treatment on psychosocial status Indicated that the HO patients felt that their lives were more dependent on factors that they could not Influence (I.e., the dialysis equipment, etc.).

Our findings suggest that the psychiatric status of elderly patients undergoing chronic dialysis treatment Is not affected by the method of treatment, a factor that should be taken Into consideration when deciding the proper dialysis treatment for these patients.
Indirect Measures of Total Body Water May Confound Precise Assessment of Peritoneal Dialysis Adequacy
Authors: Schmidt Rebecca , Dumler Francis , Cruz Cosme
Published: February 2020

Urea kinetic modeling (UKM) has yet to be optimized as a practical tool for assessing adequacy of therapy In continuous ambulatory peritoneal dialysis (CAPO) patients. Watson equation (WV) and 58% body weight (58%WT) estimates of total body water (TBW) are Indirect measures likely to yield Imprecise estimates of Kt/V. Bioelectrical Impedance (BEl) measures body composition as a function of electrical conductance, minimizing fat contribution to TBW. TBW values were highest when measured as 58%WT and lowest when calculated from WV. These differences were most striking In patients with overweight body habitus. BEI-derived TBW correlated best with UKM values. The relationship between BEI-derived and anthropometrically derived TBW was best In patients of normal habitus. Kt/V values were highest when calculated from WV-derived volumes and significantly differed from Kt/V values calculated from BEI-derived and 58%WT volumes. When segregated by habitus, however, only In overweight patients was this pattern of clinical significance. Serial body weight, lean body mass, and TBW remained stable In patients of normal habitus. Overweight patients increased weight by 5%, lean mass by 2%, and TBW by 5%, 3%, and 2% when measured by 58%WT, WV, and BEl, respectively. BEl measures of TBW exclude fat mass and thus strengthen the use of Kt/V for assessing dialysis adequacy In CAPO patients of all body weights.
Analysis of Complications in a Chronic Peritoneal Dialysis Pediatric Patient Population
Authors: Verrina Enrico , Bassi Sergio , Perfumo Francesco , Edefonti Alberto , Zacchello Graziella , Andreetta Barbara , Pela Ivana , Penza Rosa , Piaggio Giorgio , Picca Marina , Cantaluppi Alberto
Published: February 2020

During the period 1986–1991, the Italian Registry of Pediatric Chronic Peritoneal Dialysis collected data from 140 patients younger than 15 years at the start of chronic peritoneal dialysis (CPD). In this study we review the Registry's complications and patient hospitalization data.

A total of 395 complications directly related to CPD were registered during 2722 dialysis-months. There were 176 episodes of peritonitis (44.5%), 161 catheter-related complications (40.7%) (103 exit-site Infections, 17 leakages, 15 obstructions, 15 cuff extrusions, 5 hemoperitoneum, and 6 other complications), and 58 technique-related complications (14.8%) (39 abdominal hernias, 10 hydroceles, 5 with abdominal pain, 4 hydro. thorax complications). The patient hospitalization rate during the period 1989–1991 was evaluated; the analysis referred to 106 patients who underwent treatment for a total of 1520.5 dialysis-months. Patients starting CPD in the year and patients already on CAPD spent 5.8 and 2.1 days per patient-month in the hospital, respectively; the difference was not statistically significant. The evaluation of complications (both technical and systemic) causing patient hospitalization showed that peritonitis was responsible for 43.2% of patient admissions and 36.3% of days hospitalized, catheter-related complications for 22% and 19.80/0, technlque-related complications for 8.3% and 5.1%, and other clinical complications for 26.5% and 38.8%, respectively.
Decrease in Peritonitis Rate by Integrated Disconnect System in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Grützmacher Peter , Tsobanelis Theochoris , Bruns Margaret , Kurz Peter , Hoppe Dagmar , Vlachojannis Jannis
Published: February 2020

The prevention of peritonitis is of major concern for successful long-term continuous ambulatory peritoneal dialysis (CAPO) treatment. The effect of a Y-systern on peritonitis Incidence and patient morbidity was observed in a comparative, retrospective single-center analysis over a period of 5 years. The Integrated disconnect system prolonged the peritonitis-free period from 1:11 patient-months, observed with the conventional system, to greater than 1:50 patient-months. The rate of hospitalization was reduced by 45%.
Reduction in Peritonitis Incidence in Continuous Ambulatory Peritoneal Dialysis with a New Catheter and Implantation Technique
Authors: Moncrief Jack W. , Popovich Robert P. , Dasgupta Mrinal , Costerton J. William , Simmons Everett , Moncrief Blain
Published: February 2020

Recurrent episodes of peritonitis with the same organism cultured at the catheter exit site suggest that early tunnel colonization is associated with a transfer of these organisms through the catheter tunnel directly from the skin Into the peritoneal cavity. In this instance the catheter has failed In Its fundamentel design to establish and maintain a bacteriological berrier. A three-part study was conducted using the Moncrlef-Popovich catheter and Implantation technique. The first part of the study Included 59 patients who used standard spike exchange systems with this new catheter and implantation technique. A reduction in the incidence of peritonitis occurred in the continuous ambulatory peritoneal dialysis (CAPO) program at the Austin Olagnostic Clinic. The previous peritonitis incidence was 1 every 9 patient-months. This study had 1 every 29 patient-months with 530 patient months of experience.

The second part of the study had 79 patients. All except 11 used disconnect exchange systems. There was a total of 482 patient-months of experience with 1 episode every 27 patient-months. Those using the disconnect systems (86%) had 1 episode every 32 petient-months.

The third part of the study Included microscopic studies of 12 excised catheters. Three were known to be contaminated. The examiners identified those catheters that were free or nearly free of biofilm on the catheter segment between the two cuffs. It Is concluded that biofilm analysis and reduction In peritonitis Incidence supports the theory that the new catheter and implantation technique form an Improved becterlologlcal barrier In the access for peritoneal dialysis.
The Effect of Peritoneal Dialysis Solutions on Rifampin Action against Staphylococcus Epidermidis in the Fluid and Biofilm Phases of Growth
Authors: Richards Geoffrey K. , Gagnon Raymonde F. , Obst Gregory , Kostiner Geoffrey B.
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) catheter-assoclated infections can be resistant to conservative therapeutic measures despite the apparent susceptibility of the infecting bacterial strains to antibiotics. This chronicity of Infection has been ascribed to the development of bacteria on the surfaces of catheter material within a protective polysaccharide shield or matrix. CAPD catheters are unique In being exposed to nonphysiological environments of dialysis fluids of varying physical properties and constitution. We determined that the rate of growth of s. epidermldis In the fluid phase In laboratory media or fresh dialysis solution was significantly Influenced by pH. An acid milieu (pH 5) Impaired growth compared to a neutral milieu (pH 7). Spent dialysis fluid, however, which had an approximately neutral pH, also Impaired bacterial growth, the assumption being that this results from properties of spent fluid unrelated to pH.

Using rifampin as the test antibiotic, we noted that Its action on S. epidermldis was unaffected by pH or by the differing milieu of fresh and spent fluid. Bacterial growth was arrested regardless of the milieu. We further examined the potential of dialysis fluids to modify the Interaction between rifampin and the matrix-enclosed bacteria of standardized S. epidermidis blofilms. We determined that the pH of the dialysis solution was a critical factor Influencing the outcome of exposure of the biofilm to rifampin. An acid pH enhanced antibiotic activity, whereas a neutral pH was associated with antibiotic antagonism. These findings have Implications in the management of S. epidermldis catheter-associated infections using rifampin. Administration of the antibiotic In fresh peritoneal dialysis solution (pH 5.6) Is Judged more likely to be associated with a successful outcome.
A Randomized Prospective Comparison of Oral versus Intraperitoneal Ciprofloxacin as the Primary Treatment of Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis
Authors: Cheng I.K.P. , Chan C.Y. , Wong W.T. , Cheng S.W. , Ritchie C.W. , Cheung W.C. , Lo W.K.
Published: February 2020

The present study compared oral versus Intraperitoneal (ip) ciprofioxacin (ciproxin) as primary treatment of bacterial peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) In a randomized, prospective trial. A total of 54 episodes In 46 patients were recruited for study. After excluding nonbacterial episodes and those not treated according to protocol, 48 episodes evenly divided between the two treatment arms were eligible for analysis. The primary cure rate was 41.7% and 66.7%, respectively, In the oral and Ip treatment group. Half of those who tailed or relapsed were due to Infection with resistant, mostly grampositive bacteria, which accounted for 79% of culture-positive episodes. Of the gram-positive Isolates 42.3% were either resistant or Intermediately susceptible to ciproxin compared to 16.7% of gram-negative Isolates. The high level of bacterial resistance to ciproxin and treatment failure rate were related to the previous exposure to fluoroquinolones. Inadequate trough peritoneal drug levels also accounted for the failures in the Ip but not the oral treatment group. We conclude that oral ciproxin is ineffective as a primary treatment of CAPD peritonitis in patients previously exposed to fluoroquinolones and that when administered Ip, a dose of 50 mg/L Instead of 25 mg/L of ciproxin should be used as maintenance In order to achieve adequate trough peritoneal drug levels.
Pharmacokinetics of Antifungal Agents
Authors: Fabris A. , Pellanda M. V. , Gardin C. , Contestabile A. , Bolzonella R.
Published: February 2020

The authors have evaluated the pharmacokinetics of four antifungal agents used in the therapy of fungal peritonitis. Amphotericin B (Amph B) poorly diffuses from blood into peritoneal fluid, which Intraperitoneal administration induces severe abdominal pain. 5-Fluorocytosine (5FC) easily crosses peritoneum, but resistance may appear when the drug is used alone. Ketoconazole (K) poorly penetrates into peritoneal fluid, while Fluconazole (F), used per os or intraperitoneally, shows a good antifungal activity both in serum and In the peritoneal fluid. In conclusion, from a pharmacokinetic point of view, all the antifungal agents examined, perhaps with the exception of F, do not offer, when used alone, sufficient guarantees In curing peritonitis. Therefore, for treating fungal infections in CAPD, drug combinations such as AmphB + 5FC, K + 5FC or 5FC + F have to be used.
Single-Dose Pharmacokinetics of Intraperitoneal Ofloxacin in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Gheng Ignatius Kum-Po , Ghau Pak-Yin , Kumana Gyrus R. , Ghan Ghing-Ying , Kou Maybelle , Siu Leung-Kei
Published: February 2020

The present study examines the pharmacokinetics of ofloxacin given In a single dose of 200 mg intraperitoneally (Ip) In the first bag of three 2-L 8-hour exchanges. Ofloxacin was measured using high-pressure liquid chromatography (HPLC) in the serum and peritoneal effiuent over 24 hours. Six patients without and 3 patients with peritonitis were studied. Ofloxacin given Ip was almost completely absorbed after an 8-hour dwell, and this was not affected by peritonitis. The time required to reach peak serum concentration was longer than that reported previously following oral administration. Elimination halflife (11/2) of ofloxacln was markedly prolonged compared to patients with normal renal function. Peritoneal clearance accounted for only one-tenth of total serum clearance. Peritonitis appeared to shorten the T112 of ofloxacln, but this was mainly due to an Increase In total serum clearance rather than a change In peritoneal clearance. Peritoneal drug concentration >0.5 mg/L was reached In the second and third exchange by the second hour. No Bide effects from Ip ofloxacin were observed. We concluded that ofloxacin given in a single dose of 200 mg is safe and provides adequate therapeutic serum and peritoneal concentration for more than 24 hours in patients on continuous ambulatory peritoneal dialysis (CAPD) with 8-hour exchanges.
Methods for Estimation of Peritoneal Dialysate Volume and Reabsorption Rate Using Macromolecular Markers
Authors: Waniewski Jacek , Heimbürger Olof , Park Min Sun , Werynski Andrzej , Lindholm Bengt
Published: February 2020

Reabsorption of fluid and solutes from the peritoneal cavity poses several problems for the correct estimation of peritoneal dialysate volume and ultrafiltration rate with macromolecular volume markers. Although physiological mechanisms of peritoneal reabsorption (direct lymphatic absorption vs reabsorption to the peritoneal tissue) are being currently discussed, many experimental and clinical studies have demonstrated that peritoneal reabsorption of the marker is mainly a bulk “backflow” out of the peritoneal cavity. Theoretical bases for the estimation of peritoneal dialysate volume and cumulative ultrafiltration of fluid including the correction for peritoneal reabsorption are reviewed. A widely applied simplified method which, however, neglects the impact of ultrafiltration on marker concentration is also discussed. The systematic errors involved in the application of the simplified method are usually less than 10% in the standard conditions; however, in specific cases they may be much higher. Therefore, the correct method is suggested for practical applications.
Insulin Therapy in Uremic Diabetic Patients on Continuous Ambulatory Peritoneal Diaysis; Comparison of Intraperitoneal and Subcutaneous Administration
Authors: Scarpioni Lino , Ballocchi Sergio , Castelli Aurelio , Scarpioni Roberto
Published: February 2020

Objective

To compare, in diabetic uremic patients on continuous ambulatory peritoneal dialysis (CAPD), the effects of two patterns of insulin administration, four times daily subcutaneous (SC) injections and intraperitoneal (IP) route, on blood glucose, insulin, lactate, beta-hydroxybutyrate and glycerol levels.

Patients and Methods

We examined 6 uremic insulin-dependent diabetic patients on CAPD. The two insulin regimens, SC and IP, were tested successively in randomized sequence in each patient. At the end of each treatment period we determined the 24-our profiles of blood glucose, free insulin, lactate, beta-hydroxybutyrate, and glycerol.

Results

Mean blood glucose over 24 hours (SC 7.21 ±0.61 mmol/L, IP 7.49±0.93 mmol/L), Schlichtkrull's M value, an index of glycemic control and stability (SC 10±3, IP 10±5), and the blood intermediate metabolites beta-hydroxybutyrate, lactate, and glycerol were similar in both groups. Mean serum free insulin was significantly higher during subcutaneous treatment (SC 257. 4±127.2 pmol/L, IP 170.4±83.4 pmol/L, p < 0.001). Insulin requirements were 2.5 times greater for the intraperitoneal route (SC 51 ±4 U/24 hours, IP 130±43 U/24 hours).

Conclusions

In uremic diabetic patients on CAPD, good glycemic control may be achieved either with subcutaneous intensive insulin therapy or with intraperitoneal insulin administration. The latter method allows reduction of circulating free insulin levels, but requires a higher dose of insulin per day.
Cancer Antigen 1251S Locally Produced in the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis
Authors: Koomen Ger C.M. , Betjes Michiel G.H. , Zemel Oésirée , Krediet Raymond T. , Hoek Frans J.
Published: February 2020

The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10 23), dialysate CA 125 18 U/mL (range 5.2 76), dialysate/plasma ratio 1. 9 (range 0.61 -5.4), and number of mesothelial cells 400/mL (range 10 5000). Peritoneal concentrations of mesothelial cellsand CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/1 06 cells could be calculated.

It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.
In Vitro Study of the Effect of Osmotic Solutes on the Interactions between Cells from the Peritoneum and Peritoneal Cavity
Authors: Breborowicz Andrzej , Balaskas Elias , Oreopoulos George D. , Martis Leo , Serkes Kenneth , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To study how the presence of osmotic solutes in medium affects growth of the peritoneal mesothelial cells and fibroblasts and how osmotic solutes influence the production of factors regulating growth of these cells.

Design

The proliferation of mesothelial cells and fibroblasts was evaluated by measuring the incorporation of 3H-thymidine into the cells. Cells were exposed to osmotic solutes; the concentration of the latter in the medium was continuously lowered over the time of the experiment to simulate changes of their concentration in the dialysate. The synthesis of factors influencing the proliferation of the mesothelial cells or fibroblasts, by mesothelial cells or fibroblasts themselves, or by peritoneal leukocytes, was tested by the characteristics of the “conditioned” medium. The conditioned medium was produced by exposing standard medium to mesothelial or fibroblasts monolayer or to peritoneal leukocytes over 24 hours; following filtration it was applied to growing test cells for the study of growth factors.

Results

The effect of osmotic solutes on the growth of mesothelial cells is less inhibitory when their concentration is gradually lowered over the time of the study, compared to previous findings with a constant concentration. Peritoneal leukocytes produce growth factors for mesothelial cells and fibroblasts. Glucose and amino acids inhibit production of peritonealleukocyte-derived growth factors for mesothelial cells, while glycerol increases synthesis of such growth factors for fibroblasts. Mesothelial cells produce factors stimulating the proliferation of mesothelial cells and fibroblasts. In the presence of glycerol or amino acids synthesis of mesothelium derived growth factors for fibroblasts is augmented. Finally, fibroblasts produce factors that inhibit the proliferation of the mesothelial cells, and this effect is potentiated in the presence of amino acids.

Conclusions

Cytotoxicity of the osmotic solutes measured by the inhibition of growth of the mesothelial cells or their increased damage is significantly reduced during in vitro kinetic study when the concentration of these solutes is gradually lowered. Presence of osmotic solutes in the medium affects synthesis of growth factors derived from mesothelium, fibroblasts, or peritoneal leukocytes, which affect the proliferation of mesothelial cells or fibroblasts.
Anabolic Steroids in the Treatment of Malnourished Capd Patients: A Retrospective Study
Authors: Dombros Nicholas V. , Digenis George E. , Soliman Gamal , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To assess the effect of anabolic steroids on malnutrition of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design

Retrospective analysis of medical records, charts, and computer-generated laboratory and medication data.

Setting

Peritoneal Dialysis Unit of The Toronto Hospital.

Patients

Thirteen patients with moderate to severe malnutrition who had received nandrolone decanoate (ND) intramuscularly (IM) for at least three months. Nine of these patients (group A), with a mean age of 59.4 years, received only ND (100 -200 mg IM monthly). Group B consisted of 4 patients (mean age 74.0 years) who, in addition to ND, received intraperitoneal (IP) amino acids.

Results

In group A, serum albumin, while declining before ND treatment (34.4±3.2 to 31.5±3.35, x±SEM, g/L at -2 and 0 months), showed a progressive and significant (p < 0.001) increase during treatment, sustained up to the third month (36.57±1.51). In group B, serum albumin did not increase significantly (30.25±2.62, 30.75±1.9, and 31.5±4.8, x±SEM, g/L at -2, 0, and +3 months, respectively. In group A, serum creatinine was increased significantly (p < 0.01) from 0 to +3 months (731±185 to 938±92.5 mmol/L). Blood urea, bicarbonate, and total protein levels did not change significantly. In group B, serum creatinine fluctuated considerably with an insignificant trend to rise. Blood urea showed a steady trend to increase without reaching statistical significance. In relation to time 0, bicarbonate levels (28.7±3.3) were decreased significantly (p < 0.05) (27±0.8, 24.6±1.5, and 25±1 mEq/L, at + 1, +2, and +3 months, respectively).

Conclusions

Nandrolone decanoate alone, in relatively low doses, exerted a definite anabolic effect in 9 malnourished CAPD patients. The lack of a similar effect in 4 patients, who in addition to ND received amino acids IP, could be explained by the low dose of ND, the concurrent acidosis, the severity of malnutrition, and the older age of this group.
Synthesis of Phospholipids by Human Peritoneal Mesothelial Cells
Authors: Beavis Janine , Harwood John L. , Coles Gerald A. , Williams John D.
Published: February 2020

Objective

To assess the capacity of cultured human peritoneal mesothelial cells to synthesize choline-containing phospholipids. The study compares the phospholipids secreted from cultured cells with those which we, and others, have identified in the dialysate of patients treated by continuous ambulatory peritoneal dialysis (CAPD).

Patients

CAPD effluent was collected from 8 patients who had been receiving CAPD treatment for at least 11 months and who had normal ultrafiltration.

Cell Cultures

Using human omental tissue, homogeneous cultures of mesothelial cells were established.

Methods

Synthesis of phospholipids by mesothelial cells was assessed following incubation with [methyl14C] choline chloride-a precursor capable of being in corporated into phosphatidylcholine (PtdCho) and sphingomyelin. Lipids from CAPD effluent, cultured cells, and cell medium were extracted in chloroform/methanol. Phospholipids were separated and identified by thin layer chromatography. Synthesis and secretion of PtdCho and other choline-containing lipids by the mesothelial cells were determined by β scintillation counting of the appropriate bands, while the fatty acid composition of the phospholipids was ascertained by gas liquid chromatography.

Results

Synthesis and secretion of PtdCho by mesothelial cells were observed during a 96-hour period. When maintained in medium replete with essential fatty acids, the fatty acid composition of the PtdCho synthesized by cultured mesothelial cells closely resembled that isolated from the peritoneal cavity.

Conclusion

The demonstration of phospholipid secretion from mesothelial cells, with a fatty acid composition similar to the phospholipids isolated from peritoneal dialysate, lends added support to the hypothesis that the mesothelial cells are the source of the peritoneal phospholipids. As such they offer a useful experimental system in which to study peritoneal phospholipid synthesis.
Volume of Distribution and Fractional Clearance of Urea in Amputees on Continuous Ambulatory Peritoneal Dialysis
Authors: Tzamaloukas Antonios H. , Saddler Mark S. , Murphy Gayle , Morgan Kelley , Goldman Richard S. , Murata Glen H. , Malhotra Deepak
Published: February 2020

Objectives

To demonstrate the effects of amputation on the estimates of urea volume of distribution (V) and KTN urea in continuous ambulatory peritoneal dialysis (CAPD) patients and to present a method for correcting the errors created by the uncorrected anthropometric formulas estimating V.

Design

(1) A mathematical analysis of the error and the correction proposed was performed. (2) Urea kinetic modeling with uncorrected and corrected estimates utilizing both the Watson and the Hume anthropometric formulas was performed in amputees on CAPD.

Setting

Subjects were recruited from four dialysis units in one city: one Veterans Affairs unit, one university-affiliated unit, and two community units.

Patients

Fourteen amputees on CAPD: 12 with unilateralleg amputation and 2 with bilateral leg amputation, at the same length of the leg, were studied.

Interventions

Urea kinetic studies were performed in 24-hour drained dialysate and urine specimens.

Main Outcome Measures

Uncorrected and corrected estimates of V and KTN urea were compared to each other and to the predictions of the mathematical model. Body weights corresponding to uncorrected and correct ed V estimates were compared to the actual body weights.

Results

(1) The mathematical model predicts that uncorrected estimates by the anthropometric formulas will falsely characterize unilateral amputees as leaner than they are and bilateral amputees as more obese than they are. (2) In unilateral amputees studied with the Watson formulas, uncorrected V was 0.546±0.023 L/kg and corrected V was 0.520±0.023 L/kg (p < 0.001). Corresponding weekly KTN urea values were 1.97±0.14 and 2.07±0.14, respectively (p < 0.001). Similar results were obtained with the Humeformulas. In bilateral leg amputees studied with the Watson formulas, uncorrected V was 0.479±0.022 L/kg and corrected V was 0.514±0.023 L/kg. Corresponding KT N estimates were 2.11 ±0.45 and 1.96±0. 14, respectively. The differences were even greater with the Hume formulas. Estimates of body weight calculated from corrected V values were equal to actual weight measurements, whereas those calculated from uncorrected V values were lower than actual body weight measurements in unilateral amputees, and much higher than actual body weight measurements in bilateral amputees.

Conclusion

Uncorrected anthropometric estimates falsely characterize unilateral amputees as leaner than they actually are and bilateral amputees, amputated at the same leg length, as more obese than they actually are. Uncorrected KTN estimates are, therefore, falsely low in unilateral amputees, and falsely high in bilateral amputees. The proposed correction of the anthropometric formulas provides estimates agreeing closely with dietary estimates of body composition. Further studies are needed to define the accuracy of the corrected formulas.
Anabolic Steroids and Malnutrition in Chronic Renal Failure
Authors: Soliman Gamal , Oreopoulos Dimitrios G.
Published: February 2020

Objective

To determine whether anabolic steroids are useful in the management of the malnutrition of chronic renal failure.

Data Source

Original research studies and book chapters about anabolic steroids and their use in uremia and various illnesses associated with malnutrition. We included studies that describe the benefits of anabotic steroids in the treatment of anemia and sexual dysfunction of chronic renal failure. Forty-two such studies were published between 1942 and 1992.

Results

Anabolic steroids improve the nutritional status and sexual dysfunction of uremic men. In addition, anabolic steroids have a recognized place in the treatment of the anemia of chronic renal failure.

Conclusions

Based on the findings of noncontrolled studies, one may conclude that anabolic steroids exert a beneficial effect in the malnutrition of renal failure. We believe that their efficacy should be established by controlled studies.
Bicarbona Te-Based Dialysis Solution Preserves Granulocyte Functions
Authors: Dobos Gustav J. , Böhler Joachim , Kuhlmann Jens , Elsner Jörn , Andre Martin , Passlick-Deetjen Jutta , Schollmeyer Peter J.
Published: February 2020

Objective

Intraperitoneal phagocytes play an important role in local defense in preventing continuous ambulatory peritoneal dialysis (CAPD) peritonitis. This study therefore investigates the effect of the conventional lactate-based dialysis solution-pH 5.2 (LBDS-pH 5.2) and a bicarbonate-based dialysis solution (BBDS) on various cell functions.

Design

We studied C5a-induced actin polymerization (AP) as a measure of the cytoskeletal alteration, phagocytosis of zymosan particles, and chemotaxis in neutrophils incubated in either LBDS-pH 5.2, LBDS-pH 7.4, or BBDS-pH 7.4, comparing the data with cells treated with phosphate-buffered saline-pH 7.4 (PBS-pH 7.4) as a control.

Subjects

Polymorphonuclear neutrophils (PMNs) were isolated from the blood of healthy donors and incubated with dialysis solution prior to the experiment.

Results

C5a-induced AP was dramatically inhibited in PMNs incubated in LBDS-pH 5.2, paralleled by a complete inhibition of phagocytosis and C5a-induced chemotaxis. In comparison, BBDS improved AP to values above the control and also nearly normalized phagocytosis. Chemotaxis markedly improved in cells treated with the low glucose-containing BBDS (Bic 20), but was still inhibited in PMNs incubated in the BBDS containing high glucose concentrations (Bic 30).

Conclusion

In comparison with conventional lactate-based dialysis solution-pH 5.2, bicarbonate-based dialysis solution at low osmolality better preserves neutrophil functions that involve the cytoskeleton.
Hormonal, Blood Pressure, and Peritoneal Transport Response to Short -Term Ace Inhibition
Authors: Ripley Elizabeth B.D. , Gehr Todd W.B. , Kish Charles W. , Sica Domenic A.
Published: February 2020

Objectives

To evaluate the hormonal, blood pressure, and peritoneal transport effects of intraperitoneal enalaprilat and oral enalapril.

Design

A nonrandomized, nonblinded, prospective clinical trial was performed.

Setting

The study was conducted at the Clinical Research Unit at the Medical College of Virginia, a tertiary care center.

Patients

Six continuous ambulatory peritoneal dialysis (CAPD) patients with hypertension were enrolled in the study. All 6 patients received intraperitoneal enalaprilat. Five of the patients also received oral enalapril.

Interventions

Hormonal, clinical, and transport parameters were investigated in patients given intraperitoneal enalaprilat and oral enalapril. Standardized 2-L exchanges were performed during a control period, following 2.5 mg intraperitoneal enalaprilat and after a week of oral enalapril. Inulin, blood urea nitrogen (BUN) and creatinine clearances, and glucose absorption were determined during these exchanges.

Results

After intraperitoneal enalaprilat, both systolic and diastolic blood pressure significantly declined, reaching maximal decreases of -21.7±14.2% at 95±92 minutes, and of -23.3±15.4% at 105±105 minutes, respectively. Plasma angiotensin converting enzyme (ACE) activity was suppressed below detectable limits at four hours following intraperitoneal enalaprilat, and remained suppressed throughout all sampling time points following oral enalapril treatment. There was no significant change in drain volumes, glucose absorption, or BUN, creatinine, or inulin clearances, whether enalaprilat was administered intraperitoneally or enalapril orally.

Conclusion

This study demonstrates that intraperitoneal administration of enalaprilat is a rapidly effective route of administration of this ACE inhibitor. There were no changes in peritoneal transport characteristics demonstrated.
Case Forum
Authors: Twardowski Zbylut J. , Schreiber Martin J. , Burkart John M. , Dobbie James W. , Krediet Raymond T. , Twardowski Zbylut J. , Nichols W. Kirt
Published: February 2020

A 39-Year -Old Man with Loss of Ultrafiltration
The Concept of Adequacy in Peritoneal Dialysis
Authors: Ronco Claudio , Conz Piero , Agostini Francesco , Bosch Juan P. , Lew Susy A. , La Greca Giuseppe
Published: February 2020

The aim of renal replacement therapy is to obtain blood purification from metabolic waste products sufficient to achieve patient rehabilitation, the control of dry body weight, and the correction of acid base and electrolyte imbalances (1–3).

Among these, the correction of the hormonal imbalances as a result of renal disease would also be required (4). However, this is difficult to achieve, and the majority of substitute therapies such as hemodialysis and peritoneal dialysis focus on blood purification and fluid and electrolyte homeostasis.

For this reason the search for the optimal dialytic therapy has been limited to the possibility of achieving a treatment that could at least be adequate in terms of blood purification and patient rehabilitation. Therefore, dialysis adequacy has been selected as a term to indicate successful renal replacement therapy, one that could overcome most of the uremic symptoms and allow the patient to reach a sufficient degree of rehabilitation, even though the treatment is far from the complete and optimal substitution of the lost kidney function in its whole.

In recent years the concept of dialysis adequacy has been studied by several authors, and a continuous evolution of this concept has been observed. From the original description of the square-meter-hour hypothesis of Babb and Scribner in 1971 (5), a series of new studies led to the clinical application of various indices devoted to describing the level of efficiency achieved by dialysis treatment (6,7). Finally, after the American National Cooperative Dialysis Study was analyzed, and the KTN index was selected as a marker for dialysis adequacy, the majority of authors now rely on this index and are proposing various formulas for its calculation (8–11).
Predicted and Measured Daily Creatinine Production in CAPD: Identifying Noncompliance
Authors: Nolph Karl D. , Twardowski Zbylut J. , Khanna Ramesh , Moore Harold L. , Prowant Barbara F.
Published: February 2020

Objective

To evaluate the ratio of measured creatinine (Cr) production to predicted creatinine production as an index of noncompliance in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design

A cross-sectional analysis.

Patients

One hundred and twenty-one patients on CAPD.

Measurements

We have calculated Cr production from measured Cr outputs in 24-hour collections of urine and dialysate. Predicted Cr productions were calculated from standard tables. Weekly KTN urea and weekly Cr clearances were determined from the same 24-hour urine and dialysate collections. Lean body mass (LBM) was calculated from the Cr production. Serum albumin concentration was measured.

Results

The ratio of measured/predicted Cr production correlated positively and significantly with weekly KTN urea, the protein equivalent of nitrogen appearance (PNA), weekly Cr clearance, and LBM. There was a decline in serum albumin concentration at ratios greater than 1.24, supporting the opinions of previous authors who have suggested that ratios greater than 1.24 are highly suggestive of noncompliance with the dialysis prescription. Defining noncompliance as a ratio greater than 1.24 implied that at least 5% of the female and 17% of the male patients were noncompliant.

Conclusions

Declining serum albumin concentrations at higher ratios of measured/predicted Cr production support the opinion that this is an index of noncompliance. However, not all noncompliant patients necessarily have a ratio greater than 1.24. Weekly KTN urea, weekly Ccr and LBM are all artifactually increased by “washout effects” if all exchanges are done only or mainly on the collection day.
Development of Toxic Degradation Products during Heat Sterilization of Glucose-Containing Fluids for Peritoneal Dialysis: Influence of Time and Temperature
Authors: Kjellstrand Per , Martinson Evi , Wieslander Anders , Holmquist Björn
Published: February 2020

Objective

Fluids for peritoneal dialysis (PD) cause cytotoxic reactions in many different in vitro systems. The low pH, the high osmolality of the fluids, and the glucose degradation products formed during heat sterilization have been considered responsible. In the present study, we investigate the influence of temperature and time during heat sterilization of PD fluids and glucose solutions on glucose degradation and cytotoxicity of the solutions.

Design

Ampoules containing PD-fluid or glucose solution were heated in an oil bath to predetermined F o values (combinations of time and temperature giving equal energy/bacteriallethality). Cytotoxicity of the solutions was measured as groWth inhibition of cultured L-929 fibroblasts. Glucose degradation was measured as UV absorbance at 228 and 284 nm.

Results

The same general pattern was seen in both PD fluid and glucose solution. Cytotoxicity decreased from 90% to 15% when the sterilization temperature was increased from 115° to 140°C and concomitantly the length of time shortened in order to maintain equal bacteriallethality. Under the same conditions, degradation products, measured as UV absorbance at 284 nm, decreased from 0.2 to 0.02.

Conclusion

To minimizethe development of cytotoxic breakdown products, high temperatures over short periods of time should be used to heat-sterilize PD fluids. Even as small an increase as 5°C at around 120°C will improve the quality of the solutions.
Successful Self-Care Home Dialysis in the Elderly: A Single Center's Experience
Authors: McDonald Maree , McPhee Patricia D. , Walker Robert J.
Published: February 2020

Objective

This study was designed to prospectively review our experience with self-care home dialysis in the 60-years-and-older age group since the commencement of continuous ambulatory peritoneal dialysis (CAPD) in our center in 1989.

Design

Data on mortality, morbidity, dialysis technique and complications, quality of life, and rehabilitation were collected prospectively.

Setting

A regional dialysis unit providing full renal replacement services for a population of 292 000.

Patients

Twenty-five patients (16 male) with an average age of 64.4 years (range: 58.25-76.5 years) at commencement of dialysis.

Results

All patients were on self-care home dialysis. Patient survival rates were comparable with the national average at 12 months (90% vs 89%) and two years (84% vs 80%). Dialysis therapy was well tolerated and technique survival rates were comparable for both hemodialysis and CAPD. There was a very low peritonitis rate of 1 episode per 28.5 patient-months.

Conclusions

Self-care home dialysis is a viable therapeutic option with a high degree of technique success and a good quality of life in the older population.