bluuebunny/crossref_metadata_2025 huggingface dataset:
Update on Mechanisms of Ultrafiltration Failure
Authors: Kim Yong-Lim
Published: February 2020

Ultrafiltration failure (UFF) continues to be a major complication of peritoneal dialysis (PD), particularly long-term PD. Continuous exposure to bioincompatible PD solutions causes inflammation of the peritoneal membrane, which progressively undergoes fibrosis and angiogenesis and, ultimately, UFF. There is emerging evidence that epithelial–mesenchymal transition (EMT) of peritoneal mesothelial cells (MCs) may play an important role in the failure of peritoneal membrane function. Submesothelial myofibroblasts originating from MCs through EMT and from activated resident fibroblasts participate in inflammatory responses, extracellular matrix accumulation, and angiogenesis. High glucose and glucose degradation products from PD solutions are responsible for production of transforming growth factor β (TGFβ) and vascular endothelial growth factor (VEGF) by MCs, which induce EMT. Leptin and receptor for advanced glycation end-products (AGEs) augment myofibroblastic conversion through the TGFβ signaling system.

A reduction in osmotic conductance in addition to increased solute transport causes UFF. This situation may be caused by loss of aquaporin (AQP) function and formation of the submesothelial fibrotic layer. During PD, AQP1 plays an essential role in water permeability and ultrafiltration (UF), modulating processes such as endothelial permeability and angiogenesis. During a hypertonic dwell, AQP1 mediates 50% of UF. Insufficient AQP1 function may be causative for inadequate UFF. A significant amount of evidence from animal studies now exists to show that mast cells communicate with fibroblasts and are implicated in fibrogenesis, angiogenesis, and UFF. However, it is not confirmed in human studies that mast cells contribute to the fibrosis seen in the peritoneum of PD patients.

The patterns of UFF in PD patients depend on duration of treatment. Inherently high small-solute transport status is associated with hypoalbuminemia and a greater comorbidity index. However, most of the variability in peritoneal transport remains unexplained, pointing to the potential role of genetic factors. Gene polymorphisms associated with peritoneal membrane transport have been identified. Recent studies have shown that VEGF, interleukin-6, endothelial NO synthase, AGE receptor, and RAS gene polymorphisms are associated with transport properties in PD patients. Current insights into the mechanisms of UFF will provide rationales for new therapeutic strategies.
Definition of Metabolic Syndrome in Peritoneal Dialysis
Authors: Park Sun-Hee , Lindholm Bengt
Published: February 2020

Metabolic syndrome (MetS) is defined as a cluster of risk factors for type 2 diabetes and cardiovascular disease; it is also an independent risk factor for developing chronic kidney disease (CKD) in the general population. Therefore, CKD has many similarities and associations with MetS, and the individual risk factors constituting MetS—especially insulin resistance and glucose intolerance, hypertension, dyslipidemia, and obesity—are also common features of the early stages of CKD. In the later stages of CKD, uremia per se and uremic complications such as fluid retention, protein–energy wasting, inflammation, and oxidative stress further contribute to an increase in the prevalence of MetS in CKD patients. In addition, PD patients exposed to glucose-based PD fluids have an increased risk of developing metabolic complications. The broad use of MetS in clinical research has raised the awareness of the public and of individual patients concerning the value of lifestyle interventions. However, the definition and pathogenesis of MetS are still debated, and no standardized definition nor proven prognostic value has been established for MetS as a cluster of risk factors for diabetes or cardiovascular disease in PD patients. Furthermore, considering the paradoxical associations of some of the risk factors in MetS with decreased mortality, another set of risk factors—those specific to patients with uremia (for example, inflammation and malnutrition)—and the appropriate cut-off levels to individual MetS risk factors should be taken account at the same time. Also, the benefit of interventions targeting these risk factors should be clarified in further clinical studies.
Assessment and Monitoring of Nutrition Status in Pediatric Peritoneal Dialysis Patients
Authors: Edefonti Alberto , Mastrangelo Antonio , Paglialonga Fabio
Published: February 2020

Abnormalities of nutrition status are a common problem in children on peritoneal dialysis (PD) and a source of significant morbidity and mortality. The state of decreased body protein mass and fuel reserves (body protein and fat mass) common in PD patients is now better known as protein–energy wasting (PEW).

Protein–energy wasting is a slow, progressive process in chronic kidney disease. The correct approach to this problem includes measurement of early, intermediate, and late markers of PEW, and consideration of the risk factors specific to the patient and to PD.

The earliest markers of PEW are associated with some symptoms observed clinically: a decrease in dietary intake and an increase in inflammatory markers. The second stage in the development of PEW (patients with established PEW) is characterized by abnormalities in numerous markers: bioimpedance analysis (BIA) and anthropometric indices, other indices of body mass and composition, biochemical parameters, and indices of protein, glucose, and lipid metabolism. When PEW is established, clear clinical signs become evident: patients in this stage are characterized by high rates of hospitalization and an increased risk for morbidity and mortality as compared with patients without cachexia.

Risk factors for PEW can already be present in an apparently well-nourished child who initiates PD: glucose absorption from PD fluid, abdominal distension from PD volume, gastroesophageal reflux, and even more importantly, inadequate dialysis dose in relation to decline in residual renal function.

Given the complexity of the pathogenesis and clinical picture of PEW, no single measure, but rather panels of nutritional measures are necessary to diagnose the condition. Combined nutrition scores such as the anthropometry–BIA nutrition score may add value to the monitoring of nutrition status in children on PD.
Karl D. Nolph State of the Art Lecture: Feasible and Future Options for Salvation of the Peritoneal Membrane
Authors: Krediet Raymond T. , Coester Annemieke M. , Kolesnyk Inna , de Graaff Marijke , Zweers Machteld M. , Smit Watske , Struijk Dirk G.
Published: February 2020

A review is given of the various available strategies that can be used to protect the peritoneal membrane. A discussion of experimental studies on approaches that are still experimental, but that might be applied in patients in the future, follows. The currently available approaches include dietary sodium restriction, use of high-dose loop diuretics and of inhibitors of the renin–angiotensin system. All should preferably be combined with a dialysis prescription aimed at reducing the patient's exposure to glucose and its degradation products. The experimental studies indicate favorable effects of combining osmotic agents, together with drugs that interfere with the polyol pathway and the formation of advanced glycosylation end-products.
Can N-Acetylcysteine Preserve Peritoneal Function and Morphology in Encapsulating Peritoneal Sclerosis?
Authors: Bozkurt Devrim , Hur Ender , Ulkuden Burcu , Sezak Murat , Nar Hasim , Purclutepe Ozlem , Sen Sait , Duman Soner
Published: February 2020

Long-term use of the peritoneum as a dialysis membrane results in progressive irreversible dysfunction, described as peritoneal fibrosis. Oxidative stress during peritoneal dialysis has been established in many studies. Generation of reactive oxygen species (ROS) by conventional peritoneal dialysis solutions, regardless of whether produced by high glucose, angiotensin II, or glucose degradation products may be responsible for progressive membrane dysfunction.

The well-known antioxidant molecule N-acetylcysteine (NAC) is capable of direct scavenging of ROS. The aim of the present study was to investigate the effect of NAC therapy on both progression and regression of encapsulating peritoneal sclerosis (EPS).

We divided 49 nonuremic Wistar albino rats into four groups: Control group—2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for a total of 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal resting (weeks 4 – 6); NAC-R group—CG (weeks 1 – 3), plus 2 g/L NAC (weeks 4 – 6).

At the end of the experiment, all rats underwent a 1-hour peritoneal equilibration test with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio (D/P) urea, dialysate white blood cell count (per cubic milliliter), ultrafiltration (UF) volume, and morphology changes of parietal peritoneum were examined.

The CG group progressed to encapsulating peritoneal sclerosis, characterized by loss of UF, increased peritoneal thickness, inflammation, and ultimately, development of fibrosis. Resting produced advantages only in dialysate cell count; with regard to vascularity and dialysate cell count, NAC was more effective than was peritoneal rest. Interestingly, we observed no beneficial effects of NAC on fibrosis. That finding may be a result of our experimental severe peritoneal injury model. However, decreased inflammation and vascularity with NAC therapy were promising results in regard to membrane protection.
Policies and Health Care Financing Issues for Dialysis in Latin America: Extracts from the Roundtable Discussion on the Economics of Dialysis and Chronic Kidney Disease
Authors: Pecoits–Filho Roberto , Campos Camilo , Cerdas–Calderon Manuel , Fortes Paulo , Jarpa Cecilia , Just Paul , Luconi Paulo , Lugon Jocemir R. , Pacheco Alejandro , Paniagua Ramon , Rodriguez Konniev , Sanabria Mauricio , Sciaraffia Vito , Velasco Carlos , Arteaga Javier De
Published: February 2020

During the 2008 Congress of the International Society for Peritoneal Dialysis, academic nephrologists, nephrology societies, and government officials from Colombia, Brazil, Argentina, Chile, Central America, Ecuador, and Mexico participated in a roundtable discussion on the Economics of Dialysis and Chronic Kidney Disease in Latin America. The main focus was policy and health care financing. The roundtable promoted open discussion between policymakers and clinicians on how to find viable solutions to contain spending on treatment for end-stage renal disease into the future. A number of options were proposed, including early medical intervention (disease management programs) to slow the progression of chronic kidney disease in high-risk patients, promotion of pre-emptive renal transplantation, and use of the most cost-effective dialysis therapy that can be offered to a patient without compromising outcome. It was concluded that the burden of treating more patients in the future could be alleviated by wider utilization of peritoneal dialysis (PD). However, important changes in health care reimbursement systems and realignment of incentives in the region are required to support wider PD penetration.
Dialysis Trends in Toronto (1976-1979)
Authors: Fenton S.S.A. , Deveber G.A. , Goldstein M.B. , Johnson M.D. , Manuel M.A. , Oreopoulos D.G. , Saiphoo C.S. , Uldall P.R. , Williams C.C. , Wilson D.R.
Published: February 2020

We have described the extensive use of peritoneal dialysis in Toronto, a city where in 1976, before the advent of CAPD, 44.3% of ESRD patients were maintained on intermittent peritoneal dialysis. The introduction of CAPD has increased to 56.2% the proportion of patients maintained on peritoneal dialysis as of December 31, 1979. It remains to be seen if this trend will be repeated in other countries.
Nutritional Management of the CAPO Patient
Authors: Blumenkrantz Michael J. , Schmidt R. William
Published: February 2020

Malnutrition and wasting are common in patients undergoing maintenance dialysis. These problems may be more prevalent in patients undergoing peritoneal dialysis due to inadequate dialysis, poor protein intake, loss of nutrients in dialysate and tissue breakdown associated with intercurrent illnesses, particularly peritonitis. Periodic assessment of the nutritional status of these patients should be used as a guide to appropriate nutritional therapy. Protein and aminoacid loss <h1ring CAPD average only 8.0 and 3.0 g/day, respectively; with peritonitis, losses increase. Balance studies indicate that in a well-nourished patient 1.2 g protein/kg body weight is probably adequate; a malnourished patient should receive 1.4 –1.6 g/kg. Sufficient dialysis must be prescribed to enable ingestion of this diet; residual renal function makes a significant contribution to to∼al clearance. With CAPD, energy intake is supplemented by large amounts of glucose absorption; this is beneficial except for the obese or hyperlipoproteinemic patient. Nutritional support of the patient with intercurrent illness is crucial; nutrition administered via peripheral vein may be beneficial. Management of the nutritional needs of the diabetic presents additional problems which often test the skills of the clinician.
Hemodynamic Effects of Increasing Intraabdominal Pressure in Peritoneal Dialysis
Authors: Gotloib Lazaro , Mines Miguel , Garmizo Leon , Varka Izjak
Published: February 2020

Intra-abdominal pressure, cardiac out put, stroke volume, mean arterial blood pressure and total peripheral resistance were determined in 17 patients on peritoneal dialysis.

A significant positive correlation was found between exchange volume and intra-abdominal pressure. Also, we demonstrated significant decreases in cardiac output and stroke volume, in spite of higher heart rate, even with small exchange volumes rangin g between I S mi/kg and 26 mi/kg of body weight. Mean arterial blood pressure increased because of significant increase in peripheral resistance.

Peritoneal dialysis with intra-abdominal pressures up to S cm of water (I S -26 mi/kg BW) is relatively free of serious hemodynamic side effects.
The Incidence and Characteristics of Peritonitis in the Fourth Year of a Continuous Ambulatory Peritoneal Dialysis Program
Authors: Nolph Karl D. , Prowant Barbara , Sorkin Michael I. , Gloor Hans
Published: February 2020

This paper reports the frequency and characteristics of peritonitis and exit-tunnel infections in the fourth year of a continuous ambulatory peritoneal dialysis program. These findings are compared to results obtained in the first two years using bottled solutions and to third-year results using solutions in plastic bags similar to those used in the fourth year. There is a significant progressive decrease in the frequency of peritonitis. The few infections in the fourth year are more likely to be associated with tunnel infections or gastrointestinal disease requiring hospitalization. As simple contaminations decrease, other causes of infection assume greater importance in the remaining episodes.
The Value of Dialysate Cell Count in the Diagnosis of Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Williams Paul , Pantalony Dominic , Vas Stephen I. , Khanna Ramesh , Oreopoulos Dimitrios G.
Published: February 2020

Dialysate white-cell count and differential was performed by a Cytospin technique in 38 control CAPD patients and serially in 24 patients with bacterial peritonitis and one patient with “peritoneal fluid eosinophilia”. Dialysate solutions of control patients have cell counts below 501 mm3, comprised mainly of mononuclear cells; these presumably repre
Reduction of Vital Capacity Due to Increased Intra-Abdominal Pressure during Peritoneal Dialysis
Authors: Gotloib Lazaro , Garmizo Leon , Varak Itzjak , Mines Miguel
Published: February 2020

While they were in the semirecumbent (45°) position, vital capacity and intra-abdominal pressure were measured in four patients on intermittent peritoneal dialysis, using various exchange volumes. Intra-abdominal pressure showed a significant (p < 0.01) negative correlation with vital capacity. The latter decreased up to 62% of the basal value with intra-abdominal pressures higher than 7 cm of water.
Treatment of Acute Pancreatitis with Peritoneal Dialysis
Authors: Glenn Luther D. , Nolph Karl D.
Published: February 2020

A patient with acute pancreatitis was treated with peritoneal dialysis and had rapid improvement. At frequent intervals during the dialysis, samples of the patient's blood, urine, and peritoneal fluid were assayed for amylase and lipase. Calculated renal and peritoneal dialysis clearances of these enzymes showed that amylase clearance by the kidney was better than that by peritoneal dialysis; lipase, on the other hand, was more efficiently removed by peritoneal dialysis than by the kidney. A review of the literature on the use of peritoneal dialysis in the treatment of acute pancreatitis is followed by an hypothesis concerning why peritoneal dialysis is so effective in reversing the course of acute pancreatitis.
Experimental Routes of Insulin Administration
Authors: Zingg Walter , Shirriff Jennifer M. , Leibel B.S.
Published: February 2020

Bolus injections of insulin in rats have confirmed that insulin is absorbed rapidly from the peritoneal cavity. Details concerning the routes of absorption are still not clear, particularly in view of differences observed between anesthetized and unanesthetized rats. The absorption of insulin through the capsule of the liver has been demonstrated experimentally. The intraperitoneal route is useful for insulin administration, but more work is needed to establish its relative effectiveness and safety in comparison with other routes of administration.
Practices of Insulin Administration in CAPD
Authors: Roscoe Janet M.
Published: February 2020

A review of protocols for the administration of insulin in diabetics during CAPD in the various Toronto hospitals and from two other centers outside Canada show that they are similar but not identical. Toronto Western Hospital, Iowa Lutheran Hospital, Pitie-Salpetriere Hospital and Sunnybrook Medical Center use intraperitoneal insulin exclusively. Toronto General Hospital and the Wellesley Hospital used a combination of intraperitoneal and subcutaneous insulin. Most patients performed four exchanges daily, although some did three only. Nighttime insulin was reduced in most patients. Average insulin requirements were higher when given by intraperitoneal as opposed to subcutaneous injection. There was insufficient data to compare the control achieved with each protocol.
Phychiatric Aspects of Diabetics on CAPD
Authors: Demarco Vince
Published: February 2020

Frequently diabetic patients with ESRD have a wide spectrum of complications in many systems, In addition, many psychological problems are woven into this complex of medical problems. This paper has illustrated one approach to disentangling some of these psychological and psychiatric disturbances. The author believes that a detailed compliance history and an analysis of the mental state will enable the physician to tailor his management to the patient's needs and to intervene in a practical manner.
Pregnancy in a Continuous Ambulatory Peritoneal Dialysis Patient
Authors: Cattran Dan C. , Benzie Ron J.
Published: February 2020

We report a case of a woman who became pregnant after two years on CAPD and with minor modifications of her dialysis technique and transfusions, carried the pregnancy to the stage of potential viability, 30 weeks. Suggested improvements in management are outlined.
Life Threatening Hyperkalemia Associated with Clofibrate-Induced Myopathy in a CAPD Patient
Authors: Demedts Walter , Desager Jean Pierre , Belpaire Frans , Ringoir Severin , Lameire Norbert
Published: February 2020

A man being treated with CAPD developed severe hyperkalemia associated with clofibrate-induced rhabdomyolysis. A total intake of 9.5 9 of clofibrate was complicated by a 100fold increase of CPK, a dramatic increase in muscular enzymes and a life-threatening serum K level of 7.9 mEq/l. Despite a significant peritoneal elimination of clofibrate, this man exhibited a supranormal serum level of free drug.
18 Months Experience with a New (valli) Catheter for Peritoneal Dialysis
Authors: Valli Alberto , Crescimanno Ugo , Midiri Osario , Arw Khaled , Riegler Peter , Huber Walter , Cabassa Nino
Published: February 2020

The authors describe their experiences with a new type of peritoneal catheter in 45 patients with end-stage renal disease treated with intermittent (IPD) or continuous ambulatory peritoneal dialysis (CAPD) over 18 months. This new catheter consists of an abdominal part, similar in diameter to the Tenckhoff catheter but with larger holes; this part is enveloped in a silastic balloon with many holes. An important advantage of the new catheter is an outflow rate that is much higher than the Tenckhoff catheter. The incidence of malfunction was considerably reduced an d in addition, there were no cases of catheter failure due to blood or fibrin clots or wrapping by omentum.
Evaluation of Thyroid Function in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Selgas Rafael , Albero Ramon , Beberide Julia M. , Reiber Karin , Gonzalez-Gancedo Pilar , Mendez Javier , Sanchez-Sicilia Luis
Published: February 2020

Abnormal thyroid function has been described in chronic renal insufficiency, and further changes occur with increasing time on hemodialysis. This study on two groups of patients was done to determine whether treatment with CAPD induces changes in thyroid function. Group A included 16 patients with an average duration of treatment of 2.1 ± 1.1 months; group B included 12 patients with 8.1 ± 2 months. We measured total T4 and T3, free T4, TBG, RT3U, FTI, T4/T3 and basal TSH, and TSH induced by TRH stimulation in plasma, and total and free T4 in dialysate. The results showed a significant decrease in total T4 and T3 in plasma, but no change in free T4 or TSH and no appreciable amounts of the hormones in the dialysate. We believe the decrease in total T4 and T3 is secondary to alterations in transport proteins while thyroid function is maintained by normal free T4 and TSH levels more dependable parameters for the interpretation of thyroid function in chronic diseases.
Open Processus Vaginalis
Authors: Schurgers Mario L.C. , Boelaert Johan R.O. , Daneels Roger F.S. , Robbens Erwin J. , Vandelanotte Michel M.J.
Published: February 2020

Five months after starting continuous ambulatory peritoneal dialysis (CAPD), a communicating hydrocele developed with massive edema of the scrotum and of the penis. Peritoneal injection of radioactive technetium (Tc99m) demonstrated a tract suggesting an open processus vaginalis. It is assumed that the rise in intraabdominal pressure during the CAPD procedure led to a reopening of this processus vaginalis. Therapy consisted in its ligation.
The Disposition of Cefazolin and Tobramycin following Intraperitoneal Administration in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Paton Thomas W. , Manuel Arifie , Cohen Lawrence B. , Walker Scott E.
Published: February 2020

Two groups of patients with bacterial peritonitis were studied to examine the pharmacokinetics of intraperitoneal tobramycin and cefazolin. In Group I, four patients received tobramycin (5 mg/l) and cefazolin (75 mg/1) in two litres of dialysate for 12 consecutive exchanges. In Group 2, five patients received a loading dose of tobramycin (50 mg/1) and cefazolin (500 mg/l) intraperitoneally in exchange one. In exchanges three through 12, the maintenance schedule was tobramycin (7.5 mg/1) and cefazolin (250 mg/l). Tobramycin was measured by EMIT and cefazolin (in Group 2 only) by HPLC. Serum and dialysate levels were determined at the end of each of 12 exchanges. In Group 1, steady -state tobramycin levels appeared in 48 hours in both serum and dialysate to levels of 2.1 ± 0.2 μg/ml (x ± SEM) and 2.5 ± 0.3 μg/ml respectively. In Group 2, the loading dose schedule provided levels in serum at the end of the first dwell for tobramycin of 4.3 ± 0.64 μg/ml and for cefazolin 54.8 ± 6.7 μg/ml. Steady state levels for tobramycin and cefazolin were 3.7 ± 0.15 μg/ml and 110.9 ± 8 μg/ml respectively. Concomitant dialysate levels for tobramycin were 3.9 ± 0.17 μg/ml and for cefazolin 80.6 ± 26 μg/ml.
Comparison of Control of Serum Phosphate Levels during Continuous Ambulatory Peritoneal Dialysis and during Hemodialysis
Authors: Cannata Jorge B , Briggs James D , Fell Gordon S , Junor Brian J.R.
Published: February 2020

Recent reports have suggested that oral aluminium hydroxide carries the risk of aluminium toxicity. We have compared the aluminium hydroxide dose and serum levels of phosphate and aluminium in 27 CAPD and 26 hemodialysis patients. Despite a more liberal protein intake and lower aluminium hydroxide dose, the CAPD patients achieved the same serum phosphate level as those on hemodialysis. While the reason for more efficient serum phosphate control with CAPD is uncertain, the better control gives CAPD an advantage in patients in whom it is particularly important to minimise exposure to aluminium.
Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients
Authors: Stanbaugh Glen H , Gillit A. W, Holmes Diane , Reichel George W. , Stranz Mark
Published: February 2020

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.
Drugs and Peritoneal Dialysis
Authors: Manuel M. Arifie , Paton Thomas W. , Cornish William R.
Published: February 2020

This paper is a review of the literature describing drug disposition in patients with end-stage renal disease (ESRD) during either intermittent peritoneal dialysis (IPD) or continuous ambulatory peritoneal dialysis (CAPD). The removal of drugs by peritoneal dialysis and drug absorption after intraperitoneal administration are examined. Detailed pharmacokinetic data extracted from the literature are presented in tabular form and are accompanied by specific dosage recommendations for dialyzed patients. Accepted literature values for parameters reflecting the effects of ESRD alone are also included. The construction of a rational dosage regimen with emphasis on the use of the aminoglycosides and the cephalosporins is described.
Pharmacokinetics of Cefamandole in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Pancorbo Salvador , Comty Christina
Published: February 2020

The pharmacokinetics of cefamandole have been evaluated in five patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The drug was absorbed rapidly from the peritoneum reaching peak serum concentrations averaging 31.3 mcg/ml. Approximately 72% of the dose instilled into the peritoneum was absorbed over a six hour period. Subsequently cefamandole disappeared from the serum slowly with a mean half-life of 10.4 hours. The volume of distribution was 0.25 I/kg. The calculated total body clearance averaged 20.0 ml/min and the mean dialysis clearance was 3.2 ml/min. The authors postulate that in renal failure patients cefamandole may be eliminated by an alternate route.
Peritoneovaginal Fistula-unusual Complication of Peritoneal Dialysis
Authors: Diaz-Buxo Jose A. , Burgess Patrick , Walker Phillip J.
Published: February 2020

The formation of a peritoneovaginal fistula was observed in a young female who had undergone continuous peritoneal dialysis for 17 months. The patient had experienced an episode of acute bacterial peritonitis two months prior to the manifestation of the fistula and showed evidence of progressive malnutrition. This case serves to illustrate the role of peritonitis and malnutrition in the development of transvisceral erosions by indwelling peritoneal catheters and emphasizes the need for modification of the traditional peritoneal dialysis catheter design.
Growth of Bacterial Clinical Isolates in Continuous Ambulatory Peritoneal Dialysis Fluid
Authors: Flournoy Dayl J. , Perryman Fred A. , Qadri Syed M.H.
Published: February 2020

Clinical bacterial isolates (105 colony forming units/mi) were inoculated into sterile unused and used continuous ambulatory peritoneal dialysis (CAPD) fluid, incubated for 24 hours at 3SOC and observed for growth as evidenced by turbidity. The CAPD fluids also were tested for selected chemical constituent concentrations. The main differences in sterile unused and used fluids were: pH, 5.25 (unused) vs 7.60–8.62 (used); glucose, 1350–3680 vs 407–1227 mg/dl; potassium, 0 vs 2.0–4.2 mEq/l and phosphorous, 0 and 2.5–5.5 mg/dl respectively. When isolates of Candido albicans (10 strains), Enterobacter sp. (2), Escherichia coli (2), Group D Enterococci (2), Klebsiella pneumoniae (2), Proteus vulgaris (2), Pseudomonas aeruginosa (30), Pseudomonas sp. (2), Serratia marcescens (2), Staphylococcus aureus (2), S. epidermidis (2) and alphahemolytic streptococci (10) were tested against the fluids, none of the isolates grew in unused fluid but all grew in used fluid, which had been in the peritoneal cavity for as little as one and one-halfhours. Although the organisms did not grow in unused fluid, they were still viable at their original concentrations as deterrnined by quantitative subcultures.
Anemia and Oxygen Affinity in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Spinowitz Bruce S. , Sherwood Judith , Galler Marilyn , Tan Chaim Chary
Published: February 2020

Contrary to previous reports, our patients maintained on CAPD for periods up to 25 months showed no improvement in their hematocrit. However, in comparison with a group of hemodialysis patients, our CAPD patients required transfusions, anabolic steroids and iron supplements less frequently. A small but not statistically significant increase in hematocrit was noted among patients transferred from hemodialysis to CAPD.

Oxygen affinity, measured by P50, did not reveal the previously described elevation among hemodialysis patients. The reason(s) for this difference are only speculative at this time.
Nutritional Aspects of CAPD and the Potential Use of Amino Acid Containing Dialysis Solutions
Authors: Oreopoulos Oimitrios G. , Harvey Errol Marliss G. , Oren Anderson Arie , Paul Nicholas Oombros , Khanna Williams Ramesh , Rodella Helen , Brandes Lidia
Published: February 2020

As a result of a combination of a decreased appetite with increased nutrient losses in the dialysate, a number of CAPO patients may develop malnutrition. A decrease in appetite is also observed in normal animals undergoing CAPO which suggests that some factors related to CAPO influence appetite so that these animals eat less.

In addition to protein losses, CAPO patients are losing approximately two grams of amino acids a day, and they have plasma amino acid abnormalities similar to those produced by malnutrition and uremia.

An amino acid-containing dialysis solution (2%) is an effective solution with respect to ultrafiltration and solute removal.

Amino acids can be absorbed by the peritoneal route and produce an increase in plasma amino acids to levels similar to those observed after a protein meal. These observations indicate that administration of amino acids via the peritoneal route may prevent or correct malnutrition developed in patients on CAPO.
Lipid Abnormalities in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Khanna Ramesh , Breckenridge Carl , Roncari Daniel , Digenis George , Oreopoulos Dimitrios G.
Published: February 2020

Hypertriglyceridemia is a frequent complication among patients on CAPD, especially in those with abnormal triglycerides at the beginning of treatment. Diabetics on CAPD do not develop hypertriglyceridemia. HDL C is low at the initiation of CAPD and does not decrease further during CAPD. In those patients who have initial normal triglyceride levels, HDL C increased with time on CAPD at least for four to six months.
Prevention of Peritonitis during Continuous Ambulatory Peritoneal Dialysis
Authors: Oreopoulos Dimitrios G. , Vas Stephen I. , Khanna Ramesh
Published: February 2020

The measures taken to prevent peritonitis in patients undergoing CAPD depend on the routes of bacterial invasion of the peritoneum (Table I). Although we do not know the exact contribution of each route to the development of peritonitis, the intraluminal probably is the most important. Table la gives an estimate of the contribution of each route of access to such development.

For practical purposes the means of prevention have been classified according to the routes of infection they attempt to block.
Failure of Ultrafiltration in Patients on CAPO
Authors: Manuel M. Arifie
Published: February 2020

Long term complications of continuous ambulatory peritoneal dialysis have not been identified clearly. Membrane failure, i.e. inability to control body weight despite continuous use of hypertonic solutions, has been described extensively in France but has received little attention in North America. In Toronto, 14 of 508 patients failed CAPD because of membrane failure. The pathogenesis of this complication is not well understood but it is due, in part, to rapid decrease in the osmolality of the dialysate because of rapid absorption of glucose. Further investigations are urgently needed to explain the pathogenesis and prevention of this complication.
Neurotoxicity, Cognitive Function and the Outcome of CAPD
Authors: Kenny Frank T.
Published: February 2020

This paper describes a method used to assess cognitive dysfunction (and hence neurotoxicity) in individual CAPD patients. An “impairment index” ranging from 0.0 (no impairment) to 1.0 (severe impairment), was calculated on the basis of a patient's performance on eight short psychometric tests. Findings suggested that the index is sensitive to organic changes in renal patients and that it is not strongly influenced by emotional or psychosocial factors. Some distinct subgroups of patients have been identified according to the degree of initial (pre-treatment) dysfunction; one of these subgroups appears to have a poor prognosis.
Psychosocial Aspects of Failure on CAPO
Authors: Kline Stephen A. , Demarco Vince
Published: February 2020

We reviewed the charts of 20 patients designated as psychosocial failures on CAPD. As expected, these charts contained numerous psychiatric, social, economic, and treatment compliance problems. This paper describes the early indicators of significant psychosocial distress and makes recommendations concerning intervention and prospective studies.
Reduction of Catheter Complications with Lateral Placement
Authors: Helfrich B G. Baird , Pechan Warren , Alijani Mohammad R. , Barnard Winnie F. , Rakowski Thomas A. , Winchester James F.
Published: February 2020

Lateral catheter placement of a double cuffed Tenckhoff catheter for continuous ambulatory peritoneal dialysis accomplishes fixation of the internal cuff in the rectus muscle, and stabilization of the intercuff tunnel. This technique is associated with a low incidence of early dialysate leakage, tunnel infections and external cuff erosion, thus prolonging the effective life of the catheter. If the external cuffs become infected, these can be shaved-off to allow drainage of infection and preservation of the catheter. Lateral placement is preferred esthetically in adults, and allows near-normal sexual activity.
A New Tubing Change Procedure for CAPD Patients
Authors: Cagle Anne , Perry Carolyn , Moncrief Jack W. , Bobbit Melissa , Sorrels “Poppy” A.J. , Mullins-Blackson Carol
Published: February 2020

Thirty continuous ambulatory peritoneal dialysis (CAPD) patients at the Acorn Research Laboratory participated in a four month study, which examined the safety and emcacy of a new tubing change procedure. This study indicates that CAPD personnel safely can alter the traditional tubing change procedure while lessening the time required to change transfer sets. The study also indicates that the new tubing change procedure may decrease the frequency of peritonitis associated with tubing changes.
CAPD in a Central City Population
Authors: Hoy Christopher , Brensilver Jeffrey M. , Solana Mona Gulino Iris , Cortell Stanley
Published: February 2020

This paper presents the results of a CAPD program, which provides care to an underpriviliged, inner-city population. Serious medical and psychosocial problems did not interfere with training and did not produce an unusually high drop-out rate. However, we encountered a high incidence of infection. The success of such a program demonstrates that traditional criteria for CAPD patient selection are not universally applicable.
Insulin Delivery from Continuous Ambulatory Peritoneal Dialysis Bags Used with Peridex Filters
Authors: Silver Marcia R. , Sorkin Michael I.
Published: February 2020

We studied the percent delivery of insulin from CAPD dialysis solution bags used with and without the Peridex bacteriological filter. The studies were done in vitro using 125I trace. labelled insulin. The data demonstrate that most of the insulin added to bags of dialysis solution during CAPD is delivered into the peritoneal cavity. The mean (± S.D.) amount of insulin delivered for the trials without filters was 99 (± 5) %. For the group with filters, the mean was 75 (± 8)%. The difference was statistically significant (P < 0.001). Also, a statistically significant (P < 0.03) difference was observed between the data from the first three uses of new tubing sets versus subsequent uses.

We conclude that the insulin prescriptions of most diabetics will not require alteration when they change from CAPD without a Peridex filter to CAPD with the filter.
Effects of Various Peritoneal Dialysis Solutions on Bacterial Growth in Vitro
Authors: Panzetta Giovanni , Loschiavo Carmelo , Bertazzoni Elisa Minelli
Published: February 2020

We studied the influence of various peritoneal dialysis (PD) solutions mixed with nutrient broth on the growth of Proteus rettgeri Sanelli “in vitro”. The volume of the nutrient broth was reduced progressively and was replaced either by water (control) or by peritoneal dialysis solutions to make up 10%-25%-50%75% of the total initial volume. Bacterial growth was enhanced in the presence of the PD solutions, particularly those containing lactate. When the nutrient broth was prepared directly with the PD solutions, bacterial growth again was stimulated in fluids containing lactate and hypertonic glucose. These results indicate that PD solutions, in the presence of even small amounts of nutrient broth, are a good growth medium for Proteus.
Management of Hernias and Tenckhoff Catheter Complications in CAPD
Authors: Charles R. , Schleifer F. , Morfesis Andrew , Cupit Mary , Chen Chijen , Smink Robert D.
Published: February 2020

From October 1978 to December 1982, we placed 86 Tenckhoff catheters in 69 patients of whom 64 completed training and were followed on CAPD. All catheters were either straight or pigtail double-cuff Quinton type. The devices were implanted by the surgeon in the operating room under local anesthesia with direct exposure of the peritoneum. Abdominal hernias have developed in eight patients; there have been six cuff erosions; seven patients developed fluid leaks; 18 catheters were removed. Mean catheter life was 20.6::!:: 10.3 months in the 15 catheters removed because of infectious complications and 6.9::!::6.7 months in four catheters removed for non-infectious complications.
A Technique to Eradicate Tunnel Infection without Peritoneal Dialysis Catheter Removal
Authors: Andreoli Sharon P. , Jay Karen W. West , Grosfeld L. , Bergstein Jerry M.
Published: February 2020

In two adolescents maintained on CAPD, infections of the peritoneal catheter tunnel were treated by an “unroofing” technique. The infections were eradicated without catheter removal or interruption of CAPD.

Continuous ambulatory peritoneal dialysis (CAPD) has produced a dramatic improvement in the care of patients with end-stage renal disease. Peritonitis remains a major complication and the most common cause of CAPD failure (1–3). Most episodes of peritonitis can be attributed to a break in the technique of bag exchanges; however, tunnel infections are also implicated (3,4). Tunnel infections are difficult to cure and, if persistent, may make necessary the removal of an otherwise well functioning catheter. We describe two patients with tunnel infections that were eradicated after “unroofing” of the Tenckhoff catheter.
Hypertonicity Changes the Permeability of the Mesothelium
Authors: Breborowicz Andrzej , Knapowski Jan
Published: February 2020

Permeability of the mesothelium for small, middle and large solutes in a hypertonic medium was measured in vitro. Hypertonicity decreased the transmesothelial transport rate of albumin, whereas transfer of inulin was increased.
Plasma Levels of Adrenocortical Steroids in CAPD and Hemodialysis Patients
Authors: Zager P.G. , Spalding C. T. , Frey H.J.
Published: February 2020

CAPD patients appear to have higher levels of plasma renin activity than hemodialysis patients. Increased angiotensin n may result in increased secretion of 18-OH-B and aldosterone by the adrenal zona glomerulosa.

Differences in treatment design between continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) may affect secretion of adrenocorticosteroids. Ultrafiltration during CAPD is continuous and gradual. Therefore, CAPD patients experience only minor fluctuations in extracellular fluid volume and are usually at or near their estimated dry weight (EDW). In contrast, ultrafiltration in HD patients is rapid but intermittent. Hemodialysis patients approach their EDW only at the end of each treatment period. Hemodialysis patients, therefore, may remain significantly above their EDW for prolonged periods. CAPD allows patients to liberalize their dietary intake of potassium. Some CAPD patients may require potassium supplementation (I). In contrast, HD patients may need to restrict their dietary intake of potassium to prevent potentially lethal hyperkalemia. Heparin is routinely administered during HD but not during CAPD. The present study was designed to determine if these differences in treatment design produce greater stimulation of the adrenal zona glomerulosa in CAPD than in HD patients.
Response to Acid Loading in Patients on Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
Authors: Changgi Satwant Singh , Audrey D. Hong , Morgan Dale Betty
Published: February 2020

Responses to a standard acid load (Ammonium Chloride 1.87 mM/ Kgm) were studied in 9 patients on hemodialysis (HD) and 16 on CAPD. There was a significant increase in H+ concentration (maximum 8.1 ± 0.6 for HD; 7.7 ± 0.8 for CAPD) and a decrease in bicarbonate levels (maximum 4.4 ± 0.4 for HD; 4.0 ± 0.3 for CAPD). PCO2 did not change significantly. CAPD patients tolerated acid loading slightly better than HD patients studied the day after regular hemodialysis treatment. The brief duration of the experiments did not allow us to study differences in recovery rate between HD and CAPD patients.

Continuous Ambulatory Peritoneal Dialysis (CAPD) has emerged as an attractive alternative to hemodialysis for the management of end stage renal disease. In our institution, serum total CO2 levels are significantly higher in CAPD patients (mean 22) compared to predialysis levels in hemodialysis patients (mean 17, unpublished observations). Whether this is a function of the timing of blood sampling (i.e. predialysis vs steady state level) or represents better repletion of body buffers in CAPD patients is unknown. If higher levels do indeed represent better repletion of body buffer stores, CAPD patients should tolerate an acid challenge better than the hemodialysis patients. Responses to a standard acid loading (I) were observed to test this hypothesis.
Peritoneal Catheter Implantation for CAPO
Authors: Lovinggood J. Perry
Published: February 2020

Implantation of the peritoneal catheter is the important first step in beginning CAPD. In this paper the major complications of catheter implantation are discussed and ways to reduce these complications are identified. The insertion of the catheter through the rectus sheath as described by Helfrich is likely to reduce the incidence of some of these complications. This technique is described.

To discuss the principles of a good peritoneal catheter implantation for CAPD, it is of interest to identify the major problems associated with catheter implantation. These complications are 1) leakage, 2) catheter migration, 3) obstruction, 4) bleeding, 5) reflex ileus, 6) visceral perforation, 7) infection, and 8) pericatheter hernias (1). The incidence of the major complications of catheter implantation are seen in Table 1.
Outcome of Peritoneal Catheter Placement in the High-Risk Patient
Authors: Levey A.S. , Simon G.M. , McCauley J. , Smith T.J. , Cho S. I. , Harrington J. T.
Published: February 2020

Serious early complications of catheter insertion and catheter outcomes are compared in patients with or without a history of major abdominal surgery or peritonitis. Previous major surgery and peritonitis are important risk factors for early serious complications of catheter placement. Despite the higher risk of early complications, subsequent attempts at catheter placement were successful in all but one of the high risk patients.

Patients with previous major abdominal surgery or peritonitis generally are considered to be at high risk for complications of permanent peritoneal catheter placement. However, few physicians would refuse to attempt catheter insertion in patients highly motivated to undergo peritoneal dialysis. In this setting, the patient and the physician must decide whether the motivation and potential benefit justify the risk. Unfortunately, extensive quantitative data on the success rate and the likelihood of complications in the high-risk patient are not available. In order to determine the success rate and relative risk, we reviewed the outcome of catheter placement for continuous ambulatory peritoneal dialysis (CAPD) in our patients. In this report, we identify the serious early complications of catheter insertion and compare the outcomes in patients with and without a history of major abdominal surgery or peritonitis.
Patient Tolerance and Dialysis Effectiveness of a Glucose Pol YMER-containing Peritoneal Dialysis Solution
Authors: Higgins James T. , Gross Michael L. , Somani Pitambar
Published: February 2020

A polymer of glucose was tested for use as an osmotically active agent in peritoneal dialysis. The osmotic effect of the polymer is more prolonged and more effective than that of glucose. Comparison of the relative caloric loads of the polymers compared to glucose awaits documentation of the rate of uptake of the polymer and its rate of metabolism to glucose.

Osmotically active agents are necessary in peritoneal dialysates in order to achieve ultrafiltration of plasma water into the dialysate. Osmotically active agents also increase the total clearance of solutes such as urea and creatinine both by solvent drag, or convective fluid movement (1), as well as by causing vasodilatation of the peritoneal vessels, increasing blood flow and perhaps increasing the dialysis surface area (2), and by increasing pefllleability (3). To be useful as an osmotic agent, a substance must be non-toxic, should be of sufficient molecular size to remain in the peritoneal space, and any of the agent which is taken up into the systemic circulation should be metabolizable.