bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of Peritoneal Dialysis Catheter Removal after Pediatric Renal Transplantation
Authors: Arbeiter Klaus , Pichler Andrea , Muerwald Gabriele , Mueller Thomas , Bidmon Bettina , Balzar Egon , Ruffingshofer Dagmar , Greenbaum Laurence , Aufricht Christoph 
Published: February 2020

Background A peritoneal dialysis (PD) catheter is in place at the time of kidney transplantation in children receiving PD. Removal of the catheter eliminates the risk of catheter-related infections. However, the patient benefits from leaving the catheter in place if dialysis is necessary posttransplantation. There is currently no consensus on the proper timing of PD catheter removal after kidney transplantation in children. Objective To identify the risks and benefits of an indwelling PD catheter after renal transplantation in children. Design Retrospective single-center study of infectious complications and posttransplantation PD catheter use in 31 renal transplantations in 26 children. Results Peritoneal dialysis catheters were used postoperatively in 13 of the 31 transplantations. In 12 instances the catheter was needed during the first month after transplantation, and 2 of the patients involved did not have a catheter in place when needed. Six catheter-related infections occurred in 5 patients posttransplantation, with only 1 infection taking place within 1 month after transplantation. Conclusion Our data suggest that the need for catheter use occurs predominantly during the first month, while infectious complications usually happen later. This strongly suggests that PD catheters should not be removed until approximately 1 month after kidney transplantation.
Early Glycated Albumin, but Not Advanced Glycated Albumin, Methylglyoxal, or 3-Deoxyglucosone Increases the Expression of Pai-1 in Human Peritoneal Mesothelial Cells
Authors: Mandl–Weber Sonja , Haslinger Bettina , Schalkwijk Casper G. , Sitter Thomas 
Published: February 2020

Objective The continuous contact of glucose-containing peritoneal dialysis (PD) fluids with the peritoneum results in the intraperitoneal formation of early and advanced glycation end-products. This nonenzymatic glycation of proteins may cause morphological and functional alterations to the peritoneum, which may contribute to patient dropout from PD therapy. Because fibrinolytic system components have been demonstrated to play an important role in the balance of intraperitoneal generation and degradation of fibrin, we studied the effect of early and advanced glycated human serum albumin, methylglyoxal, and 3-deoxyglucosone on the synthesis of tissue-type plasminogen activator (tPA), as well as its specific inhibitor (PAI-1), in human peritoneal mesothelial cells (HPMC). Methods Antigen concentrations in the supernatants of cultured HPMC were measured by ELISA. Northern blot analysis was conducted for mRNA expression. Electrophoretic mobility shift assays were applied to demonstrate the involvement of the transcription factors nuclear factor kappa B (NF-κB) and activator protein-1 (AP-1) in signal transduction. Results Incubation of HPMC with early glycated albumin (GHSA) resulted in a time- and concentration-dependent increase in PAI-1 mRNA expression and antigen secretion. In contrast, no changes in PAI-1 synthesis occurred after stimulation with either the 1,2-dicarbonyl compounds methylglyoxal and 3-deoxyglucosone, or with late advanced glycation end-products. tPA synthesis was not affected by any of the tested components. Furthermore, HPMC exposed to GHSA induced NF-κB and AP-1 DNA binding activity, suggesting that GHSA-induced over-expression of PAI-1 is transcriptionally regulated by both transcription factors. Conclusions We conclude that Amadori modified glycated albumin upregulates PAI-1 synthesis in HPMC, possibly mediated through the activation of the transcription factors NF-κB and AP-1. The present data support the clinical relevance of the formation of glycated proteins and their involvement in pathological processes in PD patients. Thus, glycated albumin may contribute to an imbalance between intraperitoneal formation and degradation of fibrin that causes peritoneal structural alterations, with subsequent membrane failure.
The Relationship between Kt/VUrea and Npna in Anuric Peritoneal Dialysis Patients: A Comparison with Predialysis Patients
Authors:   for the NECOSAD Study Group, Jansen Maarten A.M. , Korevaar Johanna C. , Dekker Friedo W. , Jager Kitty J. , Boeschoten Elisabeth W. , Krediet Raymond T. 
Published: February 2020

Objective It is unknown whether a given level of urea clearance by the native kidneys provides better or similar control of uremia than the same level of urea clearance by continuous peritoneal dialysis (PD). More insight into possible differences between renal and peritoneal urea clearances is warranted. Therefore, we investigated the relationship between Kt/Vurea and protein equivalent of total nitrogen appearance normalized to body weight (nPNA), the relationship between urea clearance and creatinine appearance, and other nutritional parameters in PD patients without residual renal function, and in predialysis end-stage renal disease patients. Patients All patients participated in the Netherlands Cooperative Study on the Adequacy of Dialysis. This is a prospective cohort study of incident dialysis patients, in whom regular assessments of renal function are done. A group of 75 PD patients was identified at the first follow-up assessment in which their urine production was less than 100 mL/day. These patients were considered the anuric group. This group was compared with a control group of 97 predialysis patients studied 0 – 4 weeks before the start of dialysis treatment. Results Linear relationships were present between Kt/Vurea and nPNA, in both the predialysis patients and the anuric PD patients. A significant difference was present between the slopes of the two regression lines (0.40 vs 0.18, p = 0.007). When Kt/Vurea exceeded 1.3/week, a given level of Kt/Vurea was associated with a higher nPNA in predialysis than in anuric PD patients. Similar relationships were found between Kturea and PNA. Kturea was also significantly related to urine or dialysate creatinine appearance. A significant difference existed between the slopes of the regression lines in the two groups of patients ( p < 0.001). A weekly Kturea of 70 L was associated with a urine creatinine appearance of 11.0 mmol/day and a dialysate creatinine appearance of 8.4 mmol/day. Nutritional status measured with creatinine appearance and Subjective Global Assessment was better in the predialysis population, despite much lower values for Kt/Vurea in these patients. Conclusions The relationship between Kt/Vurea and nPNA in anuric PD patients is different from that in a predialysis population. It follows from our results that, when Kt/Vurea is above 1.3/week, a given level of Kt/Vurea is associated with a higher nPNA in predialysis than in anuric PD patients. This challenges the concept of equivalency between renal and peritoneal Kt/Vurea with respect to control of uremic morbidity.
Chronic Dialysis in the Elderly: Intermittent Peritoneal Dialysis or Hemodialysis?
Authors: Gibor Abdul Marai Mauro Rathaus Yair , Bernheim Jacques 
Published: February 2020

This study compared two groups of elderly patients -16 treated with IPD, and 31 treated with hemodialysis -HD. Predialysis conditions were assessed by means of a scoring system and the results were studied in terms of survival, causes of death, complications and laboratory parameters. In the IPD group, survival was similar to the hemodialysis groups during the first 15 months but declined thereafter. IPD patients also required longer periods of hospitalizations. The causes of death were quite different: mainly cardiovascular in HD, and mainly related to peritonitis in IPD. Laboratory parameters were similar. Analysis of the scoring results showed that the patients selected for IPD had more cardiovascular disease and diabetes mellitus. In conclusion, the results of IPD in elderly patients are comparable to those of HD in the first year. The choice of “poor risk” patients for IPD may explain, in part, the inferior long-term results with this technique.
Uremia and Host Resistance to Peritonitis in C.A.P.D-an Experimental Evaluation
Authors: Clarke Isabel A. , Ormrod Douglas J. , Miller Thomas E. 
Published: February 2020

Peritonitis is an important complication of CAPD. Because uremia is believed to impair immunity, we sought to determine whether uremia per se predisposes patients on CAPD to peritoneal infection. Using an animal model of CAPD, we have evaluated the effect of severe uremia on host resistance to peritonitis. Intraperitoneal catheters were implanted in severely uremic and sham-operated non-uremic rats, which were then dialysed four times a day for two days. Alternatively, they were infused with dialysis fluid twice daily for eight days without drainage of the dialysate. Peritonitis was induced by direct inoculation of Escherichia coli; the bacteria in the peritoneal cavity and spleen were counted 24 hours after this challenge. Uremia did not impair resistance to experimentally induced peritonitis in either the dialysed or infused host. Continuous ambulatory peritoneal dialysis (CAPD) is becoming increasingly popular as a method for longteffil treatment of chronic renal failure. The major disadvantage is the risk of infection and peritonitis remains the single most important complication and reason for transfer of patients to another mode of therapy. Uremia is believed to impair immunity and predispose patients to infection (1, 2). Hence the question arises: Are patients on CAPD predisposed to peritoneal infection by the uremia itself? We developed a model of chronic uremia in rats, which made possible studies uncomplicated by many variabies associated with the clinical management of uremic patients. This paper examines the contribution of uremia to the susceptibility of the dialysed host to peritonitis. In the rats, we found it difficult to maintain dialysis for longer than two days because of rapid blockage of catheters by fibrin and connective tissue. As a consequence, we employed two models: one carried out peritoneal dialysis for two days, and the other involved infusions of dialysate without drainage for a longer period. Uremic and sham-operated animals, either dialysed or infused without drainage, were compared with noffilal controls with respect to their ability to withstand an intraperitoneal challenge with viable Escherichia cali.
Improved Cell-Mediated Immunity in CAPD Patients as Compared to those on Hemodialysis
Authors: Giacchino Franca , Pozzato M. , Formica M. , Quarello F. , Piccoli G. 
Published: February 2020

T -cell subsets were classified by monoclonal antibodies (OKT3 -peripheral mature T cells; OKT4 helper/inducer; OKT8 -cytotoxic/ suppressor) in CAPD and hemodialysis patients. Data were compared with in vivo assays of T cell function, such as DNCB and PPD skin tests. Uremic patients had significant absolute lymphopenia; when the results were expressed as a percentage of OKT3+ cells, they did not differ from the controls. When they suffered from peritonitis, CAPD patients showed an increase in OKT8+ cells, but the ratio ocOKT4+ cells to OKT8+ cells showed no significant deviation from the normal population. On the other hand, CAPD patients showed a better response to DNCB and PPD antigens. In the hemodialysis patients there was a significant correlation between the negative response to the DNCB test and blood transfusion. There was no correlation between the immune response and the primary disease, or the nutritional status in either groups.
Evaluation of a Germicidal Device for Peritoneal Dialysis Connectors
Authors: Jensen William M. , Ahmad Suhail 
Published: February 2020

Fifteen peritoneal-dialysis spike connectors were contaminated deliberately, either by handling (n = 12) or by a saline suspension of micro organisms (n = 3). The spikes were then subjected to ultraviolet light in a Germicidal System according to the manufacturer's instructions. Subsequent culture revealed that the device had sterilized the spikes contaminated by aqueous suspensions. In 25% of the tests, the spikes which were handled and contaminated by skin nor a had positive cultures. These results cast doubt on the efficacy of such a device. Peritonitis, a major complication of peritoneal dialysis, is especially troublesome during continuous ambulatory peritoneal dialysis (CAPD). Here, the most common pathogens are skin flora (1), which is thought to be due to the frequent connections and disconnections needed in this method of treatment (1, 2). To reduce the incidence of contamination during the connecting procedure, Travenol Corporation has introduced a Gennicidal System (Model 5C-34–30). This system uses ultraviolet (UV) light to sterilize the connection between the patient line and the dialysate bag. The present study was done to test the efficacy of this system by violating the recommended aseptic technique in a manner which would simulate patient non-compliance. We believe that testing with aqueous suspensions of bacteria is not an adequate challenge to the system because skin contact leaves oils and debris which may shield bacteria from the UV light (3,4).
Local Anesthetic -Bupiv Acaine Increases the Peritoneal Transport of Solutes. Part I: In Vivo Study
Authors: Breborowicz Andrzej , Knapowski Jan 
Published: February 2020

A local anesthetic -bupivacaine was used in concentration 0.25 mmol/l in the dialysis fluid during peritoneal dialysis in rabbits. Bupivacaine increased the mean peritoneal clearance of urea by 33% and of inulin by 53%. The effect of the anesthetic persisted during next exchanges, performed without the drug. Bupivacaine given intraperitoneally, did not decrease blood pressure. Peritoneal dialysis is used widely for treatment of renal failure (1). During the last few years, many attempts have been made to find a substance, which would increase the efficiency of peritoneal dialysis (2, 4). In the past we observed that procaine added to the fluid augments peritoneal solute clearance (5). Local anesthetics in the peritoneal cavity influence both the mesothelium and the vascular system. In the present study we used bupivacaine a long-acting, tissue-bound local anesthetic as the adjunct during peritoneal dialysis in rabbits.
A Cross Sectional Assessment of Serum Vitamin O ANO Trigl Ycerioe Concentrations in a CAPO Population
Authors: Nolph Karl D. , Ryan Leonor , Prowant Barbara , Twardowski Zbylut 
Published: February 2020

A cross sectional analysis of 41 patients on continuous ambulatory peritoneal dialysis (CAPD) for six to 54 months (mean, 21.7) showed that 58.5% and 19.5% had low levels of 1,25-(OH)2 vitamin D and 25-OH vitamin D respectively. C-terminal and N-terminal parathyroid hormone (PTH) levels were elevated in 85 and 75%, respectively. N-terminal PTH correlated (r -0.31, p < 0.05) with serum inorganic phosphorus, but not with vitamin D levels. Triglyceride and cholesterol concentrations were elevated in 76% and 19%; HDL cholesterol was low in 37%. Except for PTH levels, none of the other above measurements correlated with time on CAPD. The findings suggest that most CAPD patients have low 1,25(OH)2 vitamin D and elevated PTH and triglyceride serum concentrations. More study should be made concerning the clinical significance of and proper therapeutic interventions in these circumstances. Reduced serum concentrations of vitamin D metabolities and increased serum triglyceride concentrations have been described frequently in patients on continuous ambulatory peritoneal dialysis (CAPD) (1–4). In 41 patients in our CAPD program, we did a cross-sectional assessment of vitamin D and triglyceride levels to quantitate the frequency and severity of these problems. We correlated serum levels of vitamin D and triglyceride with time on CAPD and other variables.
Survey of Continuous Ambulatory Peritoneal Dialysis in the United Kingdom, 1982
Authors: Gokal Ram , Marsh Frank P. 
Published: February 2020

Forty -one adult renal units undertaking continuous ambulatory peritoneal dialysis (CAPD) in the United Kingdom answered a questionnaire about available facilities and their own practices. The responses suggest that many units are struggling with unsatisfactory environmental facilities and inadequate staff. Working methods, diagnostic facilities and therapeutic policies varied considerably from unit to unit. We need more information about the influence of such variables on the results of CAPD and its complications, particularly peritonitis. The use of CAPO for the management of end-stage renal failure in the United Kingdom has increased dramatically since its introduction in 1978 (I, 2). Although statistics from the European Dialysis and Transplant Association (EDT A) revealed a high technique failure rate and considerable morbidity from catheter and peritonitis problems (2, 3), individual units have reported better results (4, 5, 6). Discussion with nephrologists in the United Kingdom suggested that there were marked differences between renal units in the techniques used and the facilities available for the practice of CAPD, and that these might be reflected in the results of treatment. Therefore, we circulated a questionnaire to the 59 dialysis units in the United Kingdom requesting information concerning their facilities, practices, and the ways in which they diagnosed and managed CAPD-related infection in 1982. Replies were received from 52 units; of these six were not using CAPD and five others were pediatric centres. The questionnaires from the remaining 41 adult renal units were analysed for this report.
Massive Colonization ofan In-Dwelling Catheter by Penicillium Pinophilum without Peritonitis
Authors: Locci Romano , Marcello Romagnoni , Beccari Marcello , Faiolo Sergio , Granello Elisabetta , Lischetti Maria G. , Quaroni Sergio , Scalia Patrizia 
Published: February 2020

This paper describes invasion of an indwelling peritoneal catheter by a fungus. This colonization by Penicillium pinophilum, whose identity was proved by isolation, mycological characterization and in situ examination by scanning electron microscopy, did not cause peritonitis. We have discussed possible causes of contamination and implications of the findings. Fungi rarely are responsible for primary peritonitis in CAPD patients, though increasingly they are recognized as secondary agents (1). Mycetes so far isolated belong to the following genera: Aspergillus, Candida. Drechslera, Fusarium, Mucar, Rhodotorula and Trichosparan (2–10). Recently Pearson et al (II) described Penicillium peritonitis which appeared to have been induced by prolonged antibiotic therapy, following repeated episodes of bacterial peritonitis. A similar sequence was encountered after intestinal perforation (3). In CAPD patients peritonitis caused by fungi does not differ from the more common bacterial peritonitis (3), though at first the clinical symptoms may be attenuated and effluent solution may be clear (6, 11). In some cases however such peritonitis can be particularly severe and persistent (12). In these circumstances the catheter should ∼ removed (2, 13, 14), because then the infection clears without specific antifungal therapy. Colonization of the in -dwelling device is associated with a poor prognosis (15). This report describes a patient with massive colonization of the exposed tract of the Tenckhoff peritoneal catheter with Penicillium without clinical symptoms of peritonitis or changes in the dialysate effluent.
Infected Intra-Abdominal Hematoma Associated with an Indwelling Tenckhoff Catheter
Authors: Braden Gregory L. , Germain Michael J. , Guardione Vincent A. , Fitzgibbons John P. 
Published: February 2020

Two months after cessation of continous cycling peritoneal dialysis a pa tient developed an infected intra abdominal hematoma while a Tenck hoff catheter was still present in the abdomen. The hematoma required surgical evacuation. This complication suggests that we should consider early removal of Tenckhot T catheters after successful renal transplanta tion or after switching to hemo dialysis. The chronic peritoneal catheter pioneered by Tenckhoff has made it possible to treat thousands of patients with end stage renal failure by chronic peritoneal dialysis. The complications of Tenckhoff catheters include dialysate leakage, outflow obstruction, pelvic pam, hydrothorax, dacron cuff extrusion, tract infections, combined inflow outflow obstruction, abdominal or in guinal hernias, and hydroceles (1–6). This paper describes a patient who developed abdominal pain and an in fected intra-abdominal hematoma two months after being transferred from continuous cycling peritoneal dialysis (CCPD) to hemodialysis. The appear ance of this complication two months after discontinuing peritoneal dialysis raises the question: When should one remove a Tenckhoff catheter after transfer to hemodialysis or successful renal transplantation?
Genital Edema in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Orfei Reto , Seybold Klaus , Blumberg Alfred 
Published: February 2020

Two patients who developed massive genital edema while on CAPD were investigated by peritoneal scintigraphy with Tc99m-glucoheptonate. In one the genital swelling was due to an umbilical hernia and in the other it was due to an abdominal-wall hernia. After the hernia was repaired CAPD could be continued. We recommend peritoneal scintigraphy as a technique for the investigaiton of leakage of peritoneal fluid in patients undergoing CAPD. Recently genital swelling has been described as a complication of CAPD (I, 2). In one patient an isotope technique demonstrated an open processus vaginalis (1), and in four patients (2) scrotal or labial edema was due to an inguinal hernia. This communication describes two patients with genital edema which was due to an umbilical hernia in one, and to an abdominal wall hernia in the other.
A Quantitative Approach to the CAPD Prescription
Authors: Teehan Brendan P. , Schleifer Charles R. , Sigler Miles H. , Gilgore Gary S. 
Published: February 2020

The CAPD prescription, expressed as daily drainage volume, can be formulated as a function of the recommended dietary protein intake and the average BUN level. This process is greatly simplified because urea nitrogen reaches a state of equilibrium on CAPD. The ratio of the actual drainage volume to this prescribed drainage volume -a dialysis index (Dl), reflects the fraction of urea nitrogen clearance achieved. Used with the average BUN level, the dialysis index provides an estimate of the protein catabolic rate (PCR), in gm/kg/day. When integrated these three factors -BUN, Dl and PCR, can be applied to optimize diet and dialysis and may provide a basis for comparing treatment results between patients and between centers. As continuous ambulatory peritoneal dialysis (CAPD) approaches its ninth anniversary, it continues to grow and to enjoy wide acceptance. Only a small minority continue to question its role in the care of end-stage renal disease patients. However, they ask fundamental questions which deserve our attention. Why is rate of hospitalization higher -peritonitis and access-related difficulties are only partially responsible (I). Does this technique's low urea nitrogen clearance provide adequate dialysis? Why do nearly 30% of patients leave CAPD programs within one year (2)? Are some CAPD patients under-dialyzed or malnourished? After nearly a decade of experience we have not answered these nagging questions and perhaps they cannot be answered. However, it is clear that they cannot be avoided. As Huxley cautioned, “Facts do not cease to exist because they are ignored.” An objective analysis of these issues raises the fundamental question, namely, the adequacy of dialysis -and adequacy compared to what?