bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Twice-Daily Icodextrin Administration on Blood Pressure and Left Ventricular Mass in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Sav Tansu , Oymak Oktay , Inanc Mehmet Tugrul , Dogan Ali , Tokgoz Bulent , Utas Cengiz 
Published: February 2020

Background Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients. Aim To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure. Method and Results Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month ( p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group ( p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced ( p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin ( p > 0.05). No statistically significant changes were observed in weekly total creatinine clearances or Kt/V of patients in either group at the end of 3 months (NS). Conclusion Twice-daily icodextrin administration was clinically beneficial as shown by reduced blood pressure and prevention of the progress of left ventricular hypertrophy without causing any decrease in dialysis adequacy or any side effects. The icodextrin metabolite results did not suggest any further increase in their values when comparing once- to twice-daily administration of icodextrin. Although prescription of icodextrin once daily may yield good clinical results in the long term, this study showed that it may be more efficient to use twice-daily icodextrin for at least a specific period for the purpose of obtaining quicker results in patients with ultrafiltration failure, serious hypervolemia, or hard-to-control blood pressure conditions.
Dialytic Phosphate Removal: A Modifiable Measure of Dialysis Efficacy in Automated Peritoneal Dialysis
Authors: Schmitt Claus P. , Borzych Dagmara , Nau Barbara , Wühl Elke , Zurowska Aleksandra , Schaefer Franz 
Published: February 2020

Background Although hyperphosphatemia is one of the few established risk factors for cardiovascular mortality in patients on dialysis, the relationship between peritoneal dialysis (PD) prescription and dialytic phosphate removal is largely unexplored. Methods and Patients We analyzed 24-hour clearances ( n = 60) together with peritoneal equilibration tests (PETs) ( n = 52) performed in children and adolescents ( n = 35) on automated PD. Results Dialytic phosphate clearance was more closely correlated with 2-hour and 4-hour dialysate-to-plasma ratio (D/P) of phosphate in the PETs ( r = 0.44 and r = 0.52, both p < 0.0001) than with 2-hour and 4-hour D/P creatinine ( r = 0.26 and r = 0.27, both p < 0.05). Dialytic 24-hour phosphate clearance was independently predicted by total fluid turnover (partial R2 = 0.48, p < 0.001), the number of cycles ( r = 0.52, p < 0.001), 2-hour D/P phosphate (partial R2 = 0.07, p = 0.001), dwell time (partial R2 = 0.05, p = 0.01), and achieved ultrafiltration (partial R2 = 0.05, p = 0.005). 4-hour D/P phosphate and 24-hour phosphate clearance were significantly lower in hyperphosphatemic children (3.38 ± 1.17 vs 4.56 ± 1.99 L/1.73 m2/day, p < 0.05), whereas creatinine equilibration and clearance rates were not distinctive. Conclusion Dialytic phosphate removal is an important modifiable determinant of phosphate control in automated PD. It strongly depends on total dialysate turnover and the prescribed number of cycles and is more adequately predicted by phosphate than by creatinine equilibration characteristics. Due to the deleterious effects of hyperphosphatemia, dialytic phosphate removal should be monitored routinely.
Bicarbonate-Based Peritoneal Dialysis Solution has Less Effect on Ingestive Behavior than Lactate-Based Peritoneal Dialysis Solution
Authors: Zheng Zhi-Hua , Anderstam Björn , Yu Xueqing , Qureshi Abdul Rashid , Heimbürger Olof , Lindholm Bengt 
Published: February 2020

Objective The anorexia seen in peritoneal dialysis (PD) patients may be due partially to factors of dialysis solutions, such as pH and buffering agent. We tested the effects of different PD solutions in an experimental rat model for appetite. Design The intraoral intake of a sucrose solution from an implanted intraoral cannula in freely moving male Wistar rats was used to evaluate appetite at 30 minutes and 120 minutes after intraperitoneal (IP) infusion of bicarbonate (25 mmol/L)/lactate (15 mmol/L)-based PD solution (P) and conventional lactate (40 mmol/L)-based PD solution (D) with different concentrations of glucose. We also tested different buffer solutions containing lactate and bicarbonate with different pH but with no glucose. Results The IP infusion as such and the 30 mL volume did not inhibit appetite; however, appetite was significantly less inhibited by P than by D in the 1.36%, 2.27%, and 3.86% solutions ( p < 0.05). Furthermore, intraoral intake was significantly higher in rats receiving IP solution with bicarbonate buffer (pH 7.4) than with lactate buffer ( p < 0.05), whereas there was no significant difference in intraoral intake for lactate with pH 5.5, pH 6.6, or pH 7.4. Conclusions The bicarbonate/lactate solution inhibited appetite less than the lactate solution; this was due partially to the use of bicarbonate. The results show possible benefit on appetite of reducing the lactate concentration in PD solutions.
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.
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.
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.
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.
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.
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.
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.
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.
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.