bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Flush before Fill” in Children Receiving Automated Peritoneal Dialysis
Authors: Warady Bradley A. , Ellis Eileen N. , Fivush Barbara A. , Lum Gary M. , Alexander Steven R. , Brewer Eileen D. , Ogrinc Frank , Watkins Sandra L. 
Published: February 2020

Objective To evaluate the impact of the “flush before fill” technique on the frequency of peritonitis in children receiving automated peritoneal dialysis (APD). Design Randomized prospective multicenter study. Setting Participating pediatric dialysis programs of the Pediatric Peritoneal Dialysis Study Consortium. Patients 121 pediatric (< 21 years of age) patients that had received peritoneal dialysis for > 2 months and that were currently receiving APD were randomized to use (flush group) or non-use (no flush group) of the “flush before fill” option. 66 patients were followed for> 12 months. Main Outcome Measure Peritonitis rates. Results Overall, patients enrolled in the flush group experienced a peritonitis rate of 1 infection every 16.8 patient months; patients in the no flush group experienced a rate of 1 infection every 12.6 patient months ( p= 0.193). However, analysis by gender revealed the peritonitis rate of females in the flush group (1 infection every 44.7 patient months) to be significantly better than females in the no flush group (1 infection every 12.4 patient months) ( p ≤ 0.01). There was no difference noted in the male patients. Conclusion The use of the “flush before fill” option in pediatric patients receiving APD is associated with a marked improvement in the peritonitis rate of female but not male patients. Further study is indicated to explain the gender differences.
Evaluation of Nutritional Status and Factors Related to Malnutrition in Children on CAPD
Authors: Ekim Mesiha , Ikinciogullari Aydan , Ulukol Betul , Bakkaloglu Sevcan A. , Ozkaya Nuray , Kendirli Tanil , Adiyaman Pelin , Babacan Emel , Ocal Gonul 
Published: February 2020

Objective The aim of this study was to investigate the nutritional status of children on continuous ambulatory peritoneal dialysis (CAPD) and to relate it to the dose of dialysis and serum levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1). Patients 17 CAPD patients (8 girls, 9 boys; mean age 13.1 ± 3.5 years, median 15 years) were included in the study. Anthropometric measurements and serum albumin levels were used in the evaluation of nutritional status. Serum interleukin (IL)-1β, IL-6, tumor necrosis factor α, and IGF-1 levels were determined in all CAPD patients and in a healthy control group. Weekly Kt/V and creatinine clearance (CCr) were measured to determine adequacy of dialysis. Results The mean dialysis period was 23.7 ± 15.2 months (median 23 months). Anthropometric measurements and serum albumin level were as follows: height 130.2 ± 15.6 cm, height standard deviation score (HtSDS) -4.2 ± 2.4, body mass index (BMI) 16.3 ± 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 ± 0.9, triceps skinfold thickness (TST) 4.2 ± 1.4 mm, midarm circumference (MAC) 16.21 ± 2.3 cm, upper arm muscle area (AMA) 1799.1 ± 535.7 mm2, upper arm fat area (AFA) 334.5 ± 143 mm2, and serum albumin 3.1 ± 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V ( r = 0.69, p < 0.01), CCr ( r = 0.64, p < 0.05), and IL-6 ( r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period ( r = -0.58, p < 0.05); and between IL-6 and serum albumin ( r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum IGF-1 level ( r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum IGF-1 level and both HtSDS ( r = 0.57, p < 0.05) and TST ( r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and IGF-1 were also noted (both r = 0.56, p < 0.05). Conclusion Although many factors may be responsible for malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low IGF-1 levels are the most important risk factors in CAPD patients.
Pharmacokinetics of Ceftazidime in CAPD-Related Peritonitis
Authors: Booranalertpaisarn Voravut , Eiam-Ong Somchai , Wittayalertpanya Supeecha , Kanjanabutr Talerngsak , Ayudhya Duangchit Panomwana Na 
Published: February 2020

Objective The aim of this study was to measure and evaluate the appropriateness of the actual concentrations of serum and dialysate ceftazidime in Thai continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective and descriptive study of patients treated following the International Society for Peritoneal Dialysis (ISPD) 2000 recommendation for the empiric therapy of CAPD-related peritonitis. Setting Institutional level of clinical care. Patients CAPD-related peritonitis patients were diagnosed by dialysate effluent white blood cell count of more than 100/mm3 and polymorphonuclear leukocytes of at least 50%. There were 10 patients, all at least 18 years of age, entered; all completed the study. Intervention In accordance with the ISPD 2000 recommendations, the antibiotic regimen comprised continuous intraperitoneal (IP) cefazolin and once-daily IP ceftazidime. Cefazolin was administered as loading and continuous maintenance doses of 500 and 125 mg/L dialysate respectively. Ceftazidime (20 mg/kg body weight) was given IP once daily. Duration of treatment was 96 hours. Main Outcome Measures Serum and dialysate effluent samples of the 10 CAPD patients with peritonitis were measured for ceftazidime levels, which were used for the development of pharmacokinetic equations that could predict drug concentrations at any treatment time. Results Following ceftazidime administration as in the ISPD 2000 recommendation, serum ceftazidime levels were above 8 μg/mL, the minimum inhibitory concentration (MIC) recommended by NCCLS, throughout 24 hours. Dialysate ceftazidime levels were below the MIC for total periods of 4.19 and 6.26 hours in day 1 and day 4 respectively. The clinical response rate to the empiric regimen was 90%. Conclusions Once-daily IP administration of ceftazidime according to the ISPD 2000 recommendation could not provide adequately therapeutic levels of ceftazidime in dialysate throughout 24 hours. Despite this finding and the poor post-antibiotic property of ceftazidime, the empiric regimen including once-daily IP ceftazidime could yield good clinical outcome.
Double Guidewire Method: A Novel Technique for Correction of Migrated Tenckhoff Peritoneal Dialysis Catheter
Authors: Lee Chi-Ming , Ko Sheung-Fat , Chen Hsin-Chi , Leung Ting-Kai 
Published: February 2020

Twenty-two consecutive patients with a continuous ambulatory peritoneal dialysis (CAPD) catheter malfunctioning due to catheter migration were treated with a novel radiological manipulation technique, the “double guidewire method.” The first guidewire is used to correct the direction of the catheter tip and the second wire is used to anchor the CAPD catheter so that an ideal course of the catheter can be maintained during removal of the first guidewire. Immediate catheter repositioning was achieved in 19 of 22 patients, and durable repositioning success was achieved in 13 patients. In conclusion, the “double guidewire method” is a simple but effective technique for prolonging CAPD catheter life in patients with malfunction due to catheter migration.
High Peritoneal Clearance of Small Molecules Did Not Provide Low Serum β2–Microglobulin Concentrations in Peritoneal Dialysis Patients
Authors: Yamamoto Suguru , Kasai Akio , Shimada Hisaki 
Published: February 2020

Objective Although early reports demonstrated that serum β2-microglobulin (s-β2m) concentrations in patients on peritoneal dialysis (PD) were lower than those in patients on hemodialysis (HD), more recent studies demonstrated lower s-β2m concentrations in HD patients treated mainly with high-flux synthetic membranes. We therefore compared s-β2m concentrations between patients on PD and on HD, and also analyzed the relationship between s-β2m concentrations and other parameters in patients on PD. Patients and Methods We investigated 24 patients who had been undergoing PD [11 on continuous ambulatory peritoneal dialysis, 13 on continuous cycling peritoneal dialysis] for 4.3 ± 2.7 years, and 24 patients who had been undergoing HD with high-flux synthetic membranes for 6.1 ± 3.2 years. Concentrations of s-β2m in the PD patients were compared to concentrations in the HD patients. In patients on PD, we also analyzed the relationship between s-β2m concentration and other parameters, including residual renal function, total weekly Kt/V urea, total weekly creatinine clearance (CCr), and dialysis schedules. Results We found no significant difference in s-β2m concentrations between the PD and HD patients (33.6 ± 10.4 mg/L vs 30.3 ± 10.5 mg/L respectively). Concentrations of s-β2m in PD patients rose with PD duration and were significantly inversely correlated with residual renal function ( r = –0.71, p < 0.0001). Unexpectedly, concentrations of s-β2m in anuric PD patients rose as peritoneal CCr increased. And most of the patients with high s-β2m levels fell into the high or high-average transport categories according to a peritoneal equilibration test. Conclusions Concentrations of s-β2m in patients on PD did not differ significantly from concentrations in HD patients who were using high-flux synthetic membranes. The contribution of residual renal function to removal of β2m was more important than the contribution of peritoneal clearance. High peritoneal clearance of small molecules did not result in low s-β2m concentrations, especially in anuric patients with accelerated peritoneal permeability.
Preventing Peritoneal Fibrosis—Insights from the Laboratory
Authors: Yung Susan , Chan Tak-mao 
Published: February 2020

Objective Peritoneal fibrosis is one of the most serious complications of peritoneal dialysis (PD). Peritoneal fibrosis is characterized by activation of the peritoneal resident cells, accumulation and deposition of excess matrix proteins within the interstitium, and neoangiogenesis and vasculopathy of the peritoneal microvasculature. Compelling evidence now exists to show that elevated glucose concentrations present as the osmotic agent in PD solutions are, per se, responsible for those detrimental changes. Until alternative osmotic agents can fully replace glucose in PD solutions, novel therapeutic strategies are essential to preserve the structural and functional properties of the peritoneum. This review highlights recent experimental data that may offer potential strategies for preservation of the peritoneal structure and improvement of clinical outcome. Method Literature review. Results Compelling evidence now exists to show that the bioincompatible nature of PD solutions—in particular, elevated glucose concentrations and glucose byproducts—play a pivotal role in the initiation of peritoneal fibrosis. Animal and in vitro studies provide some insight into methods that can potentially be employed to alleviate or retard peritoneal fibrosis. Those methods include use of alterative osmotic agents (polyglucose or amino acids), administration of TGFβ1 antagonists, gene therapy, and pharmacologic interventions. Conclusions Knowledge of the pathogenesis of peritoneal fibrosis has allowed independent researchers to design therapeutic strategies that abrogate excess matrix synthesis and deposition in cultured peritoneal cells and in animal models of experimental peritoneal fibrosis alike. Encouraging results have been obtained in those studies, but it remains to be determined whether the studied strategies can alleviate clinical disease. Future studies will enable us to establish specific molecules that can be targeted clinically to restrict the progressive deterioration of the peritoneal membrane as a biologic dialyzing organ.
Quality of Life in Elderly Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Lin Ai-wu , Qian Jia-qi , Yao Qi-ang , Gu Ai-ping 
Published: February 2020

Objective In the present study, we determined the characteristic of quality of life (QOL) in elderly peritoneal dialysis (PD) patients by using the Medical Outcomes Study Short Form 36 (SF-36) to compare QOL between two age groups of continuous ambulatory PD patients. Patients and Methods Patients were allocated to one of two groups according to age: patients in group A were ≥65 years of age, and patients in group B were <65 years of age. We compared SF-36 scores, serum albumin, prealbumin, hemoglobin, lipid profile, normalized protein catabolic rate (nPCR), dialysis adequacy (Kt/V), creatinine clearance (CCr), and glomerular filtration rate (GFR) between the two groups. Results Group A contained 25 patients, and group B, 53 patients. Mean age in the two groups was 68.6 ± 3.3 years and 47.7 ± 10.2 years respectively. Elderly patients showed lower QOL scores with regard to physical problems. Quality-of-life scores with regard to psychological problems were similar in the two groups. Duration of PD, body mass index, serum albumin, prealbumin, hemoglobin, and lipid profile were not different between the two groups. However, nPCR, GFR, and total solute clearance were lower in group A than in group B (nPCR: 0.70 ± 0.13 g/kg daily vs 0.95 ± 0.21 g/kg daily, p < 0.001; GFR: 1.03 ± 1.21 mL/min vs 3.19 ± 2.22 mL/min, p < 0.001). Conclusions In elderly patients, QOL scores were lower, mainly because of a perception of being more physically impaired. Nutritional indices and QOL scores reflecting psychological processes were similar between the two groups. These descriptive data show that PD is an ideal choice in elderly patients with end-stage renal disease. More attention needs to be paid to “healthy start” dialysis and maintenance of nutritional status in elderly patients because of lower GFR and nPCR.
Comparison of Long-Term Survival (Beyond 12 Years) in Patients on Peritoneal Dialysis and on Hemodialysis
Authors: Tse Kai-Chung , Lui Sing-Leung , Lo Wai-Kei 
Published: February 2020

Objective We investigated the clinical condition and complications of patients on peritoneal dialysis (PD) and on hemodialysis (HD) for more than 12 years. Design This retrospective review was carried out in the renal unit of the Tung Wah Hospital, Hong Kong. Patients and Methods Of 103 HD and 341 PD patients who started dialysis before 1990, 14 HD and 22 PD patients were dialyzed for more than 12 years. We evaluated basic demography at the 12th year of dialysis and at the most recent follow-up, and assessed the prevalence of cardiovascular disease, bone disease, dialysis-related amyloidosis (DRA), and acquired cystic disease (ACD). Outcomes and mortality were recorded. Results The 36 patients in the study included 22 women and 14 men. The PD patients were older ( p = 0.021) and had lower levels of serum phosphate and calcium × phosphate product. Only 3 patients were diabetic. Cardiovascular disease was present in 30 patients (83.3%), the most common types being ischemic heart disease (IHD, n = 11) and left ventricular hypertrophy (LVH, n = 22). Symptomatic DRA was found in 13 patients (36.1%), more commonly in the HD group ( p = 0.014). Bone disease was present in 32 patients (88.9%), with parathyroidectomy being more frequently performed in the PD patients ( p = 0.048). Symptomatic ACD occurred in 5 patients (13.9%). At the most recent follow-up, 26 patients were still on dialysis, 3 patients had undergone renal transplantation, and 7 patients had died, the causes of death being sudden death ( n = 3), cerebrovascular accident ( n = 1), chest infection ( n = 2), and peritonitis ( n = 1). Patient survival was similar in the PD and HD groups. Age at commencement of dialysis predicted mortality ( p = 0.012), but mode of dialysis, sex, and presence of diabetes mellitus did not. Conclusions Long-term survival is possible for both dialysis modalities (PD and HD), particularly for young, non diabetic patients. Symptomatic DRA is less common in PD patients, but the prevalence of other long-term complications is similar for both groups. Cardiovascular-related problems remain the leading cause of death.
Screening by Trained Nurses for Peripheral Vascular Disease in Continuous Ambulatory Peritoneal Dialysis Patients with and without Diabetes
Authors: Ng Suk-Yi , Cheng Suk-Wai , Chu Wai-Ling , Lui Sing-Leung , Lo Wai-Kei 
Published: February 2020

Objective We studied the effectiveness of a screening program for peripheral vascular disease (PVD) carried out by trained renal nurses in patients with and without diabetes on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods We recruited 30 stable diabetic and 30 stable non diabetic CAPD patients into this cross-sectional study. Trained renal nurses measured the patients’ ankle-to-brachial systolic pressure index (ABI) using a Doppler ultrasound machine and their foot vibration perception (VPT) using a biothesiometer, and administered a questionnaire on foot symptoms. An ABI < 1.0 was regarded as abnormal and suggestive of the presence of PVD. An ABI < 0.7 or > 1.3 was regarded as severely abnormal. Findings for VPT were classified as normal or abnormal. Patients were then followed for 1 year for any overt development of clinical PVD, leg complications, and other vascular complications and for clinical outcome. Results The mean age of the patients was 63 ± 9 years, and the ratio of men to women was 1:1.3. An abnormal ABI was seen in 22 patients (37%). The questionnaire detected clinical PVD symptoms in 3 patients. Abnormal ABI and VPT findings were more frequent in diabetic patients. After 12 months of follow-up, patients with an abnormal ABI (and particularly those with a severely abnormal ABI) were more likely to develop leg complications and any type of cardiovascular disease than were patients with a normal ABI. Foot vibration perception had no predictive value on subsequent development of leg complications. When risk factors including age, ABI, and VPT were analyzed by logistic regression, only ABI was a significant independent predictor of subsequent lower-limb vascular complications [odds ratio (OR): 21.0; 95% confidence interval (CI): 2.35 to 187.0; p = 0.00064]. The OR for moderately abnormal ABI was 13.0 (95% CI: 1.015 to 166.3); for severely abnormal ABI, it was 27.4 (95% CI: 2.35 to 187.0, p = 0.0045). Conclusions Measurement of ABI by Doppler ultrasound is a useful and effective screening test for PVD in CAPD patients. In this study, VPT was not shown to be predicative of future leg complications, indicating that peripheral neuropathy plays a less important role in the development of such complications. Our results proved that trained renal nurses can play an active role in detecting foot problems in renal patients by ABI measurement.
Outcome of Gram-Positive and Gram-Negative Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis: A Single-Center Experience
Authors: Prasad Narayan , Gupta Amit , Sharma Raj K. , Prasad Kashi N. , Gulati Sanjeev , Sharma Ajay P. 
Published: February 2020

Background The spectrum of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in India may be different from that seen in developed countries because of differences in culture and in social, environmental, financial, and educational status. We analyzed our data regarding the incidence and outcome of monomicrobial peritonitis in our CAPD patients. Patients and Methods We reviewed the records of 225 patients on CAPD to retrieve data concerning demographics, peritonitis rate, organism isolated, and outcome. Polymicrobial and fungal peritonitis were excluded from the outcome analysis because of their different outcomes. Results We identified 168 episodes of peritonitis (range: 1 – 6 episodes per patient). Of the 168 episodes, 106 (63.1%) episodes were culture-positive. Total duration of CAPD was 264.16 patient–years. The overall peritonitis rate was 0.63 episodes per patient–CAPD year. The rates of gram-negative, gram-positive, polymicrobial, and fungal peritonitis were 0.17, 0.11, 0.04, 0.09 episodes per patient–year, respectively. Among the 75 episodes of monomicrobial peritonitis, gram-negative episodes [ n = 45 (60%)] were significantly more frequent than gram-positive episodes [ n = 30 (40%), p = 0.03]. Escherichia coli was the most commonly seen organism. Organisms of fecal origin (40/75) were significantly more frequent than those of skin origin (21/75, p = 0.0016). Catheter loss (17/45 vs 5/20, p = 0.04), hospitalization (31/ 45 vs 13/30, p = 0.03), death [9/45 vs 3/30, p = nonsignificant (NS)], switch to hemodialysis (8.9% vs 3.3%, p = NS), and reimplantation of the catheter (6.6% vs 3.3%, p = NS) were all more frequent in gram-negative episodes than in gram-positive episodes. Conclusions Gram-negative peritonitis is more frequent than gram-positive peritonitis in our CAPD population in India and is associated with worse outcome.
Prophylaxis against Gram-Positive Organisms Causing Exit-Site Infection and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients by Applying Mupirocin Ointment at the Catheter Exit Site
Authors: Wong Sunny S.H. , Chu Kwok Hong , Cheuk Au , Tsang Wai Kay , Fung Samuel K.S. , Chan Hilda W.H. , Tong Matthew K.L. 
Published: February 2020

Objective We evaluated the effectiveness of local application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis attributable to gram-positive organisms in continuous ambulatory peritoneal dialysis patients. Methods This prospective randomized controlled trial included 154 patients. They were randomly allocated to a mupirocin-treated group (group M) and a control group (group C). Group M included 73 patients (47.4%) who were instructed to apply mupirocin ointment to the catheter exit site once daily after the routine daily exit-site dressing. Group C included 81 patients (52.6%) who continued their usual daily exit-site care without applying mupirocin. The two groups were followed to see whether there would be any difference in the frequency of exit-site infection and peritonitis or in the infecting organisms. Results Interim data were collected at 5 months after the start of the study. Those data showed a significantly lower incidence of exit-site infection and peritonitis attributable to gram-positive organisms in group M as compared with group C. The incidence of gram-positive exit-site infection in group C was 1 episode per 36.8 patient–months; in group M, the incidence was 1 episode per ∞ patient–months (0 incidence in 5 months, p < 0.05). The incidence of gram-positive peritonitis in group C was 1 episode per 40.5 patient–months; in group M, the incidence was 1 episode per 365 patient–months ( p < 0.05). Mupirocin treatment had no significant effect on the incidence of exit-site infection and peritonitis attributable to other organisms. Before mupirocin treatment, we saw a trend toward higher infection rates in diabetic patients and nasal carriers of Staphylococcus aureus as compared with non diabetic patients and nasal non carriers, although the differences were not statistically significant. Mupirocin brought the infection rate attributable to gram-positive organisms to an equally low level in diabetic and non-diabetic patients, and in nasal carriers and nasal non carriers of S. aureus. No adverse effect of local application of mupirocin was reported. Conclusion Local application of mupirocin ointment at the catheter exit site is a safe and effective method of preventing exit-site infection and peritonitis involving gram-positive organisms.