bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
Individualization of Exchange Volume
Authors: Twardowski Zbylut J. , Burrows LaVonne M. , Prowant Barbara F. 
Published: February 2020

This paper deals with adjustment of instillation volumes to achieve the best efficiency of dialysis in individual patients. Larger volumes may permit fewer daily exchanges which in turn decreases the number of connections and the risk of peritonitis. Factors associated with poor tolerance to increased volumes are discussed. Taller and heavier patients tolerate high volume dialysis better. It is generally accepted that most patients treated with continuous ambulatory peritoneal dialysis (CAPD) require an integrated (renal and dialysis) small molecule clearance of at least ten liters/day (7 ml/min). If dialysate concentration of small molecules equals that of plasma, a peritoneal dialysis clearance is tantamount to daily drainage volume. However, a wide variation in mass transfer has been observed among patients. Although this variation is more pronounced for large molecular weight solutes, the variation is also clinically significant for small molecules (1). In patients with small molecule dialysate concentration lower than that in plasma. the daily peritoneal clearance of ten liters can be achieved with dialysate flow rate exceeding this value and higher than ten liter drainage volumes per day may be required in some anuric patients.
ASCITES in the CAPO Patient Post Transplant
Authors: Dutton Sue 
Published: February 2020

Our experience with CAPD patients and post-transplant ascites showed: 71 per cent of the transplanted patients required dialysis post transplant. The duration of dialysis ranged from less than one week to greater than two months. Ascites occurred in 33 per cent of the patients post transplant. Mean time of onset of the ascites was 2.8 weeks post transplant. The duration of the ascites, when ascertainable, ranged from one to three weeks. In the 8 patients who developed ascites, only one graft was lost to rejection at 3 months. There was no apparent relationship between time on CAPD and the presence of ascites. Ascites in the post-transplant CAPD patient appears to be a benign process, but the mechanism and causative factors are unclear and further investigations are warranted. A recent article from Toronto (I) stated that ascites occurred post transplantation in children but that posttransplantation ascites in adults had not been reported. This prompted our analysis of the occurrence of ascites in CAPD patients who had received a transplant at the University of Missouri-Columbia Health Sciences Center.
Povidone Iodine Sterilization of Contaminated CAPD-Exchange Spikes
Authors: Golper Thomas A. , Sewell David L. , West Linda , Trinklein Marge 
Published: February 2020

Thirty routine CAPD exchange spikes (Travenol) were dipped in a Staphylococcus aureus suspension and then divided into three equal groups. Group I (G1) spikes were advanced from the bacterial suspension to a povidone-iodine solution for a five-minute soak; Group 2 (G2) spikes were advanced into a sterile, non-bacteriostatic, physiologic saline solution for a five-minute soak. Then G1 and G2 spikes were attached in the usual sterile fashion to dialysis bags pretreated with tryptic soy broth to enhance bacterial growth. Group 3 (G3) spikes were advanced immediately to pretreated dialysate bags. Cultures of the dialysis solution were obtained immediately after the spikes were connected to the dialysis bags, 48 hours later, and at weekly intervals for three weeks. All 10 of the G3 bags connected to spikes without soaking grew greater than 10 colony forming units/mi of S. aureus by 48 hours. All 10 of the saline soaked G2 bags also demonstrated growth at 48 hours. Only one of the 10 Gl povidone-iodine soaked spike bags grew detectable colonies of bacteria at 48 hours. We conclude that a five-minute povidone-iodine soaking of spikes contaminated with S. aureus usually will prevent bacterial growth but is not a perfect solution to the problems of spike contamination. The frequent occurrence of peritonitis remains the limiting factor to the widespread acceptance of CAPD. Oreopoulos et al proposed that 36.5% of episodes of peritonitis are secondary to contaminations at the connection site during the a CAPD bag exchange (1). Although the exact frequency is unknown, we agree that the likelihood is high that contamination at the time of the exchange is a common mode of bacterial access to the peritoneal cavity. When we established our CAPD programs we instructed our patients to change the tubing if the spike became contaminated. Patients only rarely notified us of this necessity, despite our suspicion that known contamination was occurring. Two of us asked the Bulletin's editors if one could manage spike contamination simply by soaking the spike in povidone-iodine (2). Vas recommended that the tubing be changed because simple soaking would not deal with contamination inside the lumen (3). We decided to study this issue further because we believed that patients would not comply with this recommendation.
The Effect of Cigarette Smoking and Previous Hypertension on the Survival of Patients Treated by Continuous Ambulatory Peritoneal Dialysis
Authors: Drew Peter J. T. , Cunningham Stephen John , Evans J. W. , Marsh Frank P. , Goodwin Frank J. 
Published: February 2020

Life-table survival curves, computed for 107 patients undergoing CAPD at The London Hospital between July 1979 and March 1983, showed that patient survival at two years was 68% and overall treatment survival was 46%. However, when we excluded satisfactory outcomes of CAPD treatment, such as renal transplantation, as causes of treatment failure, the technique survival at two years was 62.5%. Age, cigarette smoking, and a history of severe hypertension had statistically significant and independent effects on survival and most deaths were due to causes not directly related to CAPD. Although the literature contains several reports on survival rates in patients on continuous ambulatory peritoneal dialysis (CAPD) (I, 2), we know little about the factors which influence the success of this treatment. We therefore performed an actuarial analysis of patient and treatment survival in 107 patients who started CAPD at The London Hospital between July 1979 and March 1983 and examined the effects of age, sex, cigarette smoking and previous hypertension -factors known to affect survival in the general population.
Pharmacokinetics of Intravenous and Intraperitoneal Cefotaxime in Patients Undergoing CAPD
Authors: Matousovic Karel , Stefan Josef Moravek , Prat Vitko Vladimir , Horcickova Milena 
Published: February 2020

We investigated the pharmacokinetics of non-metabolized cefotaxime in 10 patients undergoing CAPD. The elimination half-life after IV administration of I g cefotaxime was 3.1 ± 1.3 hr, i.e. two to three times longer than in individuals with normal renal function but similar to patients with severe renal insufficiency. An average of 2.18% of the dose was recovered in the effluent. The halflife of I g cefotaxime administered in the dialysis solutions was 1.4 ± 0.8 hr. This difference between the half-lives after intraperitoneal and intravenous administration indicates a faster transport through the peritoneal membrane. Intraperitoneally administered cefotaxime -250 mg four times daily, was effective in the treatment of peritonitis in three CAPD patients. Since its introduction in 1976, CAPD has become an effective therapy for end-stage renal disease. The most serious complication is peritonitis and effective treatment is essential. Cefotaxime, a new broad-spectrurn cephalosporin, is active against most gramnegative and gram-positive organisms. It possesses no nephrotoxicity and may be useful in the treatment of peritonitis and other infections in patients on CAPD. This study was done to evaluate the pharmacokinetics of cefotaxime administered intravenously and intraperitoneally during CAPD.
Longitudinal Study of Nerve Conduction Velocities during Continuous Ambulatory Peritoneal Dialysis
Authors: Sunderrajan Sobha , Nolph Karl D. 
Published: February 2020

Nerve conduction velocities were measured repeatedly in 20 patients on continuous ambulatory peritoneal dialysis for one or more years. Nerve conduction velocities remained stable in most cases. Peripheral neuropathy is a severe, disabling complication of uremia, and it has been reported that patients on chronic intermittent dialysis develop severe neuropathy (1). Few reports have been published concerning the course of neuropathy in patients on continuous ambulatory dialysis. This paper describes the retrospective analysis of motor nerve conduction velocities (MNCV's) in 20 patients from the University of Missouri Hospital and Clinics. who have been maintained on continuous ambulatory peritoneal dialysis (CAPD) for one or more years.
Monolayer Mesothelium from the Ileal Rabbit'S Mesentery: An Experimental Model for Study of Peritoneal Kinetics IN VITRO
Authors: Breborowicz Andrzej , Janecki Andrzej , Breborowicz Grzegorz , Knapowski Jan 
Published: February 2020

This paper describes an experimental model of the monolayer mesothelium from the ileal rabbit's mesentery. As proved by the electron micro. scopic examination, this membrane consists of the mesothelium lying on the undamaged basement membrane. To minimize the damage to the membrane's edge, we used a new type of chamber. Over a period of 90 minutes transport rate of the various solutes across the mesothelium in vitro was constant, which proves indirectly the viability of this epithelium during this time. This experimental model seems to be suitable for the in vitro study of the mechanisms which regulate the permeability of the peritoneal mesothelium. Permeability of the peritoneal mesothelium to various solutes and water has been evaluated during in vitra studies of isolated peritoneal membranes of the mesentery or on the parietal peritoneum (1,2,3). The experimental conditions avoid or significantly diminish the interference of other barriers, like endothelium or connective tissue, which play an important role in viva. Mesentery consists of two mesotheliallayers, lying symmetrically and, as a result, the permeability so measured doesn't reflect precisely the permeability of the mesothelium. On the other hand models of the parietal peritoneum include a thick layer of muscle and connective tissue which can be a source of some artifacts. To avoid these disadvantages we developed an experimental model of the monolayer mesothelium obtained from the ileal mesentery of the rabbit. We believe this model is useful for the investigation of the function of this epithelium during the peritoneal dialysis. This paper describes this in vitra model which we have devised for the study of the peritoneal mesothelium.
Intracellular Calcium Ions Modulate Permeability of the Peritoneal Mesothelium In Vitro
Authors: Breborowicz Andrzej , Knapowski Jan , Breborowicz Grzegorz 
Published: February 2020

The authors studied the in vitro effect of a calcium-channel-blocker -verapamil, local anesthetic -bupivacaine and a calcium ionophore -A23187 on the permeability of the monolayer mesothelium from the rabbit's mesentery. Verapamil and bupivacaine increased transmesothelial flux of calcium while A23187 increased calcium transport only transiently. Verapamil augmented the permeability of the mesothelium to inulin and urea. However A23187 decreased the transmesothelial flux of inulin only whereas it increased the transport of urea. From this study we have concluded, that intracellular calcium may determine the permeability of the peritoneal mesothelium. Various important biological processes like muscle contraction, secretion of transmitters and hormones, and control of epithelial permability seem to be dependent on intracellular calcium-ion activity (1–4). Our previous paper suggested that a local anesthetic, bupivacaine, produces its effect on the peritoneal mesothelium through interaction with the cytoskeleton of the epithelial cells, and with the mem brane's calcium transport (5). In addition Palant et al found that the permeability of another leaky epithelium, that from the Necturus gallbladder, depends on the extracellular calcium concentrations and may be altered by drugs, which interfere with the entrance of these ions into the epithelial cells (6). Therefore, we decided to study the role that calcium ions may play in the transport of solutes across the peritoneal mesothelium in vitro.
Six-Year Experience with CAPD Catheters in Children
Authors: Watson Alan R. , Vigneux Annette , Hardy Brian E. , Balfe J. Williamson 
Published: February 2020

Over a six-year period, 78 chronic peritoneal catheters were implanted in 55 patients; mean age at insertion was 9.6 years (range 0.2 to 19.1 years) and mean body weight was 28.3 kg (range 4.5 to 63 kg). Singlecuff catheters were used almost exclusively and were inserted in the midline under general anesthetic. Complications included leakage (26%) and one-way catheter obstruction (17%). Exit site and/or tunnel infections developed in 25% and hernias in 20% of 55 patients. Twenty-six catheters required replacement or removal. Actuarial catheter survival was 50% at two years. A retrospective analysis of exit-site infections suggested a significant benefit with “covered” as opposed to “uncovered” catheters (p < 0.01). Despite difficulties with catheter function only one patient was taken off CAPD because of a leak into the pleural cavity. Recent experience suggests that paramedian catheter placement and the use of catheters of an appropriate length for children will reduce the incidence of leakage and one-way obstruction. The complications associated with implantation and the long-term use of chronic peritoneal catheters have produced several modifications of the original Tenckhoff catheter (1–4). However, it remains to be established whether single or double cuff catheters result in fewer exit site, tunnel, or peritoneal complications (5). When our program started in 1978, we used double-cuff catheters but subsequently have implanted single-cuff catheters almost exclusively. Our initial experience with exit-site and tunnel infections was encouraging: only one out of 37 catheters had to be replaced because of tunnel infection (6). This paper describes our additional experience and the complications encountered with increasing duration of catheter use in our pediatric population.
CAPD Fluid Examination using the Bactec 460
Authors: Dalton Maurice Terence , Prevost Eva 
Published: February 2020

In the microbiological laboratory CAPD fluid analysis is an unstandardized and sometimes a labor intensive procedure. This pilot study was set up to demonstrate the value of in-place technology -the Bactec 460 blood culture system, in reducing the work-load. Our results indicate that it is at least as effective as other, more tedious conventional methods. Since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has proved to be a major advance in the management of end-stage renal disease (I). Despite refinements in technique over the years leading to more widespread use of CAPD, the major hazard remains peritonitis and other infections (2). Also peritonitis is a major cause of failure of CAPD (3,4). Because CAPD allows more freedom of movement, several laboratories receive the postdialysis effluents from the same patient; furthermore there is no widely recognized, single method for the examination of these fluids (2, 5). Some centers recommend daily sampling for microbiological studies and while this is ideal for patient management, it imposes a significant workload on the microbiology laboratory, particularly in a larger centre (2). Currently it appears that the number of patients on CAPD will continue to increase for the foreseeable future and so will the numbers of specimens to be examined. To facilitate these examinations, we carried out a five-month pilot study using the Bactec 460 blood-culture system to examine CAPD fluids. We compared these results with a conventional method used previously in our laboratory.
Lipid Metabolism in 31 Chinese Patients on three 2–L Exchanges of CAPD
Authors: Chan Man Kam , Yeung Choi Kit 
Published: February 2020

The authors measured nine biochemical parameters -urea, creatinine, albumin, total cholesterol, total triglycerides, HDL- cholesterol, C3, C4 and post-heparin hepatic and lipoprotein lipase activities in 31 Chinese patients, who were carrying out three 2–L CAPD exchanges per day. Uremic plasma from 19 patients also was tested for the presence of hepatic and lipoprotein lipase inhibitors. Anthropometry included a record of height, weight and skin-fold thicknesses. The CAPD patients had mild hypertriglyceridemia -144 ± 60 vs 106 ± 55 in males, p = 0.05 and 176 ± 92 vs 100 ± 45 in females, p < 0.005. Their mean total cholesterol concentration did not differ from that of controls. Mean HDL-cholesterol concentration in CAPD patients was significantly reduced 28 ± 10 vs 42 ± 10 in males and 30 ± 15 vs 42 ± 13 in females. Both hepatic lipase -9.54 ± 4.26 in males and 30 ± 15 vs 42 ± 13 in females, and lipoprotein lipase -1.96 ± 0.93 in males and 1.91 ± 1.09 in females were reduced in CAPD patients. The correlation between serum triglycerides (TG) and lipoprotein lipase activities in CAPD patients was weak, though significant, but there was none between lipoprotein lipase activities and HDL-cholesterol concentrations. The mean albumin concentration of CAPD patients was close to the lower limit of (though still within), the normal range. Serum albumin concentrations did not correlate with total cholesterol concentrations. The mean C3 was reduced below the normal range. C3 concentrations correlated with those of serum triglyceride and with adiposity indices. C4 did not change consistently. Plasma from CAPD patients inhibited lipoprotein lipase but did not interfere with hepatic lipase activities. Hepatic lipase activities correlated with C3, serum TG concentrations and adiposity index, probably reflecting improved nutritional status. Factors other than impaired triglyceride catabolism also are responsible for the lipid abnormalities in CAPD. Abnormalities in lipid metabolism occur in chronic renal failure and persist in patients on hemodialysis (1). Defects in catabolism of triglyceride-rich lipoproteins have been demonstrated in vivo (2–7) and in vitro (8–13) and it appears that impaired triglyceride break down by peripheral tissues is the dominant cause of hypertriglyceridemia among hemodialysis patients (3, 5, 13). Lipid abnormalities also have been reported in CAPD patients (14–16). Although glucose absorption from the dialysis solutions may play a role, the pathogenetic mechanisms are not well defined. We have been treating our end-stage renal failure patients with CAPD but, unlike those in other centres, our patients carry out three 2– L exchanges daily. This paper describes an investigation of lipid metabolism in 31 patients.
Management of Fungal Peritonitis during Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Vassilis Vargemezis Zoe L. , Papadopoulou Homer , Liamos Anna-Maria , Belechri Taisir Natscheh , Vergoulas George , Antoniadou Rodothea , Kilintzis Vassilis , Papadimitriou Menelaos 
Published: February 2020

A group of 138 patients (pts) on CAPD for a total of 1889 patientmonths had 176 episodes of peritonitis. Eighteen (13%) had fungal peritonitis at one to 20 months after beginning CAPD. The responsible organisms were Candida albicans (nine pts), Candida parapsilosis (five), Candida torulopsis (three), and Trichosporum capitatum (one). These infections were treated by various combinations of antifungal agents using two different strategies: Removal of the Tenckhoff catheter and interruption of CAPD for 10 to 14 days in nine pts (Group A), and continuous peritoneal lavage for four to six days in the remainder -nine pts (Group B). Fourteen of the 18 were cured (seven of nine in each group). In group A, two patients died, one continues on CAPD while the other six (67%) were transferred to hemodialysis because they developed peritoneal adhesions with significant loss in peritoneal space. In group B, only two patients have been transferred to hemodialysis; the other seven continue on CAPD. In our experience, the preferred initial form of treatment is continuous peritoneal lavage in conjunction with antifungal therapy. Catheter removal should be reserved for those who fail to respond to this treatment. Continuous ambulatory peritoneal dialysis (CAPD) is now accepted as a alternative treatment for end-stage renal disease. However, despite continuous progress in this field, peritonitis still remains a major complication and results in increased morbidity and cost. Although pathogenic fungi account for only 2 7% of peritonitis in patients on CAPD (1–3), the illness is severe and represents a major clinical challenge to these patients. In addition, the therapy of fungal peritonitis is still controversial, especially with regard to the need for removal of the catheter. This paper presents a retrospective study and describes our experience during the past four years with the management of fungal peritonitis in 18 patients undergoing CAPD at our center.