bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peritoneal Transport during Dialysis with Amino Acid-Based Solutions
Authors: Park Min Sun , Heimbürger Olof , Bergström Jonas , Waniewski Jacek , Werynski Andrzej , Lindholm Bengt 
Published: February 2020

Objective To evaluate the potential clinical role of amino acids as an osmotic agent. Design The peritoneal transport of fluid, amino acids, and other solutes was investigated during a 6–hour single-cycle peritoneal dialysis with PDA 1% versus 1.36% glucose (n=6) or PDA 2.7% versus 3.86% glucose solution (n=9). Patients Fifteen stable nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Results The fractional absorption of the osmotic agents at 6 hours was higher with PDA 2.7% versus glucose 3.86% (p<0.005). The diffusive mass transport coefficient, KeD’ calculated for a period of dialysate isovolemia was higher with PDA 2.7% versus PDA 1% for essential, nonessential (p<0.005), and total (p<0.05) amino acids. The intraperitoneal volume-over-time curves and KqD values for urea, creatinine, glucose, albumin, β2microglobulin, and total protein did not differ between the amino acid solutions and the corresponding glucose solutions. KeD for urea was significantly higher during the dwell with PDA 2.7% versus PDA 1% (p<0.05). Plasma amino acid concentrations increased substantially during the first 1– 2 hours and then decreased gradually. Valine and methionine rose to 792% and 1119% of baseline values, respectively. Conclusions We conclude that the peritoneal transport of fluid and investigated solutes, except amino acids, was not different with the amino acid solutions compared with the corresponding equimolar glucose solutions. However, ultrafiltration tended to be lower with amino acid solutions. Furthermore, the fractional absorption of amino acids and KeD values for amino acids was higher with PDA 2.7% versus PDA 1 %, suggesting an effect of the hypertonic amino acid solution on the peritoneal membrane transport properties. Also, the hypertonic PDA2.7% solution yielded nonphysiologically high plasma levels of several amino acids. We therefore consider this solution not to be safe enough for long term clinical use.”
Effects of Subcutaneous Recombinant Human Erythropoietin in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Di Paolo Bruno , Marini Alvaro , Fiederling Barbara , Di Liberato Lorenzo , Santarelli Patrizia , Bucciarelli Sandro , Stuard Stefano , Paolantonio Lucia , Albertazzi Alberto 
Published: February 2020

The use of recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of renelanemia, but the dose regimens, the optimal frequency, and the effects on other target organs like the central nervous systems (CNS) are still under discussion. We designed a prospective, ongoing study with 10 stable continuous ambulatory peritoneal dialysis (CAPO) patients (6 males, 4 females; mean age 64.4±7.8 years), with a pretreatment hemoglobin (Hb) <7.0 901. and requiring regular blood transfusions. Seven patients were treated with 4000 U rHuEPO once weekly (Eritrogen, Boehringer Mannhelm), 2 patients received 4000 U every 5 and 8 days, and the last one 4000 U every 10 days. The target hematocrit was 33% and Hb 10.0 g%. The CNS activity was recorded as visual (YEP), brainstem (BAER), and somatosensory (SEP)-evoked potentials. The mean Hb concentration Increased from 6.9± 1.2g% to 10.3± 1.6 g% (p<0.001) over 8 weaks. There were no significant changes In urea, creatinine, and potassium levels, and urine output. rHuEPO Induced a decrease In latency of P100 YEP, In the four main components of BAER, and In the P27–N35 Intertime of SEP. Parallel to the Improvement of red cell Indices, patients experienced a dramatic Improvement In well-being. The subcutaneous administration of a single vial of rHuEPO Is safe, convenient, and Inexpensive In CAPO. The role of rHuEPO treatment In Improving the electro-physiological brain function In uremic and anemic patients remains to be studied and may not necessarily be based on Improved cerebral oxygenation.
Lovastatin Treatment of Dyslipoproteinemia in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Tao Li Philip Kam , Mak Tony W.L. , Lam Christopher W.K. , Lai Kar Neng 
Published: February 2020

We conducted a single, blinded cross-over placebo versus lovastatin study on 10 continuous ambulatory peritoneal dialysis (CAPD) patients with dyslipoproteinemia who failed to respond to diet control. They were given 8 weeks of lovastatin (20–40 mg) and placebo, respectively. After 8 weeks of lovastatin treatment, total cholesterol was significantly reduced by 28.6% (6.68±0.26 mmol/L, mean±SEM, to 4.77±0.12, p<0.01); low-density lipoprotein cholesterol by 40.5% (4.57±0.27 mmol/L to 2.72±0.09, p<0.01); apolipoprotein B by 32.4% (115.9±6.99 mg/dL to 78.3±2.9 mg/dL, p<0.01); and triglyceride by 17.8% (1.92±0.38 mmol/L to 1.58±0.32, p<0.05). Simultaneously high-density lipoprotein cholesterol increased by 7.6% from 1.24±0.13 mmol/L to 1.34±0.16, p<0.05. There were no significant changes in other lipid profiles between placebo and drug treatment. No significant adverse effects were observed with lovastatin treatment. Lovastatin appears to be effective in treating dyslipoproteinemia in CAPD patients.
Dialysis Adequacy in Hypoalbuminemic Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Spinowitz Bruce S. , Gupta Bharat K. , Kulogowski Josephine , Charytan Chaim 
Published: February 2020

We examined the interrelationship between hypoalbuminemia (HA) and the normalized protein catabolic rate (NPCR; g/kg/day) in the face of adequate Kt/V and weekly creatinine clearances in 40 end-stage renal disease patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We also evaluated serum albumin (SA) levels as an additional marker of nutritional status of the PD patients receiving adequate dialysis therapy in terms of Kt/V greater than 1.5 per week. Twenty-three of 40 patients had normal serum albumin (NSA; ≥3.4 g/dL) and 17 had HA «g/dL). A correlation between NPCR and SA levels was observed. Also, the NPCR values in patients with NSA (0.98±0.31) differ significantly (p<0.0005) from patients with HA (0.80±0.13). Urea kinetic parameters for adequacy of dialysis, that is, Kt/V, blood urea nitrogen (BUN), and weekly creatinine clearance, did not reveal any statistically significant difference between patients with NSA and HA. These data suggest that low values of NPCR may be seen in hypoalbuminemic CAPD patients despite adequate dialysis therapy and indicate further investigation for associated morbid conditions or supplemental nutrition.
Nutritional Status and Growth in Children Less than 12 kg Treated with Continuous Ambulatory Peritoneal Dialysis
Authors: Stefanidis Constantinos , Michelakaki Helen , Koulieri Alexandra , Michelis Kyeiakos 
Published: February 2020

Various parameters of nutritional status and growth In 13 children with weight less than 12 kg were estimated at the start of continuous ambulatory peritoneal dialysis (CAPD) and 1 year later. A significant Improvement In weight, triceps skinfold, and serum albumin was noticed. Height and midarm muscle circumference did not change significantly. However, a significant Improvement In height occurred In patients with initial abnormal height «- 2 SDS). There was no significant change In protein Intake and urea nitrogen appearance (UNA) during the study period. A significant correlation between protein Intake and UNA was noticed. All patients had normal serum Insulinlike growth factor. In conclusion, there was no significant changein either height velocity or muscle mass despite the improvement in many nutritional parameters.
Chronic Peritoneal Dialysis Catheters in Pediatric Patients: Experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis
Authors: Verrina Enrico , Perfumo Francesco , Zacchello Graziella , Edefonti Alberto , Bassi Sergio , Capasso Giovanni , Caringella Domenica A. , Castellani Alfonso , Longo Luigi , Rinaldi Stefano , Viglino Giusto , Cantaluppi Alberto 
Published: February 2020

During the period 1986–1991, 140 pediatric patients [age≤15 years at the start of chronic peritoneal dialysis (CPD)], belonging to 15 dialysis centers, were enrolled In the Italian Registry of Pediatric Chronic Peritoneal Dlaly 515. Data on 188 peritoneal catheters were collected: 161 catheters were Tenckhoff (144 double-cuff, 17 singlecuff), and 27 were two-cuff Valll-type catheters. All catheters were surgically inserted; the entry site was in the midline In 84 cases and paramedian in 104. An omentectomy was performed in 78.80/0 of the cases. Apart from peritonitis, there were 161 catheter-related complications (103 exit-site infections, 17 leakages, 15 obstructions, 15 outer-cuff extrusions, 5 hemoperltoneum, 6 others) observed during 2687.5 dialysis-months, with an Incidence of one complication every 16.7 dialysis months. Fifty-five catheters (29.2%) were removed; infection (39 cases) was the main cause for removal, followed by obstruction (9 cases), dislocation, and outer-cuff extrusion (2 cases each). Actuarial survival of all catheters was 79.7% at 1 year, 66.6% at 2 years, 42.8% at 3 years, and 39.80/0 at 4 years. No difference In catheter survival was observed according to the entry site. When considering the age of the patients at catheter insertion, a difference close to statistical significance was found (p=0.06).
Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis
Authors: Edefonti Alberto , Picca Marina , Galato Raffaele , Guez Sophie , Giani Marisa , Ghio Luciana , Damiani Beatrice , Dal Col Augusta , Santerarno Carmela 
Published: February 2020

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.
The Use of Fluconazole in the Management of Candida Peritonitis in Patients on Peritoneal Dialysis
Authors: Hoch Brian S. , Namboodiri Neel K. , Banayat Geronimo , Neiderman George , Louis Bertin M. , Manohar Namala L. , Lipner Henry I. 
Published: February 2020

In patients receiving peritoneal dialysis, fungal peritonitis is generally impossible to eradicate with previously available therapy in the absence of catheter removal. Corbella et al. described a patient with fungal peritonitis treated with fluconazole without catheter removal. We studied this drug's effectiveness in the treatment of 5 patients with peritonitis secondary to Candida species. Patients received a loading dose of 200–400 mg fluconazole, followed by 50–200 mg fluconazole daily. Patients Improved initially after therapy with fluconazole. Abdominal pain and fever abated, dialysis returns cleared, cell counts decreased, and, in four cases, cuitures were sterilized. Dialysate fluconazole levels were adequate. However, despite maintenance of fluconazole therapy, all patients had recurrent peritonitis within 1 month. Complete cure did not occur unless the Tenckhoff catheter was removed. When the catheter was removed, tip cuitures grew pure Candida species, and microscopic examination of catheter sections revealed abundant yeast. Although there may be continued isolated reports of successful eradication of fungal peritonitis without catheter removal, we conclude that in the vast majority of cases catheter removal is required.
Peritoneal Dialysis in the Prune Belly Syndrome
Authors: Crompton Charles H. , Balfe J. Williamson , Khoury Antoine 
Published: February 2020

Objectives To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS). Design From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion. Results The ages of the 6 boys ranged from 10 months 17 years. The dialysis duration was from 9–22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery. Conclusion Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.
Mass Transfer Area Coefficients in Children
Authors: Geary Denis F. , Harvey Elizabeth A. , Balfe J. Williamson 
Published: February 2020

Objective Measurement of mass transfer area coefficients (MTAC) in children of different sizes to determine if solute transport varies with age and to compare with published adult values. Design Mass transfer area coefficients calculated from prospectively collected data in 28 selected patients. Participants All children starting maintenance peritoneal dialysis at the Hospital for Sick Children. Selected patients were also studied if hospitalized for unrelated reasons. Results Mean MTAC values for creatinine and glucose were 4.0 and 4.5 mL/min, respectively, both considerably lower than adult values. When scaled per 70 kg body weight, these results were greater, and when scaled per 1.73 m2 surface area, they were lower than reported adult values. The MTAC/kg body weight was inversely correlated to age. Conclusions Solute transport in children is directly related to age and does not approach adult values until later childhood. However, more rapid transport per unit body weight is observed in children and may reflect an increased effective peritoneal surface area.
Continuous Ambulatory Peritoneal Dialysis: An Option in the Developing World?
Authors: Lent Roy , Myers Jonathan E. , Donald Deidre , Rayner Brian L. 
Published: February 2020

Objective To evaluate specified biomedical, socio-economic, and psychosocial criteria as predictors of therapeutic success to optimize patient selection for continuous ambulatory peritoneal dialysis (CAPD) in a developing country. Design A restrospective cohort study investigating the relationship between episodes of peritonitis and exitsite infection, and predetermined biomedical, socioeconomic, and psychosocial data. Setting A CAPD unit in a large tertiary care teaching hospital. Patients AI1132 patients entering the CAPD program between 1987 and 1991. Results Overall mean survival time on CAPD was 17.3 months. Peritonitis rates were high, especially among blacks. Multivariate analysis demonstrated that increased peritonitis rates were associated with age, black race, diabetes, and strongly so with several psychosocial factors. Because being black was strongly linked to poor socioeconomic conditions, repeat analysis excluding blacks showed the same associations with the above variables, but, additionally, several socioeconomic factors were associated with high peritonitis rates. No significant explanatory variables were shown for exit-site infections. Conclusions The association of biomedical, socio-economic, and psychosocial variables with high peritonitis rates has important implications for the selection of patients for CAPD in this setting.
A Multicenter Study with Once a Week Or Once Every Two Weeks High Dose Subcutaneous Administration of Recombinant Human Erythropoietin in Continuous Ambulatory Peritoneal Dialysis
Authors: Nomoto Yasuo , Kawaguchi Yoshindo , Kubota Minoru , Tagawa Hitoshi , Kubo Kazuo , Ogura Yosuke , Shoji Takao , Kawada Yukimichi , Koshikawa Shozo , Mimura Nobuhide , Maeda Teiryou 
Published: February 2020

Objective To investigate the effectiveness of administering relatively high doses of r-HuEPO subcutaneously once a week or once every 2 weeks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Design Multicenter prospective analysis. The trial was divided into two phases: an initial 8-week phase (once a week dosing) followed by a 12-week maintenance phase (once every 2 weeks dosing). A response was defined as a change in hematocrit (Ht) of 3% or more. Results were analyzed using Sheffe's test, Mantel-Haenszel's test, and Dunnett's test. Setting Eleven renal units in Japan providing a CAPD program. Patients Forty-one CAPD patients with a Ht of 28% or less. Results After the initial 8 weeks, 13 (81.3%) of 16 patients showed a response to 6000 U (106.9±20.0 U/kg) subcutaneously (sc), once a week. Eleven (84.6%) of 13 in the 9000 U (166.5±27.7 U/kg) group and all 12 (100%) in the 12 000 U (210.7 ±42.1 U/kg) group also showed responses. At the end of both phases, that is, at 20 weeks, 7 (53.8%) of 13 patients in the 6000 U group with once every 2 weeks dosing, 7 (63.6%) of 11 in the 9000 U group, and 10(90.9%) of 11 in the 12 000 U group maintained responses with the same dosing interval. There were no significant changes in mean blood pressure during the study period, and only 2 patients developed treatable hypertension with mild headache. Conclusion Administration of relatively high doses of r-HuEPO to CAPD patients once a week or once every 2 weeks is safe and potentially an effective regimen for the correction of renal anemia.
A Comparison of Infection Rates among Older and Younger Patients on Continuous Peritoneal Dialysis
Authors: Holley Jean L. , Bernardini Judith , Perlmutter Jeffrey A. , Piraino Beth 
Published: February 2020

Objective To determine if peritoneal dialysis -related infection rates are higher in older patients compared with younger patients. Design A retrospective review of prospectively collected data. Control adult patients were matched with older study patients for race, sex, insulin dependence, connection device, and time on dialysis. Setting A university-based peritoneal dialysis program which includes patients from a Veterans Administration Hospital outpatient dialysis program. Patients Infection rates of 103 patients 60 years of age (older patients) were compared with 103 matched control patients 18–49 years of age (younger patients). Main Outcome Measures Rates of peritonitis, exit site and tunnel infection expressed as episodes/patient/year (episodes/year) and the infecting organisms for each were examined. Outcomes, including catheter removal and the cause for removal, transfer to another dialysis modality and the reason for such, death and transplantation were also assessed. Results Mean time on peritoneal dialysis was the same in each group (20±21 months in the older and 18±17 months in the younger patients). The overall peritonitis rates were the same in the two groups (0.95/year in the older and 0.89/year in the younger patients), but the older patients had a higher rate of S. epidermidis peritonitis (0.28/year vs 0. 13/year, p=0.0001). S. aureus peritonitis rates were similar (0.16/year in older and 0.17/year in younger patients). Older patients had fewer exit-site infections (0.80/year versus 1.2/year, p=0.0001) and, specifically, lower rates of S. aureusexit-site infections (0.23/year vs 0.47/year, p=0.0001). Tunnel infections were also less common in older patients (0.15/year vs 0.23/year, p=0.008), but S. aureustunnel infection rates were similar (0.05/year and 0.09/year). Catheter infection was the most common reason for catheter removal in both patient groups (35% of catheters in the older and 44% of catheters in the younger patients, p=NS). More catheters were removed from older patients because of dementia or the loss of mechanical skills required to perform peritoneal dialysis exchanges (15% vs 5%, p=0.04). Conclusions Older age per se is not associated with higher peritonitis rates, but the use of disconnect sys tems should be encouraged in older patients and their mental and physical skills monitored to avoid S. epidermidis peritonitis. The lower rates of S. aureus catheter infection in older patients requires further study.
Catheter Configuration and Outcome in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Comparison of Two Catheters
Authors: Eklund Björn H. , Honkanen Eero O. , Kala Aino-Riitta , Kyllönen Lauri E. 
Published: February 2020

Objective To examine the impact of peritoneal catheter configuration on mechanical complications, catheter survival, probability of episodes of peritonitis, and probability of exit-site infections associated with the use of catheters for continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized trial. Setting CAPD unit in one university hospital. Patients Forty consecutive patients requiring a dialysis catheter for future CAPD were randomized to receive either a single-cuff straight Tenckhoff catheter or a permanently bent single-cuff Swan neck catheter. The skin exit was upward-directed in the Tenckhoff group and downward-directed in the Swan neck group. Results Dialysate leak occurred in one patient and symptomatic catheter tip migration in 3 patients with the Tenckhoff catheter but in none with the single-cuff Swan neckcatheter(p=O.5, p=0.12). No significant differences in catheter survival at 2 years, probability of episodes of peritonitis, or probability of exit-site infections could be demonstrated. Conclusion Catheter configuration did not influence the catheter-related mechanical or infectious complications. We were unable to demonstrate any advantage of the newer, permanently bent single-cuff Swan neck catheter over the conventional straight type.