bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interleukin-1β Stimulates the Production of Extracellular Matrix in Cultured Human Peritoneal Mesothelial Cells
Authors: Yang Won Seok , Kim Byung Sik , Lee Sang Koo , Park Jung Sik , Kim Soon Bae 
Published: February 2020

Objective To investigate the effect of interleukin-1β (IL-1β) on the production of extracellular matrix in cultured human peritoneal mesothelial cells (HPMCs). Design Cultured HPMCs were treated with or without IL-1β. Cell morphology was observed. The expression of fibronectin, α1(I) procollagen, and transforming growth factor-β1 (TGFβ1) mRNAs was measured by Northern blot analysis. The cell surface expression of fibronectin and type I collagen was evaluated by immunofluorescent staining. Fibronectin and type I collagen in culture supernatant were measured by inhibition ELISA. Results Interleukin-1β induced morphologic change in HPMCs from a cuboidal epithelioid shape into an elongated fibroblastoid shape. The elongated cells were positive for cytokeratin although they had a fibroblastoid appearance. Treatment of HPMCs with IL-1β resulted in increased expression of both fibronectin and α1(I) procollagen mRNA in dose- and time-dependent manners. Immunofluorescent staining showed strong and diffuse cytoplasmic expression of fibronectin and type I collagen in the cells treated with IL-1β, whereas only weak perinuclear cytoplasmic staining was noted in the cells on media alone. The concentrations of secreted fibronectin and type I collagen in culture supernatant were significantly higher in the cells treated with IL-1β than in the control cells. IL-1β also stimulated the expression of TGFβ1 mRNA. However, IL-1β-induced fibronectin mRNA expression was only partially blocked by neutralizing anti-TGFβ antibody. Conclusion Interleukin-1β stimulated the production of extracellular matrix in cultured HPMCs along with the induction of morphologic changes. This may play a role in the development of peritoneal fibrosis caused by peritonitis or bioincompatible dialysate in continuous ambulatory peritoneal dialysis patients.
Effects of Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Cycling Peritoneal Dialysis
Authors: Qamar Izhar U. , Secker Donna , Levin Leo , Balfe Judith A. , Zlotkin Stanley , Balfe J. Williamson 
Published: February 2020

Objective To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling peritoneal dialysis (CCPD). Design A prospective randomized cross-over study. Setting Nonhospitalized patients. Patients Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-stage renal disease who were receiving CCPD. Interventions Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dialysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months. Main Outcome Measures Creatinine clearance, ultra-filtration, urea, creatinine, electrolytes, total protein, albumin, fasting plasma amino acids, anthropometrics, total body nitrogen. Results Amino acid dialysis was comparable to dextrose dialysis for creatinine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabolic acidosis was observed. Caloric intake increased and protein intake improved. Appetite and total body nitrogen increased in at least half the children during amino acid dialysis. Total plasma protein and albumin concentrations did not change significantly. Fasting plasma concentrations of amino acids after 3 months of amino acid dialysis were comparable to baseline values. For several amino acids, the dose-response curve was blunted after a single amino acid exchange following 3 months of amino acid dialysis, which may, in part, be due to the induction of hepatic enzyme synthesis. Conclusions Amino acid dialysis is an efficient form of peritoneal dialysis that should be considered for children with poor nutritional status for whom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the best time to administer the amino acid dialysis fluid, and the benefits of adding dextrose to the amino acid solution.
Influence of Residual Renal Function on Dietary Protein and Caloric Intake in Patients on Incremental Peritoneal Dialysis
Authors: Caravaca Francisco , Arrobas Manuel , Dominguez Carmen 
Published: February 2020

Objective To evaluate protein and caloric intake in peritoneal dialysis (PD) patients on an incremental dialysis schedule, in an attempt to discriminate the influence of residual renal function (RRF) on these nutritional parameters. Design Prospective observational study. Patients Nine patients who had significant RRF at the beginning of PD therapy, which permitted a schedule of incremental PD (i.e., the number of peritoneal exchanges was increased as the RRF fell) in order to maintain the sum of renal and peritoneal clearance (weekly Kt/V urea) at approximately 2. Methods The mean adequacy parameters (urine and peritoneal Kt/V urea and creatinine clearance) along with the mean dietary energy (DEI) and protein intake (DPI) estimated by 3-day diet histories, were determined 6 and 9 months after the beginning of PD, when patients had RRF (period 1), and 6 and 9 months after the loss of RRF (period 2). The mean data obtained in both periods were compared. The best determinants for the changes in DEI and DPI after the loss of RRF were also investigated. Results Mean total Kt/V urea was very similar in both periods (2.16 ± 0.32 vs 2.15 ± 0.18), although creatinine clearance decreased significantly after the loss of RRF (74.41 ± 12.28 L/week/1.73 m2 vs 56.78 ± 11.77 L/week/ 1.73 m2, p = 0.0001). Absolute and normalized DPI values for actual body weight decreased after the loss of RRF (68.21 ± 11.87 g/kg vs 59.27 ± 13.66 g/kg, p = 0.02; and 1.17 ± 0.32 g/kg/day vs 0.97 ± 0.32 g/kg/day, p = 0.01). Although the energy delivered by peritoneal glucose uptake increased significantly after the loss of RRF, the mean total energy intake (DEI plus peritoneal glucose uptake) was very similar in both periods (2141 ± 339 kcal/day vs 2010 ± 303 kcal/day, p = 0.13). However, the mean total energy intake normalized for actual body weight decreased significantly after the loss of RRF (37.5 ± 10.1 kcal/ kg/day vs 32.8 ± 8.9 kcal/kg/day, p = 0.02). The changes in DEI and DPI between periods 1 and 2 correlated negatively with the difference of the energy delivered by peritoneal glucose uptake ( r = 0.65, p = 0.05, and r = 0.88, p = 0.001, respectively). The magnitude of DPI changes between both periods correlated significantly with the magnitude of urinary Kt/V urea changes ( r = 0.77, p = 0.01). However, there was no correlation between the changes in DPI and the changes in total Kt/V urea, total or renal creatinine clearance, or the length of time on PD. Conclusions The loss of RRF led to a reduction in dietary caloric and protein intake. The magnitude of the reduction in the DPI was strongly correlated with the increase in the energy delivered by peritoneal glucose uptake and with the decrease in the urinary Kt/V urea, but not with the total Kt/V urea.
The Risk of Infection and Peritoneal Catheter Loss from Implant Procedure Exit-Site Trauma
Authors: Crabtree John H. , Fishman Arnold , Siddiqi Rukhsana A. , Hadnott Linda L. 
Published: February 2020

Objective To evaluate the role of skin and subcutaneous tissue trauma at the time of catheter implant procedure as a determinant of catheter loss from infectious complications. Design Nonrandomized study with prospective collection of data. Patients Consecutive patients were divided into three groups based upon how the catheter was exited through the skin: group 1, procedure involved pulling tubing, with a permanently bonded catheter adapter, through the exit-site wound ( n = 43); group 2, same as group 1 except exit wounds were closed around the catheter with a suture ( n = 20); group 3, procedure involved pulling only tubing through the exit wound ( n = 61). Setting Primary medical center for a health maintenance organization. Main Outcome Measures Log rank comparisons of Kaplan–Meier analyses of first occurrences of infectious events and overall catheter survival. Results The risk of first exit-site infection ( p < 0.001), tunnel infection ( p < 0.001), catheter infection-related peritonitis ( p < 0.001), and catheter loss ( p < 0.01) were greatest in group 1 with large exit wounds, and lowest in group 3 with small exit wounds. Conclusions The study demonstrates the importance of careful dissection and exit-site construction. The exit site should consist of the smallest hole possible that permits passage of only the tubing and leaves the skin snug around the catheter. The present report incriminates catheter designs employing permanently bonded adapters that result in large pericannular wounds that are prone to infection and catheter loss.
Effect of Duration of Chronic Peritoneal Dialysis Therapy on the Development of Peritonitis
Authors: Troidle Laura , Gorban–Brennan Nancy , Kliger Alan S. , Finkelstein Fredric O. 
Published: February 2020

Objective Long-term chronic peritoneal dialysis (CPD) therapy has been associated with alterations in peritoneal membrane structure and peritoneal macrophage function. We thus reviewed our experience with the development of peritonitis among patients maintained on CPD therapy for various time periods to determine if the spectrum of organisms, rates of peritonitis, and outcome changed with the duration of CPD therapy. Setting and Patients Patients maintained on CPD therapy in our out-patient unit in New Haven, Connecticut. Design Retrospective review of the charts of patients maintained on CPD therapy (HomeChoice Cycler or Ultrabag, Baxter, McGaw Park, IL, U.S.A.) between 1 January 1997 and 31 March 1998. These patients were divided into three groups: group 1, patients maintained on CPD therapy < 12 months; group 2, patients maintained on CPD therapy for 13 - 36 months; and group 3, patients maintained on CPD therapy for ≥ 37 months. Results The study included 256 patients: 101 patients in group 1, 110 patients in group 2, and 45 patients in group 3. All groups of patients were similar in age. There were significantly fewer Caucasians and fewer males in group 3 in comparison to groups 1 and 2. The incidence of diabetes mellitus, coronary artery disease, and peripheral vascular disease was significantly lower among patients in group 3 in comparison to groups 1 and 2. There were 155 episodes of peritonitis during the study period for an overall rate of 1 episode in 18.7 patient-months. The overall, gram-positive, and gram-negative rates of peritonitis were not significantly different among the patients in groups 1, 2, and 3. There were more episodes of Staphylococcus aureus peritonitis among patients in group 3 in comparison to group 2 (1 episode in 59.6 vs 1 episode in 280.2 patient-months, respectively). Two weeks after the development of peritonitis, 94.6% of the patients in group 3 continued CPD therapy, while 79.4% of the patients in group 1 continued CPD therapy ( p < 0.05). No patient in group 3 transferred to hemodialysis, while 10.3% and 8.2% of the patients in groups 1 and 2 transferred to hemodialysis ( p < 0.05). The death rate 2 weeks after the onset of peritonitis was 10.3%, 9.8%, and 5.4% in groups 1, 2, and 3, respectively ( p = NS). Conclusions Despite the immunological and morphological changes that occur in the peritoneal cavity with increased time on CPD therapy, there was no difference in the overall, gram-positive, or gram-negative rates of peritonitis for patients maintained on CPD therapy for various time periods. Patients in group 3 continued CPD therapy more often than did patients in group 1. Patients in group 3 transferred to hemodialysis less often than did the remaining patients in the study period. The incidence of death was not significantly different for the three groups of patients.
Elimination of Iomeprol in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Iwamoto Masako , Hiroshige Kinya , Suda Takeshi , Ohta Takayuki , Ohtani Akira , Nakashima Yasuhide 
Published: February 2020

Objective To examine the elimination of iomeprol, its safety in clinical use, and its peritoneal permeability in continuous ambulatory peritoneal dialysis (CAPD) patients with variable degrees of residual renal function (RRF). Design A nonrandomized comparison study. Setting Hospitalized patients in CAPD unit of Chikuho and University Hospitals. Participants Fourteen patients treated by CAPD and 6 by hemodialysis (HD). Interventions Total dialysate, blood, and 24-hour urine collections were obtained for 4 consecutive days after the administration of iomeprol. A peritoneal equilibration test was performed just before and after the administration of iomeprol. Measurements Iomeprol (iodine) concentration was measured. Residual renal function was estimated as the mean of renal creatinine and urea clearances. Dialysate-to-plasma ratios (D/P) of creatinine and iomeprol were also determined. Results In all CAPD patients, plasma iomeprol clearance was markedly slow, with a biological half-life ( T1/2) of over 32 hours. However, no patients suffered from any adverse effects, and over 80% of plasma iomeprol was eliminated during the 4-hour HD. The plasma iomeprol elimination rate was significantly higher from 4 hours after the iomeprol administration in CAPD patients with RRF [mean estimated creatinine clearance (CCr) 3.8 mL/min, n = 7] compared to the remaining patients (mean estimated CCr 0.6 mL/min, n = 7); however, T1/2 in patients with RRF was over 24 hours. D/P creatinine was significantly correlated with D/P iomeprol, and peritoneal iomeprol permeability may depend on an individual's peritoneal solute transport properties. Conclusions A prolonged elimination rate of iomeprol was documented in our CAPD patients both with and without RRF. A HD procedure or intensive peritoneal dialysis just after the use of iomeprol may be advisable to promptly remove circulating iomeprol.
Re-Evaluation of Solute Transport Groups Using the Peritoneal Equilibration Test
Authors: Rodby Roger A. , Firanek Catherine A. , Sarpolis Ann L. 
Published: February 2020

Objective To determine if the previously described peritoneal equilibration test (PET)-determined solute transport groups, as defined by Twardowski, fit our patient population. Design We reviewed the 195 initial standardized PETs (on 195 patients) performed through our peritoneal dialysis program since 1989. Using the method originally defined by Twardowski using the means and standard deviations of the PET-determined dialysis/plasma ratio (D/P) of creatinine and dialysate-to-0 hour dialysate (D/D0) glucose values, transport groupings for our patient population were determined. Comparisons were then made between patient populations. Results The mean 4-hour D/P creatinine in our patients was 0.70 ± 0.10. This compares to a mean of 0.65 ± 0.15 as determined by Twardowski, and indicates that our patients have higher mean solute transport characteristics and tighter ranges within transport groups than previously reported. Only 2% of our patients fell into the previously described low (L) range, with 30% low average (LA), 51% high average (HA), and 17% high (H). Using our data, we would redefine the groups by a 4-hour D/P creatinine as L < 0.60, LA = 0.60 – 0.70, HA = 0.70 – 0.80, and HA > 0.80. Using these values, our population fits a Gaussian distribution with 17% L, 31% LA, 33% HA, and 19% H. Conclusion Our patients have higher mean solute transport and tighter ranges within transport groups than previously reported. Using the previously defined PET-determined transport groupings, low transporters are particularly underestimated. If our population data are representative of the peritoneal dialysis population as a whole, these ranges should be redefined.
Validity of a Standard Information Protocol Provided to End-Stage Renal Disease Patients and Its Effect on Treatment Selection
Authors: Gómez Cristina Gil , Valido Pilar , Celadilla Olga , De Quirós Alfredo Granda Bernaldo , Mojón Modesta 
Published: February 2020

Objective To evaluate the validity of a standard information package, comprising written and audiovisual aids, for end-stage renal disease (ESRD) patients in a pre-dialysis program. Study Design A multicenter study comprising patients entering a predialysis program. Three questionnaires were developed to gather data in this study: (1) a pre-information package questionnaire that evaluates the patient's initial knowledge of ESRD and the treatment options available (pre-informed patients); (2) a post-information package questionnaire that evaluates the patient's knowledge of ESRD and treatment options after being informed according to the protocol (post-informed patients); (3) a “start of the treatment” questionnaire that deals with the patient's choice of treatment at the time of starting dialysis, as well as the reasons leading to that choice. In all three questionnaires the patient's age, gender, level of creatinine clearance (Ccr), and hematocrit were recorded. Inclusion Criteria Any patient who was on a predialysis program in the participating centers. Results Three hundred and four patients were evaluated across 14 participating centers. Initial knowledge was assessed in 216 pre-informed patients (questionnaire 1). Patients were then guided through the information package. One hundred and fifty-eight patients answered the post-information package (questionnaire 2). During the course of the study, 174 patients (of the initial 304) started renal replacement therapy. Of these, 49.4% (86 patients) had received predialysis information according to our study protocol. All the patients who received the information throughout the trial improved their knowledge of ESRD and treatment options; this improvement was statistically significant. Conclusions The treatment options least well known at the start of the study were the peritoneal dialysis techniques. After receiving the information package, patients had an equal knowledge of all the different treatments, although hemodialysis was still the most familiar. This improvement in knowledge enabled patients who started a dialysis treatment to choose a therapy according to their own preferences. Their selections were as follows: 44% of the patients chose hemodialysis, 40% chose continuous ambulatory peritoneal dialysis, and 16% chose automated peritoneal dialysis. The standard information package, used as a patient education program, effectively resulted in patients having a significantly improved level of knowledge and understanding of ESRD and the different treatment options available.
Vascular and Interstitial Changes in the Peritoneum of Capd Patients with Peritoneal Sclerosis
Authors: Mateijsen Maartje A.M. , Van Der Wal Allard C. , Hendriks Pascale M.E.M. , Zweers Machteld M. , Mulder Jos , Struijk Dirk G. , Krediet Raymond T. 
Published: February 2020

Objective To analyze morphological changes in the peritoneum of peritoneal sclerosis (PS) patients. Emphasis was put on vascular abnormalities, because the continuous exposure to glucose-based dialysis solutions could cause diabetiform changes and because longitudinal transport studies suggested the development of a large peritoneal vascular surface area. Design Peritoneal biopsies from continuous ambulatory peritoneal dialysis (CAPD) patients were investigated in two studies. Diabetic patients were excluded. In study 1, 11 PS biopsies were compared to three control groups varying in duration of CAPD treatment: 0 months ( n = 15), 2 – 25 months ( n = 7), and > 25 months CAPD ( n = 7). The second study was a case-control study, comparing six biopsies from the long-term control group to six PS biopsies, matched for age and duration of CAPD. All biopsies were scored for presence and type of fibrosis [Picro Sirius red, type IV collagen, α-smooth muscle actin (αSMA)] and for neoangiogenesis (factor VIII). Thickening of vascular walls by type IV collagen and vasodilation of capillaries were measured by computer-aided planimetry. Results In study 1 the presence of sclerosing fibrosis, deposition of interstitial type IV collagen, and the number of myofibroblasts (αSMA-positive cells) was greater in the PS biopsies than biopsies from all control groups ( p < 0.002). Moreover, the number of vessels per field was higher in PS biopsies ( p < 0.01). Vascular wall thickening of small arteries ( p < 0.008) and vasodilation of capillaries were found in PS biopsies compared to all control groups ( p < 0.007). The second study revealed differences in the presence of sclerosis but not in the extent of fibrosis between PS biopsies and their controls. The number of vessels per field in PS biopsies was higher compared to controls ( p = 0.04). Also, thickening of the vascular wall was more marked in PS biopsies ( p = 0.03). Vasodilation of capillaries was greater in PS biopsies than in controls ( p = 0.07). Conclusion Fibrosis of the peritoneum may precede peritoneal sclerosis. The deposition of type IV collagen and the presence of myofibroblasts in the interstitial layer could be part of a pathologic process similar to the scarring in diabetic nephropathy. Neoangiogenesis and thickening of the vascular wall by type IV collagen are consistent with glucose-induced microangiopathy. These abnormalities and the vasodilation of the capillaries can explain the high dialysate-to-plasma ratios or mass transfer area coefficients of low molecular weight solutes that can be found in long-term CAPD patients.
Recurrent Infection and Catheter Loss in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Bayston Roger , Andrews Mark , Rigg Keith , Shelton Andrew 
Published: February 2020

Objective To elucidate the factors leading to catheter loss from recurrent infection in patients on continuous ambulatory peritoneal dialysis (CAPD). Design All catheters removed from patients were prospectively examined for infection. Setting CAPD unit in large tertiary-care general hospital. Patients Sixty-five consecutive patients undergoing catheter removal for whatever cause; 20 catheters rejected because of desiccation or contamination in transit. Interventions None. Main Outcome Measures Micro-organisms linked to catheter removal; their locations on removed catheters. Results Of 45 catheters removed between January 1994 and August 1995, 26 were infected: 13/26 infections were caused by Staphylococcus aureus and 7/26 by Pseudomonas aeruginosa. In only one case was S. epidermidis associated with catheter removal. The most striking finding was that the inner cuff harbored large numbers of the infecting organisms, even when antibiotics had eradicated them from the peritoneal cavity and exit site, where present, and the catheter lumen. Conclusion The importance of S. aureus and Ps. aeruginosa rather than S. epidermidis in catheter loss due to relapsing infection is confirmed. Persistence of the causative organisms in the inner cuff is a likely explanation for relapse after treatment, and might be due to the predominantly intraperitoneal administration of antibiotics. A clinical trial of the effect on catheter retention of empirical use of systemic or oral agents that give high tissue levels and are active against intracellular microorganisms, along with recommended intraperitoneal regimens, is indicated.