bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Issues in Dialysis-Dependent Female Patients
Authors: Shanmugavadivoo Kulamthaivel , Shaariah Wan 
Published: February 2020

Background Reproductive health issues in women with end-stage renal disease (ESRD) are often neglected. Data on these issues are also limited. Purpose We set out to describe the reproductive health issues in women being treated with either hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods All adult female patients on chronic dialysis in Hospital Seremban from January 1991 to December 2001 were included in our study. Patients (or their spouses or children) were interviewed regarding the menstrual status of the patient, gynecologic screening tests administered to the patient, and the patient's use of hormone replacement therapy (HRT). Results We recruited 137 women into the study. Of those women, 52.6% were on HD; the rest were on CAPD. Mean age at diagnosis of ESRD was 46.5 ± 14.1 years (range: 14 – 82 years), and mean duration on dialysis was 33.3 months (range: 2 months – 18 years). Responses about menstrual status were obtained for 118 patients. Of those 118 patients, 55 (46.6%) were postmenopausal at dialysis initiation. Average age at menopause had been 48.5 ± 4.9 years. Another 19 patients (16.1%) had still been menstruating at dialysis initiation, but subsequently entered menopause. Their average age at menopause had been 45.1 ± 10.3 years. The remaining 44 patients (37.3%) were still menstruating at an average age of 35.7 years (range: 15 – 49 years). Only 3 of 73 responders were on HRT; 63% had undergone a Pap smear; and 54% had had a breast examination. Conclusions Patients with ESRD tend to experience premature menopause. Not all dialysis patients are amenorrheic. Despite frequent contact between dialysis patients and hospital staff, gynecologic screening and use of HRT in those patients are still very low.
Acute Peritoneal Dialysis in Eastern Nepal
Authors: Sharma Sanjib K. , Manandhar Dhiraj , Singh Jagpal , Chauhan Harshand S. , Koirala Biswanath , Gautam Mani , Ghotekar LeklaRaj H. , Tamang Bangbu , Gurung Shova 
Published: February 2020

Objective B.P. Koirala Institute of Health Sciences is the only dialysis center outside the capital city of Nepal. Although the burden of renal failure in Nepal is high, limited resources and dialysis facilities are the major constraint on management of acute renal failure (ARF) and acute dialysis in chronic renal failure (CRF). In the present study, carried out from January 2000 to June 2002, we looked into the prospect of introducing peritoneal dialysis (PD) to the district hospitals for treatment of ARF and acute dialysis in CRF. Patients and Methods We designed a form to evaulate the causes of renal failure and the indications for, complications of, and outcomes of dialysis. During this study, junior doctors in our hospitals completed the forms. Resident doctors were trained to do intermittent peritoneal dialysis (IPD) and were responsible for the carrying out the procedure under supervision, together with a staff nurse. Results A total of 120 patients underwent IPD during the study period, including 66 men and 54 women. The most common indications for acute dialysis in CRF were metabolic acidosis (56%), uremic encephalopathy (45%), and fluid overload (44%). The most common causes of ARF were acute gastroenteritis (20%), sepsis (20%), and septic abortion (16%). Fifteen patients died of sepsis and multi-organ failure. Conclusions Lack of dialysis facilities in the geographic periphery means that most patients present late in the course of their disease, as evidenced by severe metabolic acidosis and uremic encephalopathy. Peritoneal dialysis is a simple procedure, easily tolerated by the patient and requiring less expertise than hemodialysis does. Moreover, nursing staff, technicians, and doctors can be easily trained in the technique. Despite certain limitations, PD still has much potential and can be successfully accomplished in district hospitals and less accessible areas.
Impact of Fill Volume on Peritoneal Clearances and Cytokine Appearance in Peritoneal Dialysis
Authors: Paniagua Ramón , de Jesús Ventura María , Rodríguez Ernesto , Sil Juana , Galindo Teresa , Hurtado María Elena , Alcántara Guadalupe , Chimalpopoca Amado , González Isabel , Sanjurjo Abraham , Barrón Lourdes , Amato Dante , Mujais Salim 
Published: February 2020

Background Current adequacy guidelines for peritoneal dialysis encourage the use of large fill volumes for the attainment of small solute clearance targets. These guidelines have influenced clinical practice in a significant way, and adoption of higher fill volumes has become common in North America. Several studies, however, have challenged the relevance of increasing small solute clearance; this practice may result in untoward consequences in patients. Objective The present study was designed to explore the relationship between dialysate volume and the clearance of different sized molecules, fluid dynamics, and appearance of peritoneal cytokines. Methods Thirteen adult prevalent patients on continuous ambulatory peritoneal dialysis were studied. Three different dialysate volumes (2.0, 2.5, and 3.0 L) were infused on consecutive days in a random order. Several measurements of peritoneal fluid dynamics (intraperitoneal pressure, net ultrafiltration, fluid absorption), solute clearances (urea, creatinine, β2-microglobulin, albumin, IgG, and transferrin), and appearance of interleukin-6 and tumor necrosis factor alpha (TNFα) were assessed. Results Increase in dialysate fill volume (from 2 to 2.5 to 3 L) was examined in relationship to body surface area (BSA). The dialysate volume/BSA (DV/BSA) ratio increased from 1262 to 1566 to 1871 mL/m2 on 2.0, 2.5, and 3.0 L dialysate volumes, respectively. In parallel, diastolic blood pressure increased from 82.7 ± 8.8 to 87.0 ± 9.5 to 92 ± 8.3 mmHg ( p < 0.05). Net ultrafiltration rate also increased, from 0.46 ± 0.48 to 0.72 ± 0.42 to 0.97 ± 0.49 mL/minute ( p < 0.01), despite a concomitant increase in fluid absorption, from 1.05 ± 0.34 to 1.21 ± 0.40 to 1.56 ± 0.22 mL/min ( p < 0.01). Urea peritoneal clearance increased from 8.27 ± 0.68 to 9.92 ± 1.6 to 12.98 ± 4.03 mL/min ( p < 0.01); creatinine peritoneal clearance increased from 6.69 ± 1.01 to 7.64 ± 1.12 to 8.69 ± 1.76 mL/min ( p < 0.01). Clearance of the other measured molecules did not change. Appearance of interleukin-6 increased 17% and 43% ( p < 0.01), and TNFα appearance increased 14% and 50% ( p < 0.01) when dialysate volumes of 2.5 and 3.0 L were used, compared with 2.0 L. Conclusions These results show that, with higher values of DV/BSA ratio, small solute peritoneal clearance is increased, but clearances of large molecules remain unchanged. With the use of higher volumes, fluid absorption rate and the appearance of proinflammatory cytokines in the dialysate are increased.
Bone Mineral Density: Serum Markers of Bone Turnover and Their Relationships in Peritoneal Dialysis
Authors: Negri Armando L. , Barone Roberto , Quiroga Mabel Alvarez , Bravo Marina , Marino Alicia , Fradinger Erich , Bogado Cesar E. , Zanchetta Jose R. 
Published: February 2020

Background The usefulness of bone mass measurements and bone turnover markers to estimate the risk of fracture and the type of underlying renal osteodystrophy are not well established in patients on peritoneal dialysis (PD). Objective To assess bone mass using total and regional bone densitometry in a group of patients on PD and to determine if serum markers of bone turnover identify patients with low bone mass. Methods Bone densitometry was studied by dual-energy x-ray absorptiometry (DEXA), and bone turnover using several serum markers, in 65 patients on PD. Bone mass was classified as normal, osteopenic, or osteoporotic according to World Health Organization criteria based on bone mineral density (BMD) T scores. Results T scores in the osteopenia range were present at the lumbar spine (LS) in 44.6% (45% of men and 44.4% of women) of patients and at the femoral neck (FN) in 56.9% (55% of men and 58% of women). T scores in the osteoporosis range were present at the LS in 13.8% of patients (10% of men and 15.5% of women) and at the FN in 21.5% (30% of men and 17.7% of women). Patients with BMD T scores in the osteoporosis range at both regions had increased serum intact parathyroid hormone (iPTH) levels compared to patients in the osteopenic/normal range. Bone mineral content in the whole skeleton (TBMC) correlated negatively with iPTH ( r = –0.34) and with total time on dialysis ( r = –0.26); in multivariate analysis, only iPTH correlated negatively with TBMC ( B = –0.26, p = 0.03). No correlations were found between the other bone markers and BMD T scores at the FN or LS. There were no significant differences in absolute BMD or BMD T scores at the LS or FN between patients with and patients without fractures. Conclusions BMD T scores in the osteopenia/osteoporosis range were observed at the LS in 58.4% of these patients on PD and at the FN in 78.4%. TBMC correlated negatively with iPTH. There were no correlations between markers of bone turnover and bone mass measurements at the two skeletal regions, although patients with BMD T scores in the osteoporosis range had increased serum iPTH levels. Bone mass measurements were not different between patients with and patients without fractures.
The Initiating Dialysis Early and Late (Ideal) Study: Study Rationale and Design
Authors:   The IDEAL Study Steering Committee, Cooper Bruce A. , Branley Pauline , Bulfone Liliana , Collins John F. , Craig Jonathan C. , Dempster Jenny , Fraenkel Margaret B. , Harris Anthony , Harris David C. , Johnson David W. , Kesselhut Joan , Luxton Grant , Pilmore Andrew , Pollock Carol A. , Tiller David J. 
Published: February 2020

Objectives The primary objective of the IDEAL study is to determine whether the timing of dialysis initiation has an effect on survival in subjects with end-stage renal disease (ESRD). The secondary objectives are to determine the impact of “early start” versus “late start” dialysis on nutritional and cardiac morbidity, quality of life, and economic cost. Design Prospective multicenter randomized controlled trial. Patients are randomized to commence dialysis at a glomerular filtration rate (by Cockcroft–Gault) of either 10 – 14 mL/minute/1.73 m2 (“early start”) or 5 – 7 mL/min/1.73 m2 (“late start”), with stratification for dialysis modality (hemodialysis vs peritoneal dialysis), study center, and the presence or not of diabetes mellitus. Setting Dialysis units throughout Australia and New Zealand. Patients Patients with ESRD commencing chronic dialysis therapy. Outcome Measures Three years from randomization, all-cause mortality, morbidity, and economic impact; structural and functional cardiac status, nutritional state, and quality of life will be assessed. Results To date, 388 patients of a minimum 800 patients have been entered and randomized into the study. Current recruitment rates suggest sufficient patients will be enrolled by December 2004 and follow-up completed by December 2007. Conclusions The IDEAL study will provide evidence for the optimal time to commence dialysis.
Relationship of Demographic, Dietary, and Clinical Factors to the Hydration Status of Patients on Peritoneal Dialysis
Authors: Asghar Ramzana B. , Green Sandra , Engel Barbara , Davies Simon J. 
Published: February 2020

Objectives To establish which clinical factors are associated with an increased proportion of extracellular fluid (ECF) in peritoneal dialysis (PD) patients. Design A single-center, cross-sectional analysis of 68 stable PD patients. Method Bioelectrical impedance measurements (RJL, single frequency; RJL Systems, Clinton, Michigan, USA) of resistance and reactance were used to determine the proportion of ECF comprising total body water (TBW) in 68 stable PD patients attending for routine clearance and membrane studies. All patients underwent detailed dietetic, adequacy, and membrane function tests. Blood pressure and antihypertensive requirements were also documented. Results Significant gender differences in body composition were observed, such that women had lower absolute TBW and fat-free mass per kilogram body weight, but proportionately more ECF for a given TBW, mean ECF:TBW 0.5 ± 0.03 versus 0.44 ± 0.05, p < 0.005. In view of this, patients were split into two groups, defined as “over-” or “normally” hydrated, either by using the single discriminator (median ECF:TBW = 0.47) for the whole population, which resulted in groups distorted by gender, or by using different discriminators according to gender (women: 0.49, men 0.45). In both analyses, overhydrated patients were older, had significantly lower plasma albumin, less total fluid removal per kilogram body weight, and higher peritoneal solute transport. When split by a single discriminator, the overhydrated patients had lower sodium removal and significantly less intracellular fluid volume due to an excess of women in this group who also had less residual function and had been on dialysis longer. Using gender-specific discrimination, overhydrated patients were heavier due to expansion of the ECF volume: 20 ± 4.1 L versus 16 ± 3.3 L, p < 0.001. Stepwise multivariate analysis found age ( p = 0.001), albumin ( p = 0.009), and fluid losses per kilogram body weight ( p = 0.025) to be independent predictors of gender-adjusted hydration status. Sodium intake did not vary according to hydration status. Conclusion Gender influences the assessment of hydration status of PD patients when employing bioimpedance, such that women tend to have more ECF. Taking this into account, age, albumin, and achieved fluid removal appear to be independently associated with hydration status, whereas peritoneal solute transport is not. Advice on dietary sodium should take account of hydration status and achievable losses.
Protein Adsorption on EX VIVO Catheters and Polymers Exposed to Peritoneal Dialysis Effluent
Authors: Yanagisawa Naoko , Li Dai-Qing , Ljungh Åsa 
Published: February 2020

Background Deposition of proteins on surfaces of medical devices has been recognized to putatively relate to the process of regulation of biomaterial-associated complications by attachment of fibrin clots, eukaryotic cells, and microbes. The molecules adsorb to a varying extent, depending not only on the physicochemical properties of the biomaterial, but also on the composition of the host fluid. Objective Adsorption of proteins on catheters exposed both ex vivo and in vitro to dialysate of patients on peritoneal dialysis (PD) was studied. Methods Peritoneal dialysis effluent was collected from 5 patients with end-stage renal disease on continuous ambulatory PD. Tenckhoff catheters were obtained from 16 patients. Deposition of proteins on excised Tenckhoff catheters and tubing of different materials exposed to PD effluent in vitro was studied using 125iodine-labeled antibodies. Adhesion of Staphylococcus aureus and Staphylococcus epidermidis strains was quantified on tubing exposed to PD effluent in vitro. Results The presence of albumin, transferrin, immunoglobulin G, fibrinogen, fibronectin, von Willebrand factor, vitronectin, and thrombospondin was determined at various concentrations in PD effluent. All proteins analyzed were detected on PD catheters removed from patients. The extent of protein deposition on Tenckhoff catheters exposed to PD effluent, in vitro, rapidly reached a plateau and remained constant, as it did on polyvinyl chloride and polyethylene tubing. Adhesion of staphylococci was enhanced on Tenckhoff catheters exposed to PD effluent compared to unused PD solution. Conclusions The data identify surface exposed proteins that may serve as adhesion sites for microbes on peritoneal catheters indwelled in patients undergoing PD.
Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations
Authors: McDonald Stephen P. , Collins John F. , Rumpsfeld Markus , Johnson David W. 
Published: February 2020

Objective The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. Design Retrospective observational cohort study of the Australian and New Zealand PD patient population. Setting Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Participants The study included all incident adult patients ( n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI ≥ 30 kg/m2), overweight (BMI 25.0 – 29.9 kg/m2), normal weight (20 – 24.9 kg/m2), or underweight (< 20 kg/m2). Main Measurements Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. Results Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 – 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 – 0.73), normal weight 0.79 (95% CI 0.77 – 0.81), overweight 0.88 (95% CI 0.85 – 0.90), obese 1.06 (95% CI 1.02 – 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a “vintage effect,” with lower peritonitis rates seen among people who commenced dialysis in more recent years. Conclusions Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.
Changes in Causative Organisms and Their Antimicrobial Susceptibilities in Capd Peritonitis: A Single Center's Experience over one Decade
Authors: Kim Dong Ki , Yoo Tae-Hyun , Ryu Dong-Ryeol , Xu Zhong-Gao , Kim Hyun Jin , Choi Kyu Hun , Lee Ho Yung , Han Dae-Suk , Kang Shin-Wook 
Published: February 2020

Background In recent years, the rate of peritonitis during continuous ambulatory peritoneal dialysis (CAPD) has been significantly reduced. However, peritonitis remains a major complication of CAPD, accounting for considerable mortality and hospitalization among CAPD patients. Objective To generate a “center tailored” treatment protocol for CAPD peritonitis by examining the changes of causative organisms and their susceptibilities to antimicrobial agents over the past 10 years. Method Retrospective review of the medical records of 1015 CAPD patients (1108 episodes of peritonitis) who were followed up from 1992 through 2001. Results The overall incidence of peritonitis was 0.40 episodes/patient-year. The annual rate of peritonitis and the incidence of peritonitis caused by a single gram-positive organism were significantly higher in 1992 and 1993 compared with those in the rest of the years ( p < 0.05). The incidence of peritonitis due to coagulase-negative staphylococcus (CoNS) decreased significantly over time, whereas there was no significant change in the incidence of Staphylococcus aureus (SA)-induced peritonitis. Among CoNS, resistance to methicillin increased from 18.4% in 1992 – 1993 to 41.7% in 2000 – 2001 ( p < 0.05). In contrast, the incidence of methicillin-resistant SA was not different according to the calendar year. Catheter removal rates were significantly higher in peritonitis due to a single gram-negative organism (16.6%) compared with gram-positive peritonitis (4.8%, p < 0.005). The mortality associated with peritonitis was also higher in gram-negative (3.7%) compared with gram-positive peritonitis (1.4%), but there was no statistical significance. Among single gram-positive organism-induced peritonitis, catheter removal rates were significantly higher in SA (9.3%) than those in CoNS (2.9%, p < 0.01) and other gram-positive organisms (2.9%, p < 0.05). In peritonitis caused by CoNS, the methicillin-resistant group showed significantly higher removal rates than the methicillin-susceptible group (8.2% vs 1.0%, p < 0.01). Conclusion The incidence of peritonitis for 2001 decreased to less than half that for 1992, due mainly to a significant decrease in CoNS-induced peritonitis, whereas the proportions of peritonitis due to a single gram-negative organism and methicillin-resistant CoNS increased. These findings suggest that it is necessary to prepare new center-based guidelines for the initial empirical treatment of CAPD peritonitis.
Vancomycin and Ciprofloxacin: Systemic Antibiotic Administration for Peritoneal Dialysis-Associated Peritonitis
Authors: Goffin Eric , Herbiet Laurence , Pouthier Dominique , Pochet Jean-Michel , Lafontaine Jean-Jacques , Christophe Jean-Louis , Gigi Jacques , Vandercam Bernard 
Published: February 2020

Objectives Peritonitis due to peritoneal dialysis (PD) is best treated empirically while waiting for the results of the dialysate culture. Thus, antibiotic therapy must cover both gram-positive and gram-negative micro-organisms. First, over a period of 9 years in a multicenter study we evaluated the efficiency of a vancomycin and ciprofloxacin combination given as the first-line treatment protocol for PD peritonitis. Second, we evaluated whether a systemic route of administration of the antibiotics could be an interesting alternative to the usual cumbersome intraperitoneal drug administration. Methods Vancomycin 15 mg/kg body weight, intravenous, and oral ciprofloxacin 250 mg two times per day (500 mg twice per day if residual creatinine clearance was above 3 mL/minute) were prescribed at diagnosis of peritonitis. Vancomycin injections were repeated (when blood trough level was expected to be below 12 μg/mL) in cases of gram-positive organisms for a total duration of 3 weeks. Ciprofloxacin was given for a total of 3 weeks in cases of gram-negative and a total of 10 days for susceptible gram-positive infections. Results A total of 129 episodes of peritonitis occurred; 28 of them were not included in the study because of protocol violation ( n = 15) or fungal ( n = 7) or fecal ( n = 6) peritonitis, leaving 101 peritonitis episodes for analysis. 52 (51.5%) gram-positive and 28 (27.7%) gram-negative organisms were grown; 38 gram-positive organisms were coagulase-negative staphylococci. No organism was identified in 8 peritonitis episodes, whereas 13 peritonitis episodes were caused by more than 1 organism. 35% of the coagulase-negative staphylococci were resistant to first-generation cephalosporin and methicillin, whereas all were susceptible to vancomycin. For gram-negative bacilli, the susceptibility rate was 96% and 95% for ciprofloxacin and ceftazidime respectively. The overall treatment success rate was 77.2% (78 of the 101 peritonitis episodes): 61.4% at first intention and 15.8% after optimization of the antibiotic therapy (second intention). The protocol failed in 22.8% of the peritonitis episodes. Hospitalization was required in 52% of the peritonitis episodes; average hospitalization was 11 (range 1 – 45) days. Conclusion Systemic vancomycin and ciprofloxacin administration is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis. In our opinion, vancomycin should still be used for gram-positive infections because of its high susceptibility rate compared with first-generation cephalosporins, providing a close monitoring of the local epidemiology. Oral ciprofloxacin provides satisfactory results in gram-negative infections, comparable to those obtained with intraperitoneal ceftazidime or aminoglycosides.