bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Icodextrin during Nocturnal Automated Peritoneal Dialysis Allows Sustained Ultrafiltration While Reducing the Peritoneal Glucose Load: A Randomized Crossover Study
Authors: Rodríguez-Carmona Ana , Fontán Miguel Pérez , López Elvia García , Falcón Teresa García , Cambre Helena Díaz 
Published: February 2020

Background Optimization of ultrafiltration and preservation of the peritoneal membrane are desirable objectives in peritoneal dialysis (PD) patients. Mixtures of glucose-and non-glucose-based solutions may help to meet both targets simultaneously. Aim To analyze the effects, in terms of ultrafiltration and peritoneal glucose load, of including icodextrin-based dialysate in the nocturnal schedule of patients undergoing automated PD (APD). Method Following a randomized crossover design, 17 APD patients underwent two 10-day study periods under identical prescription (including amino acid-based solution for the night schedule), except for the substitution of 2 L glucose-based dialysate in the nocturnal mixture (control) by a similar amount of icodextrin-based dialysate (icodextrin phase) in one period. Dependent variables included ultra-filtration, sodium removal, peritoneal glucose load, and residual renal function. We measured serum and urine levels of icodextrin metabolites at the end of each phase. Results Ultrafiltration was marginally higher during the icodextrin phase (median 815 vs 763 mL/day, p = 0.07), while peritoneal sodium removal was similar in both phases (74 vs 71 mmol/L/day). Peritoneal glucose load (median 67.5 vs 104.0 g/day, p < 0.005) and absorption (14.0 vs 35.6 g/day, p < 0.005) were lower during the icodextrin phase. Diuresis was also modestly lower during the icodextrin phase (500 vs 600 mL/day, p < 0.05). Serum levels of icodextrin metabolites were moderately higher in the icodextrin phase ( p < 0.005) in patients both on and off diurnal icodextrin. Conclusion Inclusion of amino acid- and icodextrin-based solutions in the nocturnal schedule of APD patients may allow sustained ultrafiltration and sodium removal while significantly reducing the peritoneal glucose load in these patients.
History of Peritoneal Dialysis in Latin America
Authors: Riella Miguel C. , Locatelli Alberto J. 
Published: February 2020

Latin America is a region formed by a number of countries of Latin heritage in which the common languages spoken are Spanish and Portuguese. Latin America was not isolated from the evolution of peritoneal dialysis (PD) throughout the rest of the world, as evidenced by the fact that, between the 1940s and the 1960s, PD was used to treat acute renal failure patients and later for the intermittent treatment of end-stage renal failure patients. The true development of PD took place toward the end of the 1970s and beginning of the 1980s with the introduction of continuous ambulatory peritoneal dialysis (CAPD). It is evident that the introduction of CAPD in most countries was a result of the personal effort and interest of individuals or groups of nephrologists. Initially, PD was not always implemented under ideal circumstances; locally manufactured, improvised supplies were associated with poor results. The arrival of companies with appropriate equipment and supplies led to widespread dissemination of this new modality. Furthermore, regulations and reimbursement by health authorities were additional obstacles. It is clear that PD in Latin America is still largely utilized to treat acute renal failure patients, particularly in countries where hemodialysis is not readily available. It is still employed intermittently to manage end-stage renal failure patients when hemodialysis is not available. With the exception of Colombia and Mexico, CAPD penetration is below 10%. While CAPD is nonexistent in certain countries, such as Cuba, due to lack of supplies, in other countries, such as Chile, it is restricted to patients that cannot be placed or continued on hemodialysis, those for example who lack vascular access, or those from remote rural areas. In addition, automated PD is relatively more costly and is therefore restricted in some countries.
Effects of Ionized Sodium Concentrations on Ultrafiltration Rate in Peritoneal Dialysis Using Lactate and Lactate/Bicarbonate Solutions
Authors: La Milia Vincenzo , Limardo Monica , Crepaldi Monica , Locatelli Francesco 
Published: February 2020

Objective To investigate the possible effects of different concentrations of ionized sodium (NaI) on peritoneal ultrafiltration (UF) rate using lactate (Lac) and lactate/bicarbonate (Lac/Bic) dialysis solutions. Design Two random consecutive (after an interval of 48 hours) peritoneal equilibration tests (PETs) were performed in 13 patients (4 males and 9 females) on regular continuous ambulatory peritoneal dialysis (PD) treatment for at least 3 months. Two different PD solutions containing anhydrous glucose 3.86% were used: a 40 mmol/L Lac solution and a 15/25 mmol/L mixed Lac/Bic solution. Concentrations of total sodium (NaT) and NaI were measured by flame photometer and direct ion-selective electrode respectively. Results Dialysate concentrations of NaT were not different during PETs using Lac and Lac/Bic. Dialysate concentrations of NaI in fresh PD solutions were different (133.3 ± 1.7 vs 128.2 ± 3.9 mmol, p < 0.0001); however, these differences disappeared just after the end of the infusion of the fresh solutions. Peritoneal UF rate was not significantly different during PETs using Lac versus Lac/Bic (609 ± 301 mL vs 542 ± 362 mL). The dialysate-to-plasma ratios of sodium concentrations at 60 minutes of the PETs (which are expressions of free water transport) were not different using Lac versus Lac/Bic (0.89 ± 0.04 vs 0.89 ± 0.04 respectively, p = 0.96). All the other classical parameters of the PET were not different between Lac and Lac/Bic. Conclusions The higher dialysate concentrations of NaI due to lower dialysate pH and consequently the higher effective osmolality of the fresh Lac PD solutions did not influence peritoneal UF rate, probably because of the fast reduction of NaI concentrations due to rapid correction of dialysate pH at the end of the infusion of Lac solutions into the peritoneal cavity.
Skin Color is Associated with Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients
Authors: Chen Hung-Yuan , Kao Tze-Wah , Chiu Yen-Lin , Huang Jenq-Wen , Lai Chun-Fu , Tsai Tsen-Fang , Chu Tzong-Shinn , Wu Kwan-Dun 
Published: February 2020

Background Changes in skin color are common among dialysis patients. They are associated with urochrome pigments, hemoglobin, and changes in cutaneous vasculature. Insulin resistance (IR) is strongly linked to cutaneous vascular dysfunction and is prevalent in dialysis patients. We postulated skin color may be associated with IR in dialysis patients because of the alternation in cutaneous vasculature. Methods 50 nondiabetic peritoneal dialysis (PD) patients were recruited for measurements of skin color by the Commission Internationale de I'Eclairage (CIE; International Commission on Illumination) system (“L” “a” “b” system). The “L” values represent skin brightness, “a” redness, and “b” yellowness. Correlation analysis between skin color, homeostatic model assessment (HOMAIR), high-density lipoprotein cholesterol (HDL-C), and adiponectin was performed. Results We divided patients (age 45 ± 13 years, 31 women) into 3 groups according to tertiles of HOMAIR. Patients with higher HOMAIR had a trend to have poor skin color (lower “a” and “b” values; p = 0.038 and 0.064). HOMAIR, adiponectin, and HDL-C levels were correlated with “a” and “b” values in logarithm (all p < 0.05). After adjustments for age, hemoglobin level, duration of PD, and residual renal glomerular filtration rate, only HOMAIR was associated with “a” values ( p = 0.038) and HDL-C was associated with “b” values ( p = 0.048) in logarithm. Conclusions Skin color, measured noninvasively, is associated with HOMAIR and HDL-C. Nondiabetic PD patients that had more severe IR had worse skin color.
Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Peritoneal Dialysis: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Akbari Ayub , Knoll Greg , Ferguson Dean , McCormick Brendan , Davis Alexandra , Biyani Mohan 
Published: February 2020

Background Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in clinical practice. The safety and efficacy of these agents in peritoneal dialysis (PD) patients are unclear. Objectives We conducted a systematic review to study the safety and efficacy of ACEI and ARB use in PD patients. Primary outcome measures were mortality and cardiovascular (CV) events; secondary outcome measures were renal function, proteinuria, hyperkalemia, and erythropoietin requirement at 3 months. Methods We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, trial registry Web sites, reference lists of eligible and review articles, as well as abstracts from the American Society of Nephrology and Canadian Society of Nephrology meetings. To be eligible, studies had to be randomized controlled trials that allocated PD patients to ACEI and ARB use or to placebo or other antihypertensive medications, included adult patients, and reported on at least one of the outcome measures. Results 418 citations were identified. Four met the eligibility criteria. Three examined CV events and mortality, of which two studies did not have any events. The third showed no statistically significant difference between control and treatment groups in either CV events or mortality: odds ratio 1.56 [95% confidence interval (CI) 0.24 – 10.05] for mortality and odds ratio 1.00 (95% CI 0.19 – 5.40) for CV events. Two studies reported renal function at 12 months and the weighted mean difference was 0.91 mL/minute/1.73 m2 (95% CI 0.14 – 1.68), favoring ACEI and ARB use. Conclusions In PD patients, evidence for the use of ACEIs and ARBs for reduction of mortality and CV events is lacking. Limited data suggest that they slow the loss of residual renal function.
Biocompatibility and Tolerability of a Purely Bicarbonate-Buffered Peritoneal Dialysis Solution
Authors: Weiss Lars , Stegmayr Bernd , Malmsten Gudrun , Tejde Mattias , Hadimeri Henrik , Siegert Carl E. , Ahlmén Jarl , Larsson Rutger , Ingman Bo , Simonsen Ole , van Hamersvelt Henk W. , Johansson Ann C. , Hylander Britta , Mayr Michael , Nilsson Per-Henrik , Andersson Per O. , De los Ríos Tatiana 
Published: February 2020

Background Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo. Methods This study was an open label, prospective, crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution (bicPDF) by measuring biocompatibility parameters such as cancer antigen 125 (CA125) in peritoneal effluent. 55 patients were enrolled in the study. After a 2-week run-in phase, 53 patients could be randomized into 2 groups, starting with either standard lactate-buffered peritoneal dialysis fluid (SPDF) for 12 weeks (phase 1) and then switching to bicPDF for 12 weeks (phase 2), or vice versa. Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125, hyaluronic acid, vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interferon gamma (IFNγ), and transforming growth factor-beta1 (TGF-β1). Total ultrafiltration and residual renal function were also assessed. At the end of the study, pain during fluid exchange and dwell was evaluated using special questionnaires. Results 34 patients completed the study; 27 of them provided data for analysis of the biocompatibility parameters. CA125 levels in overnight effluent were significantly higher with bicPDF (61.9 ± 33.2 U/L) than with SPDF (18.6 ± 18.2 U/L, p < 0.001). Hyaluronic acid levels were significantly lower after the use of bicPDF (185.0 ± 119.6 ng/mL) than after SPDF (257.4 ± 174.0 ng/mL, p = 0.013). Both TNF-α and TGF-β1 showed higher levels with the use of bicPDF than with SPDF. No differences were observed for IL-6, VEGF, or IFNγ levels. We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss. Pain scores could be analyzed in 23 patients: there was no difference between the solutions. Conclusions The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured, suggesting an improvement in peritoneal membrane integrity. Additionally, it seems to have a positive effect on residual renal function.
Optimal Referral to Pre-Dialysis Services: One Center's Experience
Authors: Heatley Susan Ann 
Published: February 2020

The number of patients receiving renal replacement therapy in the United Kingdom is rapidly rising. Chronic kidney disease (CKD) is a worldwide public health problem with significant comorbidity and mortality. Several organizational guidelines have been developed in an attempt to identify when appropriate referral to nephrology services should occur; however, many of these guidelines provide conflicting recommendations on referral. Recent surveys suggest that more than 30% of patients with CKD are referred later than the ideal. Late referral of patients with CKD is associated with increased patient morbidity and mortality, increased need for and duration of hospital admission, and increased initial costs of care following commencement of dialysis. Benefits of early referral include the identification and treatment of reversible causes of renal impairment and management of the multiple coexisting conditions associated with CKD. Referral time also affects the choice of modality of treatment. Patients and their families should receive sufficient information regarding the nature of their CKD and options for treatment so that they can make informed decisions concerning their care. Literature addressing the timing of referral to low-clearance or pre-dialysis clinics is limited. Existing data suggest that such clinics and patient education programs may improve the medical care of patients, promote greater patient involvement in the selection of the mode of dialysis, reduce the need for “urgent start” dialysis, and improve short-term survival and quality of life after initiation of dialysis. Audit of our pre-dialysis clinic has demonstrated improved patient outcomes, and we view this service as an essential component of the patient pathway.
Statistical Analysis of the Incidence of Peritonitis on Continuous Ambulatory Peritoneal Dialysis
Authors: Pierratos Andreas , Amair Pablo , Corey Paul , Vas Stephen I. , Khanna Ramesh , Oreopoulos Dimitrios G. 
Published: February 2020

In order to understand and eventually prevent peritonitis, which still is the most frequent complication of CAPD, workers in this field must agree on which statistical methods will be applied to the study of this complication. After a trial of various methods among our CAPD patients, we have concluded that life-table analysis, considering the first episode of peritonitis as an end event, provides the simplest method of expressing the probability of developing peritonitis. The comparison of two subpopulations of dialysis patients or of the performance of two units can be done by the comparison of the two peritonitis probability curves calculated from the respective data. Finally, regression analysis be tween the probability to develop peritonitis within a specific interval on CAPD and calendar time of entrance into the program ot Ters a simple way to assess changes in the performance of a dialysis center over time.
Amino Acid Absorption following Intraperitoneal Administration in CAPD Patients
Authors: Williams Paul F. , Marliss Errol B. , Anderson G. Harvey , Oren Arie , Stein Arthur N. , Khanna Ramesh , Petitt Jean , Brandes Lidia , Rodella Helen , Mupas Lori , Dombros Nicholas , Oreopoulos Dimitrios G. 
Published: February 2020

Six non-diabetic CAPD patients were infused over six hours with two litres of a dialysis solution containing 2 g/ dl amino acids (a mixture of essentials and non-essentials). The osmolality of the solution and the amount of ultrafiltration it induced were simiiar to that of a 4.25 g% dextrose Dianeal solution (control), suggesting that an amino acid solution is an efficient osmotic agent. By the end of the six-hour infusion, 80 to 90% of the amino acids present in the dialysis solution had been absorbed. One hour after the infusion was instituted, plasma amino acid levels increased threefold and subsequently decreased to near the initial value by the sixth hour. The amino acid solution was as effective as the dextrose solution in removing urea nitrogen, creatinine and potassium. Our data indicate that intraperitoneal administration of amino acids is effective and well-tolerated in patients on CAPD. We believe further work should be done to determine whether long-term administration of amino acids by this route will improve the nutritional status of these patients and prevent the side effects of daily absorption of large amounts of glucose.
Tenckhoff Catheter Repair by the Splicing Technique
Authors: Roman Jorge , Gonzalez Alexandro R. 
Published: February 2020

One of the main complications of the double-cuffed chronic peritoneal dialysis catheters is cuff erosion, with or without exit-site infection. We present a simple technique, which allows partial replacement of the external catheter segment with splicing. In addition it can be used to replace the intraperitoneal segment, leaving undisturbed the external segment and exit site. This technique can be carried out under local anesthesia, as an outpatient procedure, without interrupting treatment and with less trauma than total catheter replacement. This paper describes our experience with 20 external catheter replacements in 17 patients followed up to 20 months.
Acute Pancreatitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Donnelly Sandra , Levy Mortimer , Prichard Sarah 
Published: February 2020

Four patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for uremia developed acute pancreatitis (AP) over a 10-month period. No patient in the comparatively large hemodialysis population developed AP in the past 10 years. Diagnosis of AP was confirmed by the temporal change in the serum amylase levels and/or by radiographic imaging. Peritonitis was excluded by normal peritoneal fluid WBC counts and bacterial culture. Two patients developed tea-colored peritoneal fluid after the onset of the disease. Two patients required discontinuation of peritoneal dialysis (PD) to manage, their symptoms. Total corrected serum calcium was elevated in all four patients. All patients had complicated peritonitis histories. No patient was ingesting any known pancreatic toxin including alcohol and no patient had cholelithiasis or hepatitis. A literature review reveals 24 other cases of AP in CAPD patients. Of the cases described in detail, only two did not have peritonitis. AP is an entity which is more common in the CAPD population than previously recognized. Although no etiologic associations have been firmly established, hypercalcemia and a previous history of peritonitis may be important.
Acquired Renal Cystic Disease and Its Complications in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Ishikawa Isao 
Published: February 2020

Purpose To determine whether there is any difference in the prevalence of acquired cystic disease and malignancy of the kidney in patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis. Data Identification Relevant studies published from January 1983 to June 1991 were identified by manual search and MEDLINE search. Study Selection We reviewed the studies in which acquired renal cystic disease and/or renal cell carcinoma developed in patients on CAPD. Data Extraction Details of the prevalence of acquired cystic disease and renal malignancy as a complication of acquired cysts in CAPD patients were tabulated with the duration of treatment. Results Acquired cystic disease was observed in 195 of 425CAPD patients(41.1%), which is comparable to the prevalence of 47.1% (520/1103) seen in hemodialysis patients. The overall prevalence of renal cell carcinoma accompanying acquired cystic disease in this series of CAPD patients was 2 of 375 (0.4%), which is comparable to the prevalence of 1.5% (17/1103) in hemodialysis patients. So far, eight other instances of renal cell carcinoma complicating acquired cystic disease in CAPD patients were described as case reports. Retroperitoneal bleeding due to the rupture of acquired cysts has been reported on a few occasions. Conclusion In this review no differences were detected in the prevalence or severity of acquired renal cystic disease in patients treated with CAPD as compared with those on hemodialysis. Therefore, the incidence of complications associated with acquired cysts may also be the same for the two treatment modalities, although reports on such complications are rare.
The Pharmacokinetics of a Single Dose of Calcitriol Administered Subcutaneously in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Selgas Rafael , Martinez Maria-E. , Miranda Blanca , Baja Maria-Auxiliadara , Ramera Jase-Raman , Ausejo Monica , Sanchez-Cabezudo Maria-J. , Lapez-Revuelta Katia , Sanchez-Sicilia Luis 
Published: February 2020

Objectives To evaluate the kinetics of calcitriol (1,25(OH)2D3) administered subcutaneously. Study Design Calcitriol kinetics and efficacy after subcutaneous administration were studied in 13 CAPD patients with varying degrees of increased plasma levels of parathyroid hormone (i-PTH). A single dose of 2 μg of calcitriol was administered subcutaneously, and its serum levels at baseline and after 1,2,6,12, and 24 hours were determined. Plasma ionized calcium and i-PTH were also determined at these periods. Results Serum calcitriol levels reached peak levels of 60 and 70 pg/mL at 1 and 2 hours after administration, respectively. These levels decreased thereafter, but remained above baseline values during 24 hours. The mean value of the area under the curve (AUC) was 809±226 pg/mL/hour. Plasma i-PTH levels showed a slight decrease after 1 and 2 hours, returning to baselime levels after this period. Plasma ionized calcium did not show significant changes during the study. A slight pain at the site of injection was mentioned by some patients. Conclusions The subcutaneous route for calcitriol administration achieves theoretically adequate plasma levels in continuous ambulatory peritoneal dialysis (CAPD) patients. This is important when paremteral administration of calcitriol is considered in the treatment of secondary hyperparathyroidism.