bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prescription and Assessment of Tidal Peritoneal Dialysis Delivery with a Specific Equilibration Test
Authors: Edefonti Alberto , Picca Marina , Consalvo Geltrude , Ghio Luciana , Damiani Beatrice , Dal Col Augusta , Galato Raffaele 
Published: February 2020

Objective To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery. Design In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (DIP) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables. Setting Dialysis unit of a pediatric nephrology department and patients’ homes. Patients Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD. Interventions Dialysate and blood sample collections. Main Outcome Measures DIP ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15–,30–,60, and 120-minute PETtimes, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances. Results Correlation coefficients between PET -derived and total TPD dialysate-derived DIP ratios, and those between PET -derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. DIP ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the DIP ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances) -that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea. Conclusion The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the DIP ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.
Continuous Peritoneal Dialysis in Heavyweight Individuals: Urea and Creatinine Clearances
Authors: Tzamaloukas Antonios H. , Dimitriadis Athanasios , Murata Glen H. , Nicolopoulou Nicoletta , Malhotra Deepak , Balaskas Elias V. , Kakavas John , Antoniou Stavros , Dombros Nicholas V. , Batzili Elleni , Voudiklari Sonia 
Published: February 2020

Objective To study whether or not continuous peritoneal dialysis (CPD) can provide acceptable levels of normalized urea and creatinine clearance in heavyweight individuals. Design Retrospective analysis of urea and creatinine clearance studies. Setting CPD patients followed in four dialysis units in Albuquerque, two dialysis units in Thessaloniki, and two dialysis units in Athens. Participants One hundred and ninety-nine patients on CPD with 266 clearance determinations between 1991 and 1995. Interventions The heavyweight group consisted of 22 patients (24 clearance studies) weighing 100 kg or more (109.0±8.7 kg) at the time of the clearance study. All subjects were obese. The reference group consisted of 177 CPD subjects (242 clearance studies)ofnormal weight (68.7±12.2 kg). Urea fractional clearance (KT/V) and normalized creatinine clearance (Ccr) were compared between the heavyweight and the reference groups. Main Outcome Measures The lowest acceptable weekly levels were set at 1.70 for KT/V and 54.4 L/1. 73 m2 for Ccr. Results Weekly KT/V was 1.75±0.41 in the heavyweight group and 1.94±0.52 in the reference group (p = 0.047). Corresponding weekly Ccr levels were 64.0±24.3 and 77.6±40.3 L/1.73 m2, respectively (p = 0.021). In the heavyweight group, 13 studies (54.2%) had acceptable KT/V values compared to 160 studies (66.1 %) in the reference group (NS). Corresponding values for acceptable Ccr were 17 (70.8%) and 165 (68.2%), respectively (NS). Drain volume was 12.96±4.40 L/24 hours in the heavyweight group and 9.63±2.58 L/24 hours in the reference group (p = 0.001). High daily exchange volume was delivered by a combination of daily continuous ambulatory peritoneal dialysis (CAPD) and nocturnal automated peritoneal dialysis (APD) in 13116 heavyweight studies. This combination was tolerated better than any other method of delivering a large daily exchange volume. Conclusion Although normalized urea and creatinine clearances are lower in obese, heavyweight individuals than in lean CPD subjects with lower weight, approximately equal percentages of these two groups achieve acceptable clearance levels. However, heavyweight individuals require larger-than-usual daily exchange volumes. The preferred way to deliver these large dialysate volumes is a combination of daily CAPD and nocturnal APD.
Accuracy Or Bias in Nurses’ Ratings of Patient Compliance: A Comparison of Treatment Modality
Authors: Edelman Robin , Eitel Patricia , Wadhwa Nand K. , Friend Ronald , Suh Heesuck , Howell Nancy , Cabralda Thelma , Jao Erlinda , Aprile-Forlenza Suzanne 
Published: February 2020

Objective The study examined the accuracy of nurses’ assessments of patient compliance and identified factors influencing these assessments, including possible biases. Design Nurses’ assessments of compliance, lab serum levels of dietary compliance, and interdialytic weight gain (IWG) were collected and compared to each other. End-stage renal disease (ESRD) patients on peritoneal dialysis (PD) and hemodialysis (HD) were compared on these measures and their compliance. Setting The study was conducted at the tertiary care university hospital at Stony Brook. Patients Data were collected for 62 ESRD patients (38 male, 24 female; mean age 54 years). The sample consisted of 26 HD and 36 PD patients. Interventions Nurses rated patients’ compliance with fluid restrictions (HD patients only) and overall dietary compliance, as well as individual indicators of compliance including protein, potassium, and phosphorus compliance on a 7 -point rating scale. Interdialytic weight gain, dietary (serum BUN and K levels), and medication compliance were recorded from charts for a 3-month period for each patient. Main Outcome Measures The main outcome measures were the correlations between nurses’ ratings of compliance and medical compliance data and the regression coefficients, which indicate the relative importance of each of the factors that nurses use to make their compliance ratings. Results Nurses’ ratings for patients in both treatment modalities were highly correlated with the medical data for measures of fluid (r = 0.66, p < 0.001), potassium (r = 0.36, p < 0.01), and phosphorus (r = 0.36 p < 0.01). A regression analysis indicates that potassium (β = 0.48, p < 0.001), phosphorus (β = 0.19, p < 0.05), and protein (β = 0.31, p < 0.01) all significantly contributed to nurses’ assessments of patients’ overallcompliance. However, nurses’ ratings of education levels for patients in both treatment modalities were not associated with phosphorus (r = 0.07, p < 0.61), protein (r = 0.18, p < 0.23), or potassium (r = 0.03, p < 0.85) measures. Finally, regressions revealed that nurses used personal knowledge of the patients when rating noncompliant patients (β = 0.49, p < 0.05) but not when rating compliant patients (β = 0.05, p < 0.75). Conclusions Nurses rely heavily on medical records to rate patients’ compliance and to make accurate assessments. Nurses also use several individual indicators (lab values and IWG) to rate overall dietary compliance, suggesting a thorough assessment. While assessments are not biased by personal factors such as nurses’ perceptions of patients’ education levels, nurses do rely on personal knowledge when rating noncompliant patients.
Nasal Carriage and Peritonitis by Staphylococcus Aureus in Patients on Continuous Ambulatory Peritoneal Dialysis: A Prospective Study
Authors: Wanten Geert J.A. , Van Oost Peter , Schneeberger Peter M. , Koolen Marianne I. 
Published: February 2020

Objective To establish whether or not patients on continuous ambulatory peritoneal dialysis (CAPD) using current infection control measures who are nasal carriers of Staphylococcus aureus are at risk for the development of S. aureus peritonitis. Design A prospective 22-month study analyzing nasal and ski nlnasal (i.e., nasal and/orexit-site)carrier status for S. aureusand peritonitis episodes. Nasal swab cultures for S. aureus were taken with 1 to 3-month intervals; swab cultures from the catheter exit site were taken only when infection was suspected. Setting Renal unit, tertiary-care center. Patients All patients on CAPD at our center that could be observed during at least 2 months. Interventions None. Main Outcome Measures Nasal and skinlnasal carrier status, occurrence of peritonitis. Results Of 54 enrolled patients, 31 (57%) were nasal carriers for S. aureus: 6 of these 31 developed S. aureus peritonitis as opposed to none of 23 non-carriers (p = 0.03). The S. aureus peritonitis rate in 28 skin/nasal carriers was increased when compared to non-carriers (p = 0.02), but there was no difference between chronic and intermittent skin/nasal carriers (p = 0.63). Conclusions In our population, nasal carriers are at increas ed risk for the development of S. aureusperitonitis. Further studies should evaluate the effect of eradication of nasal carriage of S. aureus and the effect of additional preventive hygienic measures on the occurrence of peritonitis by S. aureus.
Epidemiologic and Demographic Aspects of Peritoneal Dialysis in Mexico
Authors: Su-Hernández Lilia , Abascal-Macías Antonio , Méndez-Bueno Francisco Javier , Paniagua Ramon , Amato Dante 
Published: February 2020

Objective To assess some epidemiological and demographic aspects of peritoneal dialysis (PD) at the Instituto Mexicano del Seguro Social (IMSS), the major institution of social security in Mexico, that provides health care services for 57% of the Mexican population at the time of the study. Study Design A cross-sectional analysis of data about patients under peritoneal dialysis in 1992. Data Sources A national survey containing demographic data, dialysis modality, type of catheter, peritonitis and death rates, and questions on costs, medical staff, and physical facilities for PD in all of the hospitals of the IMSS. Results All hospitals returned the information re quested. Intermittent peritoneal dialysis (IPD) was performed in 19 hospitals, continuous ambulatory peritoneal dialysis (CAPD) in 11, and both modalities in 90. In 61 hospitals, a special area was designed for PD; in the rest of them, beds from general internal medicine departments were used. All hospitals had a head for the PD programs; overall, teams had 240 physicians and 765 nurses for IPD, and 182 physicians and 313 nurses for CAPD. CAPD prescription was four 2-L bags/day. For IPD, patients were hospitalized once a week and received 28 manually performed exchanges of 2– L bags; the mean time of hospitalization was 2.7 days, and 878 beds were used. The number of patients receiving PD was 7785, with a prevalence of 199.6 per million population. Ofthem, 4011 were on IPD and 3774 on CAPD; 54% of the patients were males. IPD patients’ mean age was 49 ± 17 yr, and that of CAPD patients’ was 42 ± 17 yr (NS). Diabetic nephropathy was the most frequent cause of ESRD (44%). Infection was the most important complication detected. Rates of peritonitis were 0.5/patient/yr on IPD and 0.8/patient/yr on CAPD. Annual mortality rates without stratification for specific causes were 34% in IPD and 17% in CAPD. Mortality rates may have been influenced by malnutrition and cardiovascular complications of diabetes, but specific causes of death were not investigated. All of the PD programs costs were covered by the institution. The cost per patient was not calculated, but IPD is known to be more expensive, due to its higher hospitalization rate. Conclusion In spite of its higher cost and mortality, the institutions still use IPD, notso much on medical basis, but as the only alternative available for patients with adverse environmental, social, educational, and economic conditions for CAPD or HD.
Variability in Creatinine Clearance (Ccr) and Ktn Due to Different Methods of Calculating Volume and Ccr
Authors: Low Chai Luan , Bailie George R , Rasmussen Ray , Eisele George 
Published: February 2020

Objective This study aimed to compare the correlations between KTN and creatinine clearance (Ccr) calculated by different methods and to determine and compare the correlations between KTN and Ccr. Design Nonrandomized, retrospective analysis of data. Setting Continuous ambulatory peritoneal dialysis (CAPD) outpatient clinic in a teaching hospital. Patients All patients were included for analysis if the data collection was complete for the calculations of KTN and Ccr using five different methods. Interventions Volume of distribution for urea (V) was estimated by four methods: Watson nomogram, ideal body weight (IBW), actual body weight, and total body surface area. Ccr was determined by five methods: Dialysate Ccr was calculated by creatinine (Cr) uncorrected and corrected for the presence of glucose; urinary Ccr was calculated using urinary Cr alone and the average urinary clearance of urea and Cr; and by the Cockcroft and Gault method. Main Outcome Measures Correlations between KTN and Ccr. Results Sixty-three data sets were collected from 52 CAPD patients. The correlations between weekly KTN and Ccr normalized to 1.73 m2 body surface area were found to be highly variable from one method to another (r2 = 0.012 -0.494). For obese patients (20% above IBW), KTN values obtained were more variable using the Watson nomogram compared to the IBW and BSA methods. Conclusion KT/V calculated using the Watson nomogram and the Ccr determined using average of urinary urea and creatinine clearance gave the best correlation (r2 = 0.49).
Pharmacokinetics of Once-Daily Ip Gentamicin in Capd Patients
Authors: Low Chai Luan , Bailie George R. , Evans Anne , Eisele George , Venezia Richard A. 
Published: February 2020

Objective This study aimed to investigate the pharmacokinetic characteristics of once-daily intraperitoneal (IP) gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective, nonrandomized, open study. Setting CAPD outpatient clinic in a teaching hospital. Patients Ten volunteer CAPD patients without peritonitis. Interventions Each patient received a single IP dose of 0.6 mg/kg of gentamicin. Blood and dialysate samples were collected at 0,0.5,1, 2, 3,6 (end of first dwell), and 24 hours after the administration of IP gentamicin. Any urine produced over the 24hour study period was also collected. The dialysate concentration/time data were fitted to a monoexponential curve for all patients. Results The bioavailability was 56±11% over a six hour dwell. The mean serum elimination half-life (t1/2) was 35.8 hours. The volume of distribution was 0.23±0.08 L/kg. Equilibration of gentamicin across the peritoneal membrane was rapid, with a t½ equilibration of 4.5 hours. The peritoneal clearance was 5.74±1.5 mL/min. Patients with residual renal function had significantly higher systemic gentamicin clearances (7.36±1.46 mL/min) than those of anuric patients (4.76±1.08 mL/min, p < 0.024). Conclusion Currently recommended doses of oncedaily IP gentamicin for the treatment of peritonitis may not produce the desired therapeutic serum and dialysate concentrations over 24 hours for effective treatment of peritonitis.
24-Hour Dialysate Collection for Determination of Peritoneal Membrane Transport Characteristics: Longitudinal Follow-Up Data for the Dialysis Adequacy and Transport Test (Datt)
Authors: Rocco Michael V. , Jordan Jean R. , Burkart John M. 
Published: February 2020

Objective To determine the ability of the dialysis adequacy and transport test (DATT) to monitor changes in peritoneal transport characteristics over time. Setting University-based peritoneal dialysis program. Patients One hundred patients on continuous ambulatory peritoneal dialysis who underwent 226 simultaneous DATTs and peritoneal equilibration tests (PET). Methods Retrospective analysis of DA TT and PET data. Results The mean 24-hour dialysate-to-plasma creatinine (cr) concentration ratio (DIP cr) from the DATT was 0.70±0.10, and the mean four-hour DIP crfrorn the PET was 0.68 ± 0.10. The correlation coefficient between the fourhour and 24-hour DIP cr was 0.81, and the standard error of estimate was 0.065. The mean (±SD) difference between the four-hour and 24-hour DIP cr was 0.023 ± 0.061. Fifty eight patients had two or more sequential DA TTs and PETs. For these 94sets of sequential DATTs and PETs, the mean (±SD) difference between the change in the four-hour DIP cr and the change in the 24-hour DIP cr was 0.020 ± 0.024, and the standard error of estimate was 0.064. In 17 patients a change in dwell volume from 2.0 L to 2.5 L occurred between the first and second measures of peritoneal membrane transport characteristics. The mean (±SD) difference between the change in the four-hour DIP cr and the change in the 24-hour DIP cr was 0.036 ± 0.055, and the standard error of estimate was 0.087. Conclusion The DATT can be used to monitor for changes in peritoneal transport over time. It should not be used in patients receiving cycler therapy or in patients whose dwell times and dextrose concentrations vary markedly from day to day.
Efficacy of Recombinant Human Erythropoietin Administered Subcutaneously to Capd Patients Once Weekly
Authors: Frifelt Jens J. , Tvedegaard Erling , Bruun Kirsten , Steffensen Gudrun , Cintin Christina , Breddam Marianne , Dominguez Helena , Jørgensen Jørgen D. 
Published: February 2020

Objective The purpose of the present study was to compare the dosage requirements of recombinant human erythropoietin (rHuEPO) administered subcutaneously (SC) either one or three times weekly. Design A randomized, prospective study. .Setting: The patients were recruited from two university hospitals and five county hospitals. Patients Thirty-three anemic patients on continuous ambulatory peritoneal dialysis (CAPD) treatment for endstage renal failure completed the study. Interventions Initially, all were treated with rHuEPOSC three times a week until hemoglobin blood levels (Hb) remained constant between 105 and 121 g/L for three months. Following randomization, 17 patients continued the same treatment schedule (group A), while 16 patients received the same dose, but administered only once weekly for three months (group B). Main Outcome Measures The Hb levels and rHuEPO doses at the start and at the end of the three-month study period. Results In group A the median Hb at randomization was 118 g/L (109 -119) (25 -75 percentiles) and, after three months, was 113 g/L (106 -119) (p = 0.13), while in group B the median Hb was 114g/L (108–119) and 114 g/L (106 -120), respectively (p = 0.50). In group A the weekly dose of rHuEPO remained virtually unchanged during the study period, 65 (55 -86) and 66.3 (55 -95) U/kg/week, respectively, while in group B it was increased from 60.2 (46–88) to 77 (60 90) U/kg/week. The 22% increase (p = 0.03) took place during the last two weeks. Conclusions Our findings indicate that a once-weekly SC dosing regimen of rHuEPO in anemic CAPD patients was equally effective in maintaining a stable hemoglobin level as a thrice-weekly dosing regimen.
Interleukin-10, Interferon Gamma, Interleukin-2, and Soluble Interleukin-2 Receptor Alpha Detected during Peritonitis in the Dialysate and Serum of Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Lu Ying , Hylander Britta , Brauner Annelie 
Published: February 2020

Objective To analyze interleukin (IL)-10, interferon gamma (IFN-y), IL-2, and soluble IL-2 receptor alpha (sIL2Rα) in the dialysate and serum of patients on continuous ambulatory peritoneal dialysis (CAPD). Design and Patients Samples from dialysate bags were collected during the initial month of dialysis. During peritonitis, samples were collected from the first three bags on the day of admittance to the hospital and from the night bags on days 3 and 10. Serum samples were drawn on days 1 and 10. .Results: IL-10 was detected in all dialysate samples except one on the first day of infection, with a peak median level of 50 pg/mL and a slow decrease thereafter. In serum the median levels never exceeded detectable levels. Patients infected with Escherichia coli or Staphylococcus aureus had higher IL-10 levels in dialysate on day 3 as compared to the remaining patients (p < 0.05). If the catheter had to be drawn, because of persistent cloudy dialysate, the IL-10 levels remained elevated for a longer time (p<0.05). IFN-y and IL-2were detected only in the dialysate of patients infected with either S. aureusor S. epidermidis. Only one serum sample showed increased IFN-y. SIL-2Rα was found in all the serum and dialysis samples from the first day of infection. Contrary to the analyzed cytokines, the receptor showed several fold higher levels in serum as compared to the dialysate. During the infection the receptor levels in the dialysate increased, while they remained stationary in the serum, indicating a local production. Conclusion This is the first time IL-10 has been demonstrated in the dialysate during peritonitis in CAPD patients. In view of its role as a suppressor of the immune and inflammatory responses, it is a potentially important observation, which might have clinical implications in the future.
A New Self-Locating Peritoneal Catheter
Authors: Di Paolo Nicola , Petrini Giovanni , Garosi Guido , Buoncristiani Umberto , Brardi Simone , Monaci Giulio 
Published: February 2020

Objective Peritoneal catheters often become dislocated, and this may lead to malfunction. Since it is not usually possible to bring them back into their correct position, they must be replaced. With the aim of preventing this complication, we designed a new catheter. Design The new catheter has the same form as the Tenckhoff catheter except for a small increase in external diameter of the last 2 cm, made possible by the high specific weight of a small12-g tungsten cylinder incorporated in the Silasticat the abdominal end. The new catheter may be inserted by a percutaneous technique. Setting University hospitals of Sienaand Perugia, Italy. Patients In the last three years, 32 of these catheters have been implanted for a total experience of 468 patientmonths. Their position was checked on insertion and every two months thereafter by radiography; 26 Tenckhoff catheters (415 patient-months) were studied at the same time. Insertion was performed surgically and by a percutaneous method. The frequency of cuff extrusion, exit-site infections, leakage, and peritoneal infection were noted, together with peritoneal function, which was evaluated by KTN and weekly creatinine clearance one month after catheter insertion; the tests were repeated when dislocation occurred and at the end of the trial. Results No dislocations occurred with the self-locating catheters, whereas nine dislocations occurred in control patients (p = 0.0003). There were no significant differences with respect to controls for cuff extrusion, exit-site infections, leakage, peritoneal infection, and peritoneal function. Conclusions The presence of a small weight at the catheter tip prevents displacement completely, keeping the intraperitoneal part of the catheter in place.