bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-Center Intermittent Peritoneal Dialysis: Retrospective Ten-Year Single-Center Experience with Thirty Consecutive Patients
Authors: Woywodt Alexander , Meier Matthias , Kaiser Doris , Schneider Gabriele , Haller Hermann , Hiss Marcus 
Published: February 2020

Background In-center intermittent peritoneal dialysis (IPD) is sometimes performed in elderly and multimorbid patients that have failed hemodialysis and that are unable to perform peritoneal dialysis (PD) at home. Complications, frequency of hospital admission, and survival are often claimed to be dismal although current data are lacking. Methods We performed a retrospective cohort study of patients that underwent IPD at Hannover Medical School, Germany, between 1997 and 2007. Underlying renal disorders, comorbidity, and circumstances that precluded hemodialysis and home PD were recorded. Survival, cause of death, episodes of hospitalization, and episodes of peritonitis were calculated. Laboratory values at baseline and after 3 months of IPD were also retrieved. Results We identified 30 patients with severe comorbidity (median Charlson Comorbidity Index of 6; n = 30) who underwent IPD for 439 months in total. The majority of patients had vascular/hypertensive nephropathy ( n = 12; 40%); congestive heart failure was the leading cause for choosing PD ( n = 13; 43.3%); 73.3% of our patients had either no partner or at least one disease that precluded home therapy. Hospitalization rate was 1.39 admissions per patient-year and there was 1 episode of peritonitis per 48.8 IPD-months. Mean survival was 26.6 months (median 17 months; n = 30); sepsis was the leading cause of death ( n = 13; 59.1%). Conclusions IPD is associated with fewer episodes of peritonitis, fewer admissions, and longer survival than is often believed. Suitable patients in whom palliative care alone seems inappropriate should not be denied a trial of IPD if they so choose.
Omental Folding: A Novel Laparoscopic Technique for Salvaging Peritoneal Dialysis Catheters
Authors: Goh Y. Heng 
Published: February 2020

Background Omental wrap is a common cause of catheter obstruction. Current laparoscopic techniques for correcting obstruction include omentopexy and omentectomy. This study evaluates the efficacy of a new laparoscopic technique for revision of obstructed peritoneal dialysis catheters. Methods Between November 2005 and November 2006, the technique was applied in 18 patients (6 female, 12 male; median age 50 years, range 16 – 73 years) on continuous ambulatory peritoneal dialysis with catheter malfunction secondary to omental wrap. Pneumoperitoneum was induced under general anesthesia. Three ports were inserted. The catheter was released from the omentum and repositioned in the pelvis. The omentum was then folded onto itself in a cephalad direction using silk sutures. This shortened the omentum. The risk of catheter migration was minimized with a polypropylene sling passed through the abdominal wall and around the catheter, then knotted subcutaneously. The sling allowed catheter removal without a new laparoscopy. The outcomes were prospectively evaluated. Results Median operating time was 90 minutes (range 35 – 160 minutes). Adhesiolysis was performed in 4 patients: 1 patient had port-site leakage of dialysate, which settled with abdominal rest; 1 patient had bleeding during adhesiolysis and laparoscopic hemostasis was successful; 1 patient had recurrent catheter obstruction 2 weeks post-operatively and was converted to hemodialysis; and 1 patient had recurrent malfunction secondary to small bowel wrap after 5.5 months; re-salvage was successful. The success rate of the first salvage procedure was 89%(16/18). The catheters were still functioning after a mean follow-up of 16.5 ± 6.3 months (range 0.5 – 24 months). The 1-year catheter survival rate was 83.3%. Conclusions Omental folding is a safe and effective technique for salvaging peritoneal dialysis catheters.
Lercanidipine-Induced Chyloperitoneum in Patients on Peritoneal Dialysis
Authors: Yang Wei-Shun , Huang Jenq-Wen , Chen Huei-Wen , Tsai Tun-Jun , Wu Kwan-Dun 
Published: February 2020

Objective Lercanidipine is a lipophilic calcium channel blocker and a widely used antihypertensive agent. However, it can cause chyloperitoneum in patients receiving peritoneal dialysis (PD). The incidence, pathophysiology, and clinical impact of these adverse events are not known. Design Retrospective study. Method Patients were screened for use of antihypertensive agents. Those that had taken lercanidipine were identified and dialysate cholesterol (Chol) and triglyceride (TG) levels were checked. Serum levels were taken from the routine biochemistry record closest to the time of the dialysate levels. Dialysate Chol and TG from patients on other antihypertensives and with matched serum lipid profiles were compared. Patients 14 of 222 patients had taken lercanidipine during February 2005 to January 2006, accounting for 12% of all patients on calcium channel blockers in our PD center. Results Of 14 patients prescribed lercanidipine, 8 (57%) developed chyloperitoneum. None had peritonitis and the dialysate was clear under microscopic examination. Mean dialysate TG was 128.4 ± 133.0 mg/dL and mean dialysate Chol was 18.2 ± 24.9 mg/dL in patients that developed chyloperitoneum. These patients were also noted to have higher blood TG and Chol than patients that did not develop chyloperitoneum. In contrast, patients on other antihypertensive agents with matched blood TG and Chol levels had low dialysate TG levels and zero dialysate Chol. Conclusion Lercanidipine frequently causes chyloperitoneum in Taiwanese PD patients. The risk of developing this adverse event seems to be related to the blood lipid profile. The mechanism of this phenomenon is worthy of further investigation.
Cytotoxicity of Mononuclear Cells as Induced by Peritoneal Dialysis Fluids: Insight into Mechanisms that Regulate Osmotic Stress-Related Apoptosis
Authors: Gastaldello Karine , Husson Cecile , Dondeyne Jean-Paul , Vanherweghem Jean-Louis , Tielemans Christian 
Published: February 2020

Objective High glucose content of peritoneal dialysis fluids (PDFs) has been shown to contribute to loss of peritoneal function during long-term peritoneal dialysis. However, hyperosmolality and hypertonicity of PDF are usually seen as similar stress events inducing osmotic stress-induced programmed cell death. In this study, we examined the impact of various osmotic agents on apoptosis induced by hyperosmolar PDFs, focusing on the mechanisms underlying the lethal effects of PDFs on peripheral blood mono-nuclear cells (PBMCs). Methods We assessed apoptosis and necrosis by annexin V–propidium iodide (PI) labeling, and caspase-3 activity by fluorescence assay. F-actin remodeling was measured using fluorescent phalloidin labeling. Results Hyperosmolality does not cause the cytotoxicity observed with PDF, but exposure to agents incapable of permeating cell membranes results in a significant increase in the percentage of apoptotic PBMCs by annexin V–PI labeling, which is confirmed by the increase in caspase-3 activity. Interestingly, inhibition of caspase-3 by Z-VAD-FMK did not suppress apoptosis. Extracellular hypertonicity produced polymerization of filamentous actin and cell shrinkage, which displayed similar time courses. Cell shrinkage was blocked by cytochalasin D, indicating an active role for actin cytoskeleton in hypertonicity-induced cell shrinkage. F-actin polymerization was related to an increase in intra-cellular ionic strength. Finally, we excluded a direct role for actin remodeling in osmotic stress-induced programmed cell death. Conclusions Exposure to osmolytes that cannot penetrate cell membranes results in a hypertonicity-induced apoptosis that cannot be blocked by the broad-spectrum caspase inhibitor Z-VAD-FMK. In addition, extracellular hypertonicity induced by impermeant solutes produces F-actin polymerization through an increase in intracellular ionic strength. The remodeling of the cytoskeleton does not modulate apoptosis but participates in cell shrinkage.
Renal Osteodystrophy in Peritoneal Dialysis: Special Considerations
Authors: Levy Ronen , Gal-Moscovici Anca 
Published: February 2020

Bone disease is one of the most challenging complications in patients with chronic kidney disease. Today, it is considered to be part of a complex systemic disorder manifested by disturbances of mineral metabolism and vascular calcifications called chronic kidney disease – mineral bone disorder (CKD-MBD). The term renal osteodystrophy is reserved to define the specific bone lesion in CKD-MBD, whose spectrum ranges from high turnover to low turnover disease. Phosphate retention, decreased serum calcium, and 1,25-dihydroxy vitamin D synthesis are involved in the pathogenesis of high bone turnover. However, the various therapeutic approaches (calcium supplements, phosphate binders, and vitamin D metabolites, among others), the renal replacement modality (hemodialysis or continuous ambulatory peritoneal dialysis), and the types of patients to whom dialysis is offered (more patients who are diabetic or older, or both) may influence the evolution of the bone disorder. As a result, recent studies have reported a greater prevalence of adynamic forms of renal osteodystrophy, especially in diabetic and peritoneal dialysis patients. The present article reviews, for patients treated with peritoneal dialysis, the pathophysiologic mechanisms involved in the evolution and perpetuation of this bone disease and the therapeutic modalities for treating and preventing adynamic bone.
Calcium Balance with Automated Peritoneal Dialysis
Authors: Granja Carlos Andres , Francis Jean , Simon David , Bushinsky David , Finkelstein Fredric O. 
Published: February 2020

Background Calcium balance in chronic kidney disease patients on peritoneal dialysis (PD) has not been well studied. This issue is particularly important, given the careful attention now being paid to vascular calcification, the increasing use of cinacalcet therapy (with accompanying reductions in serum Ca levels), the increasing use of vitamin D and its analogs (which increase Ca), and the increasing use of Ca-containing phosphate binders. The present study was conducted to examine the factors influencing transperitoneal calcium balance during continuous cycling peritoneal dialysis (CCPD) therapy, with particular attention to net ultrafiltration (UF) and serum ionized Ca (iCa). Patients and Methods This open, prospective cohort study included 40 medically stable patients maintained on CCPD for at least 3 months. Most patients used low-Ca (2.5 mEq/L) PD fluid; the Ca content of PD fluid for patients on icodextrin-based solutions was 3.5 mEq/L. Patients were instructed to record the quantity of dialysate instilled in a 24-hour period and net UF, and to bring a well-mixed aliquot of PD drainage to the dialysis unit. Concentrations of iCa and dialysate Ca were measured. Total Ca instilled into and drained from the PD fluid was calculated, and then the transperitoneal calcium balance was determined. Results Significant correlations were noted between transperitoneal calcium balance and both serum iCa ( r = –0.360) and the UF rate ( r = –0.708). Of the patients whose iCa was over 5 mg/dL, 71% were in negative calcium balance; of those with iCa levels below 5 mg/dL, 62% were in positive calcium balance. Of patients with UF below 1000 mL daily, 58% were in positive calcium balance; of those with 1000 mL UF or more, net Ca gain was noted in only 38%. Conclusions The present study demonstrates the importance of UF and iCa in determining transperitoneal Ca transport. These findings are of particular importance given the widening use of calcimimetic agents, vitamin D analogs, and Ca-based phosphate binders (all of which alter iCa) and the potential association between UF rate and outcome in PD patients.
Long-term Intervention with Heparins in a Rat Model of Peritoneal Dialysis
Authors: Schilte Margot N. , Loureiro Jesus , Keuning Eelco D. , ter Wee Piet M. , Celie Johanna W.A.M. , Beelen Robert H.J. , Van Den Born Jacob 
Published: February 2020

Background Peritoneal dialysis (PD) is associated with functional and structural alterations of the peritoneal membrane, particularly new vessel formation and fibrosis. In addition to anticoagulant effects, heparin displays anti-inflammatory and angiostatic properties. Therefore, the effects of administration of heparins on function and morphology of the peritoneal membrane were studied in a rat PD model. Methods Rats received 10 mL conventional PD fluid (PDF) daily, with or without the addition of unfractionated heparin (UFH) or low molecular weight heparin (LMWH) in the PDF (1 mg/10 mL intraperitoneally) via a mini access port. Untreated rats served as controls. After 5 weeks, a 90-minute functional peritoneal transport test was performed and tissues and peritoneal leukocytes were taken. Results PD treatment induced loss of ultrafiltration ( p < 0.01), a twofold increase in glucose absorption ( p < 0.03), increased urea transport ( p < 0.02), and loss of sodium sieving ( p < 0.03), which were also found in the PDF + heparin groups. Increased peritoneal cell influx and hyaluronan production ( p < 0.02) as well as an exchange of mast cells and eosinophils for neutrophils after PD treatment were observed in PD rats; addition of heparin did not affect those changes. Mesothelial regeneration, submesothelial blood vessel and matrix formation, and accumulation of tissue macrophages were seen in PD animals. Spindle-shaped vimentin-positive and cytokeratin-negative cells indicated either partial injury and denudation of mesothelial cells or epithelial-to-mesenchymal transition. Neither UFH nor LMWH affected any of these morphological changes. Conclusion Within 5 weeks, PD treatment induces a chronic inflammatory condition in the peritoneum, evidenced by high transport, leukocyte recruitment, tissue remodeling, and induction of spindle-shaped cells in the mesothelium. Addition of LMWH or UFH to the PDF did not prevent these adverse PDF-induced peritoneal changes.
Substituting Citrate for Lactate in Peritoneal Dialysis Fluid Improves Ultrafiltration in Rats
Authors: Cavallini Nicola , Wieslander Anders , Braide Magnus 
Published: February 2020

Background Exposure to peritoneal dialysis (PD) fluid induces an inflammatory response in the peritoneal cavity. Blockers of complement and coagulation have improved ultrafiltration in animal models of PD. Citrate is a clinically established anticoagulant that also blocks complement activation. Objective The aim of the present study was to evaluate the effects on ultrafiltration of a gradual substitution of citrate for lactate in an experimental model of PD. Methods Fractions (0, 5, 10, and 15 mmol/L) of the 40 mmol/L lactate buffer of filter-sterilized 2.5% glucose PD fluid were replaced by citrate. The modified fluids were compared in a rat model of single PD fluid exposure through an indwelling catheter. The initial kinetics of citrate and ionized calcium were evaluated in separate, single, short time dwell experiments. Results Replacing 10 and 15 mmol/L of the lactate buffer by sodium citrate significantly increased osmotic ultrafiltration (by 24.7% ± 7.7% at 10 mmol/L), net ultrafiltration, and glucose retention at 4 hours of dwell time in the rat model. Osmotic ultrafiltration was significantly correlated to citrate concentration and glucose concentration. Citrate was rapidly eliminated from the peritoneal cavity, concentrations falling to less than half in 1 hour and concentrations of calcium ions concomitantly normalized. Conclusions Substituting citrate for lactate induced a dose-dependent increase in ultrafiltration. Mechanisms probably involve the relation between diffusion and ultrafiltration, leading to increased glucose retention. The increase in ultrafiltration was quantitatively important at a citrate concentration (10 mmol/L) that is compatible with clinical applications of citrate.
Subclinical Peripheral Artery Disease in Patients Undergoing Peritoneal Dialysis: Risk Factors and Outcome
Authors: Liu Jiung-Hsiun , Lin Hsin-Hung , Yang Ya-Fei , Liu Yao-Lung , Kuo Huey-Liang , Wang I-Kuan , Chou Che-Yi , Huang Chiu-Ching 
Published: February 2020

Background Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle–brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD). Methods We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study. Results 30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group. Conclusions ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.
Oxidative Stress in Children on Peritoneal Dialysis
Authors: Zwolińska Danuta , Grzeszczak Wladyslaw , Szczepańska Maria , Makulska Irena , Kiliś–Pstrusińska Katarzyna , Szprynger Krystyna 
Published: February 2020

Objectives Enhanced oxidative stress has been observed in dialysis and predialysis adult patients with chronic kidney disease (CKD), which resulted in increased mortality and morbidity within this population. Not much attention in the literature has been paid to nonenzymatic antioxidant defense in children with CKD on peritoneal dialysis (PD). The aim of the present study was to describe the plasma, erythrocyte, and dialysate concentrations of oxidized (GSSG) and reduced glutathione (GSH) and vitamins A, E, and C in a pediatric PD population. Patients 10 children on PD and 27 age-matched healthy subjects were enrolled in the study. Results Erythrocyte and plasma GSH concentrations were lower in PD patients, erythrocyte concentration of GSSG remained unchanged, and plasma GSSG was significantly higher in children on PD. Children on PD exhibited decreased plasma concentrations of antioxidant vitamins compared to healthy subjects. Moreover, we documented loss of vitamins A, E, and C into ultrafiltrate. Conclusion Such low plasma levels of vitamins A, E, and C and simultaneously decreased activity of erythrocyte GSH may be responsible for the increased oxidative stress occurring in children with CKD on PD.
Pulmonary Hypertension in Peritoneal Dialysis Patients: Prevalence and Risk Factors
Authors: Ünal Aydin , Sipahioglu Murat , Oguz Fatih , Kaya Mehmet , Kucuk Hamit , Tokgoz Bulent , Buyukoglan Hakan , Oymak Oktay , Utas Cengiz 
Published: February 2020

Aim To investigate the prevalence of pulmonary arterial hypertension (PAH) and the possible contributing factors for PAH in patients receiving regular continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods The study included 135 CAPD patients and 15 disease-free controls. Patients that had chronic obstructive pulmonary disease, severe mitral or aortic valve disease, connective tissue disease, history of pulmonary embolism, left ventricular ejection fraction <50%, or chest wall or parenchymal lung disease were excluded. All patients and controls were examined using echocardiography and bioelectrical impedance analysis. PAH was defined as systolic pulmonary artery pressure (PAP) >35 mmHg at rest. Results Mean systolic PAP was higher in the CAPD patients than in the controls (19.66 ± 11.66 vs 14.27 ± 4.55 mmHg, p = 0.001). PAH was detected in 17 (12.6%) of the 135 CAPD patients. Mean systolic PAP was significantly higher in patients with PAH than in those without PAH (42.00 ± 9.13 vs 16.44 ± 7.83 mmHg, p = 0.001). Serum albumin level and ejection fraction were lower in patients with PAH than in those without PAH ( p = 0.001 and 0.003 respectively). The ratio of extracellular water/total body water (ECW/TBW), which can reflect hydration status, was significantly higher in patients with PAH than in those without PAH ( p = 0.008). In the PD group, no patients were hypovolemic; 51 (37.8%) of the 135 PD patients were hypervolemic and 84 (62.2%) were normovolemic. Only 3 of the 17 patients with PAH were normovolemic; the rest were hypervolemic. Mean systolic PAP was significantly higher in hypervolemic PD patients (24.57 ± 14.19 mmHg) than in normovolemic PD patients (16.68 ± 7.61 mmHg) ( p = 0.001). PAP correlated with ECW/TBW ( r=0.317, p = 0.001) and left ventricular mass index (LVMI; r=0.286, p = 0.001). On the other hand, it inversely correlated with serum albumin level ( r = –0.281, p = 0.001), hemoglobin level ( r = –0.165, p = 0.044), and ejection fraction ( r = –0.263, p = 0.001). Serum albumin level, ECW/TBW, and LVMI were found in multivariate analysis to be independent risk factors for PAP. Conclusion PAH is a frequent cardiovascular complication in CAPD patients. Serum albumin level, hypervolemia, and LVMI are major risk factors for PAH. Therefore, strategies for treatment of hypervolemia, left ventricular hypertrophy, and hypoalbuminemia should be enhanced to prevent the development of PAH in CAPD patients.