bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis
Authors: Rocco Michael V. , Jordan Jean R. , Burkart John M. 
Published: February 2020

Objective To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. Design Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. Setting Peritoneal dialysis unit of a tertiary medical center. Outcome Measures PET results and calculated mass transfer area coefficient (MT AC) values. Patients Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. Results In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. Conclusion During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.
Continuous Ambulatory Peritoneal Dialysis in End-Stage Renal Disease Due to Multiple Myeloma
Authors: Shetty Anupkumar , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To evaluate (1) the disease course, (2) the response to recombinant human erythropoietin (rHuEPO), and (3) the morbidity and mortality of patients with endstage renal disease (ESRO) due to multiple myeloma (MM) who were treated with continuous ambulatory peritoneal dialysis (CAPO). Design Retrospective study. Setting Tertiary teaching hospital -The Toronto Hospital, Toronto, Ontario, Canada. Patients Seven patients with ESRO due to MM who were treated with CAPO. Results Mean age of the patients was 77.2 years (median 80 years, range 65 88 years). Two were in stage IB, 1 was in stage lIB, and the remaining 4 were in stage IIIB, according to Ourie and Salmon's staging. Three patients received rHuEPO; 2 of these also were receiving chemotherapy for myeloma. The mean rHuEPO requirement was 277 U/kglwk, which was more than other ESRO patients’ requirements. Mean duration of CAPO was 20.6 months (6 –58 months). The peritonitis rate was one episode in 14.4 months. The frequency of hospitalization was once in 5.6 months, and the mean number of days spent in hospital was 20 days per year. Quality of life did not get worse and, if anything, improved marginally while they were on CAPO. Three patients died after a mean survival of 32.7 months, and the remaining 4 patients are still alive. Conclusions Myeloma patients with ESRO do fairly well on CAPO without deterioration in their quality of life and with an acceptable peritonitis rate.
Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on Capd: Is There a Synergistic Effect with Insulin?
Authors: Fernandez-Reyes Maria Jose , Selgas Rafael , Bajo Maria Auxiliadora , Jimenez Carlos , Del Peso Gloria , Sanchez Maria-Del-Carmen , Dapena Fabiola , De Alvaro Fernando 
Published: February 2020

Objective To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel. Patients Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. Conclusions According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.
Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in Capd
Authors:   MIDAS Study Group, Gokal Ram , Mistry Chandra D. , Peers Elizabeth M. , Brown C.B. , Smith S. , Edwards D.L. , Junor B.J.R. , Gordon A. , McMillan M. , Robertson M. , Michael J. , McKain J. , Raftery M. , Peters J. , Clutterbuck E.J. , Clemenger M. , Walls J. , Orton C. , Goodship T.H.J. , Grieves J. , Olubodun J. , Jackson F.G. , Dharmasena D. , Hourahane G. , Howarth D.J. , Boyes R.N. , Clisby L.M. , Beran Y. 
Published: February 2020

Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patientyear, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patientyear, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
Correlations between Plasminogen Activator Inhibitor-1 and Peritoneal Transport in Pediatric Ccpd Patients
Authors: Lin Jen-Jar , Singhal Kamal , Parton Lance , Cascio Clair , Patlak Clifford S. , Stewart Charles L. 
Published: February 2020

Objective Plasminogen activator inhibitor-1 (PAI-1) is an important regulator of plasminogen activators and has been shown to be involved in the accumulation of extracellular matrix (ECM) in various tissues. Since peritoneal ECM is a resistance site for peritoneal transport, the production and release of PAI-1 in the peritoneum may affect the peritoneal transport of water and small solutes. Design The linear correlations between the dialysate PAI-1 levels and the variables of peritoneal transport during peritoneal equilibration tests (PET) wereexamined. .Setting A tertiary university hospital. Patients Six stable pediatric patients (age 10.8%4 years) undergoing continuous cycler-assisted peritoneal dialysis were included. Interventions None. Results All data are mean±SD. There was a positive correlation between the infused volume and the net ultrafiltration (UF, 198±127 mL, r = 0.82, p < 0.05). The dialysate PAI-1 levels increased during the dwell time (2.44±2.23 ng/mL or 2.46±1.72 μg at 4 hours vs 0.04±0.1 ng/mL or 0.04±0.09 μg at 0 hour, p < 0.05). The saturation indices (dialysate/plasma ratio) of PAI-1 and albumin at 4 hours were 1.05±1.21 and 0.028±0.004, respectively. The changes from O-hour dwell to 4-hour dwell in the dialysate PAI-1 concentration (PAI4-o, 2.4±2.2 ng/mL) or amount corrected to body surface area (APAI4-0/BSA, 2.61 ±2.11μg/ m2) negatively correlated with UF or UF/body surface area and positively correlated with the number of episodes of peritonitis. There was no correlation between PAI4-o, APAI4-0/BSA, or plasma PAI-1 concentration and the mass transfer coefficient and clearance of either urea or creatinine. Conclusions The elevated PAI-1 level during the PET was likely from the local production and release of PAI-1. It had an inverse relationship with the amount of ultrafiltration. Repeated inflammation of the peritoneum was associated with an increased production and release of PAI-1 into the peritoneum.
An Elevated Ratio of Measured to Predicted Creatinine Production in Capd Patients is Not a Sensitive Predictor of Noncompliance with the Dialysis Prescription
Authors: Burkart John M. , Bleyer Anthony J. , Jordan Jean R. , Zeigler Nancy C. 
Published: February 2020

Objective To determine the effect a period of “intentional noncompliance” in stable continuous ambulatory peritoneal dialysis (CAPD) patients has on the ratio of measured to predicted creatinine generation. Design Prospective study that compares baseline to noncompliant periods in individual CAPD patients. Patients Nine chronic, stable CAPD patients. Study Design At baseline, measured creatinine production and adequacy parameters (KT/V, creatinine clearance, lean body mass, and protein equivalent of nitrogen appearance) were calculated from 24-hour collections of dialysate and urine while patients were performing their routine dialysis prescriptions. After three days of intentional noncompliance (one less exchange/day) the patients repeated their 24-hour collections, again performing their routine number of exchanges. Measured creatinine production and adequacy parameters were again calculated. Predicted creatinine production for each patient was calculated from standard equations. All parameters at baseline were compared to corresponding parameters after intentional noncompliance. Results In all patients, except one where there was no change, there was a statistically significant increase in not only the ratio of measured to predicted creatinine production but also all other parameters. Conclusion As suspected by previous investigators, this study suggests that one cause of an elevated ratio of measured to predicted creatinine production may be a recent period of noncompliance with the patient's dialysis prescription. However, these data suggest that an isolated ratio of measured to predicted creatinine generation is not a sensitive predictor of noncompliance with the peritoneal dialysis prescription.
Capd Viability: A Long-Term Comparison with Hemodialysis
Authors: Maiorca Rosario , Cancarini Giovanni C. , Zubani Roberto , Camerini Corrado , Manili Luigi , Brunori Giulio , Movilli Ezio 
Published: February 2020

Objective To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD). Design Retrospective study of patients of our institution starting dialysis between January 1,1981, and December 31, 1993, and surviving for at least 2 months. Patients Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD). Main Outcomes Studied Cox -adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time. Results Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 -1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (“technique success”) was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients ≥75 years. Conclusion CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.
The Japanese National Registry Data on Pediatric Capd Patients: A Ten-Year Experience a Report of the Study Group of Pediatric Pd Conference
Authors: Honda Masataka , Litaka Kikuo , Kawaguchi Hiroshi , Hoshii Sakurako , Akashi Shunji , Kohsaka Takao , Tuzuki Kazuo , Yamaoka Kanji , Yoshikawa Norishige , Karashima Sinnyo , Itoh Yuhei , Hatae Ken 
Published: February 2020

Objective Over the past 10 years, we have collected data on pediatric patients less than 16 years of age from the National Registry of CAPD (continuous ambulatory peritoneal dialysis). We present our experience with this population. Design The database details the patient number, age, weight, height, outcome, cause of death, reason for terminating CAPD therapy, peritonitis, and catheter survival. Patients Of the 434 patients (239 males, 195 females), 37 patients (8.5%) were under 1 year of age and 164 patients (37.8%) were under 6 years of age. About half of the patients were less than 20 kg in weight, clearly indicating that CAPD was the treatment of choice in young children. The duration on CAPD for these patients was less than 2 years for 233 patients (54%), and was 5 years or more in 48 patients (11%). Results The outcome of the total patient population of 434 as of M ay, 1991, is as follows 229 patients (52.8%) were being successfully treated with CAPD, 47 patients (10.8%) died, and 78 patients (18.0%) received a kidney transplantation. The patient survival rate was 85.6% at 3 years and 81.7% at 5 years. The technique survival rate was 74.9% at 3 years and 63.5% at 5 years. The rate of peritonitis was one episode over 28.6 patient-months. The mean catheter duration was 1.68 years. Peritonitis rate, catheter survival rate, and the rate of tunnel infection were worse in children less than 6 years of age than in older children. Conclusion The excellent patient and technique survival rates indicate that CAPD is an effective treatment for children with end-stage renal disease in Japan. The high infection rates in younger children indicate that extra careful management is needed for this young age group.
Rapid Decline of Residual Renal Function in Patients on Automated Peritoneal Dialysis
Authors: Hiroshige Kinya , Yuu Kougi , Soejima Masasuke , Takasugi Masayuki , Kuroiwa Akio 
Published: February 2020

Objective To determine the effect of peritoneal dialysis modalities such as nightly intermittent peritoneal dialysis (NIPD), continuous cyclic peritoneal dialysis (CCPD), and continuous ambulatory peritoneal dialysis (CAPD) on residual renal function. Design A six-month prospective, nonrandomized comparison study. Setting Outpatient CAPD unit of a university hospital. Participants Eighteen end-stage renal disease patients treated by peritoneal dialysis (8 by NIPD, 5 by CCPD, and 5 by CAPD). Interventions Samples from the total dialysate, blood, and 24hour urine collection were obtained monthly. Measurements Urea, creatinine, and beta2-microglobulin concentrations were measured. Renal and peritoneal clearances of each substance and KT/V urea were calculated. Residual renal function (RRF) was estimated by renal creatinine clearance (RCcr). Results No significant differences in age, sex, and primary renal disease among the three groups were noted. In all groups, anemic and hypertensive states were controlled identically, and mean weekly total (renal + peritoneal) KT/V urea (over 2.1/wk) and total creatinine clearance (over 60 L/wk/1.73 m2) were maintained during the whole experimental period. Starting mean RCcr was near 4.0 mL/min/1.73 m2 in all groups. Thereafter, a rapid and significant decline in RRF was demonstrated on NIPD and CCPD. The declining rates of RCcr values at 6 months after starting NIPD and CCPD were -0.29 and -0.34 mL/min/month, respectively, which were much greater than those of CAPD (+0.01 mL/min/month). Conclusion Because of a possibly characteristic progressive loss of RRF in automated peritoneal dialysis (APD), strict regular assessment of RRF should be performed from the start of APD.
Neither Size Nor Weight Predicts Survival in Peritoneal Dialysis Patients
Authors: Fried Linda , Bernardini Judy , Piraino Beth 
Published: February 2020

Objective To determine if patient size or weight at the start of PO influences patient or technique survival. Design A prospective cohort study of adult PO patients. Setting A university and a Veterans Administration outpatient dialysis unit. Patients 343 adults patients with 660 years on PO enrolled from 1979 to 1995. Main Outcome Measures Patient survival (censoring for transplant, 60 days post -transfer to hemodialysis, and end of study) and technique survival (censoring for death, transplant, or end of the study) for patients as grouped by weight (≤ 64 kg vs. >64 kg or ≤82.7 kg vs. > 82.7 kg) or BSA (≤2.0 m2 vs >2.0 m2). Results Patient survival was 86.3% at one year, 77.0% at two years, 65.2% at three years, and 56.9% at 4 years. Technique survival was 84.9% at one year, 77.5% at two years, 63.5% at three years, and 58.3% at four years. The patient and technique survival curves were not significantly different for patients as grouped by weight or BSA. Using Cox proportional hazards model, age, diabetes, peritonitis rate, and albumin at the start of PO were independent predictors of patient survival, but BSA and weight were not. The only predictor of technique survival was the peritonitis rate. Larger patients had higher initial albumins, which may indicate better nutritional status that may offset the risk of underdialysis. Conclusions Large patients do as well as smaller patients on PO. Size alone should not preclude patients from PO.
Peritoneal Mesothelium in Vitro: An Electrophysiologic Study
Authors: Simon Marek 
Published: February 2020

Objective In vitro electrophysiologic characterization of the peritoneal mesothelium as a barrier for ion transport during peritoneal dialysis. Design Experiments were performed on rat's mesentery and diaphragm. Electrophysiologic parameters of the isolated tissue were assessed in the modified Ussing system. Results We have shown that there are significant differences between electrophysiological parameters of the parietal and visceral peritoneum. The value of the potential difference across the parietal mesothelium lining the abdominal part of the diaphragm (PDmpt) was 0.26 ± 0.03 mV (mean ± SEM), with a positive charge recorded from the apical side of the mesothelium. Electrical resistance of the mesothelial monolayer (Am t) was mAp t = 13.6 ± 1.3 Ω.cm and 1.4±0.2 Ω.cm for the tissue isolated from the diaphragm and mesentery, respectively. Both the mechanical and chemical procedures used for the preparation of the peritoneal membrane model from the diaphragm have been shown to produce similar values of electrophysiological parameters. Conclusion The electrophysiologic approach presented here may be a useful tool for studies of highly permeable biological membranes such as the peritoneal mesothelium. The mesothelial tissue isolated from the rat diaphragm has been shown to be a suitable model for electrophysiologic studies of the peritoneum as assessed by the values of the PDmpt and Ampt parameters.
Solute Clearance Approach to Adequacy of Peritoneal Dialysis
Authors: Burkart John M. , Schreiber Martin , Korbet Stephen M. , Churchill David N. , Hamburger Richard J. , Moran John , Soderbloom Robert , Nolph Karl D. 
Published: February 2020

To investigate the effect of dialysis prescription on patient outcome for peritoneal dialysis patients, the relationship between total solute clearance and the relative risk of death has been investigated. Preliminary studies have suggested that more clearance is better and that patient outcome is predicted by total solute clearance. The recently published Canada-U.S.A. (CANUSA) multicenter study, evaluating adequacy of dialysis and nutrition in peritoneal dialysis patients, has further defined this relationship. Although these publications allow us to establish guidelines for the treatment of peritoneal dialysis patients, they also define the limitations of our knowledge and raise new questions. In this article we review our current knowledge regarding the predicted value of total solute clearance with patient outcome and nutritional status. Furthermore, we attempt to outline a practical approach for optimizing total solute clearance in peritoneal dialysis patients. Based on a review of the published literature and clinical recommendations, we feel that the minimal target total solute clearance for continuous forms of peritoneal dialysis is a weekly total KTN > 2.0 and/or a weekly total creatinine clearance >60 L/week/1.73 m2. For intermittent therapies, a weekly total KTN > 2.2 and/or a weekly total creatinine clearance >70 L/week/1.73 m2 is recommended.