bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Serum Albumin at the Start of Continuous Ambulatory Peritoneal Dialysis Treatment on Patient Survival
Authors: Struijk Dirk G. , Krediet Raymond T. , Koomen Gerardus C.M. , Boeschoten Elisabeth W. , Arisz Lambertus 
Published: February 2020

Objective To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients. Design A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics. Setting University medical center. Participants Sixty-one patients, evaluated within 3 months after the start of CAPD. Main Outcome Measures Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal body weight, and presence or absence of systemicdisease. Results Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1 -43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1). Conclusions The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.
Complement in Serum and Dialysate in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Reddingius Roel E. , Schröder Cornelis H. , Daha Mohamed R. , Willems Hans L. , Koster Anja M. , Monnens Leo A.H. 
Published: February 2020

Objective During continuous ambulatory peritoneal dialysis (CAPD), activation of complement in the peritoneal cavity may theoretically occur, with inappropriately high or low levels of certain complement factors in dialysate as a consequence. In a group of children on CAPD, it was tested whether levels of a number of complement factors in dialysate were in the range that was predicted on the basis of their molecular weight. Design Serum and dialysate levels of C1 q, C3, C4, C3d, B, D, and P were measured after a night dwell in children on CAPD. Simultaneously, four non-complement proteins (β2-microglobulin, albumin, IgG, and α2macroglobulin) were also measured in dialysate and serum. Assuming a linear relationship between the log base 10 of the dialysate/serum ratio of these non-complement proteins and the log base 10 of their molecular weight, the expected ratios of all complement factors were determined. The differences between actual and predicted ratios were tested using a modified t-test, taking into account the inaccuracy of the estimate. Setting University hospital. Patients A group of 14 children on CAPD, with a median age of 7.8 years (range 2.1–13.2). These children had been on CAPD for a median period of 42.4 months (range 0.4 89.1). Results The ratios of factor D (p < 0.001) and C3d (p = 0.035) were elevated, whereas those of C3 (p < 0.001), C4 (p < 0.001), and factor P (p = 0.012) were decreased. Conclusions Relatively low dialysate/serum ratios of C4, C3, and factor P could be caused by intraperitoneal consumption of complement. High levels of C3d are compatible with this. High dialysate/serum ratios of factor D indicate intraperitoneal production of factor D. These results provide evidence for activation of complement in the peritoneal cavity in children on CAPD. A further reduction of already low levels of complement factors in dialysate as a result of this may impair host defense.
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) were examined. 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±, D. 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.
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.
Comparison of Three Different Tests for Assessment of Hepatitis C Virus in Dialysis Patients
Authors: Castelnovo Claudia , Lunghi Giovanna , De Vecchi Amedeo , Grancini Anna , Como Giovanna , Graziani Giorgio , Scalamogna Antonio , Ponticelli Claudio 
Published: February 2020

Objective To evaluate the relationship between hepatitis C virus antibodies (HCV-Ab) and viremia and to compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Design Cross-sectional study. Setting Dialysis unit of a nephrology division in a public university hospital. Patients All dialysis patients who came for routine clinic visits during the study period. None denied informed consent. Forty-eight patients on HD and 79 on CAPD were examined. Intervention Blood samples were tested by secondgeneration enzyme-linked immunosorbent assay (ELISA II) and recombinant immunoblot assay (RIBA II) to look for HCV-Ab and by the polymerase chain reaction (PCR) to look for HCV viremia. Results ELISA II was positive in 52% of HD patients and in 14% of CAPD patients. RIBA II was positive in 48% of HD patients and in 11% of CAPD patients. HCV viremia was positive by PCR in 41.6% of HD patients and in 12% of CAPD patients. Two of these PCR-positive patients did not show HCV-Ab by ELISA II and RIBA II. The sensitivity and specificity of ELISA II were 93% and 92%, the sensitivity and specificity of RIBA II were 86% and 94%. Conclusions Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.
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) dueto 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 IIB, 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.
Chronic Induction of C-Reactive Protein by Hemodialysis, but Not by Peritoneal Dialysis Therapy
Authors: Haubitz Marion , Brunkhorst Reinhard , Wrenger Eike , Froese Peter , Schulze Matthias , Koch Karl-Martin 
Published: February 2020

Objective Evaluation of the inflammatory activity in patients on chronic peritoneal dialysis (PD) and patients on chronic hemodialysis (HD) in comparison to patients with chronic renal insufficiency without dialysis treatment and healthy volunteers. Design Open, non randomized prospective study. Setting Nephrology Department, including HD and PD therapy in a university hospital. Patients Twenty -four patients on chronic PD, 21 patients on chronic HD therapy using a cuprophan dialyzer, 16 patients with chronic renal insufficiency without dialysis treatment, and 33 healthy volunteers; 8 additional patients before and after initiation of chronic HD therapy. All patients and controls were without infection or immunosuppressive therapy. Main Outcome Measures As a marker of the inflammatory activity in the different patient groups, C-reactive protein (CAP) was measured serially using a sensitive, enzyme-Iinked, immunosorbent assay in order to detect values below the detection limit of standard assays. Results All patient groups had CAP levels higher than the normal controls (p < 0.01). Patients on HD had CAP levels significantly higher than PD patients (p < 0.01) whose levels were comparable to patients without dialysis therapy. Accordingly, longitudinal measurements before and after initiation of chronic HD showed a significant increase in CAP levels after the beginning of HD treatment (p < 0.04). Conclusions The results suggest that induction of the inflammatory activity is lower during PD compared to HD, since stimulation by the dialyzer membrane, dialysate buffer, or bacterial fragments in the dialysate is avoided. This observation might indicate a possible lower risk of long-term complications in patients with PD.
Synthesis of Hyaluronic Acid by Human Peritoneal Mesothelial Cells: Effect of Cytokines and Dialysa Te
Authors: Breborowicz Andrzej , Korybalska Katarzyna , Grzybowski Andrzej , Tobis Katarzyna Wieczorowska , Oreopoulos Dimitrios G , Martis Leo 
Published: February 2020

Objective To assess effects of the inflammatory cytokines (IL-1-beta, TNF-alpha, TGF-beta 1) and dialysate effluent on synthesis of hyaluronic acid by human peritoneal mesothelial cells (HMC) in in vitro culture. Methods Dialysate effluent was collected after the overnight dwell of DianeaI 1.5% from patients during CAPD training. HMC were obtained from omentum from nonuremic donors or were harvested from the dialysate effluent from CAPD patients. Synthesis of hyaluronic acid was studied on monolayers of HMC, which were deprived of serum 48 hours priortoexperiment. Effects of cytokines were tested in a medium with low serum concentration (0.1%) or in medium mixed (1:1 v/v) with the autologous dialysate. Hyaluronic acid level in medium was measured with radioimmunoassay. Results Cytokines enhanced synthesis of hyaluronic acid by HMC, and the strongest effect was induced by IL-1. Effluent dialysate stimulates synthesis of hyaluronic acid stronger than 10% FCS. Effluent dialysate and IL-1 synergistically enhance synthesis of hyaluronic acid by HMC. Conclusion Effluent dialysate from CAPD patients stimulates production of hyaluronic acid by HMC and acts synergistically with cytokines.
Differential Glucocorticoid Responsiveness of Dialysis Patients’ Lymphocytes
Authors: Briggs William A. , Gao Zu-Hua , Scheel Paul J. , Burdick James F. , Gimenez Luis F. , Choi Michael J. 
Published: February 2020

Objectives To evaluate in vitro glucocorticoid responsiveness of phytohemagglutinin (PHA)-stimulated lymphocytes from peritoneal dialysis (PO) patients compared to hemodialysis (HO) patients. Design Cross-sectional study of prevalent PO and HO patients and concurrent control subjects. Setting Urban outpatient dialysis unit. Patients 20 HO, 14 PO, and 20 control subjects. Measurements Using standard lymphocyte culture techniques, the concentration of prednisolone (P) and methylprednisolone (MP) required to cause 50% inhibition (ICso) of the proliferative response to phytohemagglutinin (PHA) was determined from dose-response curves. Results There was considerable heterogeneity in the sensitivities of individual patients’ PBMC to glucocorticoid inhibition, especially those of HO patients’ cells to P. The mean: i: SO ICso for MP was significantly (p ≤ 0.001) lower than that for P in each cohort: PO 11 ± 5 vs. 34 ± 18 ng/mL; HO 22 ± 14 vs. 89 ± 43 ng/mL; control subjects 14 ± 11 vs. 55 ± 56 ng/mL. Interestingly, the ICSO for both P and MP was significantly higher in HO than in either PO or controls (ANOVA, P: F = 6.56, p = 0.003; MP: F = 3.77, p = 0.03), indicating decreased sensitivity of HO lymphocytes to both drugs. There were no significant differences in mean ICSO values for either P or MP between PO and controls. No correlations were found between ICSO for either P or MP and patient age, gender, duration of dialysis, serum creatinine, serum albumin, or parathyroid hormone level. Conclusions In vitro glucocorticoid responsiveness of dialysis patients’ lymphocytes appears to be influenced by dialysis modality, butthefactor(s) involved remains to be determined. Thegreater sensitivity of PO lymphocytes to both P and MP might result in better immunosuppression and less severe rejection after renal transplantation. MP may be particularly advantageous following renal transplantation for any patient manifesting relative or absolute in vitro resistance to P.
Microcirculation of the Fingernail Fold in Capd Patients: Preliminary Observations
Authors: Schumann Lutz , Korten Gero , Holdt Birgit , Holtz Manfred 
Published: February 2020

Objective To study changes in the peritoneal micro-circulation during continuous ambulatory peritoneal dialysis (CAPD) by studying change in the microcirculation of the fingernails of CAPD patients. Setting A university department. Design A cross-sectional study of 10 nondiabetic patients on CAPD. Intervention Hemorrheological tests of fingernail microcirculation using equipment built at our university. Main Outcome Measures Microcirculation was characterized by estimation of capillary density, red blood cell (RBC) column diameter, torque index, and RBC flow velocity semiquantitatively using videocapillaroscopy at the fingernail fold and plasma viscosimetry. Findings were correlated with treatment duration, peritoneal clearance, state of capillary morphology and hemodynamics, and lipid and fibrinogen levels. Results Treatment duration was significantly correlated (p ≤ 0.05) with low-density lipoprotein (LDL) (r = 0.776) and clearances of urea (r = -0.583), uric acid (r = -0.666), and potassium (r = -0.764). Changes in capillary morphology were correlated to clearances of urea (r = 0.643) and uric acid (r = 0.701). The fibrinogen concentration increases plasma viscosity (r = 0.799) and deteriorates the capillary state (r = -0.706). In addition, plasma viscosity correlates to cholesterol (r = 0.620, NS) and LDL (r = 0.781), but not to high-density lipoprotein and triglycerides. Conclusion CAPD treatment results in lipid abnormalities and high fibrinogen levels that may cause microvascular damage and poor perfusion. These interactions may explain the deterioration of peritoneal transport in some CAPD patients.
Peritoneal Dialysis Kinetic Modeling: Validation in a Multicenter Clinical Study
Authors: Vonesh Edward F. , Burkart John , McMurray Stephen D. , Williams Paul F. 
Published: February 2020

Objective To clinically validate the use of a computer-based kinetic model for peritoneal dialysis (PD) by assessing the level of agreement between measured and modeled values of urea and creatinine clearances and ultrafiltration (UF). Design An open multicenter observational study. Patients There were 111 adult continuous ambulatory peritoneal dialysis (CAPD) patients (47 female, 64 male) in four centers. All patients underwent a four-hour peritoneal equilibration test (PET) using 2.5% dextrose but with variable fill volumes (range: 1 -3 L). Patients with a residual renal function greater than 10 mL/min were excluded. Main Outcome Measures Correlations and limits of agreement between measured and modeled values of total weekly urea KTN, total weekly normalized creatinine clearance (L/week/1.73 m2), daily drain volume (L), net ultrafiltration (L), daily peritoneal urea clearance (L/day), and daily peritoneal creatinine clearance (L/day). Measured values were obtained from 24-hour urine and dialysate collections while modeled values were based on results from the PET in combination with the PD ADEQUEST® kinetic program. Results The results show there is excellent agreement between measured and modeled urea KTN and creatinine clearances, with concordance correlations of 0.94 and 0.92, respectively. Given the excessive variation and limited range in ultrafiltration values, the concordance correlation between measured and modeled UF was only 0.50. In terms of daily peritoneal clearances and ultrafiltration, the level of precision (i.e., standard deviation) in the differences between modeled and measured values is ±1.05 L/ day for urea clearance, ±1.03 L/day for creatinine clearance, and ±0.919 L/day for ultrafiltration. By contrast, the level of precision (i.e., standard deviation) in the differences between two measured values is estimated to be ±0.979 L/day for urea clearance, ±0.802 L/day for creatinine clearance, and ±0.707 L/day for ultrafiltration. Defining the limits of clinical agreement to be ±2 standard deviations of the differences between two clinically measured 24-hour clearances (or ultrafiltration), we find that 94% of the modeled urea clearances, 87% of the modeled creatinine clearances, and 86% of the modeled ultrafiltration values fall within the limits of clinical agreement. Conclusion Data from a carefully performed PET and overnight exchange can, in combination with a scientifically validated kinetic model, provide clinicians with a powerful mathematical tool for use in CAPD dialysis prescription management. Although not intended to replace actual measurements, kinetic modeling can prove useful as a means for predicting clearances for various alternative prescriptions and perhaps also as a means for checking certain types of noncompliance.
Can Low-Calcium Peritoneal Dialysis Solution Safely Replace the Standard Calcium Solution in the Majority of Chronic Peritoneal Dialysis Patients?
Authors: Buijsen Coby G.M. , Struijk Dirk G. , Huijgen Henk J. , Boeschoten Els W. , Wilmink Joep M. 
Published: February 2020

Objective To evaluate the use of low-calcium solution as the standard solution in chronic peritoneal dialysis patients. Design Prospective long-term follow-up study over a one-year period. Setting University hospital. Interventions The change of the calcium concentration of the dialysate from 1.75 mmollL to 1.25 mmollL. Main Outcome Measures Serum calcium and phosphorus concentration and intact parathyroid hormone (iPTH). Patients Fifty normo and hypercalcemic patients using the standard 1.75 mmollL calcium solution. Results Serum ionized calcium (iCa) decreased significantly during the first six months, resulting in a significant increment of iPTH (baselinevalue: 0.9 79, median 9.4 pmollL; at six months: 1.1 -111, median 20.6 pmollL; p < 0.05). In 28 patients completing the study, iPTH remained significantly elevated, despite high normal iCa. At similar changes of iCa, patients with baseline iPTH > 20 pmollL showed a significantly higher increase in iPTH than patients with low iPTH (24.0 vs 5.0; p < 0.01), despite a more than doubled dose of alfacalcidol and calcium carbonate (mean dose of 1580 increased to 3277 mg/day). During the follow-up, 21 episodes of hypercalcemia were observed. Phosphorus control was adequate. Conclusions Low-calcium solution cannot be used as a standard solution, especially in patients with iPTH levels indicating mild or severe hyperparathyroidism, because in these patients iPTH may rise further.