bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized Trial Comparing Conventional Swan-Neck Straight-Tip Catheters to Straight-Tip Catheters with An Artificial Subcutaneous Swan Neck
Authors: Li Chiu-Leong , Cui Tai-Gen , Gan Hong-Bing , Cheung Kin , Lio Weng-In , Kuok Un-I 
Published: February 2020

Objective To evaluate the safety and efficacy of inserting a straight-tip Tenckhoff catheter configured with a subcutaneous artificial swan neck. Design Clinical outcomes of conventional swan-neck straight-tip catheters and Tenckhoff straight-tip catheters implanted with an artificial subcutaneous swan neck were compared in a prospective randomized controlled trial in a single-center setting. Patients and Methods Patients undergoing peritoneal dialysis catheter insertion were randomized to receive either a double-cuff straight-tip Tenckhoff catheter with an artificial subcutaneous swan-neck (TC) or a conventional double-cuff straight-tip swan-neck catheter (SN). The primary outcome was catheter exit-site infection rate; the secondary outcomes were catheter-related mechanical events and surgery-related bleeding. Results A total of 39 consecutive patients were enrolled: 20 into the TC group and 19 into the SN group. More exit-site infections were observed in the SN group than in the TC group, although the difference was not statistically significant (0.97 vs 0.51 episodes per patient-year, p = 0.0657). However, there were more peritonitis episodes in the TC group than in the SN group (0.35 vs 0.15 episodes per patient-year, p = 0.0256). Exit-site and main wound bleeding post surgery were generally mild and similar in the 2 groups. No events of dialysate leakage, catheter tip migration, or subcutaneous cuff protrusion were observed in patients of either group. Outflow failure due to mechanical causes occurred in 2 patients in the TC group and in 1 patient in the SN group during the intermittent peritoneal dialysis period; all were corrected successfully by laparoscopic omentectomy. Conclusions Placement of the double-cuff straight-tip Tenckhoff catheter configured with an artificial subcutaneous swan neck appears to be an effective and safe procedure. It may be a good alternative to the conventional swan-neck catheter.
A Strict Low Protein Diet during the Predialysis Period Suppresses Peritoneal Permeability at Induction of Peritoneal Dialysis
Authors: Hasegawa Takeshi , Yoshimura Ashio , Hirose Makoto , Komukai Daisuke , Tayama Hironori , Watanabe Susumu , Koiwa Fumihiko , Yamazaki Shin , Ideura Terukuni 
Published: February 2020

Background The factors that predict baseline peritoneal permeability remain largely unknown. We noticed that patients that adhered to a strict low protein diet (LPD) during the predialysis period seldom showed high peritoneal permeability on the peritoneal equilibration test (PET) at the introduction of peritoneal dialysis (PD). Therefore, we investigated whether a strict LPD during the predialysis period affects peritoneal permeability. Method We retrospectively analyzed 37 patients that started PD in a single Japanese center. Patients were divided into group A and group B by the median amount of daily protein intake (PI) during the predialysis period using urine collected over 24 hours. Results There were no differences between groups A and B in age, gender, proportion of diabetic nephropathy, blood pressure, body mass index, or body surface area. There were also no differences between the groups in laboratory findings, including hematocrit, serum albumin, and serum creatinine. The PETs showed a significantly lower dialysate-to-plasma ratio of creatinine at 4 hours (Cr D/P) for group A than for group B ( p = 0.02). Furthermore, a significant positive correlation between Cr D/P and PI was observed ( r = 0.53, p < 0.01). Conclusion It is suggested that a strict LPD during the predialysis period may suppress peritoneal permeability at induction of PD.
An Original Non-Traumatic Maneuver for Repositioning Migrated Peritoneal Dialysis Catheters
Authors: Tu Wen-Ting , Su Zhen , Shan Yi-Sheng 
Published: February 2020

Objective To describe an original non-traumatic maneuver for repositioning a migrated peritoneal dialysis (PD) catheter. Methods First, tissues wrapping the PD catheter are dissociated, then a correct route is selected according to the position of the catheter, and finally the catheter is repositioned manually in 8 steps: pressing, palpating, vibrating, wave vibrating, rotating, back-pushing and vibrating, swaying, and compressing. Results Of 30 cases of PD catheter migration, repositioning was successful on the first attempt in 9 cases, on the third attempt in 10 cases, on the seventh attempt in 7 cases, and failed in 4 cases. The overall success rate was 86.7%. Conclusion Manual repositioning of a migrated PD catheter is safe, painless, economical, and feasible. Repositioning of the migrated dialysis catheter may be attempted before referral for more invasive interventions.
Computed Tomographic Findings Characteristic for Encapsulating Peritoneal Sclerosis: A Case-Control Study
Authors: Vlijm Anniek , Stoker Jaap , Bipat Shandra , Spijkerboer Anje M. , Phoa Saffire S.K.S. , Maes Robbert , Struijk Dirk G. , Krediet Raymond T. 
Published: February 2020

Background Computed tomography (CT) is often used to confirm the diagnosis of encapsulating peritoneal sclerosis (EPS) but there is no consensus on specific CT abnormalities. To establish CT findings characteristic for EPS, we compared CT findings between EPS patients and long-term peritoneal dialysis (PD) patients without EPS. Methods We included as cases all EPS patients in our center from 1996 to 2008 that underwent a CT scan at the time of diagnosis. Controls were all other long-term PD patients (PD duration ≥ 4 years) without EPS that had a CT scan for different reasons. The CT scans were blindly and independently reviewed by 3 radiologists: 2 abdominal radiologists with PD knowledge (Observers 1 and 2) and 1 radiologist without PD experience (Observer 3). Results We included 15 EPS patients and 16 controls. Observer 1 found 6 CT findings that were significantly more often present in EPS than in controls ( p ≤ 0.05): peritoneal enhancement, thickening, and calcifications; adhesions of bowel loops; signs of obstruction; and fluid loculation/septation. Observer 2 scored almost identically but Observer 3 scored differently. The sensitivity and specificity of a combination of specific CT findings were, respectively, 100% and 94% for Observers 1 and 2, and 79% and 88% for Observer 3. Conclusion CT scans showed characteristic abnormalities that were significantly more often present in EPS patients compared to long-term PD control patients. CT can be used to confirm the diagnosis of EPS when experienced radiologists apply a combination of specific CT findings.
The Effect of Oral Niacinamide on Plasma Phosphorus Levels in Peritoneal Dialysis Patients
Authors: Young Daniel O. , Cheng Steven C. , Delmez James A. , Coyne Daniel W. 
Published: February 2020

Background Hyperphosphatemia remains a significant problem for patients requiring dialysis and is associated with increased mortality. Current treatment options include dietary restriction, dialysis, and phosphate binders. Treatment using the latter is frequently limited by cost, tolerability, and calcium loading. One open-label trial found niacinamide to be effective at decreasing serum phosphorus values in hemodialysis patients. Niacinamide may effectively reduce phosphorus levels in peritoneal dialysis (PD) patients already receiving standard phosphorus-lowering therapies. Methods An 8 week, randomized, double blind, placebo-controlled trial to evaluate the effectiveness of niacinamide to reduce plasma phosphorus levels in PD patients. Patients had to demonstrate a baseline phosphorus value > 4.9 mg/dL. Patients were randomized to niacinamide or placebo and prescribed 250 mg twice daily, with titration to 750 mg twice daily, as long as safety parameters were not violated. Phosphate binders, active vitamin D, and cinacalcet were kept constant during the study. The primary end point was change in plasma phosphorus. Secondary end points included changes in lipid parameters. Results 15 patients started on the study drug (8 niacinamide, 7 placebo) and 7 in each arm had at least one on-study phosphorus measurement. The niacinamide treatment group experienced an average 0.7 ± 0.9 mg/dL decrease in plasma phosphorus and the placebo-treated group experienced an average 0.4 ± 0.8 mg/dL increase. The treatment effect difference (1.1 mg/dL) was significant ( p = 0.037). No significant changes in high- or low-density lipoproteins or triglycerides were demonstrated. Two of the 8 patients randomized to the niacinamide treatment arm had to withdraw from the study due to drug-related adverse effects. Adverse effects may limit the use of niacinamide in PD patients. Conclusion Niacinamide, when added to standard phosphorus-lowering therapies, resulted in a modest yet statistically significant reduction in plasma phosphorus levels at 8 weeks. [ClinicalTrials.gov number NCT00508885 (ClinicalTrials.gov)]
Peritoneal Small Solute Clearance is Nonlinearly Related to Patient Survival in the Australian and New Zealand Peritoneal Dialysis Patient Populations
Authors: Rumpsfeld Markus , McDonald Stephen P. , Johnson David W. 
Published: February 2020

Background The contribution of peritoneal small solute clearance per se to peritoneal dialysis (PD) patient outcomes remains uncertain. The aim of the present study was to determine whether baseline peritoneal small solute clearance predicted subsequent survival in Australian and New Zealand PD patients. Methods The study included all adult patients in Australia and New Zealand that commenced PD between 1 April 2002 and 31 December 2005 and had a peritoneal Kt/V (pKt/V) measurement performed within 6 months of PD commencement. Time to death and death-censored technique failure were examined by Kaplan–Meier analyses and both univariate and multivariate Cox proportional hazards models. Results pKt/V measurements were available in 2434 (63%) of the 3841 individuals that began PD treatment in Australia and New Zealand during the study period. These patients were divided into 4 groups according to their baseline pKt/V values: <1.45 ( n = 599), 1.45 – 1.69 ( n = 550), 1.70 – 2.00 ( n = 607), and >2.00 ( n = 678). Compared with the reference group (pKt/V 1.70 – 2.00), patient mortality was significantly increased in individuals with pKt/V <1.45 [adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.24 – 2.84; p = 0.003] and tended to be increased in those with pKt/V 1.45 – 1.69 (adjusted HR 1.46, 95% CI 0.96 – 2.21; p = 0.074). Importantly, higher pKt/V values (>2.00) also tended to be associated with higher mortality (adjusted HR 1.42, 95% CI 0.96 – 2.11; p = 0.079). The other independent predictors of death were lower residual renal function (RRF), older age, peripheral vascular disease, diabetes mellitus, late referral, higher peritoneal permeability, and untreated hypertension. No interaction was observed between pKt/V, RRF, and survival. Death-censored technique failure was demonstrated to be significantly worse in the pKt/V 1.45 – 1.69 group (adjusted HR 1.36, 95% CI 1.03 – 1.79; p = 0.028), older individuals, and individuals with Asian racial origin. Conclusions Initial peritoneal Kt/V significantly and independently influences patient survival in Australian and New Zealand PD patients. Overall survival appears to be optimal in the pKt/V range 1.70 – 2.00, with poorer outcomes observed above and below these values. In particular, survival is significantly worse when the achieved pKt/V is <1.45. In addition, RRF is an important independent predictor of patient survival in the Australian and New Zealand incident PD patient populations. The results of this study should therefore draw attention to the possible danger of not delivering adequate PD dose to patients with considerable RRF.
Intrinsic Cells: Mesothelial Cells — Central Players in Regulating Inflammation and Resolution
Authors: Yung Susan , Chan Tak Mao 
Published: February 2020

Background Preservation of the structural and functional integrity of the peritoneum is essential to maintain the dialytic efficacy of the peritoneal membrane. Although much improvement has been made to peritoneal dialysis (PD) fluids, they remain bioincompatible, and together with peritonitis, they continue to induce peritoneal inflammation and fibrosis. Method This article reviews the putative factors that mediate mesothelial cell inflammation during PD, and the mechanisms by which mesothelial cells attempt to regulate and resolve peritoneal inflammation. Results The mesothelium is the first line of defense to foreign particles and chemicals in the peritoneal cavity. Constant exposure of the mesothelium to the bioincompatible constituents of PD solutions results in denudation of the mesothelium and loss of the peritoneal cavity's protective layer. Detached mesothelial cells in PD solutions have the capacity to replenish the mesothelial layer through their ability to migrate and attach to areas of denudation. Mesothelial cells synthesize a plethora of growth factors, matrix proteins, and proteoglycans that aid in the reparative process and regulate the formation of chemotactic gradients that are essential for infiltration of leukocytes to sites of injury. Conclusions Far from being bystanders in peritoneal function, mesothelial cells have been shown to play a dynamic role in peritoneal homeostasis and immunoregulation. Studies have highlighted the potential use of mesothelial cells in gene therapy and cell transplantation, both of which may provide novel therapeutic strategies for the preservation of the peritoneum during PD.
Improving Technique Survival in Peritoneal Dialysis: What is Modifiable?
Authors: Ersoy F. Fevzi 
Published: February 2020

The continuous quality improvement approach in peritoneal dialysis practice necessitates definition of the factors and the procedures that may possibly be contributing to the final success of peritoneal dialysis. The philosophy of continuous quality improvement uses the Plan, Do, Check, Act (PDCA) cycle. To improve the procedures used during peritoneal dialysis, the first step is to create a plan, then to carry out the plan, to check it, and after the collection of satisfactory information, to execute the chosen improvement action. Several studies have identified the most frequent causes of transfer from PD to HD as infection, catheter problems, inadequate dialysis, and psychosocial factors, among others. According to training guidelines from the International Society for Peritoneal Dialysis, seven points are of major importance to decrease infection risks: exit-site care, catheter placement, antibiotic prophylaxis for procedures, prevention of bowel-source peritonitis, prevention of fungal peritonitis, and connection methods. On the other hand, other factors such as hypoalbuminemia, depression, and obesity should also be taken into consideration for better technique survival in peritoneal dialysis patients.
Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?
Authors: Xu Ying , Dong Jie , Zuo Li 
Published: February 2020

Objective In a single-center retrospective cohort study, we investigated whether the frequency of clinic patient–physician contact (PPC) correlates with quality of care and can predict outcome in peritoneal dialysis (PD) patients. Patients and Methods We enrolled 307 incident PD patients who started PD from July 2002 to February 2007. All patients who visited the clinic at least once every 6 months and who lived for at least 6 months were followed until death, transfer to hemodialysis, renal transplantation, or February 2008 (censor date). Throughout the study period, an integrative follow-up strategy was used, including PPC and three other modes of contact between patients and non-physicians. Patients’ PPC frequency was divided into 3 categories: high frequency (monthly or more often), intermediate frequency (every 1 – 3 months), and low frequency (every 3 – 6 months). Baseline demographic and biochemical data were collected. Indices of diet, dialysis adequacy, biochemistry, and nutrition were measured at every visit and then calculated as mean values. Results We followed the 307 patients for a mean of 31.45 ± 13.62 months (range: 12 – 64 months). By PPC frequency, 127 patients (41.3%) were in the high-frequency group; 136 (44.3%), in the intermediate-frequency group; and 44 (14.3%), in the low-frequency group. We observed no difference of baseline demographic and biochemical data between the three groups ( p > 0.05). Patients in the low-frequency group had lower mean hemoglobin and total urea clearance rates, but higher serum phosphate than did patients in the intermediate- or high-frequency groups ( p < 0.05). Mean indices of nutrition, including serum albumin, daily protein and energy intake, and lean body mass were not different between the three groups ( p > 0.05). Frequency of PPC did not show an effect on the survival of PD patients ( p = 0.37 by Kaplan–Meier plot). Age ( p = 0.002), Charlson comorbidity score ( p = 0.001), and pre-dialysis albumin ( p = 0.019) were independent negative risk factors for death in multivariate Cox proportional hazard models, which were adjusted for sex, PPC frequency, baseline hemoglobin, and glomerular filtration rate. Conclusions Frequency of PPC did not predict outcome in PD patients after an integrative care strategy was implemented. Control of anemia and hyperphosphatemia needs to be strengthened in patients with a low frequency of PPC.
Optimal Use of Peritoneal Dialysis in Patients with Diabetes
Authors: Chung Sung Hee , Noh Hyunjin , Ha Hunjoo , Lee Hi Bahl 
Published: February 2020

The survival of patients with end-stage renal disease (ESRD) resulting from diabetes continues to improve, but the survival rate among diabetic ESRD patients remains the lowest among all primary diagnoses probably because of the higher prevalence of cardiovascular comorbidity associated with diabetes. Diabetes, age, and comorbidity all significantly modify the effect of treatment modality on patient survival. As compared with hemodialysis (HD), peritoneal dialysis (PD) offers an equal or lower risk of death across all subgroups during the first 1 – 2 years of dialysis. The association of PD with better outcomes than are seen with HD is probably a result of a lower prevalence of infections and congestive heart failure and better preservation of residual renal function (RRF) in PD patients. Use of angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) helps to preserve RRF in ESRD patients and to maintain peritoneal membrane integrity longer in PD patients. Antioxidants can also support preservation of peritoneal membrane function. Peritoneal dialysis should be the initial modality of dialysis in all ESRD patients. Older patients (age ≥ 45 years) with diabetes and patients without diabetes may switch to HD or receive a kidney graft in 1 – 2 years’ time; younger patients (age < 45 years) with diabetes may stay on PD longer. Use of ACEI and ARB or antioxidants can help to maintain peritoneal membrane function longer.
Tuberculous Peritonitis
Authors: Akpolat Tekin 
Published: February 2020

Compared with the general population, dialysis patients are at higher risk of acquiring mycobacterial infections. The aim of the present article is to review case reports and studies published since the report by Talwani and Horvath (2000) and to discuss the main problems that arise in daily practice. After a comprehensive review of the literature, cumulative data about peritoneal dialysis and peritoneal tuberculosis from reports of 98 patients in 21 papers were analyzed. The clinical and laboratory findings of peritoneal tuberculosis are nonspecific. Diagnosis requires a high index of suspicion. The most difficult cases present as culture-negative peritonitis or culture-positive peritonitis resistant to appropriate antibiotics without any additional clues of tuberculosis. The sensitivity of smears and cultures can be enhanced by centrifuging a 50 – 150 mL dialysate sample.
In Vitro and in Vivo Studies of Erythropoiesis during Continuous Ambulatory Peritoneal Dialysis
Authors: Lamperi Silvano , Carozzi Silvia , Icardi Andrea 
Published: February 2020

In order to understand the effect of CAPD on the anemia of chronic renal failure, we studied the behaviour of some hematological parameters and of the colony-formation capacity of bone marrow cells in in vitro cultures in patients undergoing this therapy. Our studies showed a rise in hematocrit, hemoglobin and reticulocyte values, which showed a significant correlation with a recovery of the erythroid cell proliferative activity. Since serum erythropoietin levels do not change, the improvement of bone-marrow function appears to be due to a better clearance (by CAPD) of substances, which inhibit the response of bone marrow to the erythropoietin.
CAPO Raining Failures
Authors: Gutman Cathy , Clayton Sheila , Tattersal Susan 
Published: February 2020

Thirty patients (5.5% of all patients who entered CAPD training in three Toronto Hospitals) failed CAPD training during the last five years. A categorization of these training failures revealed that in three patients (10%) were due to dialysis-related problems, and in 11 of them to concurrent medical problems ultimately contributing to training failure. Only in two of 30 (6.6%) failure was due primarily to inadequate intellectual ability. In those situations where partners were responsible for carrying out the dialysis, the most common cause of failure was the inability of the partner to meet all of the other care needs beyond those of dialysis, mainly because the patients were very sick. Other reasons for spousal failure were fear of responsibility and outright spousal countermotivation. Remaining categories of failure in patients were countermotivation (four or 13.3%), inability to adjust emotionally to life with CAPD (seven or 23.3%), physical impediments to carrying out CAPD (two or 6.6%) and severe psychiatric disturbance (one patient or 3.3%).