bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrastructure, Distribution, and Density of Lamellar Bodies in Human Peritoneum
Authors: Dobbie James W. , Anderson James D. 
Published: February 2020

Objective To determine the ultrastructure, relative density, and location of lamellar bodies in the various regions, structures, cells, and intercellular matrix in normal human peritoneum; to carry out engineering analysis of the role of lamellar structures in serosal lubricancy and deduce what effect this system may have on the process of peritoneal dialysis. Design Five samples of normal human parietal peritoneum obtained at elective operation were fixed in a tannic acid-glutaraldehyde mixture and submitted to examination by transmission electron microscopy. Detailed analysis using reconstruction of serial electron micrographs and tracings of montages were employed in determining location, disposition, density, and geometric patterns of lamellar bodies in all levels of the peritoneal membrane. Results Lamellar profiles were found in greatest density enmeshed in surface microvilli and in mesothelial cytoplasm. Lamellar bodies were frequently observed capping the external portion of mesothelial junctional complexes, and within intercellular junctions. Lamellar bodies were also encountered in macrophages, both in the peritoneal cavity and submesothelial tissue, and also in fibroblasts. Lamellar bodies were present in low density in the matrix ground substance of submesothelial connective tissue, in blood vessel walls between smooth muscle, in endothelial cell cytoplasm, and in vascular lumina. Conclusion Three-dimensional analysis of lamellae on mesothelial surfaces indicates that an arrangement of constantly changing microscopic spheres and cylinders would act as “ball and roller bearings” among the microvilli for the lubrication of opposing surfaces. The entrapment offluid in lamellar bubbles, which in normal peritoneum fill the microvillous layer, would, if maintained in peritoneal dialysis, constitute a stagnant layer of considerable stability and inertia.
Osmotic Conductance of the Peritoneum in Capd Patients with Permanent Loss of Ultrafiltration Capacity
Authors: Waniewski Jacek , Heimbürger Olof , Werynski Andrzej , Lindholm Bengt 
Published: February 2020

Objective To compare the effectiveness of osmotic pressure in the induction of fluid flow during continuous ambulatory peritoneal dialysis (CAPD) in patients with permanent loss of ultrafiltration capacity (UFC) and clinically stable patients. Design Estimation of osmotic conductance in individual CAPD patients using data from single CAPD dwell studies. Patients Twenty clinically stable CAPD patients with normal ultrafiltration rate (NUR group); 8 CAPD patients with permanent UFC loss due to high diffusion rate for small solutes [high diffusion rate (HDR) group]; 3 CAPD patients with permanent loss of UFC dueto high absorption rate (HAR) of peritoneal dialysate (HAR group). Design Six-hour dwell studies were carried out in each patient using 2 L of Dianeal 3.86% dialysis fluid. Dialysate volume and the peritoneal absorption rate were measured using radioiodinated serum albumin as a marker. The dialysate volume over dwell-time curves were examined using three mathematical models of fluid transport for solutions with a crystalloid osmotic agent: model P, based on a phenomenologically derived exponential function of time; model OS, based on the linear relationship between the rate of net volume change (Qv) to the difference of osmolality in dialysate and blood; and model G, based on the linear relationship between Qv and the difference of glucose concentration in dialysate and blood. Results All three models provided an accurate description of the measured dialysate volume over time curves. The osmotic conductance, defined as the coefficient of proportionality between the rate of ultrafiltration and the osmolality (or, alternatively, glucose) gradient between dialysate and blood plasma, was 30% lower in the HDR group than in the NUR group, but close to the normal value in the HAR group. Conclusion In the HDR group the changes in the peritoneal membrane, which resulted in the increased diffusion rate of small solutes, also yielded a decrease of osmotic conductance. In contrast, the changes in the membrane in the HAR group, which resulted in increased peritoneal absorption, did not change the osmotic con ductance or the solute diffusion rate. The detailed pathophysiological mechanisms for these two different types of UFC loss failure are still unknown.
L-Cysteine Improves Growth of Human Peritoneal Mesothelial Cells In Vitro
Authors: Bird Stephen D. , Legge Michael , Walker Robert J. 
Published: February 2020

Objective To improve the growth characteristics of human peritoneal mesothelial cells (HPMC). Design The effect of commonly used agents, L-cysteine and epidermal growth factor (EGF), added individually (“single”) or mixed with hydrocortisone and apo-transferrin (“admixture”) in the culture medium (M199) on cultured HPMC, was investigated. Methods: Growth agents were added to M199 medium along with 2% fetal bovine serum and L-glutamine. Growth was determined by the analysis of thymidine ([methyl-3H] thymidine) incorporation into deoxyribonucleic acid, total cell protein, and by cell counts. Morphology was assessed by phase contrast light microscopy and scanning electron microscopy. Results HPMC exposed to L-cysteine 0.25 x 10–3 mol/L (30 μg/mL) exhibited significantly improved attachment and growth. Attached cells appeared flat and well spread out shortly after seeding, and produced a tight polygonal monolayer in 14 days, in contrast to the growth of HPMC in control M199 medium, which failed to reach confluence. After an initial lag period in cell growth, EGF (0.01 μg/mL) produced a greater increase in cell growth than L-cysteine did; however, this was associated with changes in HPMC morphology. During the growth period (14 days), EGF-stimulated HPMC appeared distorted and irregular compared to L-cysteine-treated cells, which had the characteristic tight “cobblestone” appearance. Conclusion L-cysteine improved cell attachment with preservation of the characteristic morphology of HPMC. Epidermal growth factor improved cell growth but produced changes in morphology. The addition of L-cysteine to the culture medium has an important cell growth enhancement role due to the improved cell attachment and cell viability.
Abdominal Cocoon: An Animal Model for a Complication of Peritoneal Dialysis
Authors: Levine Seymour , Saltzman Arthur 
Published: February 2020

Objective The purpose of this work was to develop an animal model of sclerosing encapsulating peritonitis, a complication of continuous ambulatory peritoneal dialysis in which the intestines are conglomerated into an ovoid cocoonlike structure. Design Toward this end, rats were injected with a chemical irritant (household bleach) intraperitoneally. One week later, before the resultant peritonitis could cause adhesions, 10 or 25 mL of fresh whole rat blood was injected into the peritoneal cavity. Two weeks later, the effect of the treatments was evaluated by macroscopic and microscopic study. Results The irritant caused a chemical peritonitis. The subsequently injected blood clotted on the surfaces of the inflamed intestines, and contraction of the clot (syneresis) was responsible for bringing the intestinal loops together. This conglomeration was made permanent by the fibrosis evoked by the chemical peritonitis. The end result was an ovoid encapsulated mass of intestines and other viscera. Conclusion An animal model for an abdominal cocoon has been produced. It can be used for studies of the pathogenesis and prevention of this complication of peritoneal dialysis.
The Study of Outcomes for Capd versus Hemodialysis Patients
Authors: Port Friedrich K. , Wolfe Robert A. , Bloembergen Wendy E. , Held Philip J. , Young Eric W. 
Published: February 2020

Objective To discuss potential reasons for reported differences in the results of several recent studies comparing mortality risk among continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis patients, and to assess the role of statistical methods and study design. Data Sources Recent published reports comparing mortality risk among patients treated with CAPD and hemodialysis. Conclusions Differences in study design, study populations, sample size, data collection, and availability of data likely account in part for the differences in available study results. The Cox model is a valuable tool, particularly for observational studies. Observed outcome differences for CAPD and hemodialysis patients may be due to either the dialytic modality itself or other factors such as differences in patient selection, practice patterns, dialysis dose, patient compliance, etc. Relative mortality rates for hemodialysis and CAPD patients may vary by country, as these factors may differ internationally. A randomized clinical trial is necessary to best determine the effect of the modality itself.
Body Composition of Children on Capd
Authors: Stefanidis Constantinos , Siapera Dimitra , Papadopoulou Alexandra , Michelis Kyriakos 
Published: February 2020

Our objectives were to estimate the body composition of children on continuous ambulatory peritoneal dialysis (CAPD), assess the fat-free mass (FFM) by bioelectrical impedance (BIA) and skinfold anthropometry (SF), and determine the effect of various parameters of the nutritional status and adequacy of dialysis on body composition. The design was a noninterventional retrospective clinical trial. The percent of fat ranged from 10% to 25% (15±2), when it was calculated from SF, and was from 9% to 32% (18±2) when it was calculated from BIA. There was a significant correlation between the percent of fat calculated by SF and by BIA (r = 0.94, p < 0.0001 with limits of agreement 4.16 to 1.37 and -0.40 to -3.19). The water content of FFM ranged from 70%-79% (74±1). There was a weak but significant correlation (r = 0.64, p = 0.016) between protein catabolic rate (PCR) and KT/V (V = 60% of weight). This correlation became more significant (r = 0.83, p = 0.0007) when the V of KT/V was calculated from BIA. The prediction of body composition with the use of bioelectrical impedance is a simple and reliable technique. Serial measurements of BIA might be an important tool for the assessment of the nutritional intervention.
Measurement of Hydrostatic Intraperitoneal Pressure: A Necessary Routine Test in Peritoneal Dialysis
Authors: Durand Pierre-Yves , Chanliau Jacques , Gambéroni Joel , Hestin Dominique , Kessler Michele 
Published: February 2020

This paper summarizes our clinical studies on hydrostatic intraperitoneal pressure (IPP), showing the interest of this measurement in routine clinical practice. IPP can easily be measured routinely by a simple an d safe method: the measure of the column of dialysate in the peritoneal dialysis (PD) line before drainage, with point 0 located on the midaxillary line. The normal value is 12±2 cm of water (cm H2O) with an intraperitoneal volume (IPV) of 2 L, with linear increases of 2.2 cm H2O for each additional liter. IPP must be measured to estimate the tolerance of IPV: the maximal permissible IPV is reached for an IPP of 18 cm H2O, squaring with a decrease of 200/0 in vital capacity and sometimes arising before clinical symptomatology. However, IPP measured at rest could not predict PD mechanical complications (hernias, dialysis leakages, hemorrhoids, etc.), which are more dependent on parietal previous history or predisposition. IPP is significantly higher during the first three days after peritoneal catheter implantation (17±3 cm H2O) than during the 12 following days (10±4 cm H2O). It is recommended to postpone the start of PD until after catheter implantation, and patients should remain supine for the first three days. On the other hand, IPP strongly reduces the overall ultrafiltration (UF) volume: an increase of 1 cm H2O in IPP caused a decrease of 70 mL in global UF after two hours. Therefore, IPP should be measured in diagnosis of losses of UF. However, UF loss during peritonitis is not due to an increase of IPP.
Effect of Different Buffers on the Biocompatibility of Capd Solutions
Authors: Schambye Hans Thalsgård 
Published: February 2020

Commercially available solutions for continuous ambulatory peritoneal dialysis (CAPO) affect the viability and function of the cells in the peritoneal cavity. The low biocompatibility of the solutions may be caused by a low pH, hyperosmolality, high glucose content, and lack of potassium, glutamine, and other components essential for normal cellular functions. The nature of the buffer employed is also important for the cytotoxicity of the solutions. Lactate, the most frequently used buffer, has been shown to inhibit cellular functions important for the peritoneal defense system including phagocytosis, bacterial killing, and secretion of cytokines. It is generally believed that the cytotoxicity of lactate is caused by lowering of intracellular pH and impairment of metabolism due to changed redox potentials. However, the cytotoxicity of lactate is highly dependent upon the pH of the solutions, indicating that passive or active diffusion across the cell membrane is determining the effects of lactate. Bicarbonate has been heavily advocated as an alternative buffer because it is the most important naturally occurring buffer in plasma and it enables a pH of approximately 7.4 in the solutions. However, due to sedimentation of calcium carbonate (CaCO3) and production of toxic glucose metabolites it is difficult to prepare and store bicarbonate-based solutions. Moreover, investigations have revealed that even bicarbonate-based solutions are not optimal regarding biocompatibility, presumably due to a paradoxical intracellular acidification caused by influx of carbon dioxide (CO2). More recently, the effect of other buffers such as pyruvate and histidine have been examined. Especially pyruvate is a promising new buffer candidate. Conventional CAPD solutions based on lactate have been shown to impair a wide variety of cell functions important for the peritoneal host defense. Apart from the influence of hyperosmolality, high glucose concentration, lack of potassium, glutamine, and other factors, this seems to be due to the combination of low pH and high lactate concentration. Presumably, lactate carries protons across the membrane, which results in intracellular acidification and increased intracellular lactate concentration, both of which may impair cell metabolism and function. Bicarbonate-based solutions are less toxic than lactate-based solutions -primarily attributable to the higher pH. However, experiments performed by our group have indicated that bicarbonate concentrations that are too high may also affect cell function, and that a solution containing both bicarbonate and lactate may be superior. However, further studies are needed to fully elucidate this problem. Pyruvate seems to be a promising new buffer candidate with lower toxicity than lactate solutions at identical pH and glucose content. Comparison of pyruvate, lactate, and bicarbonate solutions regarding cytotoxicity and especially intracellular acidification will hopefully shed new light on the toxic properties of these solutions.
Normalization of Protein Equivalent of Nitrogen Appearance and Dialytic Adequacy in Capd
Authors: Virga Giovambattista , Viglino Giusto , Gandolfo Carmen , Aloi Elisabetta , Cavalli Pier Luigi 
Published: February 2020

Caloric-proteic malnutrition is frequently encountered in peritoneal dialysis and is associated with an increased risk of morbidity and mortality. Our paper aims to assess any greater reliability of protein equivalent of nitrogen appearance (PNA) normalization to desirable body weight (dBW) compared to actual body weight (aBW) and resulting implications for the relationship between dialytic adequacy and protein intake in continuous ambulatory peritoneal dialysis (CAPD). We studied 36 patients on CAPD, 24 male and 12 female (aged 66.6±10.2 years, 24±29 months on dialysis), collecting dialysate and urine over 24 hours (126 samples) to calculate the PNA according to Randerson and the total weekly KT N. The total body muscle mass (TBMM) was calculated by anthropometry and the dBW according to Metropolitan Life Insurance tables. Finally, PNA was normalized to aBW (aPNA, g/kg/day) and to dBW (dPNA, g/kg/day). Average aBW proved to be higher than dBW (66.0±11.1 vs 59.8±6.9 kg, p < 0.0001) and aPNA lower than dPNA (0.96±0.31 vs 1.08±0.3 g/kg/day, p < 0.005). Compared to aPNA, dPNA correlates better with both blood urea nitrogen (BUN) (R2 = 0.702 vs 0.614) and KT/V (R2 = 0.348 vs 0.306). The TBMM is higher in the group with dPNA ≥ 1.0 vs < 1.0 g/kg/day (25.5±0.6 vs 23. 1±0. 7 kg, p < 0.02) while, paradoxically, it is lower in patients with aPNA≥ 1.0 vs < 1.0 g/kg/day (22.8±0.8 vs 25.4±0.6 kg, p < 0.01). The KT/V of the patients with dPNA < 0.8,0.8–1.2 and > 1.2 g/kg/day proved to be different (1.52±0.06 vs 1.80±0.03 vs 2.04±0.04, p < 0.005). On analysis of the linear regression, dPNA = 1.0 and 1.2 g/kg/day corresponds to KT/V values of 1.7 and 2.05, respectively. We consider dPNA to be more suitable then aPNA for the correct assessment of protein intake, and a weekly KT/V of 1.7 2.05 as being sufficient to guarantee satisfactory dPNA.
Endocrinology and Pd: Optimal Treatment of Anemia in Peritoneal Dialysis Patients
Authors: Bárány Peter 
Published: February 2020

The optimal treatment of anemia in peritoneal dialysis is given by subcutaneous administration of epoetin. The optimal dosing frequency is in most patients 2 -3 injections per week, but in responsive patients once a week may be enough during the maintenance phase. Both before starting and during epoetin treatment it is necessary to monitor for factors causing hyporesponsiveness. The epoetin dose is adjusted monthly aiming at an increase in Hb concentration of 10 g/L per month. Further studies are required to define the optimal target Hb concentration. Iron supplements should be administered routinely. Parenteral iron may be used liberally when oral supplements are ineffective or inconvenient. In the initial three-month period of peritoneal dialysis a marked increase in Hb concentration is common, and if epoetin treatment is necessary low starting doses will be sufficient. In patients with moderate anemia, adequate iron stores and iron availability, and no significant comorbidity, low starting doses are recommended (50 75 U kg-1 week-1). Patients with severe anemia or with comorbidity usually require higher doses and may be started with 75 150 kg-1 week-1. Hypertension is the principal adverse effect of epoetin treatment in patients with chronic renal failure, but it is usually easily controlled by fluid control and/or increased antihypertensive medication.
Subcutaneous and Intraperitoneal Insulin Therapy in Diabetic Patients on Capd
Authors: Nevalainen Pasi I. , Lahtela Jorma T. , Mustonen Jukka , Pasternack Amos 
Published: February 2020

We evaluated in a cross-over manner the consequences of subcutaneously and intraperitoneally given insulin on glucose control, insulin sensitivity, and serum lipids in 8 type I diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). The patients were treated with both subcutaneous and intraperitoneal insulin for at least three months. After each period, metabolic studies were performed. Despite significantly improved glycemic control (Hb A^ 10.00±0.38% after subcutaneous and 8.40±0.36% after intraperitoneal insulin, p = 0.01), serum lipids showed unfavorable changes. High-density lipoprotein (HDL)-cholesterol was significantly lower (1.28±0.18 mmol/L vs 0.88±0.06 mmol/L, p = 0.03) and low-density lipoprotein (LDL)/HDL-cholesterol ratio was higher (p = 0.025) during intraperitoneal insulin. Total cholesterol, LDL-cholesterol, and triglycerides were higher during intraperitoneal insulin administration. Severe hypoglycemic episodes were more common during subcutaneous than intraperitoneal insulin. It is concluded that, although intraperitoneal insulin administration offers significantly better glycemic control and insulin sensitivity than subcutaneous insulin, the effect on serum lipids is more disadvantageous possibly via a direct effect of insulin on the liver.
Does Calcitriol Therapy Improve Muscle Function in Uremic Patients?
Authors: Wanic-Kossowska Maria , Grzegorzewska Alicja , Plotast Hanna , Bombicki Krzysztof 
Published: February 2020

The purpose of the present study is to investigate whether calcitriol therapy in uremic patients undergoing dialysis treatment can improve muscle function. In 8 uremic patients [2 on continuous ambulatory peritoneal dialysis (CAPD), 6 on hemodialysis (HD) treatment], calcitriol (Calcitriol, Roche) was given in the dose of 1 μg/ day for 15 months. At the beginning of therapy and every month, the following parameters in serum were determined: creatinine (Cr), calcium (Ca), phosphate (P), and parathyroid hormone (PTH). At the beginning and at the end of treatment, quantitative electromyography (EMG) was performed. We observed a slight increase of serum Cr during 15 months of treatment in 4 patients. Serum Ca, P, and PTH did not change significantly. The EMG revealed abnormal polyphasic motor nerve unit potentials of brief durations, a decrease in the amplitude, and fibrillation potentials. The EMG findings did not change significantly after calcitriol therapy, but all patients on physical examinations exhibited the disappearance of clinical manifestations of uremic myopathy. In conclusion, our findings suggest that vitamin D deficiency is one of the causes of uremic myopathy and a careful treatment with calcitriol can diminish muscle weakness in uremic patients.
Comparisons of Y-Set Disconnect System (Ultraset) versus Conventional Spike System in Uremic Patients on Capd: Outcome and Cost Analysis
Authors: Li Philip Kam Tao , Chan Tak Hin , So Wing Yee , Wang Angela Y.M. , Leung Chi Bon , Lai Kar Neng 
Published: February 2020

We conducted a single-blind, prospective randomized study on the use of the V -set disconnect system (Uttraset) (U) versus the conventional (C) spike system to assess the peritonitis rate, exit-site infection (ESt), clinical outcome, the resulting hospitalization rate, and recurrent costs. Forty new end-stage renal failure patients admitted to the dialysis program were recruited into the study and 20 each were randomly allocated to the U and C systems. They were studied for a period of 12 months. The mean number of days required to train patients for the U and C systems were 8.6 and 9.8 days, respectively. The peritonitis rates for the U and C systems were one episode every 17 and 11.4 patient-months, respectively. The ESI rates for the U and C systems were one episode every 26.4 and 21.6 patient-months, respectively. Four catheters were removed due to fungal peritonitis (three with the C system and one with the U system). As related to peritonitis, patients on the C system required 57 hospital-days while those on the U system required 28 days per year. On cost analysis, the extra cost required for the U system can be offset by the other expenses incurred for events related to more infections on the C system. It is concluded that for the similar cumulative costs required for the patients on the two systems, the Y-set disconnect has a better morbidity profile than the conventional spike system.
Socioeconomic and Health-Care Policies and Peritoneal Dialysis
Authors: Prichard Sarah S. 
Published: February 2020

1. All ESRD treatment is expensive and a modality change adds considerably to that expense. 2. Ideally, the cost of ESRD therapy should be re ported as the cost incurred for all aspects of the treatment to the health-care system. 3. Most studies show peritoneal dialysis to be less expensive than hemodialysis, but this can vary depending on the local costs of supplies and labor. 4. Strategic decisions with regard to new innovations should be made after a full analysis of all of the involved costs and savings that the innovation might introduce. 5. Economic factors and reimbursement rates appear to have an important impact on modality selection.