bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing Comorbidity in Dialysis Patients: Principles of Measurement and Applications in Risk Adjustment and Patient Care
Authors: Miskulin Dana 
Published: February 2020

Comorbid conditions are highly prevalent in dialysis patients and are significant predictors of mortality and other adverse outcomes. Accordingly, it is important to account for differences in comorbid illness burden among groups of dialysis patients being compared. At present, there is no consensus on what conditions matter, how each should be defined, and what weights each carries when defining an individual's risk or case-mix severity. A number of comorbidity instruments, generic or disease specific, have been employed in dialysis populations. They differ by the representation and definition of conditions as well as instrument scoring. No instrument has been found to be superior to another in terms of predictive accuracy for mortality, and accuracy across the board is low. Further studies are needed to determine whether improvements would be found with the use of more specifically defined items and through assignment of item weights based on relationships for outcomes specifically in a dialysis population. The roles of other factors in risk prediction, such as markers of nutritional status, inflammation, or other physiological parameters, relative to comorbid conditions also need to be defined. Outcomes other than mortality are likely to identify different factors and/or different relationships than those noted for mortality, which also require study. Comorbidity is important for risk adjusting comparative analyses in nonrandomized trials and quality of care assessments and may, in future, influence payment for dialysis services. Efforts to improve the management of comorbid illnesses are needed. Comorbid conditions must be documented accurately and uniformly in all dialysis patients to enable these applications.
When to Start Dialysis Treatment: Where Do We Stand?
Authors: Korevaar Johanna C. , van Manen Jeannette G. , Boeschoten Elisabeth W. , Dekker Friedo W. , Krediet Raymond T. ,   The NECOSAD Study Groupa, Apperloo A.J. , Barendregt J.N.M. , Birnie R.J. , Boekhout M. , Boer W.H. , Büller H.R. , de Charro F.T. , Doorenbos C.J. , Fagel W.J. , Franssen C.F.M. , Frenken L.A.M. , Geerlings W. , Gerlag P.G.G. , Gorgels J.P.M.C. , Grave W. , Huisman R.M. , Jager K.J. , Jie K. , Koning–Mulder W.A.H. , Koolen M.I. , Kremer Hovinga T.K. , Lavrijssen A.T.J. , Mulder A.W. , Parlevliet K.J. , Rosman J.B. , Schonk M.J.M. , Schuurmans M.M.J. , Stevens P. , Tijssen J.G.P. , Valentijn R.M. , van Bommel E.F.H. , van Dorp W.T. , van Es A. , van Geelen J.A.C.A. , van Saase J.L.C.M. , Vastenburg G. , Verburg C.A. , Verstappen V.M.C. , Vincent H.H. , Vos P. 
Published: February 2020

♦ Background Since the publication of opinion-based guidelines regarding the timing of dialysis treatment, there has been a trend toward earlier initiation. ♦ Objective In this review, the existing guidelines and the currently published studies that evaluate them are discussed. ♦ Results These studies could not demonstrate a clear benefit on survival or quality of life for patients who started with relatively higher renal function. ♦ Conclusion Early start of dialysis treatment should not be confused with early referral to the nephrologist. It is concluded that initiation of dialysis should not depend on a predefined magnitude of renal function, but should be tailored to the individual patient.
Encapsulating Peritoneal Sclerosis—A Clinician's Approach to Diagnosis and Medical Treatment
Authors: Nakamoto Hidetomo 
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of continuous peritoneal dialysis. A preliminary diagnosis of EPS is usually based on clinical signs and symptoms, which commonly include abdominal pain, nausea, vomiting, anorexia, abdominal fullness, an abdominal mass, bowel obstruction, and radiologic findings, including abdominal roentgenogram, contrast studies, ultrasound studies, and computed tomography. The diagnosis is confirmed by laparoscopy or laparotomy showing the characteristic gross thickening of the peritoneum enclosing some or all of the small intestine in a cocoon of opaque tissue. A variety of therapeutic approaches to EPS have been reported. This review discusses medical treatment of EPS and includes an overview of the clinical features and diagnostic aspects of the condition.
Assisted Peritoneal Dialysis. Experience in a French Renal Department
Authors: Lobbedez Thierry , Moldovan Raluca , Lecame Marie , de Ligny Bruno Hurault , Haggan Wael El , Ryckelynck Jean-Philippe 
Published: February 2020

Background The French healthcare system offers the possibility of increasing the use of peritoneal dialysis (PD) by involving in patient care nurses who work in the private system. Objective This study was conducted to evaluate the impact of a private home-nurse network on one dialysis program. Methods This was a retrospective study of 239 dialysis patients who started dialysis in our center between 1 January 1998 and 31 December 2003. Results Of these 239 patients, 142 were treated with hemodialysis and 97 with PD during the study period. Among the PD patients, 36 of 97 were treated with assisted PD and 61 of 97 with self-care PD. Assisted-PD patients were older (74 ± 10 vs 52 ± 18 years, p < 0.001) and presented more comorbidity (Charlson Comorbidity Index 7 ± 2.5 vs 4.3 ± 2.4, p < 0.05) compared with self-care patients. Continuous ambulatory PD was the modality of choice in the assisted group (32/36). Assisted patients were frequently hospitalized (31/36); actuarial survival free of hospitalization at 6 months was 46%. Patients with nurse assistance had a high risk of peritonitis (actuarial survival free of peritonitis: 52% at 1 year). Technique survival was 85% at 6 months and 58% at 1 year. Actuarial patient survival was 90% at 6 months and 83% at 1 year. Conclusion Assisted PD enables increased use of PD in incident dialysis patients. However, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.
Effects of Peritoneal Dialysis Solutions Low in GDPs on Peritonitis and Exit-Site Infection Rates
Authors: Furkert Jürgen , Zeier Martin , Schwenger Vedat 
Published: February 2020

Background Peritoneal dialysis (PD) solutions sterilized at a low pH level contain only minimal amounts of glucose degradation products (GDPs). The latter are known to have an adverse effect on the peritoneal membrane. The present study retrospectively analyzes the effects on the incidences of peritonitis and exit-site infections. Materials and Methods Data concerning the frequency of peritonitis and exit-site infections for 120 patients treated with PD were collected. Before 2000, 67 of these patients received conventional dialysates and from 2000 on, 53 patients were treated with the new dialysis fluids. Furthermore, a correlation between the incidence of infections and the duration of treatment with dialysis was established. Results It was observed that the use of dialysis solutions low in GDPs resulted in significantly lower rates of peritonitis ( p = 0.002) and exit-site infections ( p = 0.02). When using the new treatment, peritonitis occurred, on average, after 48 months of treatment and exit-site infections after 34 months of treatment. Discussion The result supports the hypothesis that the use of the new, biocompatible, PD solutions contributes to considerable reduction in the rates of peritonitis and exit-site infections. As it is not expected that randomized prospective studies will be conducted in the future, further observational studies should be carried out in order to affirm the observed tendencies.
Stability of Tobramycin and Ceftazidime in Icodextrin Peritoneal Dialysis Solution
Authors: Pallotta Katie E. , Elwell Rowland J. , Nornoo Adwoa O. , Manley Harold J. 
Published: February 2020

Purpose The data describing the compatibility of tobramycin and ceftazidime in icodextrin-based peritoneal dialysis (PD) solution is limited. The objective of this study was to assess the chemical stability of tobramycin and ceftazidime in icodextrin PD solution in polyvinyl chloride containers. Methods Commercially available 2-L bags of icodextrin 7.5% PD solution were used for each sample. Nine tobramycin study samples were prepared by adding 80 mg tobramycin HCl to each bag. Nine ceftazidime samples were prepared by adding 1000 mg ceftazidime to each bag. Three bags of tobramycin–icodextrin solution were stored under each of the following conditions: refrigeration (4°C), room temperature (25°C), and body temperature (37°C). Three bags of ceftazidime–icodextrin solution were also stored at each of the respective temperatures. Samples were withdrawn from each bag immediately after preparation and at predetermined intervals (1, 2, 4, 6, 8, 12, 24, 48, 72, 96, 120, 168, and 336 hours after preparation). Solutions were visually inspected for precipitation, cloudiness, and discoloration at each sampling interval. All samples were immediately frozen (–80°C) after collection and stored prior to assay. Total concentrations of tobramycin and ceftazidime in dialysate fluid were determined by high-performance liquid chromatography. The last time point when tobramycin or ceftazidime concentration was >90% from baseline was used to denote stability. Results All solutions were clear in appearance and no color change or precipitation was observed during the study. For tobramycin, under refrigeration, a mean of 94.6% ± 2.3% of the initial concentration remained at 336 hours (14 days); at room temperature, 90.5% ± 4.3% remained at 168 hours (7 days); at body temperature, 90.0% ± 8.1% remained at 24 hours. For ceftazidime, under refrigeration, a mean of 98.0% ± 0.3% of the initial concentration remained at 168 hours (7 days); at room temperature, 91.6% ± 2.0% remained at 48 hours; at body temperature, 93.9% ± 1.1% remained at 8 hours. Stability was not assessed beyond these respective time points. Conclusion Premixed tobramycin–icodextrin PD solution remains stable for 336 hours (14 days) when refrigerated (4°C) and for 168 hours (7 days) at room temperature (25°C). Ceftazidime–icodextrin PD solution is stable for 168 hours and 48 hours, respectively, when stored at 4°C and 25°C. It is recommended that the bags be kept refrigerated whenever possible. Tobramycin–icodextrin solution stored at body temperature was stable up to 24 hours, and ceftazidime–icodextrin solutions up to 8 hours, permitting the practice of pre-warming solutions prior to administration.
Novel Low Na Peritoneal Dialysis Solutions Designed to Optimize Na Gap of Effluent: Kinetics of Na and Water Removal
Authors: Nakayama Masaaki , Kasai Kenji , Imai Hirokazu 
Published: February 2020

Background An imbalance between sodium intake to and excretion from the body contributes to overhydration in peritoneal dialysis (PD) patients. Novel low Na solutions were developed based on the concept of optimizing the Na gap of effluent to achieve better Na balance. The present study investigated Na and water removal by those solutions. Methods Compositions of low Na (LS) and standard Na (SS) solutions were as follows: Na 133, 126, and 118 mEq/L with respective corresponding glucose concentrations of 0.9%, 1.6%, and 2.5% in LS(90), LS(160), and LS(250) solutions; Na 135 mEq/L with glucose 1.35% and 2.5% in SS(135) and SS(250) solutions respectively. Based on the status of their daily PD prescriptions, respective LS solutions were assigned to 41 patients as follows: LS(90) or LS(160) for SS(135) solution, and LS(160) or LS(250) for SS(250) solution. Results In the 4-hour dwell, no differences were found in Na removal between LS(90) and SS(135), whereas Na removal by LS(160) and LS(250) was significantly increased compared to SS(135) and SS(250) ( p < 0.05 respectively). The Na gaps of the 3 respective LS solutions were significantly less than those of controls ( p < 0.05 respectively). With 1-day full-time use of LS solutions, no significant changes were found in daily water removal compared to controls, while Na removal was significantly increased in LS solutions ( p < 0.05), with conversion to a negative Na gap in total daily effluent. Conclusion The low Na solutions used in the present study facilitated Na removal by reducing the Na gap. This characteristic is expected to achieve better Na balance in PD patients with excess body fluid retention.
Pediatric CAPD Update -1983
Authors: Alexander Steven R. 
Published: February 2020

This paper reviews progress in CAPD in pediatric patients from the treatment of the first child in 1978 through the spring of 1983. It will summarize current approaches to catheters, dialysis mechanics, and nutrition in children and make some observations on growth and complications seen in children on CAPD. It has been established that this dialysis method is excellent for children, at least for the short term. It remains to be seen whether CAPD will be as successful over the longterm in children.
Early Post Transplantation Infections in CAPO Patients
Authors: Ryckelynck Jean-Philippe , Verger Christian , Pierre Dominique , Sabatier Jean-Claude , Faller Bernadette , Beaud Jean-Marie 
Published: February 2020

In order to evaluate the risk of infection during the post-transplantation period in CAPD patients, a retrospective multi-center study was performed among six centers: dialysis and transplantation teams differed in size and experience, and geographically were separated so that the group studied can be taken to represent the overall CAPD population. Seventeen CAPD patients were transplanted between 1980 and 1983: no infectious complication related to CAPD was observed, even in patients whose CAPD was continued after the operation. It is concluded that there is no special risk to CAPD patients receiving a kidney transplant and therefore adults waiting for a renal transplant can be safely maintained on CAPD. Compared to hemodialysis, CAPD is a relatively new treatment and therefore there is no overall agreement about its indications. This is true particularly for ESRD patients younger than 55 years who are waiting for a kidney transplantation; many teams are reluctant to transplant CAPD patients because of a possible high risk for infection due to the presence of an intraperitoneal catheter and a history of previous peritonitis. To evaluate this risk, we have undertaken a multicenter study of CAPD patients transplanted between January 1980 and January 1983.
Experience with 150 Consecutive Permanent Peritoneal Catheters in Patients on CAPO
Authors: Odor Alberto , Alessio-Robles L Luis P. , Javier Leuchter I. , Arturo Mendoza V. , Javier Bordes A. , Arturo Wadgymar R. , Gonzalez F Ricardo F. , Peon M Federico Chavez 
Published: February 2020

From 1978 to 1984, 150 consecutive CAPD catheters have been implanted in our institution. Early (first-week) and late (up to 44 months) follow-up is presented with special attention to possible surgical related complications. A paramedian incision and an original antileakage technique were used in 95% of the catheters. With this combination, hernia and leakage rates are very low (0.7%()). With the patient-training program, described here, and the installation of the catheter in the outpatient department, peritonitis during the first week dropped from 20% to 0%() (p < 0.05). Previous abdominal operations significantly increase early failures (p < 0.05). Skin exit-site infections were not seen in our patients. The most frequent long-term complications were catheter colonization, i.e. recurrent peritonitis with the same organism, and repeated peritonitis episodes leading to obstruction. The one year actuarial catheter survival is 40%. This paper discusses factors responsible for as well as possible improvement of this low figure. Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment for end-stage renal disease (ESRD). Recent surveys show that up to 45% of home-dialysis patients are in CAPD programs (1). Recently Oreopoulos analyzed the benefits and indications of CAPD and showed that the procedure is being used with increasing frequency (2). The CAPD program in our institution was started in 1978. From January 1981 to October 1984, 150 Tenckhoff catheters were implanted as part of that program. These patients who have had careful metabolic and surgical followup form the basis of this report.
Equilibrium Peritoneal Dialysis (EPD) in Acute Renal Failure (ARF) Secondary to Rhabdiomyolysis
Authors: Trevino-Becerra Alejandro , Cristina A vilez Patricia Munoz , Maimone Ma. Antonieta Schetino , Lopez Ma. Luisa Erbessd 
Published: February 2020

The purpose of this work is to assess EPD in ARF patients who have suffered rhabdomyolysis. In preparation for Tenckhoff catheter insertion dialysis exchanges through a stylet catheter were used every 30 minutes; after implantation of the Tenckhoff catheter we started 2L of solution with six four-hour exchanges. Dialysis was discontinued after 16 days on average when patients had a urinary volume of over one litre in 24 hours. Results allow us to conclude that EPD is an adequate method of treatment for ARF due to rhabdomyolysis.
The Effect of Hemoglobin Concentration on Peritoneal Mass Transfer and Drain Volumes in Continuous Ambulatory Peritoneal Dialysis
Authors: Hutchison Alastair J. , Ofsthun Norma J. , Howarth Debbie , Gokal Ram 
Published: February 2020

Objective To determine whether a correlation exists between hemoglobin levels and peritoneal mass transfer or drain volumes in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective study of two groups of CAPD patients, identified on the basis of their stable hemoglobin levels. Group A -hemoglobin less than 8.5 g/dL; Group B hemoglobin greater than 10.5 g/dL. Peritoneal mass transfer and drain volumes were measured for each patient, after which a subgroup of Group A was treated with rHuEPO (forming Group C) and measurements repeated once hemoglobin had risen by at least 2.0 g/dL. Setting Single renal unit of a university teaching hospital. Patients:Twenty-seven patients established on CAPD, selected according to their stable hemoglobin level. Group A -14 patients; Group B -13 patients; Group C (subgroup of A) -8 patients. Main outcome measures Difference between peritoneal mass transfer or drain volume in Group A versus Group B, and in Group C before and after rHuEPO therapy. Serum biochemical parameters in Group C before and after rHuEPO therapy. Results No statistically significant differences in any of the parameters measured were found between groups A and B, or before and after rHuEPO therapy in Group C. Conclusions Peritoneal transfer of small solutes and water is not influenced by hemoglobin level, and does not change following otherwise effective treatment with rHuEPO.
Tidal Peritoneal Dialysis: Preliminary Experience
Authors: Flanigan Michael J. , Doyle Cynthia , Lim Victoria S. , Ullrich Gary 
Published: February 2020

Objectives To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). Design An open enrollment pilot study. Setting The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Patients Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Interventions Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Measurements Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Results Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 + 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/ kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. Conclusion TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).
Mass Transfer Coefficient: Comparison between Methods
Authors: Teixidó Josep , Cofan Frederic , Borrás Mercé , Bonet Josep , Bonal Jordi , Galimany Roman , Biosca Carme , Caralps Antonio 
Published: February 2020

The mass transfer area coefficient (MTC) is the best parameter for solute transport evaluation in continuous ambulatory peritoneal dialysis (CAPD) patients. We compared three simplified MTC methods (calculated according Garred, Krediet, or Lindholm) and the peritoneal equilibration test (PET) (Twardowskl) to complex MTC (MTCX) (Randerson and farrell) for urea and creatinine, by means of 29 tests performed In 24 stable CAPD patients. There were no significant differences (paired t-test) between MTCX and each of the simplified MTC, except for creatinine MTC calculated by Krediet's method, which was significantly different (MTCX: 9.36.:1:.4.32, K-MTC: 10.48.:1:.4.55, p<0.05). Likewise, there was an acceptable correlation between complex MTC and each of the simplified methods including the PET. However, a more detailed study of the MTC's categorizations shows poor agreement with complex MTC categorization. Better results are obtained by PET categorization, which reaches good likelihood ratios either for positive or negative events. We conclude that simplified MTC or the dialysatelplasma ratio at 240 minutes for urea and creatinine has an acceptable correlation with complex MTC and can be useful in clinical practice. There is poor agreement between solute transport categorizations of simplified MTC and complex MTC. There Is a better coincidence between the PET ( DIP at 240 minutes) and complex MTC categorizations.
Cardiovascular Function in a Chronic Peritoneal Dialysis Pediatric Population on Recombinant Human Erythropoietin Treatment
Authors: Bassi Sergio , Montini Giovanni , Edefonti Alberto , Perfumo Francesco , Cattarelli Donatella , Piaggio Giorgio , Fesslova Vlasta , Zacchello Graziella , Bove Sergio 
Published: February 2020

Anemia, through a hyperkinetic state, is an Important contributor to myocardial function impairment. To determine the cardiovascular effects of recombinant human erythropoietin (rHuEPO) therapy, 10 chronic peritoneal dialysis (CPD)-treated anemic children were studied be fore and during 18 months of treatment. The following parameters were recorded: hemoglobin (Hb) [percent of target level (TL) = x 2 standard deviations of normal Hb values for age and sex], heart rate (HR, beats/minute), mean arterial pressure (MAP, mmHg), end-diastolic left ventricular diameter (EDLVD, mm/sm BSA), shortening fraction (SF, percent), and Interventricular septal thickness (IVS, mm/sm BSA). Student's t-test for paired data showed (vs time before treatment, TO) a progressive Increase In Hb, a progressive decrease In HR, and a progressive Increase In MAP. EDLVD progressively decreased, while SF and IVS remalned unchanged throughout the study. Regression analysis showed a close correlation between anemIa cor rection and decrease of HR (p<0.01), while no correlation was found between Hb and EDLVD or SF, IVS, or MAP. Our data indicate that anemia correction In these patients Is mainly associated with a decrease in hyperkinetic state (HR reduction with SF unvaried), while left ventricular function and dimensions remain normal, despite an Increase in MAP.