bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laparoscopic Tenckhoff Catheter Implantation in Children
Authors: Daschner Markus , Gfrörer Stefan , Zachariou Zacharias , Mehls Otto , Schaefer Franz 
Published: February 2020

Objective To assess the suitability of a laparoscopic Tenckhoff catheter implantation (TCI) technique in children. Design Prospective nonrandomized controlled study. Setting Laparoscopic and conventional TCIs in children were performed in a tertiary-care hospital. Patients Between 1998 and 2001, 25 laparoscopic and 23 conventional TCIs were performed in 42 children. Patients in unstable clinical conditions were excluded. The laparoscope was inserted via transumbilical incision, and a forceps by percutaneous puncture. After catheter insertion, the tip was positioned in the Douglas space, and the inner cuff placed adjacent to the peritoneum, without sutures. Peritoneal dialysis was initiated immediately after surgery. Main Outcome Measures Catheter-related complications during the first 4 weeks after TCI. Results After laparoscopic TCI, dialysate leakage occurred in 2 of 25 cases, one of which could be managed conservatively. In 1 patient in whom dwell volume was increased immediately after laparoscopic TCI, subcutaneous leakage occurred at the site of forceps insertion. In 2 patients with severe pre-existing intra-abdominal adhesions, outflow obstruction persisted after laparoscopic TCI. Simultaneous herniotomy was performed in 2 male infants. After conventional TCI, dialysate leakage occurred in 5 of 23 cases, 1 of which could be managed conservatively. Outflow obstruction occurred in 2 cases. Conclusion Laparoscopic TCI is feasible in children of all age groups, with at least equivalent functional results compared to conventional TCI. An additional advantage is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions or preformed inguinal hernias in male infants.
Pattern of Peritoneal Permeability in Continuous Ambulatory Peritoneal Dialysis Patients in Brunei
Authors: Dwarakanathan Ranganathan , Yaakob Hjh Zarah , Hadi Hasnani 
Published: February 2020

Objective Peritoneal permeability may be dissimilar in different populations. The present study identified the pattern of peritoneal permeability in continuous ambulatory dialysis (CAPD) patients treated at the Department of Renal Medicine, RIPAS Hospital, Brunei Darussalam. Methods Data were collected from patients on CAPD in 2001 ( n = 65). Four children were excluded from the study. The remaining 61 patients underwent a 4-hour peritoneal equilibration test (PET) as prescribed by Twardowski et al. For those patients, adequacy of dialysis (Kt/V) was estimated. A retrospective analysis of the peritoneal membrane characteristics of those CAPD patients was also conducted. The membrane characteristics were compared with the urea clearance results. Results Of the 61 patients, 40 were non diabetic, and 21 (34.43%) were diabetic. More than half of our patients (55.74%) had membranes classified as high-average, followed by low-average (22.95%), high (18.03%), and low (3.28%). When the patient population was grouped separately into non diabetic and diabetic patients, peritoneal permeability differed between the groups ( p = 0.000585). No relationship was observed between weekly Kt/V and transport characteristics in the group with diabetes ( p = 0.219306), the group without diabetes ( p = 0.74179), or the entire patient population ( p = 0.376832) Conclusion We conclude that peritoneal permeability among Bruneian CAPD patients is probably different from that among patients from other regions of Asia (more than half of our Bruneian patients had a peritoneal membrane classified as high average). We believe that the observed difference may be related to a difference in ethnicity. In general, patients with diabetes have a highly permeable membrane. Adequacy of dialysis had no correlation to PET results in our study. A larger prospective study is required to confirm our findings.
Peritoneal Equilibration Test Using a Radiopharmaceutical: Diethylenetriaminepentaacetate
Authors: Sharma Raj K. , Jeloka Tarun , Gupta Amit , Senthilnathan Musuvathy S. , Pradhan Prasant K. , Das Birendra K. 
Published: February 2020

Background The inherent characteristics of the peritoneal membrane determine the peritoneal dialysis (PD) prescription. Membrane characteristics are also an important variable affecting patient outcome. The peritoneal equilibration test (PET) described by Twardowski and colleagues in 1987 is the most commonly used test for determination of peritoneal membrane characteristics. A need exists to have simpler and more definitive tests of peritoneal membrane characteristics. In a pilot study, we used a radiopharmaceutical [99Tc-diethylenetriaminepentaacetate (99Tc-DTPA)] to determine membrane characteristics. Patients and Methods We injected 99Tc-DTPA (370 MBq) intravenously into 20 patients at the end of peritoneal instillation of 2.5% glucose-containing PD fluid as in a standard PET. After a 4-hour dwell, a dialysate sample was collected, and excretion of 99Tc-DTPA into the dialysate fluid was calculated as a percentage of the injected dose. Depending on the excretion of the radiopharmaceutical into the effluent after intravenous injection, patients were categorized into high, high-average, low-average, and low transporters. An analysis of standard PET characteristics was also conducted for 75 consecutive patients. Results Excretion of the radiopharmaceutical was found to vary between 8% and 17% of the injected dose, depending on membrane characterization. The patients were categorized into four groups depending on the percentage excretion of the radiopharmaceutical: excretion > 15%, high transporter; 12% – 15%, high-average transporter; excretion 10% – 12%, low-average transporter; and excretion < 10%, low transporter. Standard PET characteristics for 75 patients showed 32% to be high transporters, 40% to be high-average transporters, 23% to be low-average transporters, and 5% to be low transporters. The nuclear PET in 20 patients showed 40% to be high transporters, 35% to be high-average transporters, 15% to be low-average transporters, and 10% to be low transporters. Correlation with the standard PET was good (correlation coefficient: 0.64; p = 0.002). Conclusions The nuclear PET could be an alternative to the standard PET for assessing peritoneal membrane characteristics. It is reproducible and may have the added advantages of simplicity and a possibility of measuring total clearance (PD + renal) in the same sitting.
Factors that Might Adversely Affect Short-Term Survival of Patients Starting Peritoneal Dialysis and use of those Factors to Predict Outcome—A Single-Center Experience
Authors: Yeoh Lee Ying , Sivaraman Pary 
Published: February 2020

Objective Patients initiated on peritoneal dialysis (PD) have significant morbidity and mortality. It would be important to know which factors have an adverse impact on outcome in the first 6 months of PD and whether those factors could be used to predict patient outcome. Methods We identified 64 PD patients from a prospectively collected database of all consecutive patients with end-stage renal failure (ESRF) seen at our tertiary referral center between January 2000 and June 2001. The patients were divided into two groups according to whether they were still living or had died by 6 months after the start of PD. Two patients defaulted on follow-up. In the remaining 62 patients, we compared multiple parameters and identified factors that we then evaluated as prediction tools. Results Significant differences were noted between the groups (died vs still living) with respect to race (non Chinese: 35.3% vs 13.3%), ischemic heart disease (IHD: 70.6% vs 62.2%), two-dimensional echo ejection fraction (EF: 42% ± 19% vs 53% ± 17%), regional wall motion abnormality (RWMA: 53% vs 22%), serum albumin 28 ± 1 g/L vs 31±5 g/L), alkaline phosphatase (ALP: 140 ± 118 U/L vs 101 ± 36 U/L). No differences were observed with respect to age, sex, cause of ESRF, diabetes status, hypertension, hyperlipidemia, stroke, hemoglobin, or intact parathyroid hormone. As expected, patients in the group that had died by 6 months spent a higher total number of days in hospital (66 ± 47 days vs 43 ± 29 days) and had more cardiovascular events (58.8% vs 6.6%); however, no difference was observed with respect to septic events. The utility of IHD, albumin, ALP, EF, and RWMA as predictors of short-term mortality either singly or in combination were analyzed. We found that those factors were neither sensitive nor specific at predicting mortality in this group of patients. Conclusions Race (non Chinese), prior IHD, two-dimensional echo abnormalities (EF and RWMA), low serum albumin, and high serum ALP are factors that affect short-term survival in PD patients. However, it is not possible to predict patient outcome using those factors.
Methods to Determine Drain Volume for Peritoneal Dialysis Clearances
Authors: Bernardini Judith , Florio Tracey , Bender Filitsa , Fried Linda , Piraino Beth 
Published: February 2020

Objective To compare the accuracy and convenience of 3 methods for measuring drain volume for peritoneal dialysis (PD) clearance studies. Design Prospective comparison of both automated PD (APD) and continuous ambulatory PD (CAPD) clearance study methods. Setting Adults ≥18 years old at 2 dialysis clinics. Patients 28 PD patients with 43 clearance studies, 15 on CAPD and 28 on APD. Interventions None. Main Outcome Measures Drain volume was determined by 3 methods for each study: ( 1 ) graduate-measured volume using a 2-L graduated cylinder; ( 2 ) weighed volume, with and without bag weight, using a digital floor scale or spring scale; ( 3 ) cycler-measured volume using the initial drain and ultrafiltration indicated by the cycler, plus the prescribed inflow volume without the last fill. Results There was no statistically significant difference in volumes using the 3 methods studied (all p > 0.89 for APD, all p > 0.97 for CAPD). Effluent volume was more accurate with the weight of the bag subtracted. Conclusion The most convenient and a precise method for APD is to determine the effluent drain volume using the prescription and total ultrafiltration and initial drain, as measured by the cycler. For CAPD, using the weight of drained bags is accurate but the weight of the empty bag must be subtracted. These approaches have the least risk of exposing staff to body fluids.
Temperature: The Single Most Important Factor for Degradation of Glucose Fluids during Storage
Authors: Kjellstrand Per , Erixon Martin , Wieslander Anders , Lindén Torbjörn , Martinson Evi 
Published: February 2020

Objective Bioincompatible glucose degradation products (GDPs) develop during heat sterilization of peritoneal dialysis (PD) fluids. However, degradation may also take place during storage. Consequently, storage may add to the bioincompatibility caused by heat sterilization. The aim of the present study was to investigate how different factors such as the sterilization procedure, pH, glucose concentration, and temperature influence GDP production during storage. Design Degradation in glucose solutions was followed by pH and UV absorbance at 228 nm and 284 nm over 2 years of storage. Different sterilization times, storage temperatures, pH, and glucose concentrations were included in the study. Peritoneal dialysis fluids were also used in the experiment. Bioincompatibility was estimated through inhibition of cell growth in L-929 fibroblasts, and GDPs through UV absorption and liquid chromatography. Results The most important factor determining the rate of GDP production during storage was temperature. The GDPs created by heat sterilization promoted further degradation of glucose during subsequent storage. A pH of around 3.2 protected glucose from degradation during both heat sterilization and storage. At a storage temperature of 20°C and a pH of 3.2, degradation was almost negligible. Heat sterilization produced considerable amounts of GDPs absorbing at 228 nm. During initial storage, these 228 nm-absorbing GDPs almost disappeared. After reaching a nadir, absorbance at 228 nm again started to increase. Contrary to this, absorbance at 284 nm [caused mainly by 5-hydroxymethyl-2-furaldehyde (5-HMF)] increased during the whole storage period. After 2 years at 40°C, the concentrations of GDPs produced during storage were of the same magnitude as those caused by heat sterilization. Inhibition of cell growth of L-929 fibroblasts correlated well with the part of the absorbance at 228 nm not caused by 5-HMF in glucose solutions that were heat sterilized under a wide range of conditions. This part of 228 nm absorbance (denoted 228corr) was caused almost entirely by 3,4-dideoxyglucosone-3-ene (3,4-DGE). Conclusions Temperature is the single most important factor for glucose degradation during storage. The concentrations of bioincompatible GDPs produced may, under improper conditions, be as high as those produced during sterilization. High concentrations of glucose and low pH protect glucose from being degraded during both sterilization and storage. A good estimate of 3,4-DGE concentration in the fluids can be obtained correcting the UV absorbance at 228 nm for the influence from 5-HMF (and, when appropriate, for lactate). The 228corr may thus be used as a simple quality control for the fluids.
Better Preservation of the Peritoneum in Rats Exposed to Amino Acid-Based Peritoneal Dialysis Fluid
Authors: Zareie Mohammad , van Lambalgen Anton A. , Ter Wee Piet M. , Hekking Liesbeth H.P. , Keuning Eelco D. , Schadee–Eestermans Inge L. , Faict Dirk , Degréve Bart , Tangelder Geert-Jan , Beelen Robert H.J. , van den Born Jacob 
Published: February 2020

Background Glucose-containing peritoneal dialysis fluids (PDF) show impaired biocompatibility, which is related partly to their high glucose content, presence of glucose degradation products, low pH, and lactate buffer, or a combination of these factors. In a rat chronic peritoneal exposure model, we compared effects of an amino acid-based PDF (AA-PDF) with a glucose-containing PDF on the peritoneal microcirculation and morphology. Method Two groups of rats received 10 mL of either fluid daily for 5 weeks via peritoneal catheters connected to implanted subcutaneous mini vascular access ports. Leukocyte–endothelium interactions in the mesenteric venules were investigated by intravital microscopy. Quantification of angiogenesis and fibrosis and inspection of the mesothelial cell layer were performed by light and electron microscopy. Results Daily exposure to glucose-containing PDF resulted in a significant increase in the number of rolling leukocytes in mesenteric venules, whereas instillation of AA-PDF did not change the level of leukocyte rolling. Glucose-containing PDF evoked a significantly higher number of milky spots in the omentum, whereas this response was significantly reduced in animals exposed to the AA-PDF ( p < 0.02). Chronic instillation of glucose-containing PDF induced angiogenesis in various peritoneal tissues, accompanied by fibrosis in the mesentery and parietal peritoneum. Quantitative morphometric evaluation of omentum and mesentery showed a clear trend toward less angiogenesis after treatment with the AA-PDF compared to the glucose-containing PDF, which reached statistical significance in the parietal peritoneum ( p < 0.04). Instillation of AA-PDF resulted in approximately 50% reduction of fibrosis in the mesentery ( p < 0.04) and approximately 25% reduction in the parietal peritoneum ( p < 0.009) compared to glucose-containing PDF. Glucose-containing PDF damaged the mesothelial cell layer, whereas the mesothelium was intact after AA-PDF treatment, as evidenced by electron microscopy. Conclusion Our data in a rat chronic peritoneal exposure model clearly demonstrate reduced immune activation (evidenced by decreased number of rolling leukocytes and decreased induction of omental milky spots) and reduced neoangiogenesis, fibrosis, and mesothelial damage of the peritoneal membrane after treatment with AA-PDF compared to glucose-containing PDF.
The Japanese Health-Care System and Reimbursement for Dialysis
Authors: Naito Hidemune 
Published: February 2020

Like most countries, Japan is facing constraints on expansion of health system financial resources. There are almost 250000 Japanese patients with end-stage renal disease and almost all are managed by chronic dialysis. Hospital hemodialysis is the modality used by 96% of these patients. The Japanese health-care system has tended to support resource-intensive treatments because the fee-for-service remuneration system has rewarded their utilization. This has benefited hemodialysis at the expense of peritoneal dialysis. However, this may now be changing. Case management and global budget-related approaches are being more widely introduced, as are incentives to reward more efficient treatment options. The relative costs of dialysis modalities are difficult to appreciate, as center-based services, such as hospital hemodialysis, are dependent upon fixed resources, while home-based options, such as peritoneal dialysis, are dependent upon variable resources. The aim of this review is to reconcile various sources of information relevant to end-stage renal disease funding in Japan. The review will suggest that modifying the approach to modality selection could lead to more efficient allocation of future dialysis-related resources and so reduce the strain on Japan's health-care budget.
Are We Underestimating the Problem of Ultrafiltration in Peritoneal Dialysis Patients?
Authors: McCafferty Kieran , Fan Stanley L.-S. 
Published: February 2020

Background Accurate measurement of ultrafiltration (UF) is important to improve the morbidity and mortality of peritoneal dialysis (PD) patients. The introduction of “flush-before-fill” PD systems has led to improved peritonitis rates. Partly to compensate for dialysate lost during flush-before-fill, extra dialysate was added to each PD bag. A 2-L PD bag now contains a mean volume of 2.225 L. That overfill volume might be erroneously measured as UF. We previously studied how this confounding factor might be affecting the diagnosis of UF failure and found that almost all units were overestimating daily UF by 900 mL. We now repeat the study to determine if the accuracy of UF estimation has improved. Methods We conducted a telephone survey of PD units in the UK to determine how drain bags are weighed and how UF is calculated during formal assessment of adequacy and the peritoneal equilibrium test (PET). We also retrospectively analyzed our last 100, 24-hour dialysate collections and PET results to determine the potential clinical impact of overestimating UF. Results There has been an improvement since our last study, but 70% of PD units in the UK are still overestimating daily UF in patients on continuous ambulatory PD (CAPD). Half the surveyed units also inaccurately calculate UF during the PET, and 85% were reporting results of PET and 24-hour dialysate collections through the software provided by Baxter Healthcare. By including the overfill volume, 73% of patients with daily UF <750 mL would not be diagnosed as having inadequate daily UF (assuming that all were fluid overloaded and anuric). Similarly, 73% with potential UF failure during the PET (4-hour UF <100 mL) would be missed if overfill volume was misrepresented as UF. Conclusion For patients undergoing CAPD, there requires standardization on when drain bags are weighed. Awareness that calculation of UF must exclude overfill volumes has improved but remains poor. The PD Adequest software (Baxter Healthcare, Compton, UK) is widely adopted in the UK and perhaps it could draw attention of users to the potential of UF overestimation in CAPD patients.
Inflammation and Extracellular Volume Expansion are Related to Sodium and Water Removal in Patients on Peritoneal Dialysis
Authors: Ávila-Díaz Marcela , Ventura María-de-Jesús , Valle Delfilia , Vicenté-Martínez Marlén , García-González Zuzel , Cisneros Alejandra , Furlong María-del-Carmen , Gómez Ana María , Prado-Uribe María-del-Carmen , Amato Dante , Paniagua Ramón 
Published: February 2020

Background Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce. Objectives To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions. Design A prospective, multicenter cross-sectional study in six hospitals with a PD program. Patients and Methods Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured. Results CRP values positive (≥ 3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 ± 0.69 vs 47.36 ± 0.65, men 43.15 ± 1.14 vs 42.84 ± 0.65; p < 0.05), higher serum glucose (125.09 ± 81.90 vs 103.28 ± 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 ± 0.54 vs 3.17 ± 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 ± 645 vs 1323 ± 413 mL/day, p < 0.005) and total fluid removal (1260 ± 648 vs 1648 ± 496 mL/day, p < 0.001), and less peritoneal (15.59 ± 162.14 vs 78.11 ± 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 ± 142.49 vs 118.60 ± 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly ( p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal ( r = 0.16, p < 0.03) and renal sodium removal ( r = 0.2, p < 0.01). Conclusion The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.
World Trend of Peritoneal Dialysis Publications
Authors: Chen Tzen-Wen , Chou Li-Fang , Chen Tzeng-Ji 
Published: February 2020

Objectives To analyze the trend of global peritoneal dialysis (PD) publications, especially of publications in Peritoneal Dialysis International ( PDI), from 1991 to 2005 according to the Institute for Scientific Information databases of the Thomson Corporation. Methods Data were downloaded from the Web of Science, which includes the databases of Science Citation Index Expanded and Social Sciences Citation Index. The searching strategies were key-in of “peritoneal dialysis” in general search and of “SO=Peritoneal Dialysis International” in advanced search. Only articles and reviews were included in the analysis. The analysis was stratified by publication year, journal, author, country of each author's affiliation, and citation count of each paper. Results There were 7618 PD papers (6991 articles and 627 reviews) in 887 journals; 15.8% of them ( n = 1204) were published in PDI. The annual outputs of global PD publications has been more than 500 papers since 1996, with a peak of 665 articles in 2003. In total, 18531 authors from 102 countries and areas contributed to PD publications. Authors from the USA were present in 30.6% of all papers although their global share decreased with time. A PD paper received an average of 12.7 citations. A review received more citations than an article (17.0 vs 12.3 on average), yet statistical significance was not reached ( p = 0.216, Mann–Whitney U test). Conclusions The number of PD research societies in the world has been growing during the past 15 years. More and more research is from countries other than the USA and the United Kingdom. Papers on PD have thus been published in many journals other than PDI, the leading journal in PD. However, the growth rate of PD publications in the world is diminishing. We present here the most likely reasons for the decrease in PD publications and propose suggestions for PDI to keep its leading role in the development of PD.