bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Study of Peritonitis with Conventional versus O-Set Techniques in Continuous Ambulatory Peritoneal Dialysis
Authors: Owen Julie E. , Walker Rowan G. , Lemon Jeannie , Brett Liliana , Mitrou Danielle , Becker Gavin J. 
Published: February 2020

We performed a prospective randomized trial, comparing the incidence of peritonitis between a flushdisconnect (O-System, Baxter, Deerfield, IL) (OS) and a conventional (System II, Baxter) (CS) continuous ambulatory peritoneal dialysis (CAPD) method. Sixty consenting patients with no significant physical disabilities who commenced CAPD after May 1987 were entered and followed for a minimum of 12 months. Thirty were placed on the OS system and 30 were placed on CS. Age, gender, and time for training did not differ significantly. The period of observation for OS was 375 months; CS was observed for 430 months. OS patients experienced 28 episodes of peritonitis (13.4 months/patient/episode) compared with 88 (4.9 months/patient/episode) in CS (p<0.005). By 6 months, 32% of OS patients had had at least one episode of peritonitis, compared with 62% of CS patients; at 12 months, these figures rose to 48% for OS and 91% for CS (p<0.01) patients (Life Table Analysis). The median survival time to first peritonitis episode was 5.1 months in CS and 9.7 months in OS (p<0.01). Exit. site infections occurred in 14/30 (46%) of patients on OS and in 13/30 (43%) of CS patients. We conclude that the OS was associated with a significant reduction in the incidence of peritonitis.
Continuous Ambulatory Peritoneal Dialysis and Renal Transplantation: A Ten-Year Experience in a Single Center
Authors: O'Donoghue Donal , Manos John , Pearson Robert , Scott Patrick , Bakran Ali , Johnson Robert , Dyer Phil , Martin Sue , Gokal Ram 
Published: February 2020

Objective To assess whether a renal graft outcome is dependent on the modality of dialysis prior to transplantation and to assess risk of peritonitis and catheterrelated problems posttransplantation. Design Retrospect analysis of the outcome of a first cadaveric renal transplantation from hemodialysis (HD) and CAPD patients over a ten-year period. Patients Out of a total of 905 renal transplants over a ten-year period, 699 were first grafts; 500 of these (241 on CAPD, 259 on hemodialysis) were analyzed while the remaining (incomplete data, predialysis, pediatric) were assessed for graft and patient survival only. Main Outcome Graft and patient survival cases were identical in the two groups (five-year graft survival: CAPD 67%, hemodialysis 66%; five-year patient survival: CAPD 88%, hemodialysis 87%). CAPD post transplant was necessary in 37 patients, while 10 developed peritonitis mostly related to CAPD use and responded to appropriate therapy. Routine catheter removal posttransplant was undertaken between 8 and 12 weeks. Conclusion Excellent graft and patient survival is achieved independent of the modality of dialysis prior to transplantation. Peritoneal dialysis can be used postgrafting, but there is a risk of peritonitis, which can be successfully managed with antibiotics and catheter removal. Great care is needed in executing the dialysis and catheter care after transplantation.
Lipid Perxidtion and Antioxidants in Continuous Ambulatory Dialysis Patients
Authors: Taylor J.E. , Scott N. , Bridges A. , Henderson I.S. , Stewart W.K. , Belch J.J.F. 
Published: February 2020

Objective Oxidative cell damage due to the production of free radical species has been implicated in the pathogenesis of cardiovascular disease for which dialysis patients are at increased risk. Plasma lipid peroxides (malon-dialdehyde), the antioxidants plasma albumin thiol, and red cell superoxide dismutase (SOD) were therefore measured in 18 patients undergoing continuous ambulatory peritoneal dialysis (CAPD), 20 hemodialysis patients, and 30 normal controls. Setting Renal dialysis unit. Results Malondialdehyde(MDA)concentrationswere significantly higher in dialysis patients compared to controls (p<0.001 ) and were significantly higher in CAPD patients compared to hemodialysis patients, p<0.001 (CAPD, median and range: 11.25 (8.4–15.5) nmol/mL; hemodialysis: 8.75 (7.0–12.6) nmol/mL; controls: 6.65 (5.2–9.6) nmol/mL). Plasma thiol and red cell SOD were significantly lower in dialysis patients compared to controls, but there was no significant difference between CAPD and hemodialysis patients (CAPD thiol: 333.5 (282480) μmol/L; hemodialysis thiol: 344 (203–468) μmol/L; control thiol: 421.5 (351 -504) μmol/L; CAPD SOD: 78.2 (42.4 -112.8) u//2 mL red cells; hemodialysis SOD: 89.4 (44.6–121.1) u//2 mL red cells; control SOD: 96.8 (66.8153.4) u//2 mL red cells). Red cell SOD was significantly negatively correlated with duration of dialysis in CAPD patients (r=-0.683, p<0.01 ). Conclusion In dialysis patients there is indirect evidence for increased free radical activity, which may be further influenced by the mode of dialysis.
Peritoneal Clearances in Hypertensive Capd Patients after Oral Administration of Clonidine, Enaldpril, and Nifedipine
Authors: Favazza Antonio , Montanaro Domenico , Messa Piergiorgio , Antonucci Francesco , Gropuzzo Maria , Mioni Giuseppe 
Published: February 2020

The authors investigated whether the reduction of arterial pressure, induced by the oral administration of clonidine (CLO), enalapril (EN), and nifedipine (NIF), has any effect on peritoneal transport rates. The study was performed in nine hypertensive patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The patients were submitted to administration of CLO, EN, and NIF, each in randomized succession for two weeks, after withdrawal of any hypotensive therapy for eight days (washout period). The nine patients underwent a four-hour dwell exchange using a 2.27 g/dL glucose two-liter bag after washout and after each hypotensive period. The following parameters were analyzed: mean arterial pressure (MAP), performed in the sitting position; net ultrafiltration; effluent/initial dialysate glucose ratio (GL DIDo); peritoneal clearance of K, BUN, creatinine (Cr), phosphate, beta-2 microglobulin (β2), total proteins, and the ratio between B2 and Cr clearance. Moreover, residual renal Cr and B2 clearances were analyzed. The three drugs significantly reduced MAP at a similar rate. The peritoneal transport parameters after CLO were similar to the results in the washout period. On the contrary, after EN and NIF therapy, Crand B2 clearances were significantly increased, and GL DIDo decreased in comparison to the washout period. The other peritoneal transport parameters after EN and NIF were similar to the washout period. Residual renal Cr and B2 clearances after the three drugs were similar to those in the washout. These data suggest that after two weeks of therapy with EN and NIF, glucose, Cr, and B2 peritoneal transports are influenced by these hypotensive drugs irrespective of the effect on the arterial pressure. These observations may have implications for hypotensive drug selection in CAPD hypertensive patients.
CAPD and Pancreatitis: No Connection
Authors: Gupta Amit , Vuan Zheng , Balaskas Elias V. , Khanna Ramesh , Oreopoulos Dimitrios G. 
Published: February 2020

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.
The Pharmacokinetics of Intraperitoneal Erythropoietin Administered Undiluted Or Diluted in Dialysate
Authors: Bargman Joanne M. , Jones Julie E. , Petro James M. 
Published: February 2020

+ Objective To compare the bioavailability of intraperitoneal erythropoietin (EPO) administered undiluted versus diluted in 2 L of dialysis fluid. + Design Group 1 patients received one dose of EPO, 400 Ulkg BW given with vehicle only. This dwelled for 8 hours after which 2 L of dialysate were infused. Group 2 patients received the same dose of EPO diluted in 2 L of dialysate which dwelled for 8 hours. Both groups resumed their CAPD regimen after the first 8 hours. Blood levels of EPO were measured for 24 hours in both groups. +Setting The Home Peritoneal Dialysis Unit, Toronto Hospital, Western Division. + Patients The participants were on CAPD for at least three months, free of peritonitis, and had no abnormalities of peritoneal transport. Three patients took part in both arms of the study, and there were 6 patients altogether in each group. + Results When EPO was administered undiluted, there was a greater than ninefold increase in bioavailability of the hormone as measured by the area under the curve (AUC), compared to when the same dose was diluted in 2 L of dialysis fluid. + Conclusions The previous studies that reported low bioavailability of intraperitoneal EPO used the hormone diluted in dialysate. The current findings suggest that if EPO is given in the dry peritoneal cavity, the bioavailability is greatly improved and may be clinically effective. Intraperitoneal instillation may prove to be an alternative route for EPO in the peritoneal dialysis patient unable or unwilling to receive subcutaneous injections. We are currently studying the effectiveness of undiluted intraperitoneal EPO in CAPD patients.
Six -Year Experience with Swan Neck Catheters
Authors: Twardowski Zbylut J. , Prowant Barbara F. , Nichols W. Kirt , Nolph Karl D. , Khanna Ramesh 
Published: February 2020

From the beginning of our continuous ambulatory peritoneal dialysis (CAPD) program in January 1977 until June 1985, we used Tenckhoff and Toronto Western Hospital catheters. Throughout these years catheter survival probabilities of about 30% at three years persisted unchanged and were similar to survival probabilities reported by the National CAPD Registry special survey for these catheters. The first improvement in catheter results regarding leaks was noted after the adoption of lateral catheter insertion. Malfunction was less using swan neck prototypes from August 1985 to April 1986. The latter catheters were made of 80° are angle tubing between 8.5 cm spaced cuffs and were inserted in a reversed U-shape tunnel with the incision at the top of the tunnel. The use of these catheters was abandoned because of high cuff extrusion and exit infection rates. The next generation of swan neck catheters, the swan neck Missouri 2 and 3 catheters with straight intraperitoneal segments, improved the results dramatically. These catheters were made of 180° are angletubing between 5 or 3 cm spaced cuffs. The estimated survival probability of 61% at three years more than doubled compared to previously used catheters. Recently we modified the intraperitoneal segment of the catheters, replacing the straight segment with a coiled one. These modified catheters, the swan neck Missouri coiled catheters, have been used exclusively since February 1990. In addition to an acceptable survival probability of 88% at one year, there are two major advantages of these catheters, the same as for other coiled catheters: elimination of infusion pain due to a jet effect and pain related to straight catheter tip pressure on the peritoneum experienced by some patients.
Effects of Subcutaneous Calcitriol Administration on Plasma Calcium An D Parathyroid Hormone Concentrations in Continuous Ambulatory Peritoneal Dialysis Uremic Patients
Authors: Rolla Davide , Paoletti Ernesto , Marsano Luigina , Mulas Donatella , Peloso Giancarlo , Cannella Giuseppe 
Published: February 2020

Objective To ascertain whether the parathyroid hormone (PTH) secretion of continuous ambulatory peritoneal dialysis (CAPD) uremic patients could be suppressed by repeated subcutaneous injections of calcitriol (CLT). Design Nonrandomized prospective study with weekly evaluation. Setting Hospital CAPD clinic. Patients Seven uremic CAPD patients with signs of severe hyperparathyroidism. Interventions Patients were treated with CLT (2 μg), injected subcutaneously three times a week, on alternate days over a period of 8 weeks. Measurements Plasma PTH, ionized calcium (Ca), serum phosphate (Pi), and alkaline phosphatase (AP) were assayed before the start of CLT therapy and weekly thereafter. Results The average basal PTH was 349±26 pg/mL (mean ±SD).ltfell significantly by the fifth week to 158±20, then leveled off. Analysis of the individual data, however, revealed that only 5 of 7 patients had a significant decrease in plasma PTH. Basal Ca was ±.02 mmol/L; it increased continuously throughout the study, significantly by the fourth week, reaching a level of 1.33±0.3 mmol/L at the sixth week, then declined slightly. In those patients with significantly decreased PTH, there was an inverse correlation between PTH and the corresponding Ca levels. Conclusions In some CAPD patients subcutaneous administration of CLT significantly suppresses PTH. This effect is mainly mediated via an increase in ionized calcium, but a direct inhibitory effect of the vitamin on parathyroid glands cannot be excluded.
Determining Peritoneal Dialysis Prescriptions by Employing a Patient -Specific Protocol
Authors: Zabetakis Paul M. , Krapf Randi , DeVita Maria v. , Gleim Gilbert W. , Michelis Michael F. 
Published: February 2020

Objective To develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance. Design Prospective study of peritoneal dialysis patients followed for 6 months. Setting A primary care teaching hospital in New York. Patients Twenty-six patients beginning peritoneal dialysis entered and completed the study. Intervention By employing each patient's measured peritoneal equilibration test (PET) and a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour DIP croat was used for continuous cycling peritoneal dialysis (CCPD) and the 4hour DIP patients on continuous ambulatory peritcornoeal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clearance daily. Main Outcome Measures Patients were followed for 6 months to assess the ability of this approach of maintaining acceptable levels of blood urea nitrogen, creatinine, albumin, and hematocrit over the 6–month period of observation. Results Our study of 26 patients revealed that only 6 patients (23%) could be treated with the standard prescription of 8 L/day on CAPD. The remaining 77% of our patients required 9–13 L/day for CAPD and 12–21 L/day for CCPD. All patients were free of uremic symptoms and demonstrated acceptable biochemical parameters over a 3–6 month period of observation. Conclusions A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.
A Comparison of Peritoneal Dialysis-Related Infections in Short and Long Term Peritoneal Dialysis Patients
Authors: Piraino Beth , Bernardini Judith , Holley Jean L. , Perlmutter Jeffrey A. 
Published: February 2020

Objective We hypothesized that the infection rates and organisms would differ in long-term peritoneal dialysis (PD) patients versus those who died or transferred to hemodialysis during the first 4 years on PD. Design Data on PD-related infections and outcome were collected from 1979 to 1991 (prospectively since 1982). Setting The patients were followed at University and Veterans Administration dialysis centers. Patients All patients on continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD) for 4 years or more (n=43) were compared to those patients who died or transferred to hemodialysis prior to 4 years on PD (n=213). Main Outcome Measures Infection rates due to various microorganisms and reasons for transfer to hemodialysis were examined. Results Peritonitis rates were 1.2/year versus 0.8/year (p<0.001) in patients on peritoneal dialysis less than 4 years compared to those on 4 years or more, respectively, a difference due to S. epidermidis (0.32/year vs 0.20/year, p=0.0001) and gram-negative rods other than P. aeruginosa (0.15/year versus 0.06/year, p<0.001). Exitsite infection rates were 1.2/year versuss 0.7 /y (p<0.0001) in the patients on less than 4 years compared to those on 4 years or more, respectively, a difference in part due to S. aureus (0.45/year vs 0.3/year, p<0.001) and other gram positive organisms (0.28/year vs 0.1 0/year, p<0.001). The rates of infections that were similar in the two groups were tunnel infections (0.2/year), P. aeruginosa infections, and S. aureus peritonitis (0.18/year vs 0.14/year, p=0.09). S. aureus was the most common cause of exit-site and tunnel infections in both groups. Forty-two percent of the patients on PD 4 years or more subsequently transferred to hemodialysis, most often due to infections, especially S. aureus. Conclusions Although infection rates are lower in patients on peritoneal dialysis 4 years or more, S. aureus and P. aeruginosa continue to account for a high proportion of the infections. Improvement in technique survival will require prevention of these infections.
Calcium and Magnesium Mass Transfer in Peritoneal Dialysis Patients Using 1.25 Mmol/L Calcium, 0.25 Mmol/L Magnesium Dialysis Fluid
Authors: Hutchison Alastair J. , Merchant Mahendra , Boulton Helen F. , Hinchcliffe Rod , Gokal Ram 
Published: February 2020

Objective To examine the effect of a reduced calcium/magnesium dialysis fluid (1.25/0.25 mmol/L, respectively) on calcium and magnesium mass transfer in both 1.36% and 3.86% glucose solutions. Design Each patient underwent four test exchanges, two with a standard dialysis fluid containing 1.36% and 3.86% glucose, and two with a reduced calcium/magnesium fluid containing 1.36% and 3.86% glucose. Calcium and magnesium were measured in dialysate and serum at ° and 240 minutes. Setting Single renal unit of a university teaching hospital. Patients Sixteen patients established on CAPD, and peritonitis-free, for at least 3 months. Results A lower dialysate calcium results in negative mass transfer when serum-ionized calcium exceeds dialysate calcium (mean -.0.21±0.15 mmol/exchange), and positive mass transfer when serum-ionized calcium is less than dialysate calcium in 1.36% glucose solutions (mean 0.57±0.18 mmol/exchange). A negative correlation was found between serum-ionized calcium level and calcium mass transfer. With a 3.86% reduced calcium/magnesium solution, calcium mass transfer is always negative (-.0.88±0.18 mmol/exchange) due to ultrafiltration and solute drag. Fifteen patients were found to be hypermagnesemic at the time of the study. Magnesium mass transfer was neutral with the standard 1.36% glucose fluid (mean -.0.01 mmol/exchange), but negative with the reduced calcium/magnesium 1.36% glucose fluid (mean -.0.58±0.13 mmol/exchange). With the 3.86% glucose solution, both fluids produced negative magnesium mass transfer (mean -.0.32±0.11 and -1.07±0.11 mmol/exchange for standard and reduced calcium/magnesium fluids, respectively). Conclusions We conclude that this fluid formulation should reduce hypercalcemia and hypermagnesemia in CAPD patients.
Choline Incorporation into Phospholipids in Mesothelial Cells in Vitro
Authors: Hjelle J. Thomas , Steidley Kevin R. , Pavlina Thomas M. , Dobbie James W. 
Published: February 2020

Objective To determine the effect of extracellular choline concentration on phospholipid production and handling by peritoneal mesothelial cells in vitro. Design and Measurements Radiolabeled choline was used to monitor the formation of phosphatidylcholine {PC), sphingomyelin (SPH), and Iysophosphatidylcholine (LPC) by rat and rabbit mesothelial cells as a function of concentration and time of exposure to choline. The subcellular location of the newly formed phospholipids was examined by ultracentrifugation in Percoll-sucrose gradients using analytical cell fractionation techniques. The fatty acid composition of the PC formed was determined by thin-layer chromatography (TLC) and gas chromatography. Results Choline incorporation into PC, SPH, and LPC increased with extracellular choline levels up to 640 μmol/L, which is 100 times greater than physiological levels of choline in plasma and 20 times higher than choline levels measured in peritoneal dialysis effluent. The newly formed, radiolabeled phospholipids were primarily found in a single subcellular compartment that exhibited a buoyant density of 1.05 g/mL in Percollsucrose gradients. Analysis of the fatty acyl groups of PC obtained from the mesothelial cells showed enrichment in palmitic [16:0], oleic [18:1], and linoleic [18:2] acids. Conclusion The rate of phospholipid formation by mesothelial cells in vitro can be manipulated, in part, by choline concentration.
Ultrastructure Analysis of Tenckhoff Chronic Peritoneal Catheters Used in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Giangrande Alberto , Allaria Pietro , Torpia Regina , Baldassari Lucilla , Gelosia Antonella , Donelli Gianfranco 
Published: February 2020

The luminal and external surfaces of 18 curled silicone double-cuff catheters removed from patients who had been on continuous ambulatory peritoneal dialysis (CAPO) for 2-77 months (average 37±21 months) were analyzed by scanning electron microscopy (SEM) and microbiological cultures. Eight catheters (G1) were removed due to recurrent peritonitis or peritonitis refractory to antibiotic management, and the others (G2) due to local or clinical problems. The peritonitis rate was one episode every 24 patient months in G1, and 80 patient-months in G2. All catheter surfaces were covered with proteinlike granular deposits (0.15±0.111cm); 6 catheters were covered by microbial biofilm (0.24±0.161cm). Positive cultures of catheter segments were obtained in 6 cases (4 for G1 and 2 for G2) with a preponderance (33%) of StaphYlococcus aureus among the cultivated bacteria. Structural defects and small linear tears were present on both luminal and external surfaces in 8 catheters. Structural defects were frequent in the catheters removed for recurrent peritonitis. Linear tears appeared more frequently in the catheters used for a longer time. Structural defects of catheter surfaces were also discovered in the newer devices. The structural defects of the catheter appear to facilitate microbial adhesion and colonization and to predispose the patient to recurrence of peritonitis. A better catheter design and an improvement in the production process should therefore be recommended.