bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Straight and Curled Tenckhoff Peritoneal Dialysis Catheters Implanted by Percutaneous Technique: A Prospective Randomized Study
Authors: Nielsen Palle K. , Hemmingsen Claus , Friis Steffen U. , Ladefoged Jorgen , Olgaard Klaus 
Published: February 2020

Objective To examine the impact of peritoneal dialysis catheter configuration, curled or straight catheter, on catheter survival and mechanical and infectious complications. Design Prospective randomized trial. Setting Department of Nephrology of a single university hospital. Patients Seventy-two consecutive patients initiating peritoneal dialysis were randomized to receive either a single cuff straight catheter or a single cuff curled catheter, implanted by percutaneous technique. Results Significantly higher (p < 0.01) survival rate of the curled as compared to the straight catheter. The difference in catheter survival was due to a significantly higher (p < 0.01) incidence of drainage failure associated with catheter tip migration of the straight catheter than of the curled catheter. No difference in infectious complication between the two types of catheters was seen. Catheter survival at 12 months was 77% for the curled catheter and 36% for the straight catheter. Conclusion This study demonstrates superiority of the curled Tenckhoff peritoneal dialysis catheter survival as compared to the straight catheter. This difference in catheter survival is due to the higher displacement rate of the straight catheter.
Chronic Peritoneal Dialysis: Seven-Year Experience in a Large Hispanic Program
Authors: Saade Marien , Joglar Francisco 
Published: February 2020

Objective To analyze the clinical results of our patient population on continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) in relation to treatment modality systems, compliance, rehabilitation characteristics, complications, and survivals. Design The medical records of all patients trained on CAPD or CCPD between 1985 and 1992 were reviewed for the above-mentioned outcome objectives. Setting Outpatient CAPD facility affiliated to a tertiary care community hospital. Patients The total of 305 patients trained during the study period were studied. Main Outcome Measures The patients were studied for age, sex, primary renal disease, peritoneal dialysis modality, need of assistance from a partner during the dialysis procedure, causes of transfer and hospitalization, peritonitis, rehabilitation, patient compliance, and outcome including mortality. Results Patient population: 179 (58.7%) males and 126 (41.3%) females, aged 1-80 years(mean47.2±15.09) with a total observation time of 15753 patient-months. The most common diagnosis of the renal disease was diabetic nephropathy (41%). Peritonitis was the main cause of hospitalizations(36.7%) and of transfers (69.5%). Patient survival at one, two, and three years was 87.9%, 76.6%, and 67.0%, respectively. Likewise, technique survival was 65.5%,45.5%, and 30.6%. Peritonitis rate for CAPD has improved from 1.9 episodes per patient-year to 1.2 episodes per patient-year and an overall rate of 1.5 episodes per patient-year. Conclusions The experience in a large Hispanic program shows a good patient survival rate. Although there is a trend to a lower peritonitis rate, this continues to be the main cause of transfer, hospitalization, and one of the main causes of death.
Hypomagnesemia in Continuous Ambulatory Peritoneal Dialysis Patients Dialyzed with a Low-Magnesium Peritoneal Dialysis Solution
Authors: Ejaz A. Ahsan , McShane Andrew P. , Gandhi Vasant C. , Leehey David J. , Ing Todd S. 
Published: February 2020

Objective Previous studies have shown a decrease in serum magnesium (Mg) concentration when continuous ambulatory peritoneal dialysis (CAPD) patients previously maintained on a 1.0 –1.2 mEq/L Mg peritoneal dialysis solution (PDS) were dialyzed with a 0.5 mEq/L Mg PDS. However, the prevalence of hypomagnesemia in CAPD patients dialyzed with low-Mg PDS is unknown. Design A retrospective study to determine the prevalence of hypomagnesemia and the factors associated with its occurrence in CAPD patients dialyzed using a 0.5 mEq/L Mg PDS. Setting A CAPD unit in a large Veterans Affairs Hospital. Patients All our CAPD patients (33) enrolled over a 52month period. Results All patients had serum magnesium levels higher than 1.25 mEq/L prior to use of low-Mg PDS. Hypomagnesemia (serum Mg < 1.25 mEq/L) developed in 21/33 patients (64%) when a 0.5 mEq/L Mg PDS was employed. Hypomagnesemia developed a mean of 8.2 months after beginning treatments. The duration of dialysis and the number of episodes of peritonitis did not differ between patients with and those without hypomagnesemia. Serum albumin levels were significantly lower in patients with hypomagnesemia (2.5±0.12 g/dL vs 3.2±0.12, p < 0.01). Magnesium supplements were given to 13 patients; following this therapy, serum magnesium values became normal. Conclusions CAPD patients dialyzed with a 0.5 mEq/L Mg PDS may develop a considerable fall in serum magnesium level and may require magnesium supplements in order to restore normal serum values.
Growth Hormone and Malnutrition in Dialysis Patients
Authors: Blake Peter G. 
Published: February 2020

Objective To review the normal function of the growth hormone (GH) insulin-like growth factor (IGF) axis, how it is altered in end-stage renal failure, how this may contribute to malnutrition in dialysis patients, and how therapy with recombinant human growth hormone (rHuGH) and recombinant human IGF-I (rHuIGF-1)might be used to treat malnutrition in these patients. Data Sources Studies in the literature dealing with the GH-IGF endocrine axis and its role in uremic malnutrition. Study Selection Eight studies in which uremic adults were treated with either rHuGH or rHuIGF-I. Data Extraction Data were abstracted from all of these studies. Results The review shows that there are marked abnormalities of the GH-IGF axis in uremic patients and that these lead to a state of GH resistance, which can be overcome by pharmacological doses of rHuGH. A small number of clinical studies in uremic adults suggests that both rHuGH and rHuIGF-I have dramatic beneficial effects on nutritional status in these patients. Conclusions rHuGH and rHuIGF-I have both been shown to have a beneficial effect on nutritional status in shortterm studies on small numbers of patients. Further studies need to be done for longer periods in larger groups of patients. Areas for additional research are suggested.
Can Malnutrition be Prevented? Nutrition and Dialysis Adequacy
Authors: Schreiber Martin J. 
Published: February 2020

As chronic renal failure (CRF) worsens, the nutritional balance is disrupt ed at several different levels that are normally responsible for maintaining metabolic homeostasis (1–3). These abnormalities may remain constant, improve, or worsen once dialysis is initiated. The success of dialytic intervention in correcting these abnormalities depends not only on the actual dose of delivered therapy, but also on the availability of nutrient substrate and the ease of modulating body composition. In the general population body composition has long been used as a predictor for mortality (4). Several different approaches have been taken to identify individuals at risk for a poor outcome (5). These techniques may examine specific serological parameters or actual components of body composition thought to more precisely depict nutritional balance. Historically, many reports have stressed the link between serum albumin levels and patient survival for both hemodialysis and peritoneal dialysis (6–11). However, some authors have questioned the usefulness of this marker (12–14). Based on these concerns, defining nutritional status through body composition measurements may offer a more meaningful assessment than standard serological parameters. Furthermore, in the setting of uremia the ability to successfully modulate body composition may denote the essence of what aptimal dialysis should signify. Conceptually, optimal dialysis represents the therapeutic return of an individual to nutritional balance, with an expected survival comparable to that of age, gender, and disease-matched nonuremic individuals. Because of the complexity of maintaining nutrient balance, the definition of adequate dialysis should be re-evaluated. Contemporary dialysis practice should extend beyond solely quantitating dialysis to include an understanding of nutrient balance, regulation of food intake, and the application of surveillance tools for identifying abnormalities in body composition. Only through expanding the end points of adequate dialysis can we move closer to optimal dialysis synonymous with long-term treatment survival.
The Removal Index for Evaluation of Dialysis
Authors: Chen Tzen Wen , Huang Tung-Po , LiU Ming-Chang , Wang Maw-Ling 
Published: February 2020

Objectives To find an index of adequacy that takes into consideration the effect of the decreasing concentration of urea nitrogen in hemodialysis (HD) and can be used before treatments to quantitate the prescriptions with the same criterion for both HD and continuous ambulatory peritoneal dialysis (CAPD). Design The removal index was obtained through mathematical theories and then compared with the urea index (KT/V) values of the sample patients. Patients Thirty-two HD and 21 CAPD patients were included. All patients were dialyzed with optimal urea index values and had been stable for at least one year. Results The removal index in HD (ξHD) for each dialysis was 0.62±0.07, and the normalized removal index in CAPD (ξCAPD) was 0.59±0.11. There was no statistical significance. This result is consistent with the fact that no difference of morbidity or mortality exists between these two modalities. Conclusion After mathematical manipulation, the removal index in HD can be presented in the form of the urea reduction ratio, which is a retrospective measure to estimate the performance of hemodialysis. This study implies that the removal index is able to facilitate the prescriptions for adequate dialysis. The removal index can also be used to explain the reason why the urea index values are always larger in HD than in CAPD.
Peritoneal Dialysa Te Igg/C3 Levels Do Not Predict Susceptibility to Peritonitis
Authors: Anwar Nisar , Hutchison Alastair J. , Manos John , Uttley Linda , Brenchley Paul , Gokal Ram 
Published: February 2020

Objective To investigate the usefulness of dialysate IgG and C3 concentrations in predicting likelihood of developing peritonitis. Design Prospective, longitudinal, and comparative study. Setting Single university teaching hospital dialysis unit and outpatient clinic. Patients Thirty-four uremic patients were studied (20 males, 14 females: mean age 47.2, range 20 73 years). Monthly serum and overnight dialysate (eight to elevenhour dwell) samples were obtained for IgG and C3 estimations over the first six months of the study, and trimonthly samples were obtained thereafter. All patients performed exchanges using standard transfer sets (Baxter system II, Baxter Healthcare Ltd., Thetford, Norfolk, U.K.), used no hypertonic fluid (3.86%) for overnight exchanges, and were followed up for a minimum of 18 months. Outcome Measures Dialysate and serum levels of IgG and C3; peritonitis episodes. Results Forty-five episodes of peritonitis occurred in 24 patients during the study period. We examined opsonin levels in the group as a whole, and then in two subgroups of patients: those who remained peritonitis-free throughout the study, and those who did not. There were no significant differences between IgG and C3 levels in the two groups at any time point, and large interpatient and intrapatient variation in levels were seen. Conclusion Dialysate levels of IgG and C3 from the overnight dwell are not helpful in predicting the risk of developing continuous ambulatory peritoneal dialysis peritonitis in individual patients. No correlation was found between opsonin levels and onset of clinical peritonitis.
Answers to All Your Questions about Peritoneal Urea Clearance and Nutrit Ion in Capd Patients
Authors: Blake Peter G. , Oreopoulos Dimitrios G. 
Published: February 2020

In summary, SA and a number of other indices related to nutritional status have been identified as being strongly predictive of outcome in CAPD patients. Evidence connecting these indices to KTN urea, or even to protein intake, remains limited, however. Increased dialytic dose may well increase protein intake, but neither of these parameters have been shown prospectively to raise SA, total body nitrogen, or SGA status on a consistent basis. Studies addressing this issue, however, have been few and small, and more data are required. For now, we will likely continue to deal with malnutrition by attempting to raise small solute clearance and protein intake, but we should be aware that such measures will frequently be unsuccessful, and we must pay attention to other factors, particularly comorbidity. It is clear from this review that there are many unanswered questions relating to this topic and that, in particular, the effect of prospective increases in the dialytic dose needs to be further elucidated.
The Rationale and Ultimate Limitations of Urea Kinetic Modelling in the Estimation of Nutritional Status
Authors: Bargman Joanne M. 
Published: February 2020

Objective This paper reviews protein flux and amino acid metabolism and the potential inaccuracies inherent in using urea kinetics as an estimate of these processes, particularly in the patient undergoing peritoneal dialysis. The problems of extrapolating these estimates back to the whole patient are examined, addressing assumptions about neutral nitrogen balance, and the difficult issue of normalizing urea-derived indices to body size. Conclusions Urea kinetics can be a helpful tool for assessing nutritional indices, but there are many caveats and many pitfalls that must be kept in mind to avoid being lulled into a false sense of confidence by the comfort of numbers.
Intraperitoneal Interleukin-8 and Neutrophil Influx in the Initial Phase of a Capd Peritonitis
Authors: Betjes Michiel G.H. , Visser Carolien E. , Zemel Desiree , Tuk Cornelis W. , Struijk Dirk G. , Krediet Raymond T. , Arisz Lambertus , Beelen Robert H.J. 
Published: February 2020

Objective To investigate whether or not a change in dialysate interleukin-8 (IL-8) concentration precedes the onset of clinically overt peritonitis and is significant in the recruitment of granulocytes during continuous ambulatory peritoneal dialysis (CAPD)related peritonitis. Design CAPD patients stored their overnight effluent at 4°C, which was routinely thrown away after 2 days. If peritonitis developed, patients delivered their effluent of the preceding two nights and the peritonitis effluent for analysis. A control study was performed 1 to 3 months after recovery. Dialysate samples were analyzed for number of cells, differential cell count, IL-8 and elastase concentrations, and their neutrophil chemoattractive capacity. In addition, serum samples during peritonitis were analyzed for IL-8 concentrations. Results Ten peritonitis episodes in 7 patients were analyzed. Numbers of neutrophils and levels of dialysate IL-8 and elastase started to increase 4 to 12 hours before the first peritonitis effluent. The dialysate/serum IL-8 ratio was 423.5 during peritonitis and 7.0 in the postperitonitis controls. There was a significant correlation between the number of neutrophils and IL-8 concentration in the dialysate. The in vitro neutrophil chemotaxis was increased toward the peritonitis effluents, as compared to control effluents. Incubation of the peritonitis effluents with anti-IL-8 monoclonal antibody blocked the increase in neutrophil chemotaxis above controllevels by an average of 26.7%. Conclusion IL-8 is produced in the peritoneal cavity during CAPD treatment and may mediate part of the neutrophil recruitment and degranulation in the initial phase of a CAPD peritonitis.
Biocompatibility of Silver-Coated Peritoneal Dialysis Catheter in a Porcine Model
Authors: Fung Leo C. T. , Khoury Antoine E. , Vas Stephan I. , Smith Charles , Oreopoulos Dimitrios G. , Mittelman Marc W. 
Published: February 2020

Objective Previous studies have shown that silver formulations coated onto implantable materials retard bacterial colonization and reduce the incidence of catheter-related infections. The objective of this study was to assess the histologic effects of sputter-coated silverl silicone implants on host tissue. Design Sputter silver-coated silicone peritoneal dialysis catheter segments with and without Dacron cuffs were implanted in the subcutaneous fat and muscle in 4 pigs. Noncoated implants served as controls. The specimens were retrieved at 1,2,3,4,7,8,9,10,12, and 27 weeks. Experimental Animals Four 6-week-old male Yorkshire Land race pigs (5–6 kg) were used. Main Outcome Measures Histologic parameters evaluated included the degree of inflammation, the number of giant cells, the extent of silver particulate inclusions, and the thickness of the capsules. All specimens were evaluated by a single blinded pathologist. Microbiologic analyses were also performed. Results The silver-coated catheters were associated with less inflammation than were the noncoated catheters, both infatand muscle (p=0.04). The number of giant cells was also lower around the silver-coated than the noncoated catheters, which were implanted in subcutaneous fat (p < 0.05). Particulate inclusions compatible with silver or silver oxide were observed only in tissue around silvercoated implants (p < 0.0001). The thickness of the capsules and the extent of the inflammatory zones were not significantly different. There was no evidence of infection-related changes. Conclusions These data suggest that the sputter silver coating does not act as a significant tissue irritant.
Continuous Peritoneal Dialysis-Associated Peritonitis of Nosocomial Origin
Authors: Troidle Laura , Kliger Alan S. , Goldie Sue J. , Gorban-Brennan Nancy , Brown Eric , Fikrig Margaret , Finkelstein Frederic O. 
Published: February 2020

Objective To describe our experience with nosocomial continuous peritoneal dialysis (CPD)-associated peritonitis focusing on the incidence, possible risk factors, spectrum of organisms, and outcome. Design Retrospective review of the medical records of our CPD patients admitted to an acute-care hospital between November, 1993 and December, 1994. Setting University-associated acute-care hospitals in New Haven, Connecticut. Patients One hundred and eighty-eight patients maintained on CPD therapy and admitted to an acute-care hospital. Results Nineteen patients (5%) developing nosocomial peritonitis (NP) were identified from the 408 admissions occurring during the study period. Patients developing NP were older than the hospitalized CPD patients not developing NP(65.5± 14.6vs58.4± 14.7years, p<0.05). Comorbid diseases including diabetes, peripheral vascular disease, gastrointestinal disease, cardiovascular disease, and human immunodeficiency virus seropositivity were not more common in the patients developing NP. Patients developing NP were hospitalized significantly longer than the CPD patients not developing NP (39.5 ± 46.5 days vs 12.7 ± 12.4 days, p < 0.001). The mean serum albumin was lower in the NP patients than in the CPD patients not developing NP (2.35 ± 0.52 g/dL vs 3.02 ± 0.60 g/dL, p < 0.001). Antecedent antibiotic use and performance of invasive procedures were noted in 89% and 68% of the patients developing NP, respectively. Staphylococcal species, enterococcal species, and gram-negative organisms accounted for 26%, 21 %, and 53% of the episodes of NP, respectively. Furthermore, two strains of Enterococcus resistant to vancomycin were cultured. Eight patients developing NP expired, 8 patients continued CPD therapy, 2 patients transferred to hemodialysis, and one patient recovered renal function. Conclusion We conclude that NP is uncommon. Increased age, increased length of hospital stay, and hypoalbuminemia may predispose patients to the development of NP. Further studies with case controls should help to clarify whether antecedent antibiotics or prior performance of invasive procedures predispose patients to the development of nosocomial peritonitis. The spectrum of organisms accounting for NP is different than the spectrum of organisms causing community-acquired CPD-associated peritonitis. Some of these organisms may be resistant to standard antibiotic therapies. Patients developing NP do poorly, with 42% expiring while being treated for NP.
Optimal Use of Glucose Polymer (Icodextrin) in Peritoneal Dialysis
Authors: Mistry Chandra D. , Gokal Ram 
Published: February 2020

The osmotic effectiveness of glucose polymer is now well established. The relative inertness of this macromolecular compound has been the key factor in its success as the first “colloid” osmotic agent in clinical use. In its present form, it produces sustained ultrafiltration for up to 12 hours, and a daily overnight use would obviate the need for hypertonic exchanges, especially 3.86% glucose. In addition, it could be used in automated peritoneal dialysis regimes to enhance ultrafiltration and solute clearance during the daytime. Preliminary reports also indicate that it is beneficial in diabetic patients and in some patients who have lost ultrafiltration. The new “bimodal” formulations look promising, with the potential to replace all the currently used hyperosmolar exchanges with physiological solutions. Although systemic accumulation of glucose polymer breakdown products occurs, it reaches steadystate levels quickly (within two weeks) and remains stable throughout the duration of polymer use. In the long-term study, these levels of maltose and oligosaccharides over three-and-a-half years represent the longest exposure of these substances in uremic patients without any clinical or metabolic adverse effects and provide an important evidence of safety. Future work based on studies that are ongoing suggest that a family of physiological solutions (“bimodal” preparations in iso-osmolar combination) could be available, and the individual's dialysis prescription could be tailored to take into account the ultrafiltration, metabolic needs, as well as the longterm viability of the membrane. Glucose polymer will be a key component of such solutions.