bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors Influencing the Decline of Residual Renal Function in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Shin Sug Kyun , Noh Hyunjin , Kang Shin Wook , Seo Bo Jung , Lee In Hee , Song Hyun Yong , Choi Kyu Hun , Ha Sung Kyu , Lee Ho Yung , Han Dae Suk 
Published: February 2020

Objective To assess the nature of the decline in residual renal function (RRF) after the initiation of peritoneal dialysis, and to identify risk factors influencing the preservation of RRF. Design A retrospective single-center study. Setting Tertiary medical center. Patients Eighty patients who were clinically stable and had been on continuous ambulatory peritoneal dialysis (CAPD) for a minimum of 6 months. Main Outcome Measures All subjects had at least three measurements of RRF, which was calculated as the average of creatinine clearance (Ccr) and urea clearance from a 24-hour urine collection. All measurements of RRF were plotted on a logarithmic scale and a linear scale against the duration of CAPD. Covariables used in the correlation analyses were age, sex, the presence of diabetes mellitus, mean blood pressure, mean diastolic blood pressure, hematocrit and Ccr at the start of peritoneal dialysis, peritoneal membrane transport characteristics by peritoneal equilibration test (PET), and the rate of peritonitis. Results A significant correlation was found between CAPD duration and RRF decline represented on a logarithmic scale with a correlation coefficient ( r) of 0.355 ( p < 0.001). In contrast, on a linear scale, the correlation coefficient was only 0.273 ( p < 0.01). By linear multiple regression analysis, the only independent risk factor for the decline of RRF was the rate of peritonitis ( r = -0.446, p < 0.001). Conclusion These results suggest that RRF declines exponentially rather than linearly with time, and that the rate of peritonitis is an independent risk factor for the decline of RRF in CAPD patients.
Efficacy of Gastrostomy Feeding in Infants and Older Children Receiving Chronic Peritoneal Dialysis
Authors: Ramage Ian J. , Geary Denis F. , Harvey Elizabeth , Secker Donna J. , Balfe Judie A. , Balfe J. Williamson 
Published: February 2020

Objective To assess the efficacy of supplemental gastrostomy tube (g-tube) feeding in infants and children receiving chronic peritoneal dialysis (CPD). Design Retrospective observational study. Setting Pediatric nephrology division of tertiary care center. Patients Fifteen patients undergoing g-tube insertion while receiving CPD were included in the study, and were subdivided, on the basis of age, into the following groups: infants (≤ 2.5 years, n = 8); older children (> 2.5 years, n = 7). Main Outcome Measures Assessment of the effect of CPD and g-tube feeding on statural growth assessed by height standard deviation score (SDS) and percentage weight-for-height, and measured anthropometric variables including triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), and midarm mean circumference (MAC). Assessment of the effects of CPD and g-tube feeding on measured biochemical variables including total protein, albumin, cholesterol, triglycerides, and high density lipoprotein. Results No significant change in height SDS was observed; however, the reported continuing decline in height SDS in infants was arrested. Percentage weight-for-height increased significantly in infants at 6 months ( p = 0.008) and 12 months ( p = 0.006) following initiation of g-tube feeding. An increase was also observed in the older child group, being significant at 12 months ( p = 0.031) following g-tube insertion. Increases in all anthropometric variables occurred in the infant group during CPD and post g-tube insertion, significant only for MAMC at 12 months ( p = 0.037) post g-tube insertion. In older children little change occurred during CPD, with all variables increasing post g-tube insertion, significant only for MAMC at 6 months ( p = 0.02) and 12 months ( p = 0.02). An increase in total protein and albumin was noted; however, no significant changes in any biochemical parameters were observed. Conclusions Supplemental g-tube feeding facilitates weight gain in infants and older children receiving CPD and arrests the decline in height SDS traditionally observed in infants with end-stage renal disease. No significant alteration was observed in measured biochemical variables, although an increase in total protein and albumin was noted.
Attitudes of Canadian Nephrologists toward Dialysis Modality Selection
Authors: Jung Beverly , Blake Peter G. , Mehta Ravindra L. , Mendelssohn David C. 
Published: February 2020

Objective To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design. Participants Members of the Canadian Society of Nephrology. Intervention A mailed survey questionnaire. Results A 66% response rate was obtained. Decisions about modality are reported to be based most strongly on patient preference (4.4 on a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3.85), and rehabilitation (3.69), while neither facility (1.78) nor physician (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemodialysis (HD) is slightly overutilized (2.53), continuous ambulatory peritoneal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distribution to maximize survival revealed that a type of HD should constitute 62.8% of the mix, with more emphasis on cycler PD (14.9%), community-based full care HD (13.8%), self-care HD (14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fell slightly to 57.8%. Conclusions These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysis system without compromising patient outcomes.
Effect of Intraperitoneal Administration of Heparin on Advanced Glycation End-Products in Capd
Authors: Mizuiri Sonoo , Miyata Satoshi , Sakai Ken , Kobayashi Miyuki , Miyagi Moriatsu , Nakanishi Tsutomu , Liu Bing-Fen , Kojima Hiroshi , Hasegawa Akira 
Published: February 2020

Objective To evaluate the effect of intraperitoneal (IP) administration of heparin on clearance of advanced glycation end-products (AGEs) and peritoneal dialysis efficiency. Design Sequential self-controlled intervention study. Setting University hospital, Department of Nephrology. Patients and Methods Pyrraline, urea, and creatinine levels in plasma and dialysate, along with AGE-derived fluorescence intensity (excitation, 370 nm; emission, 440 nm) in dialysate were measured 0, 30, and 60 days after IP administration of heparin in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Pyrraline levels were determined by ELISA. Results Heparin induced a significant decrease in plasma pyrraline levels; the values on days 0, 30, and 60 were 162.0 ± 89.8 μmol/L, 101.1 ± 32.1 mmol/L ( p < 0.01), and 94.0 ± 19.8 μmol/L ( p < 0.001), respectively. Heparin also induced a tendency of increased dialysate pyrraline levels and a significant increase in AGE-derived fluorescence intensity in the dialysate. The values for the latter on days 0, 30, and 60 were 51.0 ± 9.3 AU (arbitrary units/ mg of collagen), 73.5 ± 16.0 AU ( p < 0.001), and 65.6 ± 15.5 AU ( p < 0.01), respectively. Furthermore, heparin administration resulted in a significant ( p < 0.01) increase in the dialysate/plasma ratio of urea (means 0.80, 0.90, and 0.94 on days 0, 30, and 60, respectively). Conclusion These results suggest that a beneficial effect of IP administration of heparin is in part due to its action on AGE kinetics, supporting a potential preventive strategy for peritoneal membrane distortion in CAPD.
Randomized Prospective Comparison of Laparoscopic and Open Peritoneal Dialysis Catheter Insertion
Authors: Wright Mark J. , Bel'eed Khalid , Johnson Brian F. , Eadington David W. , Sellars Leslie , Farr Malcolm J. 
Published: February 2020

Objective To compare laparoscopic and conventional peritoneal dialysis catheter insertion with respect to post operative discomfort, complication rates, and catheter survival. Design Randomized prospective study. Setting Tertiary referral renal unit. Patients Fifty patients commencing peritoneal dialysis. Intervention Catheters were implanted laparoscopically or by a conventional surgical technique. Main Outcome Measures The duration of surgery, hospital stay, pain scores, and analgesic requirements were recorded. Complications (early/late) and catheter survival were compared. Results The conventional procedure was faster than the laparoscopic (14.3 vs 21.9 minutes, p < 0.0001). There was no difference in any other parameter assessed. Conclusions The data suggest that the insertion techniques are equivalent, and that laparoscopic insertion does not reduce early complication rates.
Effects of Amino Acid Dialysis Solution on the Nutrition of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Grzegorzewska Alicja E. , Mariak Irena , Dobrowolska–Zachwieja Agnieszka , Szajdak Lech 
Published: February 2020

Objective To evaluate the influence of 1.1% amino acid dialysis solution (AADS) on parameters of nutrition in continuous ambulatory peritoneal dialysis (CAPD) patients. Study Design Studies were performed in 8 men, using AADS for the overnight exchange. Before starting AADS, food intake, nutritional status, and laboratory indices were evaluated and compared to the respective parameters obtained after 3 and 6 months of treatment with AADS, as well as after 3 months of AADS withdrawal. With the start of AADS, doses of antacids were increased and modified during AADS administration; the modified doses were continued through 3 months after cessation of AADS. Another group of CAPD patients using standard dialysis solutions served as controls. In these patients the same parameters were evaluated four times at 3-month intervals. Results Administration of AADS resulted in: (1) 91% absorption of amino acids and improvement of serum amino acid pattern; (2) no change in nutritional intake during the treatment, but after the 3 months of AADS therapy, levels of nutrient intake were lower than those 3 months after withdrawal of AADS with correction of metabolic acidosis; (3) no change in indices of nutritional status, but 3 months after AADS discontinuation, total body weight, lean body mass, and body mass index were significantly higher than those shown after 3 months of treatment; (4) an increase in hemoglobin concentration, hematocrit, BUN, and blood H+. The examined parameters were not significantly changed in patients treated for 9 months with standard dialysis solutions exclusively. The values of nitrogen balance obtained during AADS administration and after 3 months of AADS withdrawal were significantly higher than those obtained in the respective periods in the control group. The blood pH, pCO2, and HCO3– in the last period of the study were higher in the AADS group than in the control group. Conclusion In relatively well-nourished CAPD patients, overnight AADS administration results in increased serum concentration of amino acids without changes in other nutritional parameters. The use of AADS should be associated with increased doses of antacid medication, which abolishes the metabolic effects of acidosis that develop during AADS administration and facilitates positive nitrogen balance.
Automated Peritoneal Dialysis in Asia
Authors: Lai Kar Neng , Lui Sing Leung , Chan Daniel T.M. 
Published: February 2020

The socioeconomic statuses of Asian countries are diverse, and government reimbursement policies for renal replacement programs vary greatly from one country to another. Both factors affect not only the availability of treatment, but also the choice of dialysis modality. A close correlation is demonstrated between the dialysis treatment rate for end-stage renal disease (ESRO) and the gross domestic product (GOP) per capita income. A biphasic relationship with the GOP per capita income and the peritoneal dialysis (PO) utilization rate is observed, in that the countries with the highest and lowest treatment rates tend to have lower PO utilization rates, whereas countries with modest treatment rates tend to have higher PO utilization rates. In contrast, countries with high continuous ambulatory peritoneal dialysis (CAPO) utilization rates have the lowest automated peritoneal dialysis (APO) utilization rates. The low APO utilization rates are due to fact that, in most instances, patients themselves must purchase the APO machine, and the machines are relatively more expensive in Asian Pacific countries. Continuous cycling peritoneal dialysis (CCPO) is most frequently practiced. Generally, convenience for employment is the main indication for the utilization of APO. Other important indications are the convenience of treatment in young or elderly uremic patients. Contrary to the practice in CAPO treatment, detailed documentation of dialysis adequacy and nutritional status is not routinely done in patients undergoing APO treatment in most Asian Pacific countries. In conclusion, APO is an underdeveloped treatment modality in the renal replacement programs of Asian Pacific countries. The low utilization of APO is clearly influenced by non medical factors including government reimbursement policy and the cost of PO machines.
Role of Hypoalbuminemia in the Genesis of Cardiovascular Disease in Dialysis Patients
Authors: Kim Soon Bae , Yang Won Seok , Park Jung Sik 
Published: February 2020

Our objective was to review the articles about the association between hypoalbuminemia and atherosclerotic or thrombotic cardiovascular disease (CVD) and to look for possible explanations for the role of hypoalbuminemia. Increased incidences of CVD were reported in patients with hypoalbuminemia owing to renal or other diseases. Hypoalbuminemia increases plasma levels of lipoprotein(a), fibrinogen, and arachidonic acid metabolites; it also increases platelet aggregability and blood viscosity, all of which may contribute to the development of CVD. This cause-effect association is thought to be “dependent.” Changes in atherogenic lipoproteins or lipids, such as LDL cholesterol, triglycerides, and apolipoprotein B, are controversial in hypoalbuminemic dialysis patients, possibly because coexistent malnutrition and volume status can affect both albumin and lipids. In our recent study, there was a negative correlation between serum albumin and C-reactive protein, D-dimer (an index of intravascular thrombogenesis), and von Willebrand factor (a marker for endothelial cell injury), but infusion of albumin did not affect the level of these parameters, which suggests that the correlations may be an effect-effect association by a confounding variable, such as inflammation. In conclusion, hypoalbuminemia is associated with cardiovascular disease via two pathways: one, a “dependent” cause-effect association; the other, an effect-effect association.
Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Wu Mai-Szu , Yu Chun-Chen , Wu Ching-Herng , Haung Jeng Yi , Leu Mei-Lin , Huang Chiu-Ching 
Published: February 2020

Objective To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO). Materials and Methods One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded. Results The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.
Bicarbonate/Lactate Dialysis Solution Improves In Vivo Function of Peritoneal Host Defense in Rats
Authors: Pawlaczyk Krzysztof , Kuzlan-Pawlaczyk Malgorzata , Tobis Katarzyna Wieczorowska , Polubinska Alicja , Wisniewska Justyna , Faict Dirk , Holmes Cliff J. , Breborowicz Andrzej 
Published: February 2020

Objective To assess the in vivo peritoneal inflammatory reaction in rats dialyzed with neutral, bicarbonatelactate-buffered dialysis fluid. Methods Chronic peritoneal dialysis was performed for 4 weeks in Wistar rats with two solutions: (1) 40 mmol/l lactate-buffered fluid, pH 5.2, with a glucose concentration of 2.27 gldl (lac); and, (2) 15 mmolll lactate and 25 mmolll bicarbonate-buffered fluid, pH 7.0 -7.5, with a glucose concentration of 2.27gldl (Bic-lac). After 4 weeks, two peritoneal equilibration tests (PET 1 and PET 2) were performed in all animals with each respective solution. PET 1 was done with test solutions alone, whereas, on a subsequent day, PET 2 was performed with test solutions supplemented with endotoxin [lipopolysaccharide (IPS)] to induce peritonitis. Results During PET 1 no consistent differences were detected in peritoneal permeability between the lac and Bic-lac groups. Total dialysate cell count in the Bic-lac animals was lower than in rats treated with lac fluid: that is, at 8 hours, the respective counts were 1858 ± 524 cellslμl versus 2785 ± 1162 cellslμl (p < 0.01). Dialysate from animals dialyzed with Bic-lac contained more macrophages (at 4 hours: 53.6% ± 35.8% versus 35.8% ± 8.8%, p < 0.001) and fewer neutrophils (at 4 hours: 3.6% ± 1.8% versus 15.4%± 6.1%, p < 0.001) as compared to those dialyzed with the lac solution. Concentration of nitrites in 8-hour dwell dialysate samples from Bic-lac rats was lower than that in the lac group (0.98 ± 0.28 μmollml versus 2.32 ± 0.87 μmollml, p < 0.002), but cytokine levels in the dialysates were comparable. During PET 2, the in -crease in peritoneal permeability resulting from the lPS induced inflammatory response was similar for both test solutions. Dialysate cell count was higher in the lac group versus the Bic-lac group (at 8 hours: 8789 ± 4862 cellslμl versus 3961 ± 581 cellslμl, p < 0.001), contained more neutrophils (at 8 hours: 80.0% ± 11.3% versus 54.8% ± 4.4%, p < 0.001) and fewer macrophages (at 8 hours: 6.8% ± 5.6% versus 21.2% ± 3.3%, p < 0.05). During peritonitis, we found a higher overall dialysate concentration of both tumor necrosis factor (TNFα: +53%, p < 0.05) and of interferon gamma (lFN-y: +303%, p < 0.02), in the Bic-lac group than in the lac group. Conclusions A lower dialysate cell count, higher percentage of macrophages, and lower percentage of neutrophils in dialysate suggest that Bic-lac fluid induces a diminished nonspecific inflammatory response of the peritoneal cavity during dialysis. However, after in vivo stimulation, peritoneal cells from animals dialyzed with Bic-lac solution possess an augmented ability to produce inflammatory cytokines.
Nitric Oxide Production in Peritoneal Macrophages from Peritoneal Dialysis Patients with Bacterial Peritonitis
Authors: Plum Jörg , Tabatabaei Maryam Mirza , Lordnejad Mohammad Reza , Pipinika Olga , Razeghi Peter , Huang Chumnei , Meyer-Kirchrath Jutta , Grabensee Bernd 
Published: February 2020

Nitric oxide (NO) is produced by various cell types, and it is an important mediator in many biological processes, including macrophage-mediated cellular host defense. The relevance and amount of NO production in peritonitis during peritoneal dialysis (PD) treatment is still not clear. We studied whether human peritoneal macrophages (PMΦ) isolated from healthy PD patients or PD patients with peritonitis showed different spontaneous or lipo-polysaccharide (LPS)linterferon gamma (IFN-y) -induced NO production (LPS, 1 nglmL 10 μglmL; IFN-y, 101000 UlmL; incubation between 6 -48 hours; measured by Griess reagent). Results were compared with human blood monocytes (HBM) isolated from buffy coats. Inducible nitric oxide synthetase (iNOS) mRNA expression was looked for in PMΦ by reverse transcriptase polymerase chain reaction (RT-PCR). Furthermore, plasma (P) and peritoneal dialysate effluent (D) nitrite concentrations were measured in vivo. The dialysate-to-plasma ratio (DIP) of nitrite concentration was inverse in the case of peritonitis compared to infection-free patients (peritonitis DIP = 1.3, non peritonitis DIP = 0.4; p < 0.01). PMΦ from peritonitis patients produced higher amounts of NO than did those from infection-free patients (0.040 ± 0.044 nmol per microgram cell protein versus 0.018 ± 0.015 nmol per microgram cell protein, p < 0.05). NO release could not be further enhanced by stimulation with LPS plus IFN-y (1 ng/mL, 250 UlmL, respectively). However, NO production in PMΦ from infection-free patients increased during in vitro stimulation (0.044 ± 0.031 nmol per microgram cell protein versus 0.018± 0.015 nmol per microgram cell protein, p < 0.01). An increase of iNOS mRNA expression could be demonstrated by RT-PCR. Blood monocytes from healthy donors also increased NO release during cytokine stimulation (0.032± 0.015 nmol per microgram cell protein versus 0.019 ± 0.009 nmol per microgram cell protein, p < 0.05). Our results indicate that significant amounts of NO are released intraperitoneally in the case of bacterial peritonitis. PMΦ represent a site of NO production, though the absolute amounts released in vitro are only moderate. NO production can be induced in PMΦ and HBM by LPSIIFN-y stimulation in vitro.