bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal Osteodystrophy and the Status of Aluminum and Other Trace Metals in CAPD Patients: A Panel Review
Authors: Campese Vito , Easterling Ronald E. , Finkelstein Fred , Mattern William , Ogden David A. , Steiner Robert W. , Oreopoulos Dimitrios G. 
Published: February 2020

Most reports indicate that in patients on CAPD, hyperparathyroid bone disease progresses, while osteomalacia improves. With 1.5g% Dianeal, and when dialysate Ca is 7mg%, peritoneal mass transfer of calcium is positive, i.e., it is absorbed from the solution, while with hypertonic solutions it is less positive or even negative. Daily phosphorus removal by CAPD is insufficient to control serum phosphorus, hence CAPD patients require phosphate binders and/or phosphate restriction. Peritoneal phosphorus removal is greater with hypertonic than with isotonic solutions. In patients on CAPD, the loss of substantial amounts of D-binding protein and 25(OH)DJ into the dialysate, produces a gradual decrease in plasma 25(OH)D levels. Similarly, these patients have low 1,25(OH)D2 DJ levels and, hence, should receive vitamin D or its analogues. Unlike hemodialysis, CAPD results in a significant removal of PTH, with a peritoneal clearance of 1.5 ml/min. However, despite an estimated daily loss of 13.5% of the circulating PTH, there probably is not a significant effect on plasma PTH levels, which usually respond to changes in serum Ca. Levels of the intact PTH molecule provide a better index of hyperparathyroidism than do levels of its COOH-terminal fragment. With regard to investigation and treatment, one should measure serum ionic calcium rather than total calcium, even if the latter is corrected for total protein. The minimal dialysate calcium should be 7 mg/dl and for hypertonic solutions, perhaps it should be higher (7.5–8.0 mg%). Total serum calcium should be maintained at 10.2–10.7 mg/dl (ionized calcium of 5.1–5.5 mg/dl); adjunctive use of active forms of vitamin D and prevention of aluminum intoxication may prevent progressive bone disease in CAPD, and existing bone disease may heal. Whereas there are enough data supporting the connection of aluminum toxicity and osteomalacia in hemodialysis patients, data concerning the incidence of osteomalacia and its relationship to aluminum in CAPD patients are scarce. Apparently CAPD removes aluminum more efficiently than hemodialysis. CAPD patients are less likely to develop osteomalacia because the dialysate aluminum content is low and these patients tend to require lower doses of phosphate binder. There are no extensive studies on trace element deficiencies or excess in patients on CAPD. These patients may be more susceptible to deficiencies of trace elements which are protein bound. Desferoxamine may be effectively used for the treatment of patients with either aluminum or iron overload.
Peritoneal Mass Transfer in Patients on long Term CAPD
Authors: Selgas R. , Rodriguez-Carmona A. , Martinez M.E. , Perez-Fontan M. , Salinas M. , Escuin F. , Rinon C. , Martinez-Ara J. , Sanchez-Sicilia L. 
Published: February 2020

Continuous contact of the peritoneum with the dialysis solution during CAPD and peritonitis may produce changes in the peritoneal masstransfer properties. In 35 patients who have been on CAPD for 1–34 months, we have studied the effect of time on CAPD, and peritonitis on mass transfer coefficients (MTC) of urea, creatinine, uric acid, inulin and parathormone (PTH). Even though the mean values of the whole group showed no statistically significant changes, in six patients, the MTCs of some solutes did show significant changes (increase or decrease). Similarly peritonitis produced a varying effect on the MTC of some patients but they counteracted each other, hence the absence of significant effect in mean whole-group values. We have concluded that the permeability of the human peritoneum is highly individual and, in some patients, mass transfer properties of the peritoneum should be assessed periodically in order to make appropriate adjustments in the dialysis schedule.
Outcomes of CAPD and IPD Therapy at Manhattan Kidney Center, 1979–83
Authors: Ira Norman Deane , Herman C. , Garvey Michael A. , Wineman Robert J. 
Published: February 2020

The study undertaken by Dr. Norman Deane of Disparate Patient Groups undergoing CAPD and IPD found the interval between peritonitis was higher for IPD patients. Duration for hospitalization for peritonitis was similar for both therapies. Total hospitalization was greater for IPD patients. The primary cause of death for the CAPD patient was GI related and for IPD, cardiovascular. Survival of the CAPD group was similar to that of the in-center hemodialysis patient survival. Survival of the IPD group was inferior to that of CAPD due to the presence of greater co-morbid conditions. Finally, survival of patients aged 55 years or older on either therapy was similar. The purpose of the study was to evaluate the outcomes of patients using continuous ambulatory peritoneal dialysis (CAPD) and intennittent peritoneal dialysis (IPD) therapies over the last 4 years.
Comparison of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis for Diabetics
Authors: Mejia Gonzalo , Zimmerman Stephen W. 
Published: February 2020

To determine the relative efficacy of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) we compared all diabetic patients starting these treatments between April 1978 and August 1983. There were 37 HD patients and 34 CAPD patients who were comparable in age and degree of systemic disease. In the CAPD group survival was 81% at one and three years, and in the HD group 76% and 400/() at one and three years (P < 0.05) respectively. Initially CAPD patients spent more days in the hospital for catheter placement and training but subsequently had fewer hospital days. Infections other than peritonitis and catheter related were more frequent in HD (P < .05) patients, as were access repairs (P < .05). Also we compared at one year 12 patients on CAPD to eight patients on HD. Although they were comparable in all respects at the start of therapy, at the end of follow-up (24 ± 3 mo HD, 27 ± 3.5 mo CAPD) all CAPD patients remained on CAPD while only three remained on HD. Also HD patients had spent more than twice as many hospital days/patient months as did CAPD patients (P < .01). We have concluded that CAPD compares favorably with HD as a renal replacement therapy for diabetic patients at our institution. In the last decade increasing numbers of diabetic patients with end-stage renal disease (ESRD) have been accepted for various types of renal replacement therapy (1–17). Of these, hemodialysis (HD) has been carried out for the longest period and although results have improved, the mortality rates in diabetics are still higher than in nondiabetic populations (14–16). Continuous ambulatory peritoneal dialysis (CAPD) is a new and reportedly efficacious therapy for diabetic patients with ESRD. While some studies have suggested that CAPD has an advantage over HD, definite proof is lacking because many reports (1,2,7) included patients who were transferred from one form of dialysis to another or were started on dialysis after a renal transplant. Furthermore, few studies have compared CAPD with hemodialysis in the same institution. For these reasons at our affiliated institutions we did a retrospective study, which compared HD and CAPD as the primary form of therapy for ESRD due to diabetic nephropathy.
Surgical Complications during Continuous Ambulatory Peritoneal Dialysis
Authors: Valenti Giovanni , Cresseri Donata , Luisa Maria , Enzo Bianchi , Lorenz Corghi Marc , Buccianti Gherardo 
Published: February 2020

In 30 patients (20 males and 10 females) undergoing CAPD, we observed 15 catheter-related complications -group A: leakage, dislodgement, slipping-out, protrusion of the external cuff, hemoperitonitis, and eight abdominal-cavity complications -group B: umbilical, inguinal, incisional and diaphragmatic hernias. Group A complications which occurred in 30% of the men and 80% of the women (mean age 47.2 ± 9) were easy to manage; group B complications developed mainly in elderly males (seven men and one woman, mean age 61.4 ± 5); these required temporary change of mode of dialysis in three, and permanent transfer from CAPD in two. From this review we have concluded that loss of anatomical integrity of the abdominal cavity is one of the main factors which prevents the continuation of CAPD.
Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Developing Country
Authors: Dominguez Jorge , Gonzalez Gladys , Figueroa Lenin , Mendez Jose 
Published: February 2020

This paper describes our experience during the first 39 months of the CAPD program at the Miguel Perez Carreno Hospital in Caracas, Venezuela. Forty-eight patients were started on CAPD and treated for a total of 767 patient/months. Mean age was 45.8 years. Average time in the program was 15.9 months. At 39 months 87% of patients were alive and 78% were still on CAPD. The peritonitis rate was one episode per 6.39 pt/month with a probability of peritonitis of 0.70 at 25 months. Incidence of sterile peritonitis was high (41 %). Our patients had a low hospital admission rate (0.5 days per patient month) and a high percentage were rehabilitated (81%). Chronic ambulatory peritoneal dialysis (CAPD) is a widely accepted therapy for end-stage renal disease (ESRD): in Venezuela, approximately 160 patients (37%) of all those under treatment for ESRD receive this form of therapy. The Nephrology Section of the Miguel Perez Carreno Hospital in Caracas manages the largest CAPD program in the country. Here 149 patients are receiving treatment for ESRD by different techniques -hospital hemodialysis, home hemodialysis, intermittent peritoneal dialysis, CAPD and renal transplantation, under the care of five nephrologists, four nephrology residents and 30 nurses. Our CAPD program started in January 1980. This paper, which describes our three years of experience, indicates that CAPD is feasible in a country such as ours which, because of economic problems, is limited in its ability to provide other forms of treatment for ESRD.
Estimating Rates of Recurrent Peritonitis for Patients on CAPO
Authors: Vonesh Edward F. 
Published: February 2020

Recurrent peritonitis is a major complication of Continuous Ambulatory Peritoneal Dialysis (CAPD). As a therapy for patients with end stage renal disease, CAPD entails a continuous interaction between patient and various medical devices. The assumptions one makes regarding this interaction play an essential role when estimating the rate of recurrent peritonitis for a given patient population. Assuming that each patient has a constant rate of peritonitis, two models for evaluating the risk of recurrent peritonitis are considered. One model, the Poisson probability model, applies when the rate of peritonitis is the same from patient to patient. When this occurs, the frequency of peritoneal infections will be randomly distributed among patients (Corey, 1981). A second model, the negative binomial probability model, applies when the rate of peritonitis varies from one patient to another. In this event, the distribution of peritoneal infections will differ from patient to patient. The poisson model would be applicable when, for example, patients behave similarly with respect to their interactions with the medical devices and with potential risk factors. The negative binomial model, on the other hand, makes allowances for patient differences both in terms of their handling of routine exchanges and in their exposure to various risk factors. This paper provides methods for estimating the mean peritonitis rate under each model. In addition, “survival” curve estimates depicting the probability of remaining peritonitis free (i.e. “surviving”) over time are provided. It is shown, using data from a multi-center clinical trial, that the risk of peritonitis is best described in terms of survival curves rather than the mean peritonitis rate. For both models, the mean peritonitis rate was found to be 0.85 episodes per year. However, under the negative binomial model, the one-year survival rate, expressed as the percentage of patients remaining free of peritonitis, is 52% as compared with only 42% under the Poisson model. Moreover, the negative binomial model provided a significantly better fit to the observed frequency of peritonitis. These findings suggest that the negative binomial model provides a more realistic and accurate portrayal of the risk of peritonitis and that this risk is not nearly as high as would otherwise be indicated by a Poisson analysis.
Successful Use of Continuous Ambulatory Peritoneal Dialysis in Refractory Heart Failure
Authors: Kim Donald , Khanna Ramesh , Wu George , Fountas Panos , Druck Maurice , Oreopoulos Dimitrios G. 
Published: February 2020

Four patients with end-stage heart failure, massive ascites refractory to medical interventions and a variable degree of renal failure were treated successfuly with CAPD for eight to 24 months. The New York Heart Association functional class improved in all four. In two patients, who presented initially with signs and symptoms mainly of right-sided heart failure, ejection fraction improved. Each day dialysis achieved a significant degree of ultrafiltration and a negative sodium balance. We propose that CAPD is an alternative therapeutic modality in patients with severe heart failure refractory to the conventional medical treatment. The advent of potent diuretics and preload and afterload reducing agents has had a major impact in the treatment of refractory congestive heart failure. Recently, captopril, an angiotensinconverting enzyme inhibitor, has been used with major benefit in some patients (I). However, some patients still do not respond to these treatments and their management presents a major therapeutic challenge. Furthermore, overzealous therapy with diuretics may lead to intravascular volume depletion resulting in hypotension, azotemia and electrolyte disturbances which further complicate their management. In the past, intermittent peritoneal dialysis (IPD) or hemodialysis (HD) has been used to remove fluid from patients with intractable edema due to heart failure (2 7). But the benefit is only transient and fluid accumulates again, requiring repeated sessions of acute dialysis. However, hypotension is a frequent complication during either form of acute dialysis especially in hemodynamically unstable patients due to rapid removal of large amounts of fluid from intravascular space. Continuous ambulatory peritoneal dialysis (CAPD), whose main characteristic is the slow continuous removal of sodium and water, offers obvious advantages in patients with intractable heart failure. This paper describes our experience of four patients with intractable heart failure who have been treated with CAPD for eight to 24 months.
A New Approach for Catheter Placement and Care in CAPD
Authors: Henao Jorge , Mejia Gonzalo , Arbelaez Mario , Sus Alvaro , Arango Jorge L. , Aramburo Olga , Sanchez Julieta 
Published: February 2020

Between April 1981 and December 1984, 54 double-cuff straight Tenckhoff catheters were inserted in 50 patients. This paper describes our experience with a new approach for catheter placement and care. It is based on a) ambulatory insertion by nephrologists; b) no flushing, heparinization or cycling; c) “break-in” delayed for two weeks and performed with regular two-liter bags; dialysis and d) ambulatory training carried out over 7–10 days. The actuarial survival rates of the catheters were 98% at 12 months and 80% at 24 and 36 months. Catheter failure was seen in six patients, three were due to peritonitis, two to tunnel infection and one to outflow obstruction caused by peritoneal adhesions. We conclude that this approach is feasible, safe, cheap and affordable and probably will produce less complications than other methods. Our nephrology section started a CAPD program in early 1981 but limited financial resources led us to devise a simplified and affordable protocol for catheter placement and care and for patient training and follow-up. Thus, we provide ambulatory catheter placement followed by two weeks without any type of peritoneal dialysis or catheter flushing. After this period, patients are trained as outpatients for seven to 10 days. This paper reports our experience with this approach.
Appendicitis Perforata in CAPD Patients -Report of Two Cases
Authors: Vogt Konstantin , Hess Bernhard , Baumgartner Dieter , Maass Dirk , Keusch Gerald , Binswanger Ulrich 
Published: February 2020

Two patients on CAPD had peritonitis due to perforated appendicitis. Both presented with diffuse painful peritonitis with nausea, fever and prostration. There was blood leukocytosis with a shift to the left. The peritonitis did not respond to antibiotic therapy. The diagnosis was made after 8 and 18 days respectively by exploratory laparotomy. Both patients had a gangrenous perforated appendix surrounded by abscess. Both patients had uncomplicated recovery after appendectomy, drainage, removal of the Tenckhoff catheter with discontinuation of CAPD and change to hemodialysis. Our experience suggests that a perforated appendix might be recognized early in a patient with apparent fecal peritonitis in whom other more common causes (e.g. diverticulosis/ diverticulitis) have been ruled out, or when he presents with severe symptoms and a low peritoneal white cell count. Perforated appendicitis leading to fecal peritonitis is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Among 85 patients treated with CAPD since 1978 for a total of 1062 patient months, we observed two such cases. Although CAPD now is established as a kidney replacement treatment and appendicitis is a common condition, we know of no other report of perforated appendicitis during CAPD. Therefore we describe our experience with two such patients, treated with CAPD for 14 and 5 months, respectively. The diagnostic and therapeutic implications are discussed in the context of other forms of fecal peritonitis, mainly due to colonic perforation, secondary to diverticular disease. This report emphasizes the need for a high level of suspicion that the peritonitis may be related to bowel disease, especially when it does not respond quickly to standard treatment.
Arterial Calcifications in Patients Undergoing Chronic Peritoneal Dialysis: Incidence, Progression and Regression
Authors: Meema H. Erik , Oreopoulos Dimitrios G. 
Published: February 2020

The authors graded radiologically detectable arterial calcification (A.C.) in 168 patients with end-stage renal disease treated with peritoneal dialysis; 41 of them had diabetes mellitus (DM). Comparison of DM and nondiabetic (ND) patients showed that during an average dialysis period of more than two years, the incidence of A.C. increased from 37% before dialysis to 45% at the last examination in the ND patients, and from 90% to 100% in DM patients. Both prevalence and progression of A.C. were significantly higher in DM patients (P < 0.001 and <0.05 respectively). Regressions of A.C., unrelated to parathyroidectomy or renal transplantation, were observed in 5 ND and 4 DM patients. This 9% incidence of regressions should encourage further investigations to detect the factors responsible because severe A.C. sometimes is associated with gangrene and other complications. Although numerous publications on radiologic changes in renal osteodystrophy include descriptions of arterial calcifications (A. C.), only a few have focused on the latter (1–4). Furthermore, none have looked at the relative proportions of diabetic (DM) and non-diabetic (ND) patients with A.C. and chronic renal failure. The main purpose of this paper is to make such a comparison.
Biofilm and Foreign Body Infection the Significance to Capd-Associated Peritonitis
Authors: Holmes Clifford J. , Evans Rosemary 
Published: February 2020

Microbial colonization of indwelling and implantable medical devices and prostheses is known to precede the formation of an adherent biofilm, such as is found on peritoneal catheters during CAPD. Micro-organismderived exopolysaccharides within the biofilm matrix seem to confer unique biological properties on this material, such as enhanced resistance to host defenses and antimicrobial agents. It has been proposed that an adherent biofilm is a major contributing factor in the development of foreign-body infections, including CAPD peritonitis. The source of organisms which lead to biofilm formation on peritoneal catheters is unknown but may include “seeding” at the time of surgical placement and migration from the subcutaneous tunnel via the inner cuff. Strategies to inhibit biofilm development in industrial systems usually involve physical destruction of the biofilm and the use of biocides. Clinical success has been achieved by antimicrobial agents impregnated into or coated onto susceptible devices. Microbial adhesion to inanimate surfaces is a complex and multifaceted event. Continued research in this area, however, should increase our understanding of the factors involved underlying foreignbody infection.
Rupture of the Spleen: A Complication of Continuous Ambulatory Peritoneal Dialysis
Authors: De Los Santos C. Abaete , Von Eye Osvaldo , Vila Domingos d’ A , Mottin Claudio Cora 
Published: February 2020

A 44-year-old woman on CAPD for 20 months presented with severe intraperitoneal bleeding secondary to rupture of the spleen. On the day of the accident displacement of the Tenckhoff catheter to the left upper quadrant of the abdomen was detected by X-ray. We believe this dislodgement caused the rupture either by direct trauma or erosion of the organ. This complication of CAPD has not been described before. There are no previous reports of rupture of an abdominal organ during chronic peritoneal dialysis. However massive intraperitoneal hemorrhage in CAPD has been described secondary to abdominal wall erosion by the Tenckhoff catheter. We believe that rupture of the spleen in the present case was due to trauma and/or erosion induced by a displaced Tenckhoff catheter.
Renal Osteodystrophy in Patients on Continuous Ambulatory Peritoneal Dialysis: A Five Year Study
Authors: Rahman Rabihur , Heaton Alexander , Goodship Timothy H.J. , Stuart R. , Rodger C. , Tapson Leslie John S. , Ellis Sellars Hew A. , Wilkinson Robert , Ward Michael K. 
Published: February 2020

The clinical, biochemical, radiological and histopathological data related to renal osteodystrophy were extracted from the computer records of 81 patients who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for more than two years. Paired bone histopathology was available in 45 of these patients. The majority maintained normal serum ionised and total calcium concentrations, while mean serum phosphate concentration ranged from 1.68 to 1.80 mmol/l. Serum parathyroid hormone concentrations fell significantly in those with high values at the start of CAPD. Five patients underwent parathyroidectomy. Mean serum aluminium concentrations were higher than normal healthy controls and the levels rose further after the addition of aluminium-containing phosphate binders (ACPB). Of the patients with histological evidence of secondary hyperparathyroidism, 82% showed improvement on repeat biopsy. Nine, who had no evidence of osteitis fibrosa at the beginning of CAPD, remained free of bone disease during the study period. Osteomalacia was present in two patients at the onset of CAPD and developed in three more, two of them after parathyroidectomy. Except for one patient, all those with osteomalacia improved after the addition of alfacalcidol and continuation of CAPD. This last patient died with evidence of aluminium deposition in his bones. We conclude that when used as clinically indicated, CAPD, with the addition of calcium carbonate, phosphate binders and alfacalcidol, achieves good control of renal osteo dystrophy in the majority of patients.