bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral versus Intraperitoneal Application of Clindamycin in Tunnel Infections: A Prospective, Randomized Study in Capd Patients
Authors: Plum Joerg , Artik Suzan , Busch Theo , Sahin Kurtulus , Grabensee Bernd 
Published: February 2020

Objective To evaluate the potential superiority of either oral or intraperitoneal treatment of catheter tunnel infections (TI), using clindamycin as a first-Iine antibiotic and ultrasound as a diagnostic tool. Design This was a prospective, randomized study in continuous ambulatory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically and ultrasound-proven episodes of TI were randomly assigned to either an oral or an intraperitoneal (IP) treatment (100 patients, 1414 patient-months). Main criteria for TI diagnosis were purulent drainage from the exit site and/or a positive ultrasound (pericatheter fluid collection of at least 2 mm, 7.5 MHz transducer). Initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case of incompatibility or resistance to clindamycin, either oxacillin orciprofloxacin were used orally or IP. Results Based on ultrasound criteria, the mean time until a ≥50% reduction of pericatheter abscess diameter was 26 days (median) (range: 8 28 days) in the oral, and 15 days (8 27 days) in the IP group (p ≤ 0.05). Showing no significant difference of pericatheter fluid at study entry with 4 mm (median) (range: 2 -6 mm) in the oral group and 4 mm (2 -4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0 2 mm) after 28 days (p < 0.05), while the diameter was still 2 mm (0 10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitoneal group (51 vs 15 days, NS). Catheter removal had to be done once in the IP group and twice in the oral group within 6 months after study entry. Conclusions The results give evidence for greater efficacy of the IP application of clindamycin as a first -Iine antibiotic compared to the oral route for the treatment of tunnel infections.
Beta-Blockers May Cause Ultrafiltration Failure in Peritoneal Dialysis Patients
Authors: Stegmayr Bernd G. 
Published: February 2020

Objective To elucidate mechanisms of ultrafiltration failure (UFF) in patients on continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective analysis of patients with UFF during CAPD compared with cross-sectionally selected controls. Setting University peritoneal dialysis center. Patients Thirteen patients with UFF during CAPD necessitating change to hemodialysis (n = 6) or continuous cycling peritoneal dialysis (n = 1), or causing greatly increased need for high glucose-containing solutes, were compared with 18 CAPD patients without such problems. Statistics Fisher's exact test, Student's independent t-test, univariate and multivariate correlation analyses. Main Outcome Measures Data were collected prior to analyses. Results Systolic blood pressure and total cholesterol and triglyceride levels were higher in the UFF patients than in the controls (p = 0.006, p = 0.028, p = 0.013). Betablockers were used by 12 of the UFF patients, but only 2/ 18 controls (p < 0.0001). There was no intergroup difference in number of women, patient age or weight, incidence of diabetes or previous peritonitis, duration of PD, serum levels of albumin, creatinine, iron, or ferritin, or dosage of erythropoietin. Correlation was found between the daily amount of glucose instilled into the abdomen and serum triglycerides (r = +0.72, p < 0.001), total choles terol (r = +0.56, p = 0.008), and HbA1C(r =-0.41, p =0.039). Many patients were high absorbers of dialysis glucose. Conclusion The study indicates that beta-blockers may cause UFF, and that glucose and lipid metabolism differed between these patients and controls without UFF.
Effect of Bicarbonate-Based Dialysis Solutions on Intracellular Ph (Phi) and Tnfα Production by Peritoneal Macrophages
Authors: Rogachev Boris , Hausmann Michael J. , Yulzari Robert , Weiler Michal , Holmes Clifford , Faict Dirk , Chaimovitz Cidio , Douvdevani Amos 
Published: February 2020

Objective To compare the effect of Dianeal and two newly-formulated bicarbonate-based peritoneal solutions on intracellular pH (pHi), tumor necrosis factor-α (TNFα) mRNA level, and TNFα secretion by peritoneal macrophages (PMΦ). Design and Measurements Peritoneal macrophages were isolated from dialysates collected after overnight dwells in peritonitis -free continuous ambulatory peritoneal dialysis patients. Dialysis solutions contained 1.5% or 4.25% dextrose. HCO3 concentrations of bicarbonate(TB)and bicarbonate/lactate-buffered (TBL) solution were 38 mM and 25 mM, respectively. TBL also contained lactate at a concentration of 15 mM. pCO2 levels were 78 mmHg and 51 mmHg, respectively. In all experiments pC02 was carefully maintained at a stable level. The pHi was measured by spectrofluorometry in BCECF-Ioaded PMΦ exposed to different dialysis solutions or Hank's balanced salt solution. TNFα levels were measured by ELISA in the supernatant of lipopolysaccharide (LPS) stimulated PMΦ after their incubation in different solutions for 15 and 30 minutes. TNFα mRNA was measured by reverse transcriptase polymerase chain reaction (RT PCR) of total RNA extracted from LPS-stimulated PMΦ after their incubation in different solutions for 30 minutes. β-actin mRNA was used as the control. Results Dianeal caused a profound drop in pHi to below 6.2. Following an initial drop, pHi stabilized after 4 minutes at levels of 6.96 and 6.8 after incubation in TB and TBL, respectively. In comparison to the control solution, a fall of 11% and 21% in TNFα secretion was seen after incubation in TB for 15 and 30 minutes, respectively, and 15% and 26% after incubation in TBL. Under identical conditions, Dianeal (Baxter, McGaw Park, IL, U.S.A.) caused 59% and >95% suppression of TNFα secretion. Accordingly, TNFα mRNA level in PMΦ was severely depressed by Dianeal but no detectable inhibition was observed following incubation for 30 minutes in TB and TBL. When dextrose concentration in TB and TBL was increased from 1.5% to 4.25%, TNFα secretion by PMΦ was not suppressed by more than 49%, even after 30 minutes incubation. Moreover, suppression of TNFα mRNA levels could not be detected with TB or TBL even at high dextrose concentrations. Conclusions In contrast to Dianeal, both bicarbonate based solutions caused only a mild drop in pHi of PMΦ. We postulate this effect to be responsible for the improved capacity of PMΦ to secrete TNFα when incubated in bicarbonate-based solutions compared to Dianeal. Reflecting its known cytotoxicity, dextrose in high concentrations diminishes the protective effect of TB and TBL on immune function of PMΦ. TBL is as effective as TB in preventing the deleterious effect of Dianeal on PMΦ function.
Increased Endothelin-1 Mrna Expression in Peripheral Blood Monocytes of Dialysis Patients
Authors: Ebihara Isao , Nakamura Tsukasa , Takahashi Toshimasa , Tomino Yasuhiko , Shimada Noriaki , Koide Hikaru 
Published: February 2020

Objective To compare plasma endothelin (ET)-1 level and ET-1 mRNA level in peripheral blood monocytes of patients undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Design Endothelin-1 mRNA level in peripheral blood monocytes and plasma ET -1 level were studied in 30 HD patients, 15 CAPD patients, 20 chronic renal failure patients not being dialyzed, and 20 normal healthy controls. Hemodialysis patients were dialyzed three times per week with a bicarbonate dialysate. Different types of dialyzer membrane, viz., cellulose triacetate, cuprophane, poly-sulfone, polyacrylonitrile, and ethylenevinylalcohol were used in 8,6,6,5, and 5 patients, respectively. Continuous ambulatory peritoneal dialysis patients were dialyzed with four daily exchanges of a 2-L dialysate containing glucose at a concentration of 1.5% to 2.5%. Results Higher levels of ET -1 mRNA in monocytes were observed in HD patients than in CAPD patients (p < 0.01), chronic renal failure patients (p < 0.01), or normal healthy controls (p < 0.001). The level of ET -1 mRNA in monocytes at the end of HD was not significantly higher than that at the start of HD. ln addition, these mRNA levels in HD patients showed littledifference with different types of dialysis membrane. Plasma ET -1 level in HD patients (10.2 ± 2.4 pg/mL) was also higher than that in CAPD patients (7.8 ± 1.6 pg/mL, p < 0.01), in chronic renal failure patients (4.8 ± 1.2 pg/mL, p < 0.01), or in normal controls (2.6 ± 0.8 pg/mL, p < 0.001). Conclusion Dialysis itself did not significantly affect ET -1 mRNA levels in monocytes. Chronic stimulation of peripheral blood monocytes may be associated with higher levels of ET -1 mRNA and plasma ET -1 in HD patients than in CAPD patients.
Swan Neck Presternal Peritoneal Dialysis Catheter: Five-Year Experience in Children
Authors: Warchol Stanislaw , Roszkowska-Blaim Maria , Sieniawska Maria 
Published: February 2020

Objectives To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titanium connector, with the exit site located on the chest wall, was designed. Design A prospective study was undertaken to estimate the usefulness of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children. Setting University Children's Hospital, Medical Academy, Warsaw, Poland. Patients From December 1991 to June 1997, 11 SNPCs were implanted in 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More than one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted. Intervention In all children the presternal catheter was implanted surgically by the modification of the technique described by Twardowski et al. Results The observation period ranged from 1 -60 months. The rate of ESI was 11162 patient-months. The major complication was trauma of the exit site (4 times in 3 of 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two parts of the SNPC became disconnected in 2 children (after 7 and 33 months respectively). Conclusion Our results achieved with the SNPC in children are very good. The presternal catheter reduces the risk of ESI. However, the chest localization of the exit site does not help to prevent trauma in children. This type of PD catheter should be reserved for patients with specific indications.
Acute in Vivotoxicity of Heat-Sterilized Glucose Peritoneal Dialysis Fluids to Rat Peritoneal Macrophages
Authors: Jonasson Peter , Braide Magnus 
Published: February 2020

Objective To evaluate the in vivo effects of heat-sterilized peritoneal dialysis (PD) fluids on the respiratory burst response of rat peritoneal leukocytes. Design Rats were exposed to intraperitoneal injections of a laboratory-made PD fluid that was either heat-sterilized (HPD) or filtered (F-PD). Control groups of animals were given Hank's buffer (HBSS) or saline (NaCI). Leukocytes were harvested by intraperitoneal lavage at different times in different animals and analyzed with respect to cell numbers, differential counts, and production of superoxide (chemiluminescence) in response to opsonized zymosan. The chemiluminescence responses of the macrophage and the neutrophil populations, respectively, were obtained by curve-fitting techniques from the responses of the mixed populations. Results All fluids induced a recruitment of neutrophils, the PD fluids causing a cell number increase that was more transient than that caused by NaCI and HBSS. Macrophage numbers were only slightly influenced, but were generally higher after NaCI and HBSS injections than after PD fluid injections. The H-PD exposure induced a significant inhibition of the macrophage chemiluminescence response after 2 and 12 hours, compared with the exposure to F-PD. The neutrophil chemiluminescence response was not significantly affected. Conclusion The toxins produced by heat-sterilization of glucose-containing PD fluids inhibit in vivo the respiratory burst response of peritoneal macrophages.
The Use of TWH Catheters in Capd Patients: Fourteen-Year Experience in Technique, Survival, and Complication Rates
Authors: Apostolidis Nicholas S. , Panoussopoulos Dimitrios G. , Manouras Andreas J. , Pararas Basil N. , Voudiklari Sophia G. , Zirogiannis Panagiotis N. 
Published: February 2020

Objective To evaluate the technique of insertion, complication rates, and survival rates of Toronto-Western Hospital (TWH) peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods A total of 222 TWH catheters were inserted into 203 CAPD patients (113 males and 90 females) with end-stage chronic renal failure during a period of 14 years (1 January 1982 to 31 August 1995). The mean age of the patients was 58.5 years (range 18 86 years). For the first 6 years, the peritoneal cavity approach was performed via a lower midline incision (45 insertions), various other approaches (17 insertions), and, finally, for the last 160 insertions (for approximately 8 years) the transverse paraumbilical incision was exclusively employed. The duration of CAPD ranged between 1 to 151 months (mean time 33.2 months). Results Regarding early and late complications (namely leakages, obstructions, eviscerations, tunnel infections, herniation, and others), as well as catheter survival, the transverse paraumbilical insertion, compared to other approaches, had the smallest number of complications. Thus, early leakage occurred in 5/222 (2.25%) versus 10/222 (4.5%), obstruction nil versus 2/222 (0.9%), and evisceration nil versus 1/222 (0.45%). In addition, as far as the late complications are concerned: tunnel infections 5/222 (2.22%) versus 13/222 (5.85%), herniations 1/222 (0.45%) versus 16/222 (7.3%), and cuff protrusion nil versus 7/222 (3.1 %). Finally, overall peritonitis occurred with a rate of one episode every 21.2 months. Actuarial survival for 1 and 3 years was 75% and 37%, respectively. Conclusions The transverse paraumbilical incision seems to be the most advantageous approach in inserting (by “surgical method”) the TWH catheters. We found it to be a safe, simple, versatile procedure, giving good results in all parameters concerned.
1996 Peritoneal Dialysis Core Indicators Study: Report on Nutritional Indicators
Authors: Flanigan Michael J. , Bailie George R. , Frankenfield Diane L. , Frederick Pamela R. , Prowant Barbara F. , Rocco Michael V. 
Published: February 2020

Objective The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996. Design and Patient Population The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996. Outcome Measures Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status. Results The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/V urea) and weekly creatinine clearance (wCrCI) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that “dialysis efficiency,” over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6 ± 20.0 kg and BMI = 27 ± 7), 47% of patients had an average serum albumin below “normal” (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day. Conclusions Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.
Nystatin Prophylaxis: Its Inability to Prevent Fungal Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Thodis Elias , Vas Stephen I. , Bargman Joanne M. , Singhal Manoj , Chu Maggie , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To evaluate the potential effectiveness of nystatin as prophylaxis for fungal peritonitis (FP) in patients on continuous ambulatory peritoneal dialysis (CAPD). Design This historically controlled study was designed to investigate the effectiveness of nystatin in the prevention of FP. For this purpose we compared the incidence of FP among 240 (new and prevalent) CAPD patients between January 1996 and November 1996 (period A) with its incidence in 240 new and prevalent CAPD patients in our program between January 1997 and November 1997 (period B) when nystatin prophylaxis was used. There were 2400 patient-months in each period. Nystatin (500000 IU four times per day), was given orally at the beginning of other antibiotic therapy (usually for peritonitis) and continued for 5 days after the end of the antibiotic therapy. Results During period A, 133 peritonitis episodes were recorded, and during period B, 99 episodes were recorded. Six episodes of FP were identified in over 2400 patient months of period A, and 12 in over 2400 patient-months of period B. This difference was not statistically significant. Three episodes of antibiotic-related FP were seen in period A, and four in period B. The remaining episodes arose de novo, that is, unrelated to the use of antibiotics. We observed no side effects for nystatin. Conclusion In CAPD patients the use of nystatin, a nonabsorbable antifungal agent, as prophylaxis in every instance of peritonitis or other indications for antibiotics, did not lower the incidence of fungal peritonitis.
Does a High Peritoneal Transport Rate Reflect a State of Chronic Inflammation?
Authors: Wang Tao , Heimbürger Olof , Cheng Hui-Hong , Bergström Jonas , Lindholm Bengt 
Published: February 2020

Objective It has recently been reported that a high peritoneal transport rate was associated with increased mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. One possible explanation is that a high peritoneal transport rate might be caused by a state of chronic inflammation, which also per se might result in increased mortality. Therefore, in this study we investigated whether high peritoneal transport rate patients are in a state of chronic inflammation. Methods The study included 39 clinically stable peritoneal dialysis patients (free of peritonitis) who had been on PD for more than 3 months (16.8 ± 11.8 months). Seven patients were treated with continuous cycling peritoneal dialysis (CCPD) and the others were on CAPD. A 4-hour standard peritoneal equilibration test (PET) using 2.27% glucose solution was performed in each patient. Dialysate samples at 4 hours and blood samples at 2 hours were measured for interleukin-1β (IL-β), tumor necrosis factoroc (TNFα), C-reactive protein (CRP), and hyaluronan as markers of inflammation. Results There was no significant correlation between dialysate/plasma (D/P) creatinine (0.82 ± 0.15, range 0.51 - 1.15) and blood concentrations of IL-1β (11.2 ng/L, range <5 - 65.9 ng/L), TNFα (12.1 ng/L, range <5 - 85.4 ng/L), CRP (<10 mg/L, range <10 - 76 mg/L), nor with the blood hyaluronan concentration (165 μg/L, range 55 - 955 μg/L). The dialysate concentrations of IL-1β and TNFα were below the detectable level in most of the samples. Although dialysate hyaluronan concentration (334 μg/L, range 89 - 1100 μg/L) was correlated with D/P creatinine ( r = 0.36, p < 0.05), there was no correlation between the total amount of hyaluronan in the effluent and D/P creatinine. However, a significant correlation was found between serum hyaluronan concentration and glomerular filtration rate (GFR) ( r = -0.49, p < 0.005); GFR also tended to be correlated with serum TNFα ( r = -0.31, p = 0.058) but not with serum IL-1β and serum CRP. Conclusion Our results suggest that a high peritoneal transport rate is not necessarily related to a state of chronic inflammation in CAPD patients. The high mortality rate observed in high transporters may relate to other issues, such as fluid balance or abnormal nutrition and metabolism, rather than to chronic inflammation.
Analysis of the Peritoneal Equilibration Test in Mexico and Factors Influencing the Peritoneal Transport Rate
Authors: Cueto-Manzano Alfonso M. , Díaz-Alvarenga Angel , Correa-Rotter Ricardo 
Published: February 2020

Objective To validate the peritoneal equilibration test (PET), establish reference values in the Mexican population, compare our results with those reported by Twardowski et al., and analyze the influence of some factors on the peritoneal transport rate (PTR). Design Retrospective, cross-sectional study. Patients Eighty-six PETs were performed in 45 female and 41 male patients; 35 of the patients were diabetics. Creatinine D/P and glucose D/D0 ratios were calculated and compared with those from Twardowski et al. In a multi-variate analysis, age, gender, diabetes mellitus (DM), time on dialysis, and peritonitis rate were considered as independent factors influencing the PTR. Results Creatinine D/P and glucose D/D0 ratios at 4 hours were not significantly different from those reported by Twardowski et al. Creatinine D/P at 4 hours was not different between DM and non-DM patients when the rate of peritonitis and time on dialysis were not taken into account. Multivariate analysis did not result in any significant model predicting the creatinine D/P at 4 hours. Conclusions PET validation is reported for the first time in a Latin American population. The PET results of this study are similar to those in the literature. We found that DM, peritonitis rate, time on dialysis, age, and gender did not clearly influence the PTR.