bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autopsy Findings in Patients Treated by Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Sombolos Kostas , McNamee Peter , Mitwalli Ahmed , Rabinovich Sol , Oreopoulos Dimitrios G. 
Published: February 2020

From October 1977 to October 1985, our pathology department did autopsies on 19 patients (14 men, five women) treated by CAPD for four to 55 (mean 29.3) months. Their mean age was 60.2 (range 28–79) years and the primary renal diseases were diabetes mellitus (eight), nephrosclerosis (five), polycystic kidneys (three), chronic glomerulonephritis (one) and chronic renal failure associated with sarcoidosis and congestive cardiomyopathy in two. During the same period, the authors selected as controls 18 autopsied patients (14 men, four women), who had not had chronic renal failure, and these were matched with the CAPD patients for age, sex, longstanding hypertension and insulin-dependent diabetes. Direct causes of death for CAPD patients were cardiovascular incidents (12) infection (5), pancreatitis (1) and lung cancer (1); in controls, the causes were cardiovascular in 11 and infection in two. Thirteen of the CAPD and 12 autopsied controls had coronary artery stenosis equal to or greater than 70%, and affecting one or more arteries. The mean weight of organs in CAPD patients and controls were similar except for kidneys and the spleen; we found the latter weighed more in those on CAPD (p = 0.002). In CAPD patients the most important organ changes were: evidence of myocardial infarction, old or acute, in nine, acquired cystic disease of the kidney in five, and thickening and adhesions of peritoneum in nine and five respectively.
Exaggerated Protein Loss Complicating Sterile Peritonitis Results from Increased Diffusion
Authors: Hirszel Przemyslaw , Chakrabarti Eva , Maher John F. 
Published: February 2020

To assess the mechanism of protein loss during chemical peritonitis, dialyses with sodium desoxycholate added to the instilled solution were compared to controls in rabbits. Sodium desoxycholate caused an inflammatory reaction characterized by increased protein loss, leukocyte exudation, decreased ultrafiltration and increased clearance of solutes including neutral dextrans. It is suggested that increased protein loss accompanying peritonitis which is due to increased diffusion through capillaries unrelated to effects of membrane anionic charge. Exaggerated protein loss is a recognized sequel of the peritonitis that complicates peritoneal dialysis (I, 2). Such excessive protein loss can contribute to malnutrition, impeding recovery from infection. It has been assumed that the augmented protein loss is due to increased diffusion but this has not been verified. Secretion from inflammed cells adjacent to the peritoneum could account for increased protein loss. Enhanced transfer of plasma proteins across the capillary wall may be due to an overall increase in permeability following capillary dilation which stretches pores, or alternatively it might represent a loss of the anionic charges, which line the pores and retard transport of anionic macromolecules. Previously the transfer rate of polydispersed dextrans from plasma to peritoneal dialysate has been used to assess peritoneal porosity, presumably reflecting capillary-wall permeability (3). The transfer of neutral dextrans should not be inhibited by the fixed anionic charges of the capillary wall interstices. Moreover, these carbohydrates would not be secreted by injured cells; their distribution is extracellular. An increased rate of transfer from plasma to peritoneal dialysate should indicate enhanced diffusion, when there is no increase in convective transport accompanying ultrafiltration. Sodium desoxycholate, the solvent used with amphotericin B, is an irritant that has been shown to induce a sterile peritonitis characterized by dialysate leukocytosis, increased diffusion of small solutes such as urea, and decreased ultrafiltration, owing to the loss of the glucose-induced osmotic gradient (4). These studies were designed to determine whether sodium desoxycholate would increase the peritoneal transfer rate of neutral dextrans from plasma to dialysate. The higher rate of dextran transfer observed with this agent is interpreted to support the hypothesis that proteins, lost excessively during peritonitis, derive from plasma.
Improvement of Iron Utilization and Anemia in Uremic Patients Switched from Hemodialysis to Continuous Ambulatory Peritoneal Dialysis
Authors: Movilli Ezio , Natale Carlo , Cancarini Giovanni Carlo , Maiorca Rosario 
Published: February 2020

Serum ferritin, hematocrit (Ht) and hemoglobin (Hb) were studied in seven patients treated with hemodialysis (HD) who later switched to continuous ambulatory peritoneal dialysis (CAPD). No iron supplements were given during the study. During the whole observation period (12 months on HD and 12 months on CAPD), there was a progressive decrease in serum ferritin during HD, accompanied by a progressive drop in Hb and Ht; on the contrary, on CAPD, Hb and Ht showed a sharp increase despite further ferritin reduction. The CAPD ferritin drop was not due to peritoneal loss of iron or ferritin, which appeared negligible. We propose that the increase in both Ht and Hb in CAPD is due to the removal of toxic factor(s) inhibiting erythropoiesis, which allow(s) increased iron utilization, and consequently a reduction in serum-ferritin levels. Anemia of chronic renal failure is a complex event to which many factors may contribute -reduced erythrocyte survival, hemolysis, iron losses from gastrointestinal leakage, reduced erythropoiesis, presence of inhibitors of erythropoiesis (1).
Renaissance of Tuberculosis in the 19905: Lessons for the Nephrologist
Authors: Vas Stephen I. 
Published: February 2020

Objective To call attention to the worldwide increase in tuberculosis and to review the disease in peritoneal dialysis patients. Data Sources Recent epidemiological publications. Data Extraction Epidemiological data summarized in tables and diagnostic and therapeutic recommendations reviewed. Conclusions Tuberculosis is on the rise worldwide. Multiple drug-resistant strains are emerging, causing therapeutic problems. The role of atypical mycobacterial infections in continuous ambulatory peritoneal dialysis (CAPD) is reviewed. Early diagnosis of cases and thorough chemotherapy are advocated.
A Randomized Prospective Study of the Cost -Effectiveness of the Conventional Spike, O-Set, and Uvxd Techniques in Continuous Ambulatory Peritoneal Dialysis
Authors: Cheng Ignatius K.P. , Chan Ching-Ying , Cheng Suk-Wai , Poon Joana F.M. , Ji Yu-Lian , Lo Wai-Kei , Chan Daniel T.M. 
Published: February 2020

Objective To compare the clinical outcome and cost-effectiveness of three techniques for continuous ambulatory peritoneal dialysis (CAPD): the conventional spike technique (C), the O-set (0), and UVXD (U, ultraviolet irradiation connection box). Design A randomized and prospective comparison of three CAPD techniques. Setting A tertiary referral and a satellite dialysis center.. Patients: One hundred patients with end-stage renal failure between 10 and 70 years of age, with good handeye coordination and not anticipated to receive a living related transplant within 6 months. Interventions Patients were randomized by referral to a table of random numbers to perform one of the three CAPD techniques. Main Outcome Measures Training time, details of peritonitis and exit-site infection (ESI) including the costs of antibiotic treatment, outpatient visits, hospital stays, technique, and patient survival were analyzed after a minimum follow-up period of one year. Results There were 38, 31, and 31 patients in groups C, 0, and U, respectively, and the total observation periods were 838,802, and 745 patient-months, respectively. The peritonitis rates for C, 0, and U were 21.5, 30.8, and 29.8 patient-months/episode, respectively. The corresponding ESI rates were 16.4,14.9, and 24 patient-months/ episode, respectively. When the time from the commencement of CAPD to the first infection was expressed using the Kaplan-Meier life table analysis, 39.5%, 67.7%, and 61.3% of patients in Groups C, 0, and U were free from peritonitis at one year (p = 0.088). The corresponding figures for ESI were 52.6%, 48.4%, and 61.3% (p = 0.35). There was no significant difference in technique survival in the three treatment groups. An analysis of the costs related to the use of antibiotics, outpatient visits, and hospital stays necessary for the treatment of peritonitis and ESI and those related to training time, additional equipment, and consumables required for the three CAPD techniques showed that, overall, the cost in 0 was the lowest, followed by U and C (U.S. $158, $170, and $179 per patient-month, respectively). Conclusion It was concluded that the O-set is a more cost-effective CAPD technique than UVXD, while both are more cost-effective than the conventional spike technique.
Cell Populations Present in the Nocturnal Peritoneal Effluent of Patients on Continuous Ambulatory Peritoneal Dialysis and Their Relationship with Peritoneal Function and Incidence of Peritonitis
Authors: De Castro Mercedes Fernandez , Selgas Rafael , Jimenez Carlos , Baja Maria Auxiliadora , Martinez Victoria , Romero Jose Ramon , De Alvaro Fernando , Vara Francisco 
Published: February 2020

Objective To study the relationship between peritoneal effluent cells and infection rate and to relate this population with functional characteristics. Design Prospective, longitudinal, and comparative study. Setting Outpatient continuous ambulatory peritoneal dialysis (CAPD) unit of a university medical center. Participants Seventy-one uninfected patients, treated for 0-156 months on CAPD, in stable condition were studied (33 female, 38 male). Interventions Nocturnal peritoneal effluent (NPE) was drained with EDT A (2.5 mmol/L) at 37°C and centrifuged at 2500 rpm for 9 minutes. Measurements Accumulated peritoneal inflammation days/year and ultrafiltration/diffusion (mass transfer coefficients (MTCs) for small molecules) capacities were recorded. Cellular count (cells/night) was performed using a Neubauer chamber. Macrophage function was assessed by cytochemical (lysosomal enzyme content: ANAE, beta-glucuronidase, acid phosphatase) and immunohistochemical procedures (expression of membrane antigens, CD4, 11b, 11c, 14,16,25,35, and 71). Results The macrophage is the most frequently appearing cell in the NPE. Cell count decreases over time on CAPD (from 20 x 106 to 5 x 106 after the first year). Intrapatient variability was low, but interpatient differences were marked. Mesothelial cell count remained stable over time (0.25 0.5 x 106). Four of our patients showed a “transforming” change in these cells. Previous incidence of peritonitis and values of functional measurements did not correlate with cell count or expressions of macrophage function (lysosome enzyme content and percentage of cells expressing different membrane antigens). Conclusion There is difficulty interpreting the results on peritoneal effluent cells and their relationship with the incidence of peritonitis and functional characteristics of the peritoneum. No definite conclusions can be drawn other than the great interpatient and intrapatient variability. The presence of abnormal peritoneal cells with undetermined origin and function suggests the need for periodic studies of peritoneal effluent cells on long-term CAPD patients.
History, Chemical, and Pharmaceutical Development of Icodextrin
Authors: Alsop R. Michael 
Published: February 2020

Pharmaceutical formulations employing glucose as the osmotic agent in continuous ambulatory peritoneal dialysis (CAPD) have been available in the United Kingdom for some 15 years. They do, however, exhibit certain disadvantages related to the absorption of glucose through the peritoneum which have been well characterized. The development of possible alternatives such as dextran, amino acids, and glycerol is briefly reviewed. No commercially available products have emerged from this work. The use of a starch-based polyglucose as an alternative osmotic agent has also been the subject of clinical trials both in the United States and the United Kingdom. In the United States a narrow fraction low molecular weight product [molecular weight (MW) 1000 dalton] was extensively examined in dogs and patients. Disadvantages with high carbohydrate transference to the serum appear to have precluded its further development. In the United Kingdom a wider fraction based on an existing oral product, Caloreen, was first examined. This product had a bimodal MW distribution containing a fraction of MW 1000 dalton and another of MW 20000 dalton. These overlapping fractions were separated and the two component parts examined clinically. Surprisingly, the higher MW fraction showed most promise. The low MW fraction, virtually identical to the U.S. material, was rejected for the same reasons. The high MW material was purified, the critical aspects of its molecular size defined by the development of improved size exclusion chromatography techniques, and a new membrane manufacturing process established. The products made were extensively tested for toxicity and further examined clinically. A final product was selected and its specification defined. A multicenter clinical trial of the product, icodextrin, was conducted with excellent results. The importance of product control, especially with respect to MW, and the mode in which the osmotic effect occurs between virtually iso-osmolar solutions (colloidal osmosis) is emphasized. The development pharmacy and chemistry necessary to obtain a U.K. product license, now granted, is described.
Protein Clearance and Icodextrin
Authors: Krediet Raymond T. , Brown Colin B. , Imholz Alexander L.T. , Koomen Gerardus C.M. 
Published: February 2020

Objective To analyze the peritoneal transport of serum proteins during continuous ambulatory peritoneal dialysis (CAPD) with icodextrin. Design A comparison was made between CAPD with glucose-based dialysate and, in the same patients, 4 weeks after the instillation of icodextrin for the long night dwell, with icodextrin-based dialysate. Patients Ten stable CAPD patients, who participated in a large randomized multicenter study comparing icodextrin with glucose-based dialysate. Five patients used glucose 1.5% dialysate for the night dwell before its replacement by icodextrin (good ultrafiltration group), and 5 used glucose 4.25% (poor ultrafiltration group). Results The clearance of β2-microglobulin increased by 28% on icodextrin, due to increased convective transport. The clearances of the larger proteins -albumin, IgG, fibronectin, and α2-macroglobulin -remained unaltered, indicating transport of these proteins across the large pore system. The patients with poor ultrafiltration had a higher β2-microglobulin clearance on glucosebased dialysate than the high ultrafiltration group. This indicates that the ultrafiltration failure was caused by a large effective peritoneal surface area, leading to a rapid absorption of glucose. Icodextrin produced significantly more ultrafiltration in the poor ultrafiltration patients than in the high ultrafiltration group. A correlation was found for the β2-microglobulin clearance on glucose-based dialysate and the ultrafiltration produced by icodextrin. Conclusions Icodextrin causes ultrafiltration through the small pore system, whereas glucose-based dialysate has its effect on transcellular water transport. Therefore, the use of icodextrin causes an increased clearance of β2 microglobulin, but not of larger proteins. Icodextrin was especially useful in patients with a large effective surface area leading to ultrafiltration failure during treatment with glucose-based dialysate.
Clinical Experience with Icodextrin in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Stein Andrew , Peers Elizabeth , Hattersley Jane , Harris Kevin , Feehally John , Walls John ,   The MIDAS Study Group, Brown C.B. , Nichols N. , Mistry C.D. , Ashman R. , Raftery M. , Peters J. , Gokal R. 
Published: February 2020

Objectives To review the clinical experience in the United Kingdom with icodextrin (Ic). Design A retrospective multicenter study. Patients (1) the MICAS 1 patients who received Ic and elected to continue using it (called MICAS 2 patients), and (2) patients started on Ic on a named-patient basis (called compassionate use patients). Nearly all this latter group had ultrafiltration (UF) failure and were approaching hemodialysis (HC). Interventions The institution of one Ic bag, as the overnight exchange, usually in addition to three glucose bags. Results (1) MICAS 2: Of the 67 patients who received Ic and completed MICAS 1, 48 (72%) patients from eight units in the United Kingdom wished to continue Ic. Forty two percent of MICAS 2 patients were well on Ic after approximately 30 months of study (including the 6 months on MICAS 1). The main reasons for withdrawal were transplantation (21 %), death (17%), or transfer to HC for reasons other than UF failure (10%). There were no significant changes in laboratory data, including hematology, simple biochemistry, bone biochemistry, liver function tests, serum osmolality, and maltose levels. The adverse events reported were incidental to Ic. (2) Compassionate use: 30/63 (48%) patients remain well on Ic after 10 months of study. Eight patients (12%) went on to experience UF failure (again) after 13 months on Ic, requiring transfer to HC. The other main outcomes were death (11 %), transplantation (11 %), or transfer to HC for reasons unrelated to Ic (16%), usually intractable peritonitis. The serum sodium concentration decreased from 136.6±3.8 to 134.4±4.2 mmol/L (p < 0.05). There were no other significant changes in hematology or biochemistry measurements. Conclusion In MICAS 2 Ic probably maintained its effects, since there were no withdrawals due to UF failure. The compassionate use program has shown that a single Ic exchange is useful in UF failure, being able to prevent or delay transfer to hemodialysis. In both studies the safety and efficacy of Ic has been demonstrated in a large group of patients. A total of 192 patient-years of experience (including MICAS 1) has been accumulated to date. Properly controlled studies are needed to determine whether Ic, in its present form, should remain a “special needs” product (for UF failure) or whether it could replace glucose as the treatment of choice for CAPC patients.
Serum Advanced Glycosylation End-Products in Patients on Hemodialysis and CAPD
Authors: Ateshkadi Arasb , Johnson Curtis A. , Founds Henry W. , Zimmerman Stephen W. 
Published: February 2020

Objectives Part I: To evaluate the long-term effects of daily glucose absorption from the peritoneal dialysis fluid on the formation of low-molecular-weight advanced glycosylation end products (AGE-peptides) in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Part II: To determine the acute effect of CAPD on serum AGE-peptide concentrations. Design Part I: Noninterventional, parallel, cross-sectional clinical trial. Part II: Crossover clinical trial. Setting A university-based hospital, and clinics. Patients Part I: Sixty nondiabetic subjects recruited into three age-matched (:1:5 years) groups, as follows: 20 healthy volunteers (controls); 20 hemodialysis patients; and 20 CAPD patients. Part II: Eight patients with diabetes mellitus (type lor II) and chronic renal failure who were about to undergo CAPD. Intervention Part I: None. Part II: Uninterrupted CAPD, as medically required. Measurements Part I: To determine serum AGEpeptide concentrations blood samples were obtained randomly from controls and CAPD patients, and predialysis from hemodialysis patients. Hemoglobin A1c was also measured in all subjects. Part II: To determine serum AGE-peptide concentrations, blood samples were collected within one month prior to initiation of CAPD (predialysis) and, again, one week after initiation of uninterrupted CAPD (postdialysis). Hemoglobin A1c was measured predialysis. Results Part I: Mean hemoglobin A1c values for all groups were within the normal range; however, the mean value for CAPD patients was significantly higher than for both hemodialysis patients and healthy controls (controls, 5.21%:1:0.6%; hemodialysis, 5.12%:1:0.5%; CAPD, 5.78%:1:0.6%; p < 0.01). The dialysis patients had a significantly higher mean serum AGE-peptide concentration than the control subjects (controls, 7.02:1:3.4 units/mL; hemodialysis, 11.9:1:3.6 units/mL; CAPD, 11.1:1:4.5 units/mL; p < 0.01). There was no difference in the mean serum AGE-peptide concentration of patients in the hemodialysis and CAPD groups. Part II: The mean hemoglobin A1c value in the diabetic predialysis patients was 9.2%:1:1.9%. There was no difference between the predialysis and postdialysis serum AGE-peptide concentrations (predialysis, 16.9:1:9.6 units/mL; postdialysis, 16.0:1:2.9 units/mL; p = 0.78). Conclusions Despite the increased glucose load and the higher hemoglobin A1c values, indicating poor glycemic control, nondiabetic CAPD patients did not have higher serum AGEpeptide concentrations than the nondiabetic hemodialysis patients. In diabetic patients, CAPD did not further increase the serum concentrations of AGEpeptides.
Expected White Blood Cell Counts and Differentials in a Rat Model of Peritoneal Dialysis
Authors: Suzuki Kazuyuki , Khanna Ramesh , Nolph Karl D. , Twardowski Zbylut J. , Moore Harold L. 
Published: February 2020

Objective The purpose of this study was to establish baseline dialysate white blood cell (WBC) counts and differentials in noninfected rats on peritoneal dialysis (PO). Design Sixteen male Sprague-Oawley rats underwent PO in the first protocol, and eight from the 16 continued PO in the second through fourth protocols. At the beginning of the experiments, all animals had a PO catheter implanted and were initiated on PO with 1.5% dextrose dialysis solution twice daily. In the first protocol, WBC counts and differentials were assessed from day 4 to day 15 of dialysis in noninfected animals to establish “normal values” for such a rat model. In protocol 2, WBC counts and solute concentrations in small aliquots of dialysate obtained from the catheter were compared to values in well-mixed total drainage. Protocol 3 was designed to assess effects of dwell time on WBC counts. Protocol 4 examined the effect of glucose concentration of dialysis solution on WBC counts. Results In the first protocol, the mean dialysate WBC counts were significantly higher on the fourth day of dialysis, but stabilized below 2500 cells/mm3 by the eighth day. The percentage of neutrophils was stable around 20% -25%. In the second protocol, we found aliquots < 1 mL might underestimate the dialysate WBC count compared to the complete drainage. In the third protocol, WBC counts increased as cycle time became longer, but the percentage of neutrophils remained below 50%. In the fourth protocol, we did not find any effects of glucose concentration of instilled solutions on WBC counts and differentials. Conclusion This study of WBC counts and differentials in noninfected rats on peritoneal dialysis establishes the range above which infection should be suspected. WBC counts increase with cycle time. Small dialysate aliquots may underestimate WBC counts. Glucose concentration does not effect WBC counts.