bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polymers as Osmotic Agents for Peritoneal Dialysis
Authors: Twardowski Zbylut J. , Moore Harold L. , McGary Terry J. , Poskuta Mira , Stathakis Charalambos , Hirszel Przemyslaw 
Published: February 2020

A sustained ultrafiltration during long-dwell peritoneal dialysis exchanges cannot be obtained with rapidly absorbable small molecular weight osmotic agents. Slowly absorbable synthetic poly ions tested on rats and rabbits yielded high and sustained ultrafiltration, but were toxic. Gelatin solutions were not toxic in acute rat studies and produced sustained ultrafiltration but were difficult to work with because of gelation. A review of the literature on the properties of gelatin derivatives, used as plasma substitutes, led us to believe that they may be also useful as osmotic agents in the peritoneal dialysis solutions. In the peritoneal dialysis system, hydrostatic pressure in the blood compartment cannot be readily manipulated. Therefore, traditionally a solute (osmotic agent) is added to the peritoneal dialysis solution to create an osmotic driving force. During the process of ultrafiltration (Figure I), the rate of ultrafiltration decreases with time due to dilution by ultrafiltrate and absorption of the osmotic agent. Thus, ultrafiltration will eventually cease after the dialysis solution is infused. The bigger the molecule of the osmotic agent, the longer ultrafiltration lasts because solute absorption through the peritoneal membrane is slower. Thus, to achieve sustained ultrafiltration, an osmotic agent with a bigger molecule would be more advantageous than the smaller one at comparable osmotic gradients.
Nutritional Problems in Continuous Ambulatory Peritoneal Dialysis
Authors: Flynn Margaret A. 
Published: February 2020

There are difficulties in ohtaining trustworthy information about nutritional status. Methods of assessment must be very specific and sensitive. Today's traditional anthropometric and biochemical standards should be re-evaluated. Reliability of plasma proteins as indicators of protein status is suspect. There is need to review contents of food composition tables used in computing nutrients in diets. Diet therapy for uremic patients using CAPD has similar problems encountered by pioneers who originated total parenteral nutrition. Patients in chronic renal failure who use continuous ambulatory peritoneal dialysis may have a number of nutritional and metabolic problems: glucose intolerance, loss of amino acids in dialysate leading to possible protein depletion, decreased energy intake, hypertriglyceridemia, astro dystrophy, anemia, anorexia, hypocalemia, nausea, constipation. Nephrologists, like other clinicians and researchers who have accepted nutritional care as a required therapy for rehabilitation or management of sick people, have adopted some generally accepted methodologies for assessment of the nutritional status of these individuals. They include diet assessment, biochemical indices, anthropometric measurements and more elegant documentation of body composition.
A Randomized Multicenter Clinical Trial to Evaluate the Effects of An Ultraviolet Germicidal System on Peritonitis Rate in Continuous Ambulatory Peritoneal Dialysis
Authors:   A Multicenter Study Group, Nolph K.D. 
Published: February 2020

In continuous ambulatory peritoneal dialysis (CAPD), peritonitis frequently is assumed to result from spike contamination during bag exchanges. An ultraviolet germicidal chamber has been developed, which disinfects the spike and the solution-bag outlet before spike insertion. This report summarizes the results of a multicenter trial carried out to determine if this device reduces the incidence of peritonitis in patients on CAPD. Ten centers contributed 167 patients who were followed during a base-line historical control period for a minimum of four months. Thereafter, 93 patients were randomized to a control group, and 74 to the test group. After an interim period for retraining (both groups) and change over (test group), a trial period of nine months was undertaken. Peritonitis rates and actuarial analyses of time-to-peritonitis showed no significant differences between historical and trial periods in either group, or between groups during either period. In both groups, rates of peritonitis were consistently lower than rates reported in the National Registry. The results suggest that, in the patients participating in these studies, spike contamination may have been an infrequent cause of peritonitis. In the U.S.A. over 9000 patients with end-stage renal disease are maintained on continuous ambulatory peritoneal dialysis (CAPD) (I). A peritonitis rate of 1.6 episodes per patient year represents the national average in the latest report of the U.S.A. CAPD Registry (2). Most clinicians assume that spike contaminations during bag exchanges are responsible for some portion of these episodes. Popovich, Moncrief and colleagues have described preliminary experiences with an ultraviolet germicidal system shown to disinfect intraspike contaminations with solutions containing 200,000 organisms per ml (3–4). An integrated dose of ultraviolet light within the germicidal chamber kills microorganisms before spike insertion into a fresh bag of solution. An improved chamber has been made available for clinical trials by Travenol Laboratories Inc (Deerfield, Illinois) (5). This study summarizes the results of a multicenter trial designed to test the effects of this germicidal chamber on the frequency of peritonitis in a population of patients maintained on CAPD.
Effect of Peritoneal Dialysis and a Single Hemodialysis on Erythrocyte Membrane Atpase Activity of Uremic Subjects
Authors: Hakan Ozdogu , Ali Gurcay , Tevfik Akoglu , Emel Akoglu 
Published: February 2020

In this study erythrocytic A TPase activities were studied in 21 patients before and after six hours of hemodialysis. In another group of 20 patients A TPase activities were also studied before and after 48 72 hours of peritoneal dialysis. As a control group 20 healthy normal subjects were used. Comparison of the results revealed that all three (Na+/k+, Mg++, Ca++/Mg++) ATPase activities were lower in the chronic renal failure patients than normal controls (p < 0.001). Both peritoneal and hemodialysis increased significantly all three A TPase activities. When peritoneal and hemodialysis results were compared no significant difference was noted. It is concluded that the increase in A TPase activites observed by both dialysis methods is due to removal from the plasma of substances which are responsible for the decrease in A TPase activities before dialysis. In uremia numerous substances alone or together have been held responsible for various clinical findings. In addition some other metabolic wastes of unknown structure act upon important enzyme systems resulting to an altered cellular function. A TPase enzymes are a group of enzymes responsible for the maintenance of the ionic and osmotic balance of the cells. In this study we studied the status of these enzymes in ESRD patients undergoing dialysis and also the acute effect of peritoneal dialysis and hemodialysis on them.
Recurrent, Fatal Hemophilus Influenzae Sepsis in a Splenectomized Child on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Cohn Richard A. , Nevins Thomas E. , Moel Donald I. 
Published: February 2020

This child, who was on CAPD, had two episodes of Hemophilus influenzae sepsis, the second of which proved fatal. Predisposing factors were prior splenectomy, recent immunosuppression and cytomegalovirus infection. Peritonitis was not present. Nephrologists must consider various risk factors when caring for the increasing number of young children on CAPD, particularly those who are splenectomized. In some renal transplant recipients splenectomy has been advocated in an effort to improve graft survival (I). The procedure entails both perioperative risk and long-term complications, most notably bacterial sepsis. The risk of overwhelming, post splenectomy infection (OPSI) is higher in young children (2) and may be further increased in patients with end-stage renal disease. We report a fatal case of recurrent Hemophilus influenzae (H. flu) septicemia in a splenectomized child receiving continuous ambulatory peritoneal dialysis (CAPD). In the absence of an available, effective vaccine to prevent hemophilus infections in children, our experience with this child suggests that prophylactic antibiotics should be given to reduce the risk of OPSI in susceptible individuals.
Allergic Eosinophilic Dermatitis Due to Silicone Rubber: A Rare but Troublesome Complication of the Tenckhoff Catheter
Authors: Kurihara Satoshi , Tani Yoshio , Tateishi Keita , Yuri Takehisa , Kitada Hirohisa , Sugishita Naoyasu , Fukuda Yoshihiro , Ishikawa Isao , Shinoda Akira , Hayakawa Yukinori 
Published: February 2020

A 42-year-old Japanese woman developed an eczematous skin rash around the catheter exit during continuous ambulatory peritoneal dialysis (CAPD). The same kind of lesion developed around a Scribner shunt exit. Skin biopsy indicated chronic eosinophilic dermatitis. In the patch test she developed an allergic reaction to the silicone rubber catheter but not to the antiseptic solutions. Based on these findings, we concluded that her “eczematous” rash represented an allergic response to silicone rubber in the peritoneal catheter. To this date the literature contains no reports of such a catheter complication in CAPD. Catheter complications in patients on CAPD are mainly infection and mechanical dysfunction such as poor drainage or leaks (I, 2). Eosinophilic dermatitis around the catheter exit caused by the silicone rubber is extremely uncommon (3). As yet no reports have been published concerning this rare catheter complication.
Treatment of Fungal Peritonitis in CAPO Patients Using Peritoneal Lavage
Authors: Keogh J.A. Brian , Carr Michael E. , Murray Frank , McEvoy Marian , Grant Gabrielle , Keane Conor T. 
Published: February 2020

This paper describes four CAPD patients with fungal peritonitis. The causative fungi were Candida albicans (twice), C. tropicalis and Cryptococcus neoformans. The infections were managed using the following regimen: 1 Removal of the Tenckhoff catheter. 2 Insertion of a temporary peritoneal catheter and commencement of peritoneal lavage, and administration of intraperitoneal miconazole and oral ketoconazole. 3 Insertion of a new Tenckhoff catheter after resolution of the peritonitis. Three of these patients recovered. We believe that it helps to remove the Tenckhoff catheter early and that, with our regimen, we can manage fungal peritonitis without suspending peritoneal dialysis. It appears that a combination of intraperitoneal miconazole and oral ketoconazole constitutes an effective antifungal therapy in CAPD peritonitis.
Surface-Active Material in Peritoneal Effluent of CAPD Patients
Authors: Grahame Gordon R. , Torchia Mark G. , Dankewich Katherine A. , Ferguson Ian A. 
Published: February 2020

The dialysis effluent of patients on continuous ambulatory peritoneal dialysis contains a surface-active material (SAM). This is composed of phospholipids; on thin-layer chromatography, this appears to be mainly phosphatidylcholine. Similar to the material described by Hills on the pleural surfaces of dogs (4), this SAM markedly reduces surface tension and promotes water repellency. The authors postulate that it may playa role in ultrafiltration and in the prevention of infection in CAPD patients. In the 10 years since its introduction, continuous ambulatory peritoneal dialysis (CAPD) has come into increased use to treat patients with chronic renal failure. Two problems stand in the way of the success of CAPD: infection of the peritoneum, and loss of ‘ultrafiltration’ -partitioning of water between the peritoneal cavity and the extracellular space (1, 2). The peritoneal membrane has not been studied extensively and we have a limited understanding of the exchange or non-exchange of water and other materials at this surface (3). Hills and co-workers (4) who demonstrated surface-active material (SAM) in washings of the pleural space of dogs have shown that biological SAM's, in addition to lowering surface tension, can lubricate a membrane as a boundary or adherent-type lubricant (4) and can confer water repellency to the surface (5,6). The present preliminary study was undertaken to determine whether the effluent dialysate of patients undergoing CAPD contained a similar surfaceactive material -a finding that would imply its presence on the peritoneal membrane. Secondly, if the dialysate contained SAM, whether that presence might be correlated with successful or complicated CAPD.
Long Term Continuous Ambulatory Peritoneal Dialysis
Authors: Gilmour Janet , Wu George , Khanna Ramesh , Schilling Holger , Mitwalli Ahmed , Oreopoulos Dimitrios G. 
Published: February 2020

After five years on CAPD, 10 patients continued to enjoy a good sense of well being and a reasonable quality of life. More women than men survive on CAPD. After 60 months or more of CAPD, the peritoneal membrane continues to function efficiently, both with regards to dialysis of solutes and ultrafiltration of water. Long-term CAPD patients are at risk of developing vitamin B12 deficiency and should receive regular supplements of this vitamin before clinical manifestations develop. Dally administration of I mg of folic acid gives adequate replacement of such losses during peritoneal dialysis. In spite of vitamin D supplementation and phosphate binders, osteitis fibrosa persisted in these patients and they suffered a gradual loss of bone mineral mass. More frequent use of calcium carbonate as phosphate binder and calcium supplement may minimize this complication. Hypertension is well controlled after initiation of CAPD, but recurs after four to five years of this treatment. We conclude that long term CAPD is feasible and that, with reduction in drop-out rates, more patients will remain on this treatment for long periods.
pH Equilibration with Acetate and Lactate Solutions during Peritoneal Dialysis
Authors: Cullom Edward T. , Moore Harold L. , Nolph Karl D. , Keller Rebecca S. 
Published: February 2020

Commercial dialysis solutions contain acetate or lactate and have pH values usually below 6.5. Losses of ultrafiltration in CAPD have been more frequent with acetate than with lactate solutions. It has been suggested that a slower increase of pH following intraperitoneal instillation of acetate solutions may produce alterations in membrane function. We compared intraperitoneal equilibration of pH in rats with acetate and lactate solutions. In our rat model pH equilibration rates were similar for acetate and lactate solutions. Commercial peritoneal dialysis solutions contain glucose as an osmotic agent and acetate or lactate as a buffer (1,2). The pH is adjusted to below 6.0 to prevent glucose caramelization during heat sterilization (3). Acetate and lactate are absorbed during peritoneal dialysis and, when metabolized generate bicarbonate (2). Bicarbonate itself is not used in commercial solutions because these solutions also contain calcium and calcium bicarbonate is unstable in solution on storage. Many workers (4–8) have observed that patients on continuous ambulatory peritoneal dialysis (CAPD) with solutions containing acetate suffer losses of ultrafiltration over time. Also encapsulating sclerosing peritonitis is seen more often in association with acetate solutions (9–11). Pedersen et al (12) fear that prolonged exposure to a low pH may irritate the peritoneal membrane and that, during peritoneal dialysis cycles with acetate as the buffer, the pH in the intraperitoneal solution increases more slowly. These studies were undertaken to determine whether, during peritoneal dialysis exchanges, acetate and lactate solutions had the same rate of change of pH.
Reduplicated Basal Lamina of Small Venules and Mesothelium of Human Parietal Peritoneum: Ultrastructural Changes of Reduplicated Peritoneal Basement Membrane
Authors: Gotloib Lazaro , Bar-Sella Pnina , Shostak Abshalom 
Published: February 2020

We examined under the electron microscope samples of parietal peritoneum obtained from nine nondiabetic chronic uremics -six of them on maintenance intermittent peritoneal dialysis, ranging in age from 52 to 82 years -mean 64.4 ± 8.1 years and of nine non-uremic, non-diabetic patients -mean age 40.7 ± 12.2 years. Postcapillary venules and small venules showed areas with several layers of reduplicated basal lamina. Some microvessels showed gaps in basallamina with and/or without focal reduplication. Reduplicated submesothelial basal lamina was found in only one patient. These changes were not observed in the nine non-uremic, non-diabetic controls. To the best of our knowledge, this is the first description in humans of such alterations in the aforementioned locations, which may well be secondary to aging and/or to the intense mesothelial renewal observed in I.P.D. patients. We need to determine the possible influence of these ultrastructural changes on transperitoneal transfer of water and solutes during peritoneal dialysis. The basal lamina of blood vessels may not be of uniform thickness. Human non-diabetic adults show significant increase in capillary basal lamina thickness as one moves from head to foot (1). Those regional variations may be related to differences in venous hydrostatic pressure effective on the capillary bed (1). This paper decribes the first observations of reduplicated basal lamina of microvessels in the parietal peritoneum and of that subjacent to mesothelial cells in elderly, non-diabetic uremic patients.
The Need for a “Swan Neck” Permanentl Y Bent, Arcuate Peritoneal Dialysis Catheter
Authors: Twardowski Zbylut J. , Nolph Karl D. , Khanna Ramesh , Prowant Barbara F. , Ryan Leonor P. , Nichols W. Kirt 
Published: February 2020

In 1968 to ensure optimal function of a permanent catheter during periodic peritoneal dialysis, Tenckhoff recommended that a double-cuff catheter be inserted so that a slightly arcuate subcutaneous course would give the external and intraperitoneal segment a caudal direction. During the rapid growth of CAPD over the past five years, nephrologists generally have adapted the Tenckhoff's methods of catheter insertion but have encountered numerous complications. This paper describes a retrospective analysis of the complications associated with 83 peritoneal dialysis catheters functioned for 48,325 catheter days (132 catheter years) in 63 patients on continuous ambulatory peritoneal dialysis (CAPD) at our institution. Pericatheter leaks were seen only with midline insertions. Exit-site infections were significantly more resistant to treatment with singlecuff than with double-cuff catheters as assessed by the proportion of time that the exit-site is infected. If the subcutaneous tunnels were directed downward the infections were more responsive to treatment. Significantly more frequent catheter-tip migrations were observed with subcutaneous tunnel directed left and downward. Thus, our study supports Tenckhoff's observation that we can expect the lowest complication rate with double-cuff catheters with an arcuate tunnel, convex upwards. However, frequently this shape of tunnel is associated with external-cuff extrusions due to resilience of the straight catheter. To reconcile these conflicting requirements we recommend a new catheter permanently bent between the cuffs to eliminate one of the forces responsible for cuff extrusion. Such a catheter, named the swan-neck tunnel peritoneal dialysis catheter, should be inserted surgically through the belly of the rectus muscle.
Renal Transplantation in Children Undergoing Peritoneal Dialysis
Authors: Hymes Leonard C. , Warshaw Barry L. 
Published: February 2020

Between January 1980 and January 1986, 25 children undergoing peritoneal dialysis (CAPD or CCPD) received 29 renal allografts. Patient survival was 100% and graft survival at 12 and at 24 months was similar to that of transplant recipients who received hemodialysis or no dialysis before operation. In 28 of 29 cases, Tenckhoff catheters were left in situ. Eighteen children were treated for acute rejection while retaining their catheters. Fourteen patients required post -transplant dialysis using the in situ catheter because of rejection or cyclosporine nephrotoxicity. No child developed peritonitis during post-transplant CAPD or while being treated for rejection. Peritonitis developed in one child who had a catheter in situ but who did not require dialysis. We conclude that peritoneal dialysis does not incur unacceptable risks to pediatric transplant recipients. During operation, the dialysis catheter may be left in situ and, if necessary, it may be used for CAPD in the post -transplant period. Renal transplantation in peritoneal dialysis patients has not been extensively described in children. One report by Stefanidis et al (1) in children and others in the adult population (2–5) found acceptable results among such patients. However, several centers have reported an increased risk of complications after transplantation. including a high incidence of infection (6–8) and inferior allograft survival when compared to hemodialysis patients (9). The issue is important in children because both continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have become the major forms of renal replacement in many pediatric programs (10–16) including our own. Moreover, since it has been reported that peritonitis is seen with increased frequency among children on peritoneal dialysis (17), we might expect immunosuppression in this group to result in an increased number of infections. This paper describes our experience with children, who received a renal allograft, after undergoing peritoneal dialysis.
Studies on Ultrafiltration in Peritoneal Dialysis: Influence of Plasma Proteins and Capillary Blood Flow
Authors: Ronco Claudio , Brendolan Alessandra , Stefano Luisa Bragantini , Mariano Chiaramonte , Fabris Feriani Aldo , La Greca Giuseppe 
Published: February 2020

This study has evaluated the influence of peritoneal blood flow and plasma protein concentration on the peritoneal ultrafiltration rate. In vitro and in vivo experiments were done to assess the effective peritoneal capillary blood flow. Based on the assumption that one can compare the behavior of an hollow fiber hemofilter with the peritoneal dialysis system, we have compared the opera tional characteristics of the two systems. After demonstrating that there was filtration pressure equilibrium in the filter, the plasma protein concentration was measured in the venous site of the filter at different applied transmembrane pressures. The nomogram, so obtained, was used to calculate the plasma-protein concentration in the blood leaving the peritoneal capillary during exchanges with an established glucose concentration (and therefore at a given transmembrane pressure), and to calculate the filtration fraction. Once that fraction had been calculated, based on the value of the ultrafiltration rate, one can calculate the importance of the plasma flow and then the blood flow. In this study the filtration fraction ranged between 45 and 55% and the blood flow ranged between 21 and 27 ml/min. It was concluded that the blood flow may be very low and hence may limit ultrafiltration.