bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initiating Capd with a Regimen Low in Glucose and Glucose Degradation Products, with Icodextrin and Amino Acids (Nepp) is Safe and Efficacious
Authors: le Poole Caatje Y. , Welten Angelique G.A. , Weijmer Marcel C. , Valentijn Rob M. , Van Ittersum Frans J. , ter Wee Piet M. 
Published: February 2020

♦ Background The high levels of glucose, glucose degradation products (GDPs), and lactate buffer present in standard peritoneal dialysis (PD) solutions contribute to peritoneal damage, malnutrition, and dyslipidemia. Therefore, we studied the feasibility of a PD regimen as low as possible in glucose and GDPs. ♦ Methods In a prospective 30-week study, patients new to continuous ambulatory PD (CAPD) were randomized to either a standard PD regimen (SPD; 4 dwells glucose-/lactate-based) or a low glucose-GDP regimen (NEPP; 1 dwell amino acids, 1 dwell icodextrin, and two dwells bicarbonate/lactate-buffered glucose-based solution). ♦ Results Results obtained during a 30-week study period for 63 new CAPD patients (30 NEPP, 33 SPD) were analyzed. Intraperitoneal glucose load was lower in the NEPP group (111 ± 76 vs 159 ± 40 g/day at 30 weeks, p < 0.001). Dialysis efficacy, ultrafiltration, weight, blood pressure, and laboratory results were similar in the groups, whereas, in the NEPP group, cancer antigen 125 in dialysate effluents decreased less but dialysate-to-plasma ratios were slightly higher. ♦ Conclusion Short-term treatment of new CAPD patients with a PD regimen low in glucose and GDPs is feasible. Dialysis efficacy, ultrafiltration, and metabolic consequences are similar to those during a standard glucose-lactate-based regimen, whereas peritoneal transport seems slightly higher and preservation of mesothelial cell mass better during NEPP.
Clinical Epidemiology of Major Nontraditional Risk Factors in Peritoneal Dialysis Patients
Authors: Zoccali Carmine , Enia Giuseppe , Tripepi Giovanni , Panuccio Vincenzo , Mallamaci Francesca 
Published: February 2020

♦ Background End-stage renal disease (ESRD) is a situation with a cardiovascular (CV) risk profile of almost unique severity. While traditional risk factors dominate the scene in the general population, in chronic kidney disease (CKD), nontraditional risk factors play an increasingly important role, being perhaps dominant in ESRD patients. ♦ Objective We review the role inflammation [C-reactive protein (CRP)], hyperhomocysteinemia, high plasma norepinephrine, and accumulation of the endogenous inhibitor of the nitric oxide synthase asymmetric dimethylarginine (ADMA) in the high all-cause and CV mortality of patients on continuous ambulatory peritoneal dialysis (CAPD). ♦ Results The association between CRP and clinical outcomes in patients on peritoneal dialysis (PD) was examined in six studies totaling 692 subjects. The largest of these studies in Caucasians indicates that the independent risk of CV events in patients in the top CRP quartile is about five times higher than in the bottom quartile. Seven prospective studies, including over 1000 hemodialysis and 176 CAPD patients, reported both positive and negative associations between homocysteine and mortality and/or CV events. Because homocysteine circulates bound to albumin, negative associations — rather than negating the vasculotoxicity of homocysteine — most likely reflect the very deleterious effects of malnutrition. Plasma norepinephrine is higher in CAPD than in hemodialysis patients, and multivariate analyses suggest the difference quantitatively entails a 16% higher risk of incident CV events. Likewise, ADMA is more elevated in CAPD patients and such an elevation corresponds to a 15% increase in risk. ♦ Conclusion Nontraditional risk factors are far more prevalent in ESRD patients than in the general population. ADMA and norepinephrine may play a greater role in CV risk in CAPD than in hemodialysis patients.
Cardiovascular Disease as a Late Complication of End-Stage Renal Disease in Children
Authors: Groothoff Jaap , Gruppen Mariken , De Groot Eric , Offringa Martin 
Published: February 2020

♦ Objective To analyze the late cardiovascular outcome of end-stage renal disease (ESRD) in children. ♦ Design A nation-wide long-term follow-up study. Determinants of outcomes and causes of death were retrospectively assessed. Patients underwent assessment of overall health state, B- and M-mode ultrasound of the carotid arteries, and echocardiography for cross-sectional analysis. ♦ Results We analyzed the medical course of all 249 adult Dutch patients with ESRD onset between 1972 and 1992 at age 0 – 14 years, and who were born before 1979. Of the 187 living patients, 140 participated in the cross-sectional part of the study. The standardized mortality rate was 31.0. Overall 5-, 10-, and 20-year survival after ESRD onset was 87%, 82%, and 78%, respectively. Cardiovascular disease accounted for most deaths (41%). In the whole group, left ventricular hypertrophy (LVH), aortic valve calcification, and arterial wall stiffening were highly prevalent. LVH was associated with hypertension at time of assessment. Aortic valve calcification was strongly associated with a long total duration of peritoneal dialysis (β = 0.33, p < 0.001). Arterial wall pathology was not associated with current treatment modality. ♦ Conclusions As in adults, cardiovascular disease is the most important cause of death in children with ESRD. Stricter reduction of volume overload, prevention of high serum calcium–phosphate product, and more vigorous treatment of hypertension are important targets to improve cardiovascular survival in children with ESRD.
The International Pediatric Peritonitis Registry: A Global Internet-Based Initiative in Pediatric Dialysis
Authors:   Members of the International Pediatric Peritonitis Registry, Feneberg Reinhard , Warady Bradley A. , Alexander Steven R. , Schaefer Franz 
Published: February 2020

♦ Objectives Recommendations for the management of peritoneal dialysis-associated peritonitis in children have recently been developed by an International Society for Peritoneal Dialysis (ISPD) expert committee. The International Pediatric Peritonitis Registry (IPPR) was established in October 2001 as a global consortium of 47 pediatric dialysis centers in order to assess the validity of these guidelines. ♦ Design The IPPR is an internet-based registry collecting data on pediatric peritonitis episodes treated according to the ISPD guidelines. Data on 375 episodes have been collected as of July 2004. ♦ Data Acquisition Detailed data are obtained online on the diagnosis of peritonitis, antibiotic and adjunctive therapy, as well as on possible risk factors and treatment results. ♦ Conclusions Final data analysis of the IPPR will yield extensive information on the treatment and outcome of peritoneal dialysis-associated peritonitis in children.
Successful Surgical Management of Encapsulating Peritoneal Sclerosis
Authors: Kawanishi Hideki , Watanabe Hiroshi , Moriishi Misaki , Tsuchiya Shinichiro 
Published: February 2020

♦ Background Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. Also, therapeutic guidelines for EPS have not yet been established. In our hospital, favorable postoperative results were obtained in 50 patients whose EPS was treated surgically. ♦ Patients All patients had chronic glomerulonephritis as the underlying kidney disease. All had undergone PD for between 29 months and 220 months (average: 113.9 months). During the course of PD, 3 patients developed EPS and were subsequently transferred to hemodialysis (HD). The other 47 patients (94.0%) developed EPS after discontinuation of PD. The reasons for transfer to HD were inadequate ultrafiltration (26 patients), bacterial peritonitis (16 patients), hypoalbuminemia (2 patients), renal transplantation (3 patients), and occurrence of EPS (3 patients). ♦ Intervention At laparotomy, a definitive diagnosis of EPS was established in all patients by the presence of clumped intestine cocooned with a dense sclerotic membrane. In all cases, the small intestine was completely released by ablation of the capsules, resulting in resolution of the bowel obstruction symptoms. In 5 patients, the large intestine was ablated solely at the region of the sigmoid colon. The operating time varied from 3 hours to 18 hours (average: 6.9 hours). Oral food intake was initiated 5 – 60 days (average: 10.2 days) after surgery. ♦ Results Perforation of the small intestine was detected postoperatively in 2 patients, who died 26 days and 37 days after surgery. The remaining 48 patients were followed for between 9 months and 107 months (average: 34.6 months). During follow-up, 6 – 12 months after the initial surgery, 4 patients experienced a recurrence of bowel obstruction symptoms that required a second laparotomy with enterolysis. Excluding the 2 patients with fatal outcomes, 46 patients (96%) experienced complete relief from bowel obstruction symptoms. The remaining 2 patients continued to experience mild, sub-acute bowel obstruction symptoms that could be successfully controlled solely by diet. ♦ Conclusions Surgical treatment of 50 patients with EPS produced successful outcomes in all but 2 patients (96% success). Encapsulating peritoneal sclerosis should be actively treated by surgeons who genuinely understand this pathologic condition.
Is Normal Saline Harmful to the Peritoneum?
Authors: Breborowicz Andrzej , Oreopoulos Dimitrios G. 
Published: February 2020

♦ Background Normal saline (0.9% NaCl) is used during various abdominal surgical interventions and during peritoneal dialysis to rinse the peritoneal cavity. Although no clear clinical evidence exists for the bioincompatibility of normal saline, various experimental studies have suggested that 0.9% NaCl solution can initiate fibrosis of peritoneum. ♦ Material and Methods We review the data derived from in vitro and in vivo experimental studies demonstrating the cytotoxic effect of 0.9% NaCl and its ability to initiate peritoneal adhesions. ♦ Results Normal saline reduces the viability and fibrinolytic activity of peritoneal mesothelial cells. Use of normal saline to wash the peritoneal cavity during abdominal operations or after chronic peritoneal dialysis is more likely to produce adhesions than is no irrigation at all. Chronic exposure of the peritoneum to normal saline causes overgrowth of the connective tissue and formation of new blood vessels within that tissue. Conclusion ♦ Normal saline is a bioincompatible solution that predisposes to the formation of peritoneal adhesions and fibrosis of the peritoneum. A 0.9% NaCl solution should therefore not be used to rinse the peritoneal cavity after interruption of peritoneal dialysis.
Risk Factors and Outcomes of Extended-Spectrum Beta-Lactamase-Producing E. Coli Peritonitis in Capd Patients
Authors: Yip Terence , Tse Kai-Chung , Lam Man-Fai , Tang Sydney , Li Fu-Keung , Choy Bo-Ying , Lui Sing-Leung , Chan Tak-Mao , Lai Kar-Neng , Lo Wai-Kei 
Published: February 2020

Objective To determine the risk factors and outcomes of peritonitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods Episodes of E. coli CAPD peritonitis in our unit from October 1994 to August 2003 were reviewed. Demographic data, underlying medical conditions, recent use of gastric acid inhibitors (including H2 antagonist and proton pump inhibitor), recent antibiotic therapy, antibiotic regimen for peritonitis episodes, sensitivity test results of the E. coli isolated, and clinical outcomes were examined. Results Over a 10-year study period, 88 episodes of E. coli peritonitis were recorded; 11 of the 88 cases were caused by ESBL-producing E. coli. Recent use of cephalosporins and gastric acid inhibitor were associated with the development of ESBL-producing E. coli peritonitis. Compared with non-ESBL-producing E. coli peritonitis, more cases in the ESBL-producing E. coli group developed treatment failure (45.5% vs 13.0%, p = 0.02) and died of sepsis (27.3% vs 3.9%, p = 0.02). Peritoneal failure rate was higher in the ESBL-producing E. coli group, although the difference was not statistically significant (18.2% vs 3.9%, p = 0.12). Conclusion Peritonitis caused by ESBL-producing E. coli is associated with worse clinical outcomes. The use of cephalosporins and gastric acid inhibitors may contribute to its development. Further studies are warranted to investigate and determine the predisposing factors for ESBL-producing E. coli peritonitis.
Continuous Ambulatory Peritoneal Dialysis in Patients with Hepatitis B Liver Disease
Authors: Chow Kai Ming , Szeto Cheuk Chun , Wu Alan Ka Lun , Leung Chi Bon , Kwan Bonnie Ching Ha , Li Philip Kam-Tao 
Published: February 2020

Objective We hypothesized that patients with hepatitis B virus infection and cirrhosis are more susceptible to peritonitis as a complication of peritoneal dialysis (PD). Methods A retrospective study was carried out to compare peritonitis rates between cirrhotic and non-cirrhotic patients with hepatitis B virus infection. Results Between 1994 and 2004, 25 PD patients with hepatitis B cirrhosis and 36 patients with hepatitis B without cirrhosis were included for analysis. Mean follow-up duration was 52 months. Subjects with hepatitis B cirrhosis consisted of more males and had higher total body weight. No cirrhotic patients (20 of them being Child–Pugh class A, 2 class B, and 3 class C) had undergone portosystemic shunting or liver transplantation. Cirrhotic patients had slightly higher bilirubin concentration than the non-cirrhotic group (22 ± 50 vs 9 ± 4 μmol/L, p = 0.16). There was no difference in median peritonitis-free survival between cirrhotic and non-cirrhotic patients (40 vs 37 months, p = 0.64 by log-rank test). The average peritonitis rate was 1 episode every 19.2 patient-months in the cirrhotic group and 1 episode every 20.5 patient-months in the non-cirrhotic group. Time to first peritonitis did not differ between the two groups with respect to gram-negative organisms ( p = 0.88) or gram-positive organisms ( p = 0.52). Cirrhotic patients had more frequent Streptococcus species peritonitis, which accounted for 13% of all peritonitis episodes, as opposed to 2% among the non-cirrhotic patients ( p = 0.01). Overall treatment response rate and outcome did not differ between patients with and patients without cirrhosis. Conclusions Peritonitis-free survival of cirrhosis patients infected by hepatitis B virus compares favorably with that in patients without cirrhosis. The presence of liver cirrhosis does not appear to compromise PD outcome.
What is the Optimal Dwell Time for Maximizing Ultrafiltration with Icodextrin Exchange in Automated Peritoneal Dialysis Patients?
Authors: Jeloka Tarun K. , Ersoy Fevzi F. , Yavuz Mahmut , Sahu Krishna M. , Çamsari Taner , Utaş Cengiz , Bozfakioglu Semra , Özener Çetin , Ateş Kenan , Ataman Rezzan , Akçiçek Fehmi , Akpolat Tekin , Karayaylali Ibrahim , Arinsoy Turgay , Mehmet Emin Yilmaz , Süleymanlar Gültekin , Burdzy Dorothy , Oreopoulos Dimitrios G. 
Published: February 2020

Background Icodextrin is increasingly being used in automated peritoneal dialysis (APD) for the long dwell exchange to maintain adequate ultrafiltration (UF). However, the UF reported in the literature varies with different dwell times: from 200 to 500 mL with 12 – 15 hour dwells. In order to maximize UF, it is important to know the relationship between dwell time and UF when using icodextrin in APD patients. With this knowledge, decisions can be made with respect to dwell period, and adjustments to the dialysis prescription can be made accordingly. Methods We prospectively studied this relationship in 36 patients from Canada and Turkey. All patients did the icodextrin day exchange manually after disconnecting themselves from overnight cycler dialysis. Dwell period was increased by 1 hour every week, from 10 to 14 hours. Ultra-filtration was noted for each icodextrin exchange. Mean UF for each week ( i.e., dwell period) was compared by repeated measures ANOVA. Results We found no difference in mean UF with increasing dwell time: 351.73 ± 250.59 mL at 10 hours versus 371.75 ± 258.25 mL at 14 hours ( p = 0.83). We also compared mean UF between different subgroups and found that males ( p = 0.02 vs females) and high transporters ( p = 0.04 vs low) had higher mean UF. Further analysis of maximal UF showed no correlation to age, sex, diabetic status, transport category, creatinine clearance, Kt/V, duration on peritoneal dialysis, or duration of icodextrin use. Conclusion Icodextrin-related UF in APD patients is not related to demographic factors and does not increase significantly beyond 10 hours.
Improvement of Peritoneal Ultrafiltration with Peritoneal Dialysis Solution Buffered with Bicarbonate/Lactate Mixture
Authors: Simonsen Ole , Sterner Gunnar , Carlsson Ola , Wieslander Anders , Rippe Bengt 
Published: February 2020

Background In computer simulations, according to the three-pore model of peritoneal transport, neutralization of conventional acidic peritoneal dialysis fluids is predicted to produce an improved ultrafiltration (UF). However, in a previous study, a two-compartment peritoneal dialysis system with a minimum of glucose degradation products (GDP), PD-Bio, having a pH of 6.3 and being conventionally lactate buffered, did not produce an increased UF. Setting We tested a newly formulated, glucose-based, GDP-reduced solution, denoted “N” for “neutral,” containing a mixture of lactate (30 mmol/L) and bicarbonate (10 mmol/L) as buffer system, and having a pH of 7.2. This new formulation was compared with Gambrosol trio (GT) (identical in composition to PD-Bio, but delivered in a three-compartment system; both by Gambro Lundia AB, Lund, Sweden) in an open, prospective controlled study of 13 patients. Material and Methods Each of the 13 patients used GT for 14 days, followed by 14 days of N. All bags were weighed on a digital scale before instillation and after drainage to assess the UF in each dwell (and during 24 hours). Glucose concentration in each bag was noted. In the morning and night dwells, dialysis fluid glucose concentration was standardized to 2.5%. Body weight was measured every morning (empty abdomen). In the middle of each 14-day period, a 4-hour standardized (“study day”) dwell was performed, using 125I-albumin (RISA) as volume marker, during which blood and dialysate samples were taken repeatedly and analyzed for RISA, creatinine, urea, phosphate, glucose, standard bicarbonate, lactate, and pH. The permeability surface area product (PS) for small solutes (and A0/ΔX; “area parameter”) was calculated. Clearance (Cl) of RISA to plasma (P) (Cl→P), “direct lymphatic absorption,” and total Cl of RISA out of the peritoneal cavity (Clout) were also determined. Results The 13 patients using N, compared to GT, displayed an increased daily UF, the difference being 233 mL ( p < 0.05). The pH values of N were higher during the first 90 minutes of the 4-hour dwell compared to the pH values of GT. Neither the small solute PS values nor RISA determined UF, nor did body weight differ significantly between the GT and the N periods. Conclusions A new bicarbonate/lactate-buffered solution, N, with neutral pH (of 7.2) and low in GDP seems to produce an improved UF compared to a lactate-buffered solution with a pH of 6.3, equally low in GDP, partly in agreement with our earlier predictions. A dialysis solution with a neutral pH combined with a reduced lactate concentration, partially replaced by bicarbonate, evidently increases UF, conceivably by causing less peritoneal vasodilatation than solutions buffered by lactate or high concentrations of bicarbonate alone.
EndothelinB Receptor Blocker Inhibits High Glucose-Induced Synthesis of Fibronectin in Human Peritoneal Mesothelial Cells
Authors: Shimizu Miyuki , Ishibashi Yoshitaka , Taki Fumika , Shimizu Hideki , Hirahara Ichiro , Kaname Shinya , Fujita Toshiro 
Published: February 2020

Background Long-term peritoneal dialysis using glucose-based dialysates is associated with peritoneal fibrosis. The object of this study was to investigate the hypothesis that endothelin (ET)-1, which is known to play an important role in various fibrotic diseases, may also be involved in peritoneal fibrosis using human peritoneal mesothelial cells (HPMC). Methods HPMC were cultured with 4% d- or l-glucose, or loaded with 10 nmol/L ET-1. In some experiments, the ETA receptor antagonist BQ-123, the ETB receptor antagonist BQ-788, and antioxidants 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (TEMPOL) and diphenyleneiodium chloride (DPI) were used. mRNA expression of ET-1, ETA receptor, ETB receptor, and fibronectin (FN) was analyzed by real-time polymerase chain reaction (real-time PCR). The protein levels for FN and ET-1 were measured by ELISA. CM-H2DCFDA-sensitive reactive oxygen species (ROS) were evaluated by flow cytometry. Results d-Glucose significantly induced mRNA expression of ET-1 and the ETB receptor but not the ETA receptor. FN production under high glucose conditions was inhibited by BQ-788. ET-1 directly stimulated HPMC to increase mRNA expression of FN and CM-H2DCFDA-sensitive ROS production. BQ-788, TEMPOL, and DPI inhibited mRNA expression of FN induced by ET-1. Conclusion The present study suggests that high-glucose-induced FN synthesis is mediated by the ET-1/ETB receptor pathway and, therefore, an ETB receptor antagonist may be useful in preventing FN production in HPMC.
Physiological Properties of the Peritoneum in an Adult Peritoneal Dialysis Population over a Three-Year Period
Authors: Johansson Ann-Cathrine , Haraldsson Börje 
Published: February 2020

Objectives To describe the physiological properties of the peritoneal membrane in adult patients treated with peritoneal dialysis (PD) and to analyze the effects of patient characteristics and time. Design Observational study. Setting Department of Nephrology at the Sahlgrenska University Hospital. Method Peritoneal function was analyzed by the Personal Dialysis Capacity (PDC) test, based on the three-pore theory of capillary transport. The functional PDC variables are absorption, large-pore flow, and the area parameter (A0/Δx), which determines the diffusion of small solutes. The ultra-filtration (UF) coefficient is determined mainly by A0/Δx. Patients All patients ( n = 280) who had at least one PDC test done between September 1990 and August 1999. Results In 249 patients examined soon after start of PD, area was 19000 (SD 7100) cm2/cm/1.73 m2, large-pore flow 0.112 (SD 0.052) mL/min/1.73 m2, and the UF coefficient 0.071 (SD 0.032) mL/minute/mmHg/1.73 m2. Absorption was 1.54 (SD +2.64, –0.97) mL/min/1.73 m2. Large-pore flow was greater in patients with severe comorbidity than in patients with fewer comorbid conditions. Elderly patients had a lower UF coefficient than did younger patients ( p < 0.05). Repeated PDC tests were performed in 208 patients during a mean observation time of 18.4 months. There was a slight increase in the slope of the area-versus-time curve of 54 cm2/cm/1.73 m2 per month (approximately 10% after 3 years, p < 0.01); all other parameters remained constant. Conclusion Patient characteristics have an impact on peritoneal performance already at the start of dialysis. Peritoneal function can remain essentially stable during medium long-term PD.