bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacokinetics of Teicoplanin in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Stamatiadis Dimitrios , Papaioannou Maria G. , Giamarellos–Bourboulis Evangelos J. , Marinaki Smaragda , Giamarellou Helen , Stathakis Charalambos P. 
Published: February 2020

Objective To achieve concentrations of teicoplanin in serum and dialysate within the therapeutic range in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Design Pharmacokinetic study. Setting A tertiary-care hospital. Patients Eight hospitalized anuric patients undergoing CAPD. Interventions One single dose of 10 mg/kg teicoplanin was administered intravenously, and blood and dialysate were sampled at regular time intervals for 48 hours post drug infusion. Concentrations of teicoplanin were determined by microbiological assay. Results Teicoplanin serum levels above 10 μg/mL, the level desired to treat systemic infections, were detected for 24 hours after administration. All dialysate concentrations were very low. Teicoplanin presented two phases of elimination: an early first phase and a late second phase. Mean maximum serum concentration was 75.56 μg/mL, mean half-life (t°) of the early elimination was 3.34 hours, mean t° of the late elimination was 61.68 hours, mean area under the serum-concentration–time curve was 1491.92 mg·hr/L, mean clearance rate was 10.68 mL/minute, mean apparent volume of distribution was 0.80 L/kg, and mean volume of distribution at steady state was 0.22 L/kg. Mean dialysate excretion was 3.16% and mean peritoneal clearance rate was 0.023 mL/minute. Conclusions Based on the time period with the achieved serum levels and on the prolonged t°, it is proposed that teicoplanin might be administered at 10 mg/kg every 24 hours for the therapy of systemic infections in patients undergoing CAPD. However, its intravenous administration should be avoided in the treatment of peritonitis, because the achieved dialysate concentrations were very low.
Clinical Experience with a New Bicarbonate (25 Mmol/L)/Lactate (10 Mmol/L) Peritoneal Dialysis Solution
Authors: Otte Kjeld , Gonzalez Maria Theresa , Bajo Maria-Auxiliadora , Del Peso Gloria , Heaf James , Erauzkin Gorka Garcia , Tomero Jose A. Sanchez , Dieperink Hans , Povlsen Johan , Hopwood Alexandra M. , Filho Jose C. Divino , Faict Dirk 
Published: February 2020

Objective Physiological bicarbonate/lactate-based solutions may correct acidosis in a better way than standard lactate-based solutions. In this study, a new 25 mmol/L bicarbonate/10 mmol/L lactate peritoneal dialysis (PD) solution was compared with a standard 35 mmol/L lactate solution. Design This was a prospective open label study. All patients had a 2-week baseline period using the standard lactate solution, followed by 8 weeks on the bicarbonate/lactate solution and 2 weeks on the lactate-basedsolution. Setting Four Danish and four Spanish nephrology centers. Patients 40 well-dialyzed (creatinine clearance > 55 L/week/1.73 m2 body surface area) patients on continuous ambulatory PD. Interventions Blood samples were taken for biochemistry (including venous blood gases) at week –2, day 1, weeks 2, 4, and 8, and at follow-up. A physical examination, a peritoneal equilibration test (PET), and quality of life (K/DQOL), ultrafiltration, and adequacy assessments were performed at baseline and at week 8. Vital signs and other safety parameters were followed at each visit. Extraneal (Baxter Healthcare, Castlebar, Ireland) was used by all patients for the long dwell. Main Outcome Measure Effect on the venous plasma bicarbonate level. Results Venous plasma bicarbonate levels rose from 24.4 mmol/L when patients were on the pure lactate to 26.1 mmol/L when using the bicarbonate/lactate solution ( p < 0.001). When patients were using the bicarbonate/lactate solution, 66% of values were maintained within the venous normal range of 24 – 30 mmol/L, versus 46.2% when patients were on the pure lactate solution ( p < 0.001). There were no adverse findings with respect to clinical symptoms, vital signs, or physical examination. The PET and adequacy, ultrafiltration, and K/DQOL assessment results were unchanged. Conclusions The new 25 mmol/L bicarbonate/10 mmol/L lactate solution provided better correction of acidosis than an equivalent 35 mmol/L standard lactate solution, without any safety issues.
Recovery of Renal Function and the Discontinuation of Dialysis in Patients Treated with Continuous Peritoneal Dialysis
Authors: Goldstein Adam , Kliger Alan S. , Finkelstein Fredric O. 
Published: February 2020

Objective Previous studies have shown that patients with end-stage renal disease (ESRD) treated with continuous peritoneal dialysis (CPD) have better preservation of endogenous renal function than patients treated with hemodialysis (HD). We wondered if this better preservation of endogenous renal function seen with CPD patients translates into the improved likelihood of recovery of endogenous renal function in those patients with potentially reversible causes of renal failure. Methods To evaluate this question, we reviewed the records of all 1200 patients that completed CPD training at a large, freestanding peritoneal dialysis center in New Haven, Connecticut, between 1979 and 1999, and the records of all patients completing CPD training in New England between 1993 and 1998. In New Haven, about half the new patients with ESRD were started on CPD compared to only 15% in New England. We then compared the chances of recovery of renal function in these two cohorts of CPD patients to the chances of recovery of renal function in two groups of HD patients. The first group consisted of all patients that started on HD in New England between 1993 and 1998. The second group consisted of all patients that started HD in our HD unit in New Haven, Connecticut, between 1993 and 1999. The data on the New England patients were provided by the ESRD Network of New England. All patients entered into the present study had to have been on dialysis for a minimum of 3 months, as in the United States Renal Data System database, and had to have recovered sufficient renal function to be able to be maintained off dialysis for a minimum of 30 days. Results 29 of 1200 CPD patients (2.4%) trained in New Haven recovered sufficient renal function to permit the discontinuation of dialysis for a minimum of 30 days. In comparison, only 305 of 19 032 patients (1.6%) managed with HD in New England ( p < 0.05 compared to New Haven CPD patients) and 3 of 430 patients (0.7%) in our HD center ( p < 0.05 compared to New Haven CPD patients) recovered sufficient glomerular filtration rate (GFR) to allow the discontinuation of dialysis for at least 30 days. If only those CPD patients that initiated dialysis between 1993 and 1999 in New Haven were analyzed, 15 of 369 (4.1%) recovered sufficient GFR to allow discontinuation of dialysis for at least 30 days ( p < 0.025 compared to both groups of HD patients). Of the 2924 patients completing CPD training in New England, 60 (2.1%) recovered renal function; this percentage is not significantly different from the percent of HD patients in New England recovering renal function. Conclusion Although the present study is a retrospective study and the actual criteria for selection of CPD and HD therapy are not controlled for, the data raise the question of whether there may be a therapeutic advantage to treating newly diagnosed ESRD patients, that have a potentially reversible cause of renal failure, with CPD.
Peritoneal Transport Kinetics of Proteins in Children on Chronic Peritoneal Dialysis
Authors: Arbeiter Klaus , Stemberger Regina , Greenbaum Laurence , Mueller Thomas , Konstantin Andrea , Herkner Kurt , Aufricht Christoph 
Published: February 2020

Objective This study describes a modified 4-hour peritoneal equilibration test (PET) for analyzing peritoneal transport characteristics of proteins with different molecular weights and predicting daily peritoneal protein losses in children on chronic peritoneal dialysis (PD). Design Cross-sectional study. Setting A single regional pediatric dialysis unit in a teaching hospital. Patients 9 stable pediatric dialysis patients; 4 were on continuous ambulatory PD, 5 were on continuous cycling PD. Main Outcome Measures Serum and dialysate concentrations of IgG, albumin, β2-microglobulin, and transferrin were determined during a PET. Changes in dialysate-to-plasma (D/P) ratios were determined hourly. Agreement between PET-derived and measured daily peritoneal protein losses was examined. Results The D/P ratio decreased with increased molecular radius ( p < 0.0001). Many children had low plasma levels of IgG, albumin, and transferrin, but elevated levels of β2-microglobulin. The D/P ratio increased linearly during the PET for all measured proteins, regardless of molecular weight. There was close correlation between 4-hour PET protein losses and 24-hour losses during routine PD. Conclusions Proteins are lost through the peritoneum according to their size, demonstrating linear transport kinetics during a 4-hour PET. The PET-derived data predicted daily protein losses in children on chronic PD. This approach might help to eliminate inaccuracies due to incomplete dialysate collection.
Risk Factors for Abdominal Wall Complications in Peritoneal Dialysis Patients
Authors: Del Peso Gloria , Bajo María Auxiliadora , Costero Olga , Hevia Covadonga , Gil Fernando , Díaz Cándido , Aguilera Abelardo , Selgas Rafael 
Published: February 2020

← Background Patients treated with peritoneal dialysis (PD) have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. ← Objective The purpose of this study was to determine the incidence of hernias and peritoneal leaks in our PD patients and to investigate their potential risk factors. ← Patients We studied 142 unselected patients treated with PD during the past 5 years, including those that were already on PD and those that started PD during this period. Mean age was 54 years and mean follow-up on PD was 39 months. 72 patients had been treated with only continuous ambulatory PD (CAPD), 8 with automated PD (APD), and 62 with both modalities. ← Results 53 patients (37%) developed hernia and/or leak. A total of 39 hernias and 63 leaks were registered. The overall rates were 0.08 hernias/patient/year and 0.13 leaks/patient/year, 17 patients had both abdominal complications. Hernia was most frequently located in the umbilical region, and the most frequent site of leakage was the pericatheter area. Both complications appeared more frequently during the CAPD period (87% of hernias, 81% of leaks). The rate of hernias was higher in patients treated only with CAPD than in those that used only cyclers [0.08 vs 0.01 hernias/patient/year, not significant (NS)]. No patient treated only with APD had peritoneal leak; 25% (18/72) of patients treated with CAPD developed this complication ( p = 0.18, NS). Dialysate exchange volumes ranged from 2000 to 2800 mL. 25 (66%) patients required surgical repair of the hernia, with recurrence in 7 patients (28%). 27 (84%) patients with leaks were initially treated with transitory temporary transfer to hemodialysis, low volume APD, or intermittent PD for 4 weeks. The leak recurred in half of the cases and surgical repair was necessary in 12 cases. The development of hernia and/or leak did not correlate with gender, diabetes, duration of follow-up, type of PD, history of abdominal surgery, or with the largest peritoneal exchange volume used. Polycystic kidney disease was the only factor associated with higher rate of hernias ( p = 0.005), whereas increased age ( p = 0.04) and higher body mass index ( p = 0.03) were significantly associated with the appearance of leaks. ← Conclusion Abdominal hernias and peritoneal leaks are very frequent in the PD population. Advanced age, polycystic kidney disease, and high body mass index are independent risk factors for their development. Automated PD with low daytime fill volume should be considered in all patients at risk for hernias and/or leaks.
Predictors of Decline of Residual Renal Function in New Peritoneal Dialysis Patients
Authors: Johnson David W. , Mudge David W. , Sturtevant Joanna M. , Hawley Carmel M. , Campbell Scott B. , Isbel Nicole M. , Hollett Peter 
Published: February 2020

♦ Objective The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population. ♦ Design Prospective observational study of an incident PD cohort at a single center. ♦ Setting Tertiary-care institutional dialysis center. ♦ Participants The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 ± 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants ( n = 26) were excluded. ♦ Main Measurements Timed urine collections ( n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded. ♦ Results The mean (±SD) follow-up period was 20.5 ± 14.8 months. The median slope of RRF decline was –0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< –0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39 – 2.40] and a higher baseline dialysate/plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05 – 1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60 – 0.81], D/P creat (HR 2.87, 95% CI 2.06 – 82.3), body surface area (HR 6.23, 95% CI 1.53 – 25.5), dietary protein intake (HR 2.87, 95% CI 1.06 – 7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00 – 2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate. ♦ Conclusions The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.
Nutritional State Correlates with Renal Function at the Start of Dialysis
Authors: Cooper Bruce A. , Aslani Alireza , Ryan Murielle , Ibels Lloyd S. , Pollock Carol A. 
Published: February 2020

← Objective To determine the effect of renal function at the commencement of dialysis on nutritional state. ← Design Retrospective cohort study. ← Setting University tertiary referral hospital. ← Patients Patients with end-stage renal disease commencing renal replacement therapy over 8.5 years. ← Main Outcome Measures Total body nitrogen assessment using in vivo neutron activation analysis, expressed as nitrogen index (NI = observed total body nitrogen/predicted total body nitrogen); serum albumin measurement and creatinine clearance estimation, using the Cockcroft– Gault equation, at the start of dialysis. “Early” start group = creatinine clearance > 10 mL/minute ( n = 26). “Late” start group = creatinine clearance ≤ 10 mL/min ( n = 108). ← Results Mean NI was significantly lower [95% confidence interval (CI) 6% – 30%, p < 0.0001] in the late start group (NI = 88%) compared to the early start group (NI = 106%). The late start group also had a significantly lower (95% CI 0.06 – 0.47 g/dL, p = 0.02) mean serum albumin level (3.66 g/dL) compared to that of the early start group (3.93 g/dL)A. positive independent correlation existed between renal function and total body nitrogen ( r2 = 0.21, p < 0.0001). No other clinical or demographic variable at the start of dialysis was found to predict nutritional state. ← Conclusions Patients that start dialysis with low levels of renal function are likely to be significantly malnourished. Whether this translates into a survival advantage requires prospective study.
Increased Severity of Escherichia Coli Peritonitis in Peritoneal Dialysis Patients Independent of Changes in in Vitro Antimicrobial Susceptibility Testing
Authors:   Grupo de Estudios Peritoneales de Madrid, Valdés-Sotomayor Jorge , Cirugeda Antonio , Bajo María-Auxiliadora , Del Peso Gloria , Escudero Elena , Sánchez-Tomero José A. , Selgas Rafael 
Published: February 2020

Objective Despite improvements in peritoneal dialysis (PD) technique, peritonitis continues to be one of the most frequent complications of PD. Nonresolving peritonitis remains a risk for severe anatomical peritoneal changes that may limit the viability of the membrane for dialysis purposes. We have observed remarkably poor outcome of peritonitis caused by Escherichia coli in the past 6 years. With its very low response rate to broad-spectrum antibiotics, the increased severity of E. coli peritonitis deteriorates peritoneal function and affects patient outcome. Design Retrospective study. Setting Two large PD units in two university hospitals. Patients and Methods The total number of patients reviewed was 456. The records of 49 E. coli peritonitis episodes were studied. The observation period started in 1980 and ended in March 2001. Sixteen males and 19 females were included. Severity was defined in terms of days of peritoneal inflammation, lack of response to a potentially useful antibiotic, requirement for catheter removal, and/or laparotomy. Study cases (study group) were those episodes appearing after 1996 (when the first severe cases appeared) and historic controls were episodes occurring before1996. Results In the study group, 18 peritonitis episodes developed in 15 patients. In the control group, 31 peritonitis episodes developed in 20 patients. There were no significant differences in clinical presentation; however, the outcome was significantly poorer for the later period. A severe outcome occurred in 50% of study versus 10% of control patients. In fact, 68% of the episodes registered before 1996 were cured in 3 days or less. Concurring with this trend, the numbers of surgical interventions and catheter removals were also higher in the study group. Strikingly, E. coli did not show changes in in vitro susceptibility testing to antibiotics, although the in vivo response was much worse. Conclusions We describe a change in the virulence of E. coli peritonitis episodes over the past 5 years leading to a high percentage of treatment failure, which does not depend on antibiotic sensitivity and seems to be dependent on changes in host response mechanisms.
Influence of Peritoneal Dialysate Flow Rate on the Pharmacokinetics of Cefazolin
Authors: Manley Harold J. , Bridwell Darcie L. , Elwell Rowland J. , Bailie George R. 
Published: February 2020

Objective To determine the impact of dialysate flow rate (DFR) on cefazolin pharmacokinetics (PK) in peritoneal dialysis (PD) patients. Methods A meta-analysis of published reports, identified by MEDLINE search (1966-2002) and other sources, containing information on cefazolin PK data in PD patients was conducted. Data were analyzed based upon low DFR (≤ 5.50 mL/minute) or high DFR (> 5.50 mL/minute). Data available were from North American (NA) ( n = 45) and Singaporean ( n = 10) patients. Complete data sets were available for 33 patients (CDS patients). Data were analyzed with respect to data origin and data set completeness: all patients (ALL), NA, and CDS. Analysis of log-transformed cefazolin PK data was performed to determine coefficient of determination ( r2) between DFR and cefazolin elimination rate constant (kel), clearance total (ClT), and clearance peritoneal (ClPD). Clearance total data were extrapolated to DFR observed in continuous flow PD. Results Published literature provided data on 55 PD patients (12 high DFR, 43 low DFR). Regardless of data origin (ALL, NA, or CDS), a prominent coefficient of determination ( p < 0.0001) existed between DFR and all cefazolin PK data except ClPD. The p value for DFR correlation to ClPD was 0.953, 0.011, and 0.036 for ALL, NA, and CDS patients, respectively. Cefazolin ClT and ClPD increased at higher DFRs. Conclusion These findings demonstrate that an increased DFR leads to an increased rate of cefazolin clearance in NA PD patients. The impact of Asian descent on cefazolin ClPD warrants further investigation. Clinicians dosing cefazolin in PD patients using a higher DFR than that used to determine cefazolin PK should use increased doses or prescribe lower/comparable DFRs. Data are not yet available for patients prescribed very high DFRs ( e.g., continuous flow PD); extrapolation of our results demonstrates significant influences on clearance and risk for underdosing.
Peritoneal Dialysis in Children with Spina Bifida and Ventriculoperitoneal Shunt: One Center'S Experience and Review of the Literature
Authors: Grunberg José , Rebori Anabella , Verocay María Cristina 
Published: February 2020

Objective The goal of this paper was to review the viability of peritoneal dialysis (PD) in patients with spina bifida and/or ventriculoperitoneal shunt (VPS). Setting Pediatric dialysis unit in a tertiary-care hospital. Data Source The course and outcome in 9 children, 5 from the authors’ experience and 4 from reported experience, are analyzed. Results One patient died of a cause unrelated to PD or VPS, 2 were transferred to hemodialysis because of recurrent peritonitis, 1 discontinued PD transiently, 2 were transplanted, and 3 continue on PD. Six of these 9 children had a functioning VPS, and none presented evidence of ventriculitis or VPS dysfunction, even though 4 had PD-related peritonitis. One child presented with a massive PD-related hydrothorax. Conclusions ( 1 ) Having a VPS is not an absolute contraindication to PD; the available data support the viability of PD in patients with spina bifida and/or a VPS. ( 2 ) If cerebrospinal fluid diversion is needed simultaneously or after starting PD, an extraperitoneal site should be a better choice than VPS. This should avoid the risk of intra- and postoperative infection in the PD catheter secondary to surgical intervention for VPS insertion. ( 3 ) Loss of peritoneal function is a potential late risk related to cerebrospinal fluid and PD. ( 4 ) Spina bifida patients on PD present specific diagnostic challenges due to overlapping symptoms ( e.g., vomiting, abdominal tenderness, fever) secondary to PD- or VPS-related complications ( e.g., peritonitis, visceral injury by devices) or primary disease ( e.g., neurogenic bladder, pyelonephritis), with inherent risks of delaying adequate treatment. Cloudy peritoneal effluent is an early indication of peritonitis, although it is not specific. ( 5 ) Early evaluation by a pediatric surgeon and a neurosurgeon is required for effective management of complications and selection of more efficient individualized therapeutic alternatives. Prompt treatment of complications is crucial. A registry of children with spina bifida on PD and the accumulation of a large population followed up for longer periods will provide an objective assessment of their problems and management.