bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Peritoneal Dialysis in Newborns
Authors: Zaramella Patrizia , Andreetta Barbara , Zanon Giovanni Franco , Murer Luisa , Montini Giovanni , Cantarutti Felice , Zacchello Graziella 
Published: February 2020

Objective To report the complications and outcome of 10 newborns affected by acute renal failure (ARF), treated by continuous peritoneal dialysis (CPD). Design All newborns admitted for tertiary treatment to the Neonatal Intensive Care Unit of the University of Padova, who underwent CPD between February 1986 and December 1990, were analyzed retrospectively. Patients Ten newborns (mean weight 2077 g, range 540–4930 g) received CPD, 6 of whom were preterm. All the survivors completed the study. Interventions A number 9,5 French Tenckhoff catheter was used, and a closed circuit was created by means of a modified continuous ambulatory peritoneal dialysis (CAPD) technique. The mean duration of dialytic therapy was 7 days. Results At the end of the dialytic period, 7 of the 10 patients had normal serum potassium and sodium values. CPD produced two different types of complications: leakage of the dialytic fluid in very low weight newborns and one episode of peritonitis during a chronic dialysis treatment. Six died of severe respiratory failure (in no case, however, was this attributable to ARF or CPD procedure). All but one of the survivors regained normal renal function. The only exception necessitated a kidney trans plant. Conclusion We believe that this technique, although invasive, improves the outcome of both preterm and low birth weight newborns affected by ARF.
Comparison of Three Different Tests for Assessment of Hepatitis C Virus in Dialysis Patients
Authors: Castelnovo Claudia , Lunghi Giovanna , De Vecchi Amedeo , Grancini Anna , Como Giovanna , Graziani Giorgio , Scalamogna Antonio , Ponticelli Claudio 
Published: February 2020

Objective To evaluate the relationship between hepatitis C virus antibodies (HCV-Ab) and viremia and to compare the prevalence of HCV-Ab and HCV viremia in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Design Cross-sectional study. Setting Dialysis unit of a nephrology division in a public university hospital. Patients All dialysis patients who came for routine clinic visits during the study period. None denied informed consent. Forty-eight patients on HD and 79 on CAPD were examined. Intervention Blood samples were tested by second generation enzyme-Iinked immunosorbent assay (ELISA II) and recombinant immunoblot assay (RIBA II) to look for HCV-Ab and by the polymerase chain reaction (PCR) to look for HCV viremia. Results ELISA II was positive in 52% of HD patients and in 14% of CAPD patients. RIBA II was positive in 48% of HD patients and in 11% of CAPD patients. HCV viremia was positive by PCR in 41.6% of HD patients and in 12% of CAPD patients. Two of these PCR-positive patients did not show HCV-Ab by ELISA II and RIBA II. The sensitivity and specificity of ELISA II were 93% and 92%, the sensitivity and specificity of RIBA II were 86% and 94%. Conclusions Our data confirm a higher prevalence of HCV viremia in HD than in CAPD patients. The absence of Ab against virus C in 2 patients positive with PCR might be due to recent HCV infection or to weak virus replication or to a poor immune response.
Nursing Forum: Urea Kinetics and Nitrogen Appearance Rates in Diabetic Patients on Peritoneal Dialysis
Authors: Prowant Barbara F. , Bernardini Judith Y. , Kelman Betty , Bernardini Judith , Piraino Beth 
Published: February 2020

Objective We compared the relationship of protein intake (as measured by protein nitrogen appearance) and dialysis delivery in insulin-dependent diabetic (IDDM) and nondiabetic patients. Design One to two 24-hour dialysate and urine collections were obtained in 20 diabetic patients and 42 nondiabetic patients. The protein equivalent of nitrogen appearance (PNA) was calculated by the Randerson formula. KTN was determined using V obtained by the Watson formula. PNA was normalized using three different methods to determine body weight: first, by normal or ideal body weight according to the Metropolitan Table (nPNA); second, by standard body weight according to the NHANES Table (sPNA); and third, by V/0.58 (vPNA). Results The mean PNA was not different in diabetics and nondiabetics (53±21 g/day vs 60±14 g/day), nor was weekly KTN (2.1 ±0.6 vs 2.1 ±0.6). Mean normalized PNA was not different in IDDM versus non-DM regardless of the method. KTN correlated with nPNA in IDDM (r = 0.54, p = 0.002 and non-DM, r = 0.31, p = 0.03), and with vPNA in IDDM (r = 0.73, p < 0.00001, and non-DM, r = 0.45, p = 0.0009). KTN also correlated with sPNA in IDDM (r = 0.57, p = 0.001), but not in non-DM (r = 0.25, p = 0.08). The slope for normalized PNA versus KTN was steeper for IDDM than for non-DM. Conclusion KTN and PNA are more closely correlated in IDDM patients than in non-DM patients. Thus it is extremely important that IDDM patients receive an adequate level of dialysis.
Low Seroconversion with Hepatitis B Vaccination in Peritoneal Dialysis Patients
Authors: Khan Abdul N. , Bernardini Judy , Rault Raymond M. , Piraino Beth 
Published: February 2020

Objective To compare seroconversion using hepatitis B vaccine between hemodialysis (HD) and peritoneal dialysis (PD) patients. Design Data on PD patients vaccinated were collected retrospectively for the period 1992 to 1995. The data on HD patients were collected prospectively from 1991 to 1994. Setting A university outpatient dialysis center. Participants All adult patients who received all four doses of hepatitis B vaccine while on dialysis were included (47 PD and 50 HD patients). Intervention Recombinant hepatitis B vaccine (Engerix), 40 μg IM was administered at 0, 1, 2, and 6 months. Main Outcome Measure Seroconversion was measured after completion of the vaccination series. Results 74% of the HD patients seroconverted compared to 53 % of PD patients (p = 0.03). Older, heavier patients compared to all the other patients had a lower seroconversion rate in both the HD patients (55 % vs. 78 %) and PD patients (38 % vs. 59 %) (p = 0.03). Conclusion The seroconversion rate to recombinant hepatitis B vaccine is lower in patients on PD than on HD for unclear reasons. Further studies are required to determine the etiology of this difference.
Demonstration of Aquaporin-Chip in Peritoneal Tissue of Uremic and Capd Patients
Authors: Pannekeet Marja M. , Mulder Jos B. , Weening Jan J. , Struijk Dirk G. , Zweers Machteld M. , Krediet Raymond T. 
Published: February 2020

Aquaporin-CHIP is a 28 kD channel forming integral membrane protein. It acts as an osmotically driven, water-selective pore. The presence of aquaporin-CHIP has been demonstrated in the proximal tubule in the kidney and in the pleura, as well as in other tissues. During peritoneal dialysis a dissociation between the transport of water and sodium using hyperosmolar solutions has been reported, suggesting the presence of ultrasmall pores. Water channels, like aquaporin-CHIP, could be the morphological equivalent of these pores. We investigated the possible presence of aquaporinCHIP in cryo-sections of peritoneal tissue using affinity purified human anti-CHIP IgG (P. Agre, Baltimore, MD). Peritoneal biopsies (omenta) were obtained at catheter insertion in 2 uremic patients with end-stage renal disease, and at catheter reimplantation of 1 patient treated with continuous ambulatory peritoneal dialysis (CAPD) for two years. Peritoneal tissue obtained at autopsy from 1 patient who had been on CAPD for four years, but in whom CAPD had been discontinued for five months, was also studied. Aquaporin-CHIP antiserum specific staining was found in the endothelial cells of the peritoneal capillaries in all patients. No obvious difference in the intensity of staining was seen between uremic and CAPD patients. This demonstration of aquaporin-CHIP in human peritoneal endothelial cells supports the hypothesis of the existence of ultrasmall pores within the peritoneal membrane. These water channels facilitate the transcellular transport of water, induced by an osmotic gradient, in the absence of sodium transport. It may be the explanation for the dissociation of water and sodium transport that occurs during hyperosmolar solutions. Aquaporin-CHIP is present in human peritoneal endothelial cells in both uremic and CAPD patients. Aquaporin-CHIP may be the morphological equivalent of the ultrasmall pores within the peritoneal membrane.
Nutritional Status in Children Receiving Chronic Peritoneal Dialysis
Authors: Canepa Alberto , Perfumo Francesco , Carrea Alba , Menoni Stefania , Trivelli Antonella , Delucchi Paola , Gusmano Rosanna 
Published: February 2020

Chronic peritoneal dialysis (CPD), widely used in uremic children, may have contrasting effects on the nutritional status of patients. Metabolic and nutritional abnormalities due to the combined effects of uremia per se, glucose absorption from the dialysate and catabolic factors, such as protein and amino acid losses into dialysate, poor appetite, and recurrent episodes of peritonitis are the most important. Although CPD allows for fewer dietary restrictions and supplies an extra amount of calories by glucose absorbed with the peritoneal fluid, when protein and energy intakes are assessed the protein intake was almost sufficient or more than that prescribed, whereas the energy intake was low. In CPD children the standard deviation score for weight, height, triceps skinfold thickness, and midarm circumference has been reported as more severely impaired in children less than ten years old. Anthropometric parameters did not worsen during CPD treatment. Plasma proteins and albumin are reported as being low in CPD children. The dietary intake and protein losses have been considered to be the most important determinants of the albumin level in CPD patients. The reported average dialysate losses of free amino acids (AA) during CPD in children vary from 0.02 to 0.03 g/kg/day in different studies. The patterns of plasma AA in CPD is represented by reduced levels of branched chain AA and of other essential amino acids and increased concentrations of some nonessential AA. Several factors may influence plasma AA profile: uremia per se, hormonal alterations, protein and AA losses, and dietary intake. A more specific uremic AA pattern is found in muscle, the largest pool of free AA in the body. Studies on muscle AA in adults on CPD are conflicting: some authors have reported several muscle AA alterations, but others have shown an almost normal pattern. Low valine and leucine muscle levels have been reported in children on CPD.
Peritoneal Surface Area and Its Permeability in Rats
Authors: Kuzlan Malgorzata , Pawlaczyk Krzysztof , Tobis Katarzyna Wieczorowska , Korybalska Katarzyna , Breborowicz Andrzej , Oreopoulos Dimitrios G. 
Published: February 2020

Objective Evaluation of peritoneal surface area and its permeability during dialysis in rats of various ages. Design Study I: planimetry of peritoneum and its topographic areas was performed in 47 rats of various ages (8 -30 weeks). Study II: net ultrafiltration (UF), dialysate-to-serum ratios for urea, creatinine, albumin, and total protein as well as their peritoneal permeability coefficients, were measured during a 1-hour peritoneal exchange with Dianeal 2.5%, in 21 rats of different ages (9 30 weeks) and with various peritoneal surface areas. Animals: Male Wistar rats. Results The peritoneal surface area in rats increases during aging, but young animals with lower body weight have a relatively larger peritoneal surface area than older, larger animals. The area of the topographic fragments of peritoneum expressed as a percentage of the total peritoneal surface is steady during aging. Efficiency of transperitoneal water removal expressed as net UF per amount of absorbed glucose declines in older animals, with larger peritoneal surface areas. Dialysate/serum ratio of solutes transported from blood to dialysate is proportional to peritoneal surface area. Permeability coefficient (K) of peritoneum to urea and creatinine is unchanged during the aging of animals. However peritoneal permeability (K) to albumin increases during aging, with the opposite tendency for total proteins. Conclusions Kinetics of peritoneal dialysis in rats of different ages is determined by peritoneal surface area and permeability of peritoneum to individual solutes.
Role of Peritoneal Mesothelial Cells and Fibroblasts in the Synthesis of Hyaluronan during Peritoneal Dialysis
Authors: Breborowicz Andrzej , Wisniewska Justyna , Polubinska Alicja , Tobis Katarzyna Wieczorowska , Martis Leo , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To assess the in vitro synthesis rate of hyaluronan (HA) by human peritoneal mesothelial cells and peritoneal fibroblasts in the presence of effluent dialysate from continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We used primary cultures of human peritoneal mesothelial cells and peritoneal fibroblasts from nonuremic patients to study the effect of interleukin-1 β (11–1 β) and pooled effluent dialysate, from noninfected and infected CAPD patients, on the synthesis of HA by the studied cells. We also tested the effect of the exogenous HA on the synthesis rate of that glycosaminoglycan. We studied the correlation between HA concentration in effluent dialysate and the stimulatory effect of that solution on in vitro synthesis of HA by mesothelium. Results Peritoneal fibroblasts produce more HA than mesothelial cells. Noninfected effluent dialysates or dialysates from CAPD patients with peritonitis stimulate synthesis of HA by mesothelial cells and fibroblasts. Interleukin-1 β has a stimulating effect, which was synergistic with effluent dialysates, on the synthesis of HA by mesothelium and peritoneal fibroblasts. A weak correlation was demonstrated between the level of HA in effluent dialysate and the stimulatory effect of that dialysate on in vitro synthesis of HA by mesothelial cells. Conclusions Peritoneal fibroblasts are a more potent source of HA than are mesothelial cells, but probably the latter are the main source of HA in drained dialysate. Although effluent dialysates contain factors that stimulate the production of HA by mesothelium, there is weak correlation between that stimulatory effect and the actual HA concentration in the dialysate, which, in some patients, might suggest low “responsiveness” of the membrane.
The Futility of Pretransplant Coronary Bypass Grafting in Asymptomatic Patients on Peritoneal Dialysis
Authors: Rao S. Panduranga , Lenkei Susan , Chu Maggie , Bargman Joanne M. 
Published: February 2020

Objective To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia. Design Retrospective review in a single PD unit. Participants Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and diseasematched PD patients who did not receive CABG were used as a comparison group. Measurements Clinical outcome from 1990 to the present. Results Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list. Conclusion As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.
Frequency and Causes of Discrepancy between Kt/V and Creatinine Clearance
Authors: Satko Scott G. , Burkart John M. , Bleyer Anthony J. , Jordan Jean R. , Manning Thomas 
Published: February 2020

Objective This study examines the frequency of discrepancy between Kt/V urea and creatinine clearance (Ccr) measurements in patients on peritoneal dialysis (PD) and the reasons for this discrepancy. Design Nonrandomized, retrospective data analysis. Setting Single PD unit of a university teaching hospital. Patients All adult patients receiving PD at our center from January 1995 to December 1996. Methods Actual (a) and desired (d) body weight (BW) were used to calculate urea volume of distribution (V) and body surface area (BSA). Patients were divided into four groups based upon their total small solute clearances (Kt/V and Ccr, normalized by actual weight) and three additional groups based upon actual/desired (a/d) body weight ratio. An additional analysis was performed for the subset of anuric patients. Data collected for all patients included the following: total Kt, total Ccr, 4-hour dialysate/ plasma (D/P) creatinine, serum albumin concentration, duration of PD, actual body weight, age, and height. Results Twenty-three percent of the clearance measurements in our study were discrepant, defined as having values for either Kt/V or Ccr (but not both) above the accepted targets of Kt/V ≥ 2.0/wk and Ccr ≥ 60 L/wk/ 1.73 m2. Patients with both values above target are more likely to have higher residual renal function. Patients who are significantly less than BWd and patients on PD for a longer time are more likely to have adequate Kt/V but not Ccr. Furthermore, patients who are less than 90% or greater than 110% of BWd have markedly different values for Kt/V and Ccr when BWa versus BWd values are used. Conclusions Kt/V and Ccr values are frequently discrepant; a number of factors affect these two measurements to varying degrees, including weight, degree of residual renal function, and duration of PD.
Thrombin Upregulates Production of Plasminogen Activator Inhibitor Type 1 in Human Peritoneal Mesothelial Cells
Authors: Mandl–Weber Sonja , Haslinger Bettina , Sitter Thomas 
Published: February 2020

Objective To determine the influence of thrombin, which is generated intraperitoneally during peritoneal dialysis, on the synthesis of fibrinolytic system components in human peritoneal mesothelial cells (HMC). Methods Confluently grown HMC, isolated from the omental tissue, were used in the experiments. Conditioned media were obtained by incubating cells with serum-free M199 containing the appropriate concentration of the test compound. Tissue type plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) antigen concentrations were measured by ELISA. Northern blot analysis was conducted for mRNA expression experiments. To test thrombin specificity, we used the thrombin inhibitor hirudin. The protein kinase C (PKC) inhibitor Ro 31-8220 was inserted to examine whether the effect of thrombin depends on PKC activity. Results Thrombin increased PAI-1 antigen in the conditioned media of HMC in a time- and concentration-dependent manner. After 24 hours incubation, PAI-1 levels increased from 350 ± 30 ng/105 cells in control conditions to 620 ± 30 ng/105 cells in HMC exposed to 5 U/mL thrombin ( n = 8, p < 0.05). In contrast, there was no effect of thrombin on tPA antigen levels. An increase of PAI-1 mRNA expression was also observed by Northern blot hybridization. Hirudin (10 U/mL) inhibited the thrombin-induced increase in PAI-1 synthesis. In addition, a complete inhibition of the stimulating effect of thrombin on PAI-1 synthesis was obtained by blocking PKC activity with Ro 31-8220 (3 μmol/L). Conclusions Thrombin increases PAI-1 synthesis in HMC via a PKC-dependent mechanism. Thereby the synthesis of tPA is not affected. Thus, thrombin may not only promote fibrin formation in the peritoneal cavity, but may also inhibit fibrin degradation by release of free PAI-1 from HMC.
Peritoneal Defense Using Icodextrin Or Glucose for Daytime Dwell in Ccpd Patients
Authors: Posthuma Nynke , Ter Wee Pieter M. , Donker Ab J.M. , Dekker Hubertha A. Th. , Oe Po L. , Verbrugh Henri A. 
Published: February 2020

Objective To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD). Design In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell. Setting University hospital and teaching hospital. Patients Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ico) started the study. The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5 – 25 months and 5 – 25 months, respectively). Outcome Measures Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months. Results Total peritoneal white cell count tended to decrease over time in both groups. After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMΦs) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percentage of mesothelial cells increased over time in Ico patients. The phagocytic capacity of PMΦs decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci ( p = 0.05) and a significant difference for Escherichia coli ( p < 0.05) phagocytosis in favor of Ico patients. PMΦ oxidative metabolism remained stable over time without a difference between the groups. PMΦ cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study. Conclusion CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, Ico-treated patients did better.
Surgical Management of Refractory Exit-Site/Tunnel Infection of Tenckhoff Catheter: Technical Innovations of Partial Replantation
Authors: Wu Yao-Ming , Tsai Meng-Kun , Chao Seh-Huang , Tsai Tun-Jun , Chang King-Jen , Lee Po-Huang 
Published: February 2020

Objective Catheter-related infection has been the major cause of catheter removal for peritoneal dialysis (PD) patients. A salvage technique — partial replantation of the infected catheter — was developed in our hospital to rescue catheters with refractory exit-site or tunnel infection. Patients We performed 26 partial replantations of Tenckhoff catheters for 23 patients with refractory exitsite or tunnel infection and 2 patients with near-cuff perforation of the catheter. Their problems were all resolved successfully without interruption of PD. Interventions We removed the infected portion of the catheter and preserved the still-functioning internal conduit, connecting it to a divided new catheter. All of the patients resumed PD immediately after the advancement of the new catheter through a new subcutaneous tunnel and exit site on the opposite side. Results No technical complications such as disconnection of the catheter or leakage of dialysate were noted. Repeated partial replantation of the catheter was done for 1 patient with a new refractory exit-site infection. Tunnel infection was not an absolute contraindication for this procedure. About one third (34.6%) of our patients had preoperative tunnel infection. Conclusion Partial replantation of a Tenckhoff catheter is a simple and effective procedure for patients with refractory exit-site/tunnel infection and patients with near-cuff perforation of the catheter. Repeated partial replantation is also feasible for repeat exit-site infections.