bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between Peritoneal Equilibration Test and Dialysis Adequacy and Transport Test, for Peritoneal Transport Type Characterization
Authors:   for the Mexican Nephrology Collaborative Study Group, Paniagua Ramón , Amato Dante , Correa–Rotter Ricardo , Ramos Alfonso , Vonesh Edward F. , Mujais Salim K. 
Published: February 2020

Objective The aim of this study was to analyze the correlation between the peritoneal equilibration test (PET) and the dialysis adequacy and transport test (DATT) for peritoneal transport type characterization, and the degree of patients’ acceptance for each test. Design Cross-sectional, observational multicenter study. Setting Five referral (tertiary) dialysis centers of institutional practice. Patients The study included 107 adult continuous ambulatory peritoneal dialysis (CAPD) patients with a prescription of four exchanges of 2 L per day, irrespective of age, gender, cause of end-stage renal disease, time on dialysis, nutritional status, or residual renal function. Patients on immunosuppressive therapy and those with cancer, hepatitis B, or HIV, and those having a peritonitis episode within the previous 30 days, or three or more episodes during the previous 12 months, were excluded. Main Measures Peritoneal transport type as classified by creatinine and urea dialysis-to-plasma (D/P) ratios by PET and DATT. Results Correlation coefficients between D/P ratios for creatinine and urea, obtained for the PET and the DATT, were 0.73 for D/P creatinine and 0.96 for D/P urea. Patients were classified into high, high-average, low-average, and low transport categories according to the mean and standard deviation of D/P creatinine values obtained from the PET at 4 hours. These values showed excellent concordance with those generated from the DATT data (κ = 0.82, 95% confidence interval 0.67 – 0.93). Nineteen percent of patients showed discordance in their category when classified according to the PET versus the DATT. Patients’ acceptance was better for the DATT than for the PET, as evaluated with a questionnaire. Conclusion The DATT is an easy, inexpensive, and reliable test to assess peritoneal transport type, and it also provides information about peritoneal clearance of solutes and ultrafiltration. The DATT has better patient acceptance than the PET. Since the DATT has only been validated for patients on a fixed CAPD daily schedule of 4 x 2 L, the results should be confined only to patients receiving such a prescription.
Quality of Life in Predialysis End-Stage Renal Disease Patients at the Initiation of Dialysis Therapy
Authors:   for The NECOSAD Study Group, Korevaar Johanna C. , Jansen Maarten A.M. , Merkus Maruschka P. , Dekker Friedo W. , Boeschoten Elisabeth W. , Krediet Raymond T. 
Published: February 2020

Objective To assess health-related quality of life (QL) in a group of Dutch predialysis end-stage renal disease (ESRD) patients prior to the initiation of dialysis, and to compare QL between patients with different intended initial dialysis treatments. Design In a prospective cohort study, demographic, clinical, and QL data were obtained from Dutch adult patients who were consecutively enrolled from 27 different centers 0 – 4 weeks prior to the beginning of their chronic dialysis treatment. Patients Of the 301 patients who completed the QL questionnaires (of a possible 337 enrolled patients), 152 intended to start with hemodialysis (pre-HD) and 149 patients with peritoneal dialysis (pre-PD). Main Outcome Measure Perceived QL of pre-HD and pre-PD patients. Quality of life was assessed with two generic health assessment instruments: the SF-36 and the EuroQol. Results After correction for group differences, pre-HD patients scored consistently, but not significantly, lower for all separate dimensions of the SF-36 and the overall health score of the EuroQol compared to pre-PD patients. However, analyzing the dimensions of the SF-36 together, adjusted for case-mix, pre-HD patients scored significantly lower than pre-PD patients. Mean difference was 6.5 points ( p = 0.04). Conclusion Multivariate adjustment for known case-mix differences at the start of dialysis therapy was not sufficient to adjust for all patient selection effects on QL. Consequently, published QL comparisons between HD and PD in nonrandomized cohort studies should be interpreted with caution. Assessment of QL just before start of dialysis therapy and subsequent adjustment for baseline values may be the only valid alternative for randomized studies.
A Retrospective Study of Seven Cases of Candida Parapsilosis Peritonitis in CAPD Patients: The Therapeutic Implications
Authors: Wong Ping-Nam , Mak Siu-Ka , Lo Kin-Yee , Tong Gensy M.W. , Wong Andrew K.M. 
Published: February 2020

Background Candida peritonitis accounts for the majority of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD), but the Candida species were not routinely subtyped in previous studies. The clinical course and the outcome of Candida parapsilosis peritonitis remain unclear. Objective To study the clinical course and outcome of C. parapsilosis peritonitis in CAPD patients. Setting Peritoneal dialysis unit in a regional hospital. Patients and Design A retrospective study on seven cases of C. parapsilosis peritonitis occurring in a single center over 3 years. Results The 7 patients included 4 males and 3 females. Their mean age was 62 ± 11.5 years. Two (29%) were diabetic. Three (43%) had a history of preceding peritonitis and 5 (71%) had received broad spectrum antibiotic within the previous 1 month. All presented with cloudy dialysate, abdominal pain, and fever. The mean dialysate white cell count was 300 ± 168/mm3 with a predominance of neutrophils (81.4% ± 13.1%). The mean time from onset of symptoms to diagnosis was 5.7 ± 3.1 days. All had been treated with immediate catheter removal within 24 hours of diagnosis and antifungal therapy, including oral fluconazole, intravenous (IV) amphotericin, or their sequential combination. Environmental samplings were negative for C. parapsilosis. The overall complication rate was exceptionally high (71%), with three (43%) complicated by abscess formation requiring surgical drainage, one peritoneal adhesion (14%), and one mortality (14%). In the end, only two (29%) could resume CAPD. Conclusions The outcome of this study group appeared worse than those previously described in the literature, and the optimal treatment for this group of patients remains unclear.
The Effect of Small Solute Clearances on Survival of Anuric Peritoneal Dialysis Patients
Authors: Bhaskaran Shanmukham , Schaubel Douglas E. , Jassal Sarbjit V. , Thodis Elias , Singhal Manoj K. , Bargman Joanne M. , Vas Stephen I. , Oreopoulos Dimitrios G. 
Published: February 2020

Objective Primarily, to determine whether peritoneal small solute clearance is related to patient and technique survival among anuric peritoneal dialysis [continuous ambulatory (CAPD) and automated peritoneal dialysis (APD)] patients. A secondary goal was to describe the ability to attain Dialysis Outcomes Quality Initiative (DOQI) targets among anuric patients on peritoneal dialysis. Design Retrospective cohort study via chart reviews. Setting Peritoneal Dialysis Unit of Toronto Hospital (Western Division). Patients The study included 122 CAPD and APD patients between January 1992 and September 1997, with 24-hour urine volume less than 100 mL, or renal creatinine clearance (CCr) less than 1 mL/minute. Adequacy data were available for 115 patients. Outcome Measures Mortality and technique failure (TF). Regression analysis was used to estimate the mortality and TF rate ratios (RR) for peritoneal Kt/V urea (pKt/V) and pCCr, adjusting for age, gender, diabetes, months of follow-up prior to anuria, albumin, transport status, coronary artery disease, cardiovascular disease, and peripheral vascular disease. Results Fifty seven per cent (51/89) of patients on CAPD and 81% (21/26) on APD had a weekly pKt/V ≥ 2 and ≥ 2.2, respectively (DOQI targets); whereas only 35% on CAPD (31/89) and 35% (9/26) on APD had a weekly pCCr ≥ 60 L/1.73 m2 and 66 L/1.73 m2, respectively. Median follow-up times among patients were 16.5 and 19.5 months pre- and postanuria, respectively. Patients with pKt/V ≥ 1.85 experienced a strong decrease in patient mortality (RR = 0.54, p = 0.10); the effect was less pronounced for pCCr ≥ 50 L/1.73 m2 (RR = 0.63, p = 0.25). No relationship was observed between pKt/V or pCCr and TF. Conclusion Mortality was noticeably less frequent among patients with a pKt/V ≥ 1.85 compared with those with a Kt/V < 1.85 ( p = 0.10). Given the magnitude of the association, the failure to observe statistical significance relates to the size of the patient cohort. Our results imply that it is, in fact, possible to achieve DOQI targets among anuric patients on peritoneal dialysis.
Dyslipidemia in Peritoneal Dialysis — Relation to Dialytic Variables
Authors: Johansson Ann-Cathrine , Samuelsson Ola , Attman Per-Ola , Haraldsson Börje , Moberly James , Knight–Gibson Carolyn , Alaupovic Petar 
Published: February 2020

Objective To investigate whether the specific lipoprotein (LP) abnormalities of peritoneal dialysis (PD) are associated with functional variables of this mode of dialysis. Design A survey of the LP profile in relation to peritoneal dialysis capacity (PDC) variables. The LP profile was compared to that of a group of age- and sex-matched controls. Setting The Peritoneal Dialysis Unit at Sahlgrenska University Hospital in Gothenburg, Sweden. Patients Twenty-two nondiabetic PD patients (5 women, 17 men) who had been on PD for at least 6 months. Main Outcome Measures The LP profile included plasma lipids, apolipoproteins (Apo), and individual ApoA- and ApoB-containing LP. The PDC measurement determined peritoneal glucose uptake, protein losses, effective peritoneal surface area, and total weekly creatinine clearance. Results The patients had been on PD for 6 to 48 months (mean 15.3 months) and had a total weekly creatinine clearance of 69.7 ± 13.3 L/1.73m2 body surface area, an average peritoneal glucose uptake corresponding to 446 ± 162 kcal/24 hour, and a protein loss of 8.1 ± 2.5 g/24 hr. The patients had significantly higher total cholesterol (7.1 mmol/L), VLDL-cholesterol (1.0 mmol/L), LDL-cholesterol (4.7 mmol/L), and triglyceride levels (2.5 mmol/L); whereas the HDL-cholesterol level (1.2 mmol/L) was significantly lower than in controls. The PD patients had increased levels of ApoB-containing LPs, both of the cholesterol-rich LP-B and of the triglyceride-rich LP-B complex, reflected in higher plasma concentrations of ApoB, ApoC-III, and ApoE. Furthermore, they had significantly lower levels of LP-A-I:A-II, as well as of ApoA-I and ApoA-II. The LP-A-I:A-II and ApoA-II levels correlated inversely with the duration of PD treatment ( r = 0.54, p < 0.01 and r = 0.52, p < 0.05, respectively). The ApoA-II level was inversely correlated with the peritoneal surface area ( r = 0.53, p < 0.05). There were no other correlations between LP variables and PDC variables, nor did any of the LP variables correlate with peritoneal glucose uptake or protein losses. Conclusion The proatherogenic lipoprotein profile of patients on PD is characterized by increased concentrations of cholesterol-rich and triglyceride-rich ApoB-containing LPs. While the duration of treatment appears to have some influence on the development of this type of dyslipidemia, the pathophysiological links to the dialysis mode must be further explored.
Continuous Ambulatory Peritoneal Dialysis is Responsible for an Increase in Plasma Norepinephrine
Authors: Vlachojannis John G. , Tsakas Sotiris , Alexandri Sotiria , Petropoulou Chrysanthi , Goumenos Dimitris S. 
Published: February 2020

Objective To investigate the reason for increasing norepinephrine (NE) levels reported in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Norepinephrine was measured in the plasma and peritoneal dialysate of CAPD patients ( n = 22) and in the plasma and the urine of healthy subjects ( n = 20). It was also measured in the plasma of patients with chronic renal failure (CRF) ( n = 15) and patients on hemodialysis (HD) ( n = 15). Results It was found that NE was increased in CAPD patients compared with healthy individuals (687 ± 221 pg/mL vs 199 ± 25 pg/mL, p < 0.01). The daily removal of NE from the peritoneum of CAPD patients was lower compared with the amount of NE excreted in the urine of healthy subjects. Plasma NE increased after infusion of peritoneal dialysate. In 15 new patients on CAPD, it was found that NE plasma levels increased from 329 ± 67 pg/mL before initiation of dialysis, to 584 ± 173 pg/mL after 12 months of treatment ( p < 0.01). Finally, plasma NE in CAPD patients (687 ± 221 pg/mL) was significantly higher compared with the already increased levels in patients on HD or with CRF (406 ± 143 pg/mL and 378 ± 142 pg/mL, respectively). Conclusions It is concluded that CAPD in patients with end-stage renal disease is responsible for a progressive increase of plasma norepinephrine.
Preliminary Evaluation of Incremental Peritoneal Dialysis in 25 Patients
Authors: De Vecchi Amedeo F. , Scalamogna Antonio , Finazzi Silvia , Colucci Patrizia , Ponticelli Claudio 
Published: February 2020

Background Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule. Objectives To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life. Design Pilot prospective study, not controlled. Setting Nephrology division, public clinical research hospital. Patients Twenty-five patients (19 men, mean age 61 ± 13 years, body weight 63 ± 11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/V. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose. Outcome Measures Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances. Results During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4. Conclusions Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.
Incremental Initiation of Dialysis: One Center's Experience over a Two-Year Period
Authors: Burkart John M. , Satko Scott G. 
Published: February 2020

Objective This pilot study describes our center's experience with peritoneal dialysis (PD) over the past 2 years using a “healthy start” dialysis protocol with an incremental approach to prescription management. Design Nonrandomized, prospective pilot study. Setting Single PD unit of a university teaching hospital. Patients Thirteen PD patients who initiated dialysis at our center from April 1997 to June 1999. Methods Patients initiating PD with residual renal Kt/V of 1.0 – 2.0/week were invited to participate. They were given an initial dialysis prescription so that total (residual renal + dialysis) weekly Kt/V exceeded 2.0. The dialysis prescription was “incrementally” increased as residual renal function (RRF) declined. Data collected for all patients included monthly serum chemistries, residual renal weekly Kt/V and creatinine clearance (CCr) at 1- to 2-month intervals, and peritoneal weekly Kt/V and CCr at 3-month intervals and 1 month after each prescription change. Results To date, we have followed 13 patients on our incremental PD protocol for a total of 159.3 patient-months. Mean serum albumin concentration and mean normalized protein equivalent of nitrogen appearance (nPNA) were stable throughout the study. Mean total Kt/V and CCr remained above the recommended targets of 2.0/wk and 60 L/wk, respectively. Residual renal function declined rather slowly in our PD patients. One patient died from complications of aortic valve surgery and a second died from pneumonia. A third patient died from peritonitis. One patient required a new Tenckhoff catheter after catheter migration. Three patients were temporarily switched to hemodialysis after a hernia repair, a pleural leak, and elective native/transplant nephrectomies, respectively. Two patients were permanently switched to hemodialysis: one after an episode of peritonitis, the second after accidentally damaging his PD catheter. Conclusions Providing incremental dialysis to maintain adequate total small solute clearance has been technically feasible in our patient population. However, a larger than expected number of complications was seen in our study. Fortunately, complications were easier to manage due to the presence of RRF. Because this study was not designed to compare outcome with that observed after traditional initiation of dialysis, further large-scale studies are needed.
Continuous Adaptation of the Dialysis Prescription Maintains Adequate Kprt/V in CAPD Patients
Authors: Andersson Helene , Buxbaum Martina , Meisl Franz Thomas 
Published: February 2020

Objective To analyze the effect of individual adaptation of the dialysis prescription in continuous ambulatory peritoneal dialysis (CAPD), as compensation for the decline of residual renal function (RRF), on peritoneal (Kpt/V) and total (Kprt/V) urea clearance as well as on peritoneal (Kpcr) and total weekly creatinine clearances (CCr). Design Retrospective analysis of a 2-year period. Patients We analyzed 18 patients [15 male, 3 female; mean age 58.2 (24 – 80) years]. Main Outcome Measures Correlations between increased dialysis prescription and Kpt/V, Kprt/V, and Kpcr. Kprt/V and CCr measurements were based on a 24-hour dialysate and urine collection. Measurements were performed over a time period of 3 to 6 months. Results The results show a linear correlation between Kpt/V and Kpcr and the prescribed volume by kilogram body weight. Kprt/V was increased slightly by increasing the dialysis prescription. Dialysate-to-plasma (D/P) ratios of urea and creatinine remained unchanged. The mean prescribed dialysate volume increased from 7.4 ± 1.1 L to 10.6 ± 2.5 L. Mean Kprt/V could be maintained on a stable level for a 36-month period. Conclusion By adapting the dialysis prescription on an individual basis to the continuous decline of RRF, and taking the patient's body weight into account in the prescription decision, the increases in Kpt/V offset the decline in RRF. We recommend early individualization of prescription for patients on CAPD.
Peritoneal Transport Characteristics, Comorbid Diseases and Survival in CAPD Patients
Authors: Chung Sung Hee , Chu Won Suk , Lee Hyun Ah , Kim Yong Hwa , Lee In Sang , Lindholm Bengt , Lee Hi Bahl 
Published: February 2020

Objective To evaluate the influence of initial peritoneal transport rate, serum albumin concentration, and comorbid diseases on continuous ambulatory peritoneal dialysis (CAPD) patient survival. Design A prospective single-center study with a long-term follow-up. Patients A total of 213 consecutive CAPD patients, who underwent a peritoneal equilibration test (PET) at a mean of 7 days (range 3 – 30 days) after beginning CAPD, were included in this study. One hundred twenty patients were male, 116 patients had comorbid diseases, and mean age was 49.5 years (range 18 – 76 years). Methods A modified PET was performed using 4.25% glucose dialysis solution. Based on the dialysate-to-plasma creatinine concentration ratio at 4 hours’ dwell (D4/P4 Cr, 0.62 ± 0.14), patients were divided into high (H), high-average (HA), low-average (LA), or low (L) transporters. Results Of 213 patients, 16.9% were classified as H transporters, 30.5% as HA, 36.6% as LA, and 16.0% as L transporters. The H transporter group had a higher proportion of men, higher proportion of patients with comorbid diseases, lower initial serum albumin concentration, lower D4/D0 glucose, and lower drained volume. The initial D4/P4 Cr correlated with initial serum albumin ( r = –0.35, p < 0.001). The patients with comorbid diseases had lower initial serum albumin and higher initial D4/P4 Cr. On Kaplan–Meier analysis, 2-year patient survival of group H was significantly lower compared to the other groups combined (57.1% vs 79.5%, p = 0.009). On Cox proportional hazards analysis, age, comorbid diseases, initial serum albumin concentration, and initial D4/P4 Cr were found to be independent risk factors for mortality. However, in the patients without comorbid diseases, patient survival was not different between group H and the other transport groups combined ( p > 0.05), and only age was found to be an independent risk factor for mortality. Conclusion These data suggest that a high peritoneal transport rate at initial PET is associated with high mortality, and that this is in part due to an increased prevalence of comorbid disease in H transporters. These H transporters with comorbid diseases represent a subset of patients with an especially poor prognosis. In patients without comorbid diseases, high transport status or low serum albumin concentration was not an independent risk factor for mortality.