bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival on Chronic Peritoneal Dialysis: Have Results Improved in the 1990s?
Authors: Rodríguez-Carmona Ana , Falcon Teresa García , Fontán Miguel pérez , Bouza Pablo , Adeva Magdalena , Rivera Constantino F. , Valdés Francisco 
Published: February 2020

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patient or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.
Hepatitis C Antibodies in Patients on Peritoneal Dialysis: Prevalence and Risk Factors
Authors: Lee Grace S.L. , Roy Dilip K. , Fan Fung-Yin , Thanaletchumi K. , Woo Keng Thye 
Published: February 2020

Our objective was to determine the prevalence of the antibody to hepatitis C (anti-HCV) in a population of endstage renal failure patients on continuous peritoneal dialysis (CPD) and study the possible risk factors associated with anti-HCV seropositivity and seroconversion. A cross-sectional study included 155 adult patients enrolled in the CPD program in a single renal unit of a teaching hospital who were screened for anti-HCV by second-generation enzyme immunoassay, which was confirmed by recombinant immunoblot assay. Serum was also assayed for hepatitis B surface antigen (HBsAg). History of renal transplantation, blood transfusions, and exposure to hemodialysis was obtained from medical records. Ten of 155 patients (6.5%) in this study population were anti-HCV positive [anti-HCV(+)] and 11/155 (7.1%) were HBsAg positive; no patient was positive for both. All the anti-HCV(+) patients were on continuous ambulatory peritoneal dialysis (CAPD); no continuous cycling peritoneal dialysis (CCPD) patient was anti-HCV(+). Exposure to hemodialysis was a risk factor for anti-HCV seropositivity, with 7 out of 10 (70%) anti-HCV(+) patients having been on hemodialysis compared to 55/134 (41%) anti-HCV(-) (p < 0.05, Fisher's exact test). No difference was noted between anti-HCV(+) and anti-HCV(-) groups in relation to age, gender, duration on CPD, renal transplantation, or exposure to blood transfusions. Seroconversion occurred in only one patient after a mean observation period of 20±0.6 months. The prevalence of anti-HCV seropositivity in this population of CPD patients is 6.5%, and HBsAg is 7.1%. Exposure to hemodialysis is a significant risk factor for development of anti-HCV seropositivity. Seroconversion rate appears to be low.
Nursing Involvement in Research: An Academic Pursuit Or Relevant to Nursing Practice?
Authors: Schneider Anni E. , Donald Catriona , Short Pam , King Bruce B. , Junor Brian J.R. , Rowe Peter A. 
Published: February 2020

It is said that nursing is ‘informed by research.’ We evaluated the effect a clinical research project had on the nursing procedure of a nonrotating, permanent continuous ambulatory peritoneal dialysis (CAPD) team involved primarily in patient care. A trial of the overnight solute clearance as a simple measure of the adequacy of CAPD was carried out and its effect on the following aspects of nursing practice was assessed: 1. Teamwork Can research be successfully incorporated within the team's work structure in a clinical environment? 2. Nurse's role -Duties of the nurse involved in the research (selection of patients, organization of appointments, collection of samples, and calculation of results). 3. Nurse/patient relationship -Individual knowledge of patients’ needs and communication skills employed (necessity for true informed consent). The experience showed us that participation in research is not only possible, but also interesting from the nurses’ viewpoint and of direct benefit to the patients.
Successful Pregnancy Complicated by Peritonitis in a 35-Year-Old Capd Patient
Authors: Tison Andree , Lozowy Christine , Benjamin Alice , Usher Robert , Prichard Sarah 
Published: February 2020

A 35-year-old woman conceived six months after initiating continuous ambulatory peritoneal dialysis (CAPO). A medical plan was developed to give the patient adequate dialysis for a 1.5 g/kg/day protein Intake. In addition, alterations in calcium, magnesium, and erythropoietin administration were required to reach the objectives set by the obstetrical/renal team. Three weeks prior to delivery, an amniotic leak developed, and vaginal cultures were positive for Escherichia coli. Oral amoxiclllin was administered (500 mg per os q.i.d.) until the day of delivery. A 1545-g baby girl was delivered by cesarean section at 32 weeks. Five days postpartum the patient developed severe peritonitis, which subsequently grew E. coli. The patient fully recovered from the peritonitis, but catheter removal was required. Successful pregnancy can be expected on CAPO, and adequacy can be achieved with aggressive dialysis. Cesarean section delivery should probably be accompanied by full peritonitis therapy.
Modification of An Amino Acid Solution for Peritoneal Dialysis to Reduce Risk of Acidemia
Authors: Jones Michael , Kalil Roberto , Blake Peter , Martis Leo , Oreopoulos Dimitrios G. 
Published: February 2020

Objective Some patients develop a mild acidemia during treatment with amino acid-based peritoneal dialysis solutions due to hydrogen ion produced by metabolism of lysine, arginine, and methionine. In this study we modified the formulation of such a solution by reducing these amino acids and adding anionic amino acids so as to provide minimal net acid production. Design A modified formula (MF) was compared to a conventional formula (CF) of the solution in a randomized crossover study in 12 stable continuous ambulatory peritoneal dialysis patients. Patients were given each solution for 14 days without a wash-out period. Each patient replaced one or two dextrose dialysis exchanges with amino acid solution, depending upon oral protein intake and body weight. Total intake (oral protein plus amino acids absorbed) was equivalent to 1.1 -1.3 g protein/kg body weight/day.Plasma bicarbonate and urea were assessed at the beginning and end of each 14-day period. Results In the group as a whole, without regard to the order in which the solutions were given, patients had a decrease in serum bicarbonate with CF and an increase in bicarbonate when they received MF. Similar trends were observed regardless of the order in which the solutions were administered. Serum urea did not differ between the two solutions. Conclusion The results suggest that patients are less prone to develop acidemia when receiving MF as opposed to CF. Further studies will be necessary to determine the long-term effects and the relative nutritional benefits of the two solutions.
Estimation of Total Daily Creatinine Clearance in Capd from Serum Creatinine Concentration
Authors: Jones Colin H. , Newstead Charles G. , Will Eric J. 
Published: February 2020

Objective To establish whether estimation of creatinine clearance (CrCI) from serum creatinine, gender, age, and weight might reduce the number of 24-hour urine and dialysate collections required to monitor adequacy of delivered dialysis on continuous ambulatory peritoneal dialysis (CAPO). Design Retrospective single-center study. Setting University Hospital. Patients Creatinine excretion and CrCI were measured in 187 24-hour urine and dialysate collections from 99 CAPO patients (55 male, 44 female). Multiple regression analysis was used to estimate creatinine excretion from age and weight in males and females. CrCI was derived and also calculated using the Cockcroft-Gault and Mitch-Walser formulas. Positive and negative predictive values for indicating adequacy of dialysis were determined. Results Measured and derived CrCI were correlated (males: r = 0.85; females: r = 0.83; p < 0.001), but agreement was poor (95% limits of agreement: males, 26.05 to -25.75 L/wk; females, 37.47 to -19.49 L/wk). Taking the minimum acceptable CrCI as 60 L/week, the respective positive predictive values of the derived, Cockcroft, and Mitch methods in predicting underdialysis were 88%, 100%, and 100% in males and 88%, 88%, and 89% in females. Negative predictive values were 83%, 57%, and 53% in males and 53%, 48%, and 45% in females. Conclusion A derived CrCI >6 0 was not predictive of adequate dialysis. Because the detection of underdialysis is our objective, formal clearance studies should be performed in this group. A derived CrCI <60 L/wk was predictive of underdialysis in males and females and an increase in dialysis dose without formal clearance measurements could be suggested in these patients. The use of this approach could allow an important reduction in the number of clearance studies required to monitor CAPO adequacy.
Calcium Metabolism in Blood and Peritoneal L Ymphocytes from Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Lewis Sharon L. , Kutvirt Susan G. , Seamer Larry C. , Holmes Clifford J. 
Published: February 2020

Objective Cellular immune function in peritoneal dialysis patients has been shown to be depressed, but the mechanism of this immunosuppression has not been ascertained. Because calcium is an important mediator of lymphocyte activation, this study was designed to investigate if there was an alteration of calcium metabolism in the lymphocytes of continuous ambulatory peritoneal dialysis (CAPD) patients. Design Sixteen CAPD patients were studied at the initiation of CAPD and after two months of treatment. Twenty-three normal controls were also enrolled in the study. Cytoplasmic calcium changes were investigated in response to the mitogen phytohemagglutinin (PHA) in peripheral blood and peritoneal lymphocytes, using the intracellular calcium probe indo-1 and flow cytometry. Baseline cytoplasmic calcium levels and changes in cytoplasmic calcium in response to PHA were assessed at the initiation of CAPD and after two months of therapy. Results Peripheral lymphocytes of patients and controls had similar calcium baseline levels, but the peritoneal lymphocytes had baseline cytoplasmic calcium levels averaging 81% higher than the corresponding calcium levels of the patients’ peripheral blood lymphocytes. As compared to peripheral lymphocytes, the response to PHA stimulation was significantly less in the peritoneal lymphocytes, increasing an average of only 46.8% above baseline. Peripheral blood lymphocytes of the patients responded by an average increase of 78.9% over baseline. Control cells increased an average of 66.3% over baseline. Follow-up studies done two months after the initiation of CAPD indicated there were no significant changes (as compared to month 0) that occurred in baseline or stimulated intracellular calcium concentrations. Conclusions While the peripheral lymphocytes of CAPD patients respond adequately to PHA, the high baseline calcium levels of the peritoneal lymphocytes suggest that these cells may be in a state of chronic activation and may respond minimally to an antigenic challenge.
Technique Failure in Peritoneal Dialysis and Its Impact on Patient Survival
Authors: Woodrow Graham , Turney John H. , Brownjohn Aleck M. 
Published: February 2020

Objective To determine the frequency and causes of continuous ambulatory peritoneal dialysis (CAPD) technique failure and its effect on patient outcome. Design Retrospective study of CAPD technique and patient outcome. Setting Teaching hospital renal unit. Patients All 221 patients commencing CAPD over a 14-year period. Outcome measures: Outcomes assessed included patient survival and technique survival (with change to hemodialysis being considered as technique failure). Results CAPD failure occurred in 46 patients, with a CAPD technique survival of 93%,73%, and 63% at 1,3, an d 5 years after start of treatment. Peritonitis was the major cause of technique failure. CAPD system had no effect on technique survival, despite the lower peritonitis rate in patients using Y-connection systems. Overall patient survival was 91 %, 72%, and 53% at 1, 3, and 5 years after start of treatment, with increasing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later. Conclusion Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or indirectly by the later effects of damage to the peritoneal membrane with loss of dialysis adequacy. The high mortality in the period following CAPD failure warrants careful monitoring of patients during this phase, along with efforts to optimize correctable factors such as nutrition, adequacy of the new form of dialysis, and treatment of residual sepsis.
Continuous Flow through Peritoneal Dialysis (Cfpd): Comparison of Efficiency to Ipd, Tpd, and Capd in An Animal Model
Authors: Ash Stephen R. , Janle Elsa M. 
Published: February 2020

Objective To determine whether continuous flow through peritoneal dialysis (CFPD), a treatment schedule in which peritoneal dialysate is infused continuously into one part of the abdomen (over the liver) and is drained from a distant part of the abdomen (the pelvis), can provide greater clearance than continuous ambulatory peritoneal dialysis (CAPD), tidal peritoneal dialysis (TPD), or intermittent peritoneal dialysis (IPD). Design A prospective study comparing four schedules of peritoneal dialysis in the awake, normal dog, using glucose clearance as a substitute for urea clearance. Methods We placed two chronic dialysis catheters into the abdomen of anesthetized dogs (with intraperitoneal portions of fluted or miniature column-disc design). On successive days, with the dogs awake and prone, we performed peritoneal dialysis for 4 hours with 1.5% dialysate according to one of four schedules, each with 2 L maximum intraperitoneal volume: CFPD (unidirectional flow at an average of 3.6 L/hr), IPD (2 L/hr), TPD (average of 3.6 L/hr, 1 L residual volume), and CAPD (2 L/4 hr). Glucose and urea clearances were calculated from blood and peritoneal concentrations and dialysate flow rates. Results Stabilized glucose clearances (from 60 to 240 minutes) averaged 11 ± 5 mL/min for IPD, TPD, and CFPD, and 5 ±2 mU minfor CAPD. However, glucose clearances of CFPD were 13 ± 6 mL/min when the intraperitoneal volume was maintained at 800 -1000 mL, and 16.5 ± 6 mL/min when flow rate was 6 L/hr. Urea clearances were twice the measured glucose clearances. Conclusion When CFPD is performed with an appropriate intraperitoneal volume and flow, it is the most chemically effective method of peritoneal dialysis in removing small molecules like urea.
Effect of Dialysis Modality and Membrane Transport Characteristics on Dialysate Protein Losses of Patients on Peritoneal Dialysis
Authors: Kathuria Pranay , Moore Harold L. , Khanna Ramesh , Twardowski Zbylut J. , Goel Sharad , Nolph Karl D. 
Published: February 2020

Objective To determine if peritoneal dialysis modality has an impact on protein losses in dialysate. Design Retrospective, cross-sectional study. Patients 190 patients who had selected peritoneal dialysis were classified into one of four transport categories (high, high-average, low-average, or low) based on standard peritoneal equilibration test results. Patients were then assigned to continuous ambulatory peritoneal dialysis (CAPD) or nightly intermittent peritoneal dialysis (NIPD) based on membrane transport characteristics and individual preferences. Results Patients with similar membrane transport characteristics had essentially no differences in dialysate protein and albumin losses whether treated with CAPD or NIPD. Conclusions Although high transporters may be better managed with short -dwell therapies such as nocturnal intermittent peritoneal dialysis or daily ambulatory peritoneal dialysis, consistent marked decreases in protein losses cannot be cited as a benefit of NIPD over CAPD.
Is Heparin Therapy Necessary in Capd Peritonitis?
Authors: Nadig Canradin , Binswanger Ulrich , Van Felten Arthur 
Published: February 2020

Objective Heparin therapy in continuous ambulatory peritoneal dialysis (CAPD) peritonitis seems well established; it is costly due to the necessity of hospitalization. There are no clinical studies that show a benefit of such a treatment. The aim of this study was to investigate whether heparin therapy in CAPD peritonitis isnecessary. Design and Patients 194 samples of peritoneal dialysates were collected from 17 patients over a period of 24 months. Samples were subdivided into three groups: those without peritonitis (<100 leukocytes/ILL), those with mild peritonitis (100 -499 leukocytes/ILL), and those with severe peritonitis (≥500 leukocytes/ILL). Measurements The number of leukocytes per ILL dialysate and total protein concentrations were determined. Furthermore, dialysate concentrations of thrombin-antithrombin 111 (TAT-) complexes (indicator of thrombin formation), D-dimers (indicator of fibrinolysis), and plasminogen activator inhibitor 1 (PAI-1) were measured. Results The dialysate protein concentration progressively increased from no peritonitis to mild and severe inflammation. In parallel, dialysate TAT -complex and D-dimer concentrations increased. Thrombin-antithrombin 1I1-complex and D-dimer concentrations correlated strongly in 179 cases (r = 0.76; 62 samples showing peritonitis, 117 samples with no evidence of peritonitis). In the remaining 15 samples of 3 patients, high PAI-1 levels (>40 ng/mL) and low D-dimer concentrations were found. Eleven of the 15 samples showed evidence of peritonitis. In these 11 samples with evidence of peritonitis, high levels of TAT -complexes were detected, while Ddimer concentrations were found to be very low, pointing to a blocked fibrinolysis. The P AI-1levels were not related to leukocyte counts or protein concentrations in the dialysates. Conclusions Based on our findings, the routine intraperitoneal administration of heparin in CAPD peritonitis is not necessary. In rare cases an imbalance between coagulation and fibrinolysis due to high PAI-1 levels exists (15 of 194 dialysate samples, 11 of the 15 samples showing peritonitis). These cases -which do require heparinization -can be identified by demonstrating low D-dimer levels in CAPD dialysate at times of peritonitis.
Calcium Concentration in the Capd Dialysate: What is Optimal and is There a Need to Individualize?
Authors: Bro Susanne , Brandi Lisbet , Daugaard Henrik , Olgaard Klaus 
Published: February 2020

Objective To evaluate risk/benefit of various continuous ambulatory peritoneal dialysis (CAPD) dialysate calcium concentrations. Data Sources A review of the literature on the effects of various CAPD dialysate Ca concentrations on plasma Ca, plasma phosphate, plasma parathyroid hormone (PTH), doses of calcium carbonate, doses of vitamin D analogs, and requirements of aluminum-containing phosphate binders. Study Selection Eleven studies of nonselected CAPD patients, and 13 studies of CAPD patients with hypercalcemia were reviewed. Results In nonselected CAPD patients, treatment with a reduced dialysate Ca concentration (1.00, 1.25, or 1.35 mmol/L) improved the tolerance to calcium carbonate and/or vitamin D metabolites and reduced the need for Al-containing phosphate binders. When using dialysate Ca 1.25 or 1.35 mmol/L, the initial decrease of plasma Ca and increase of PTH could easily be reversed with an immediate adjustment of the treatment. After 3 months, stable plasma Ca and PTH levels could be maintained using only monthly investigations. In patients with hypercalcemia and elevated PTH levels, treatment with dialysate Ca concentrations below 1.25 mmol/L implied a considerable risk for the progression of secondary hyperparathyroidism. When hypercalcemia was present in combination with suppressed PTH levels, a controlled increase of PTH could be obtained with a temporary discontinuation of vitamin D and/or a reduction of calcium carbonate treatment in combination with a dialysate Ca concentration of 1.25 or 1.35 mmol/L. Conclusion Most CAPD patients can be treated effectively and safely with a reduced dialysate Ca concentration of 1.35 or 1.25 mmol/L. Treatment with dialysate Ca concentrations below 1.25 mmol/L should not be used. A small fraction of patients with persistent hypocalcemia need treatment with high dialysate Ca, such as 1.75 mmol/L.
Touch Contamination of Connection Devices in Peritoneal Dialysis-Aquantitative Microbiologic Analysis
Authors: Miller Thomas E. , Findon Glenne 
Published: February 2020

Objective To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD). Design The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberatetouch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag. Subjects Patients undergoing PD were used as the “test” group. Departmental secretarial and laboratory staff served as the comparative control group. Setting The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes. Outcome The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels. Results Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms trans located to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95% -99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group. Conclusion Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95% -99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.