bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of Fungal Peritonitis with Nystatin Prophylaxis in Patients Receiving CAPD
Authors: Wong Ping-Nam , Lo Kin-Yee , Tong Gensy M.W. , Chan Shuk-Fan , Lo Man-Wai , Mak Siu-Ka , Wong Andrew K.M. 
Published: February 2020

Objective Fungal peritonitis (FP) is a serious complication of continuous ambulatory peritoneal dialysis (CAPD), being associated with significant morbidity and mortality. The role of nystatin prophylaxis during antibiotic therapy in the prevention of FP remains controversial, especially in programs with a modest or low baseline FP rate. The aim of the present study was to evaluate the effect of nystatin prophylaxis on the occurrence of FP in programs with a relatively modest baseline FP rate. Patients and Methods Incident and prevalent patients receiving CAPD between April 1995 and April 2005 at our center were included and divided into 2 groups. The control group included 320 patients (total follow-up 8875 patient-months) being treated without nystatin before October 1999; the nystatin group included 481 patients (total follow-up 13725 patient-months) being treated after October 1999. Nystatin tablets (500000 units, 4 times per day) were given orally during whatever use of antibiotics to cover the whole course of antibiotic therapy. Occurrence of FP and antibiotic-related FP (AR-FP) in patients with and without nystatin prophylaxis was compared. Results The two groups were of similar age but the nystatin group had a significantly higher percentage of diabetics. In addition, the nystatin group had a higher proportion of patients using disconnecting twin-bag exchange systems and had a significantly lower peritonitis rate compared with the control. There were 13 and 14 episodes of FP in the nystatin and control groups respectively. The fungal peritonitis rate of the nystatin group was slightly lower than that of the control group (0.011 vs 0.019 per patient-year) but it did not reach statistical significance. There was, however, a significant decrease in the incidence and proportion of AR-FP in the nystatin group compared with the control group, which persisted even after adjustment for the peritonitis rate. Kaplan–Meier analysis further demonstrated significantly better AR-FP-free survival in the nystatin group compared with the control group. No significant side effects were observed for nystatin. Subgroup analyses in patients of the 2 different connecting systems revealed a similar but nonsignificant trend toward reduction of AR-FP in patients given nystatin prophylaxis. Conclusion Oral nystatin prophylaxis might prevent the occurrence of AR-FP in CAPD patients, resulting in a trend toward reduction in the incidence of FP even in programs with a modest baseline FP rate. A large scale, prospective, randomized controlled trial is needed to further examine this issue.
Risks and Outcomes of Peritonitis after Flexible Colonoscopy in CAPD Patients
Authors: Yip Terence , Tse Kai Chung , Lam Man Fai , Cheng Suk Wai , Lui Sing Leung , Tang Sydney , Ng Matthew , Chan Tak Mao , Lai Kar Neng , Lo Wai Kei 
Published: February 2020

Objective The ISPD 2005 guidelines for peritonitis recommend antibiotic prophylaxis for patients undergoing colonoscopy with polypectomy while on continuous ambulatory peritoneal dialysis (CAPD) but there is little literature to support this recommendation. This study aimed to look into the risks and outcomes of peritonitis after colonoscopy in CAPD patients. Patients and Methods All records of flexible colonoscopy performed on our CAPD patients from January 1994 to January 2006 were retrieved. Demographic and clinical data, use of antibiotics before colonoscopy, endoscopic findings, procedure performed, and peritonitis data were analyzed. Results 77 CAPD patients underwent 97 colonoscopies. No peritonitis developed in the 18 cases where antibiotics were given before colonoscopy. Among those without antibiotic prophylaxis, 4 episodes of peritonitis occurred within 24 hours after the procedure and 1 occurred 5 days later. All responded to intraperitoneal antibiotics. Colonic biopsy and polypectomy were not associated with more peritonitis (2 in 41 with biopsy vs 3 in 38 without biopsy, p = 0.67; 1 in 30 with polypectomy vs 4 in 49 without polypectomy, p = 0.64). Conclusion The risk of peritonitis after colonoscopy without antibiotic prophylaxis was 6.3%. All peritonitis episodes responded to intraperitoneal antibiotics. Colonic biopsy or polypectomy did not appear to increase the risk of peritonitis. Although statistically not significant when compared with patients without antibiotic prophylaxis, we observed no peritonitis after colonoscopy in patients that were given antibiotics for prophylactic purposes or for other reasons. The efficacy of prophylactic antibiotics would be better defined by large randomized trials.
A Quarter of a Century of Adult Peritoneal Dialysis-Related Peritonitis at an Australian Medical Center
Authors: Brown Fiona , Liu Wen Jiun , Kotsanas Despina , Korman Tony M. , Atkins Robert C. 
Published: February 2020

Background Peritonitis remains one of the major complications of peritoneal dialysis (PD) and results in reduced technique survival and increased patient morbidity and mortality. Methods We prospectively recorded comprehensive data on all episodes of PD peritonitis over a 25-year period, including organisms isolated and antibiotic sensitivities. Data on 1588 PD patient-years with 2073 episodes of peritonitis were analyzed; 2089 organisms were isolated in 608 patients. Peritoneal dialysis technique and patient survival were also recorded. Results There was a significant decline over the years in the incidence of peritonitis, from 6.5 to 0.35 episodes/patient-year, with the decline in the post twin-bag era from 2.3 to 0.47 ( p < 0.001) due primarily to a decrease in gram-positive organisms. The most common isolates (68.9%) were gram-positive organisms; gram-negative organisms comprised 26.8% and fungi 4.1%. Coagulase-negative staphylococci were the most common pathogen isolated (35.3%). Culture-negative peritonitis was seen in 13.4% of episodes. Conclusion This is the largest series of PD peritonitis reported, demonstrating a dramatic reduction over a 25-year period and also detailing the changing trends of organisms isolated in association with improved technique and patient survival. Although rates have improved, peritonitis remains a major complication and further research needs to be done to improve both PD technique and patient survival.
Serum BNP Concentration and Left Ventricular Mass in CAPD and Automated Peritoneal Dialysis Patients
Authors: Bavbek Nüket , Akay Hatice , Altay Mustafa , Uz Ebru , Turgut Faruk , Uyar Mehtap E. , Karanfil Aydýn , Selcoki Yusuf , Akcay Ali , Duranay Murat 
Published: February 2020

Objective To compare ultrafiltration under continuous ambulatory peritoneal dialysis (CAPD) and automated PD (APD), disclosing potential effects on serum B-type natriuretic peptide (BNP) levels and echocardiographic findings. Patients and Methods This cross-sectional clinical study included 32 patients on CAPD and 30 patients on APD without clinical evidence of heart failure or hemodynamically significant valvular heart disease. Peritoneal equilibration tests, BNP levels, and echocardiographic measurements were performed in each subject. BNP measurements were also performed in 24 healthy control subjects. Results Patients on APD had lower ultrafiltration and higher values of BNP and left ventricular mass index (LVMI) compared with patients on CAPD (respectively: 775 ± 160 vs 850 ± 265 mL, p = 0.01; 253.23 ± 81.64 vs 109.42 ± 25.63 pg/mL, p = 0.001; 185.12 ± 63.50 vs 129.30 ± 40.95 g/m2, p = 0.001). This occurred despite higher mean dialysate glucose concentrations and far more extensive use of icodextrin in the APD group. Conclusion Treatment with APD is associated with higher plasma BNP levels and LVMI compared to CAPD. This may be the result of chronic fluid retention caused by lower ultra-filtration in APD patients.
Quality of Sleep and Psychosocial Factors for Patients Undergoing Peritoneal Dialysis
Authors: Yang Ju-Yeh , Huang Jenq-Wen , Peng Yu-Sen , Chiang Shou-Shang , Yang Chwei-Shiun , Yang Chin-Ching , Chen Huey-Wen , Wu Ming-Shiou , Wu Kwan-Dun , Tsai Tun-Jun , Chen Wan-Yu 
Published: February 2020

Objectives Sleep disorders are common in end-stage renal disease patients. This study examined the relationship between self-reported quality of sleep (QoS) and certain psychosocial domains for patients on peritoneal dialysis (PD). Methods The study subjects included 190 PD patients from 7 urban dialysis clinics in Northern Taiwan, from whom we obtained biochemical parameters and demographic data. QoS, quality of life (QoL), religious/spiritual activity, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Medical Outcomes Study Short Form (SF-36) for QoL, the Royal Free Questionnaire, and the Beck Depression Inventory, respectively. Results The average PSQI score was 9.1 ± 4.1 and, in total, 85.8% of all patients were poor sleepers (global PSQI ≥ 5). There was no difference in age, gender, and mode or duration of PD between good and poor sleepers. Biochemical data did not differ between the two groups. Widowed patients experienced significantly poorer QoS than patients with other marital status (PSQI scores: 12.3 ± 4.9 vs 8.88 ± 4.0, p = 0.006). The percentage of patients that held a bachelor's degree or above was significantly higher in good sleepers (55.6% vs 29.4%, p = 0.008). The PSQI value correlated negatively with the QoL scale in both physical ( r = –0.295, p < 0.001) and mental domains ( r = –0.410, p < 0.001), and correlated positively with the depression scale ( r = 0.351, p < 0.001). There appeared to be no association between QoS and spiritual/religious activity ( r = –0.097, p = 0.223). Conclusions Psychosocial factors including depression, patients’ perceptions regarding QoL, marital status, and educational background correlated significantly to the subjective QoS for PD patients. When dealing with sleep disorders in PD patients, physicians should pay considerable attention to their psychosocial backgrounds.
Intraperitoneal Calcitriol in Infants on Peritoneal Dialysis
Authors: Cano Francisco J. , Azocar Marta A. , Guerrero Jose Luis , Delucchi Maria A. , Lillo Ana Maria , Emilfork Marcos , Rodríguez Eugenio E. 
Published: February 2020

Background Calcitriol has long been used as the main therapy in renal osteodystrophy, but the efficacy of the oral route is not always as high as expected. Objective To asses the safety and efficacy of intraperitoneal calcitriol in infants undergoing peritoneal dialysis (PD). Patients and Methods PD patients on oral calcitriol therapy, with serum parathyroid hormone (PTH) >1000 pg/mL during the previous 3 months of treatment, were switched to intraperitoneal calcitriol therapy, 1 μg twice per week. Dose was increased to 1 μg three times per week if PTH remained >1000 pg/mL, and was later readjusted. Target PTH was 200 – 300 pg/mL according DOQI guidelines. Statistics: All results are expressed as mean ± SE. The Wilcoxon signed rank test was used to evaluate differences in measurements for each pair of values. The confidence interval for differences between population medians was 96.9%. A p value less than 0.05 was considered significant. Results Six male children, mean age 17 ± 3.86 months, completed a 12-month follow-up. Mean pretreatment PTH was 1654 ± 209 pg/mL. Mean PTH at months 0, 3, 6, 9, and 12 was 1448 ± 439*, 1277 ± 723, 910 ± 704, 582 ± 282*, and 465 ± 224* pg/mL, respectively (*p < 0.05). Twelve hypercalcemic and 10 hyperphosphatemic episodes were successfully treated. Conclusion Infants on PD who fail to respond to oral calcitriol therapy can be safely treated with intraperitoneal administration of active vitamin D.
Ultrafiltration and Absorption in Evaluating Aquaporin Function from Peritoneal Transport of Sodium
Authors: Waniewski Jacek , Debowska Malgorzata , Lindholm Bengt 
Published: February 2020

Background Evaluation of free water transport is a tool for assessing aquaporin function in peritoneal dialysis patients. The dialysate “sodium dip” and estimation of sieving coefficient for sodium may be used for quantification of the free water fraction in ultrafiltration flow from blood to the peritoneal cavity. Method The mini peritoneal equilibration test (mini-PET) [La Milia et al., Nephrol Dial Transplant 2002; 17(Suppl 3):17–18] is a simple method for evaluating free water transport using sodium as a marker. We compared the evaluation of free water transport using the mini-PET against detailed data on fluid and sodium transport from clinical dwell studies using a macromolecular volume marker to estimate fluid absorption and ultrafiltration rates, and the modified Babb–Randerson–Farrell model to assess the sodium transport components. Results and Conclusion According to our results, the mini-PET may result in underestimation of fluid transport by about 20% because it neglects the impact of peritoneal fluid and solute absorption and sodium diffusion during the peritoneal dwell time. Nevertheless, estimation of the free water fraction in the mini-PET yields values (about 0.4) similar to the more detailed analysis.
Transluminal Replacement of Displaced Peritoneal Catheter Using a Special “Alpha-Replacer” Guidewire: Effectiveness and Limitations
Authors: Terawaki Hiroyuki , Nakayama Masaaki , Nakano Hirofumi , Hasegawa Toshio , Ogura Makoto , Hosoya Tatsuo , Karino Tomokazu 
Published: February 2020

Background Transluminal replacement of a displaced peritoneal catheter (TRC) using a metal guidewire is a noninvasive treatment of catheter displacement with acute malfunction. The “alpha-replacer” is a special guidewire developed specifically for TRC. This wire is usually flexible but becomes harder if coiled in the hand. Application of this unique guidewire might improve the effectiveness of TRC. Methods TRC using an alpha-replacer was performed in 10 cases for urgent correction of peritoneal catheter displacement. All patients had received a double cuffed, straight-end swan-neck catheter. Results The primary success rate of TRC using the alpha-replacer was 90% (9 of 10 cases). No patients developed complications such as injury of the peritoneum or abdominal organs. Relapse of catheter displacement was observed in 2 cases (20%) within 1 week, requiring surgical intervention to prevent relapse. Conclusion TRC using the alpha-replacer as described herein offers effective and safe treatment of peritoneal catheter displacement.
Comparison between Bicarbonate/Lactate and Standard Lactate Dialysis Solution in Peritoneal Transport and Ultrafiltration: A Prospective, Crossover Single-Dwell Study
Authors: Fang Wei , Mullan Robert , Shah Hemal , Mujais Salim , Bargman Joanne M. , Oreopoulos Dimitrios G. 
Published: February 2020

Objective It has been proposed that biocompatible bicarbonate/lactate based (Bic/Lac), physiologic-pH peritoneal dialysis (PD) solutions will be beneficial in long-term PD. However, we do not yet have detailed knowledge concerning the comparative physiology of buffer transport for these new solutions and their impact on underlying peritoneal transport of solutes and ultrafiltration (UF). The purpose of this study was to investigate the profile of buffer handling and peritoneal membrane transport characteristics during a single dwell of the new Bic/Lac-based versus standard lactate-based (Lac) PD solution. Methods In this prospective crossover study, we compared a 25 mmol/L bicarbonate/15 mmol/L lactate buffered, physiologic pH, low glucose degradation product (GDP) solution (Physioneal; Baxter Healthcare, McGaw Park, Illinois, USA) with a standard lactate buffered, acidic pH, conventional solution (Dianeal; Baxter). 18 patients underwent two peritoneal equilibration tests (PETs) with 2.5% Dianeal and 2.5% Physioneal separated by 1 week. Buffer transport, mass transfer area coefficients (MTACs), solute transport, and UF were determined for the two PETs. All bags were weighed by a nurse before instillation and after drainage to assess the net UF in each dwell. Results 18 patients that met the inclusion criteria were enrolled in this study. Whereas intraperitoneal pH remained constant at 7.52 ± 0.11 throughout the dwell with the Bic/Lac solution, pH was still in the acidic range with the Lac solution after 1 hour (7.29 ± 0.13, p < 0.001); this difference disappeared after the second hour of dwell. The MTACs for creatinine (10.68 ± 3.66 vs 10.73 ± 2.96 mL/minute/ 1.73 m2, p > 0.05) and urea (27.94 ± 10.50 vs 27.62 ± 6.95 mL/min/1.73 m2, p > 0.05), for Bic/Lac versus Lac respectively, did not differ between these two solutions; transport of glucose and other solutes was also similar. However, after a 4-hour dwell with Bic/Lac solution, net UF was significantly lower than that observed with Lac solution (274.2 ± 223.3 mL vs 366.1 ± 217.3 mL, p = 0.026). Conclusions Compared to standard Lac-based solution, Bic/Lac based, pH neutral, low-GDP solution avoids intra-peritoneal acidity. Peritoneal mass transport kinetics are similar for small solutes. Net UF is significantly lower with Bic/Lac solution; the mechanism for this is unclear.
How Accurate is the Description of Transport Kinetics in Peritoneal Dialysis According to Different Versions of the Three-Pore Model?
Authors: Waniewski Jacek , Debowska Malgorzata , Lindholm Bengt 
Published: February 2020

Objective The three-pore model of peritoneal transport is used extensively for modeling peritoneal fluid and solute transport, but the currently used versions include certain modifications of the transport parameters that have not been validated quantitatively versus detailed data on fluid and solute kinetics. The aim of this study was to evaluate different versions of the three-pore model. Method Detailed clinical peritoneal fluid and solute transport data were obtained from 40 peritoneal dwell studies in clinically stable continuous ambulatory peritoneal dialysis patients in whom the dialysate volume was measured using a macromolecular volume marker (RISA). Results Using a new version of the three-pore model with several adjusted transport parameters, good agreement between the measured and the simulated values of dialysate volume and concentrations of small solutes and RISA (but not of endogenous protein) versus dwell time was obtained; however, the predicted peritoneal absorption for longer than the investigated dwell time would be too high. Conclusion The three-pore model, with some adjustments proposed in this study, may be used for detailed description of peritoneal transport kinetics, but it should be pointed out that, even after these adjustments, it still does not provide the correct description of peritoneal fluid absorption and transport of macromolecules.
Acute Central Hemodynamic Effects of a Volume Exchange in Peritoneal Dialysis
Authors: Verbeke Francis , Van Biesen Wim , Pletinck Anneleen , Van Bortel Luc M. , Vanholder Raymond 
Published: February 2020

Background Although peritoneal dialysis is considered to offer more hemodynamic stability than hemodialysis, the acute hemodynamic effects of peritoneal dialysis have only been investigated scarcely. The present study assesses the central hemodynamic impact of volume infusion using pH-adjusted icodextrin, thus avoiding interference of glucose, pH, and osmolarity. Methods Patients were randomized to 3 different starting volumes (A: 1000 mL, B: 1500 mL, and C: 2500 mL) of icodextrin, followed by addition (A and B) or drainage (C) of 200 mL every 10 minutes for 50 minutes. Local carotid systolic blood pressure (BP; as a surrogate for central BP), augmentation index, and augmentation pressure were measured by applanation tonometry before and after infusion of the starting volumes and after each volume change. Results We included 13 patients (median age 57 years). Baseline brachial BP was 126/77 mmHg. After infusion of the starting volume, carotid systolic BP and augmentation pressure increased by 4.7 mmHg ( p = 0.006) and 3.1 mmHg ( p = 0.015). Augmentation index increased by 5.7% ( p = 0.04) and heart rate decreased by 2.6/minute ( p = 0.006). Intraperitoneal pressure increased by 2.3 cm H2O ( p = 0.03). No additional hemodynamic changes except for a rise in diastolic BP with increasing volume ( p = 0.004) were observed after subsequent addition or removal of volumes. Conclusions Infusion of peritoneal dialysis fluids causes an acute increase in carotid systolic B P, followed by a progressive rise in diastolic BP. These effects persist until complete drainage of the abdomen and may be due to an enhanced preload, resulting from intraperitoneal venous compression, and/or increased wave reflection.
Fluoroscopically Guided Peritoneal Dialysis Catheter Placement: Long-Term Results from a Single Center
Authors: Moon Ju-Young , Song Sebin , Jung Kyung-Hwan , Park Mina , Lee Sang-Ho , Ihm Chun-Gyoo , Oh Joo-Hyeong , Kwon Se Hwan , Lee Tae Won 
Published: February 2020

Objective Despite percutaneous fluoroscopy ensuring appropriate placement of peritoneal dialysis (PD) catheters, the efficacy of this method is not well known. Therefore, we evaluated our long-term experience with fluoroscopy-assisted placement of PD catheters. Patients and Methods We retrospectively reviewed 134 PD catheters in 114 PD patients that were treated in the PD center of a university-based hospital. We evaluated complications related to PD catheters, causes for catheter removal, and catheter survival. We used the multivariate Cox proportional hazard model to identify independent factors related to PD catheter survival. Results Early complications related to insertion included 1 case of pericatheter bleeding; there were no placement failures. Early complications occurred in 8.5% of patients. Most late complications were migration and leakage, which occurred in 10.4% and 9.7% of patients respectively. The most common cause for catheter removal was intractable and recurrent peritonitis. The 12- and 24-month survival rates of the catheters were 80.0% and 74.9%. The most significant prognostic factor of percutaneous fluoroscopy-assisted PD catheter survival was late leakage ( p < 0.01). Conclusions In addition to the advantages of simplicity, minimal invasiveness, and relative safety, the survival rate of PD catheters placed using the percutaneous fluoroscopy-assisted method was comparable to that of more invasive methods. Percutaneous fluoroscopy-assisted placement of PD catheters should be considered when available, and may be preferred to other placement methods.