bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short Term Clinical Study with Bicarbonate-Containing Peritoneal Dialysis Solution
Authors: Feriani Mariano , Dissegna Daniela , La Greca Giuseppe , Passlick-Deetjen Jutta 
Published: February 2020

Objective The evaluation of the efficacy, adequacy, clinical tolerance, and safety of a new bicarbonate continuous ambulatory peritoneal dialysis (CAPD) solution. Design and Patients A 6–week cross-over clinical study in 6 stable CAPD patients was performed. After a control period (2 weeks) with a standard CAPD solution (lactate, 35 mmol/L), a two-chamber bag containing 34 mmol/L of bicarbonate was used for 4 weeks. A breakable valve divided the two chambers, one containing bicarbonate and the other calcium. The two solutions were mixed just before use, thus avoiding the calcium and magnesium carbonate precipitation. Results No differences between control and study periods were found for blood urea nitrogen, creatinine, total proteins, albumin, total and ionized calcium, phosphate, sodium, potassium, chlorine, and hemoglobin. Blood bicarbonate significantly increased from 21.25±2.02 to 23.36±1.15 (p<0.05) during the study. The peritoneal equilibration tests for urea nitrogen, creatinine, proteins, sodium, potassium, and glucose were slightly reduced during bicarbonate dialysate, but this effect was compensated for by a slight increase of ultrafiltration, thus keeping peritoneal clearances constant. Residual renal function did not change during the study. No side effects occurred during the bicarbonate period. Conclusion A CAPD bicarbonate solution is effective in uremic acidosis correction, does not affect dialysis adequacy, is safe, and well tolerated.
The Role of Sympathetic Dysfunction in Blood Pressure Regulation in Uremic Patients Treated by Continuous Ambulatory Peritoneal Dialysis
Authors: Jankovic Nikola , Varlaj-Knobloch Vesna , Pavlovic Draško , Milutinovic Slobodan 
Published: February 2020

The role of autonomic nervous system dysfunction In the regulation of arterial blood pressure In 4 male and 10 female uremic patients, age 35–65 years (57±9 years), treated by continuous ambulatory peritoneal dialysis (CAPO) for 6–40 months (20±12 months), was studied. The integrity of the entire autonomic reflex arc was checked using Valsalva's test and the orthostasis challenge test in parallel, efferent sympathetic function was tested with the handgrip test. A significantly decreased Valsalva ratio was found In 7 patients (50%), and it was normal in only 2 patients (14%). The handgrip test was subnormal in 5 patients (36%) and abnormal In 7 patients (50%). On the contrary, the orthostatic challenge test showed normal compensatory reaction in 10 patients (72%). The evaluation of three autonomic tests showed combined (afferent + efferent) lesion In 6 patients (43%), predominant afferent lesion In 3 patients (21 %), and In 3 patients predominant efferent lesion. In 2 patients (14%) there was no end-organ response. Despite significant autonomic nervous system dysfunction In uremics on CAPO, as demonstrated by these results, blood pressure regulation In the supine and up right position was adequate In most patients (72%), indicating a relatively greater role of other blood pressure-regulating factors.
Transperitoneal Calcium Mass Transfer using Dialv Sate with a Low Calcium Concentration (1.0 mM)
Authors: Weinreich Thomas , Colombi A. , Echterhoff H.H. , Mielke G. , Nebel M. , Ziegelmayer C. , Passlick-Deetjen J. 
Published: February 2020

Lower dialysate calcium concentrations were recently proposed to overcome the risk of hypercalcemia In continuous ambulatory peritoneal dialysis (CAPD) patients on calcium containing phosphate binders and/or vitamin D metabolites using the standard dialysate calcium concentration (sCa) of 1.75 mM. To assess transperitoneal calcium mass transfer (CaMT) in CAPD patients using a dialysate with a low calcium concentration (LCa, 1.00 mM), 18 stable patients were randomly allocated to receive either LCa or SCa. CaMT was assessed over 4 hours using 2L dialysate bags with three different dialysate glucose concentrations (1.5%, 2.3%, 4.25%). Total serum calcium (tCa), Ionized calcium (iCa), and the exact dialysate volume were measured before and after the 4-hour dwell. A sample of the drained dialysate was obtained to measure the dialysate calcium concentration. The tCa and iCa levels were not significantly different In both groups prior to and did not change throughout the test. CaMT (median/range) was .0.64 mmol/exchange (0.35 –1.29 mmol/exchange) using LCa with 1.5% glucose compared to 0.23 mmol (.0.18 -0.87 mmol) with SCa (p<0.0001). CaMT was negatively correlated to ICa and ultrafiltration volume [4.25%: LCa -1.22 (.0.84 -1.9); SCa .0.43 (-1.35 -0.13); p<0.001]. In summary, LCa results in a loss of calcium into the dialysate even at low ultrafiltration volumes and serum ICa levels. This might facilitate the prevention and therapy of renal osteodystrophy with calclum-containing phosphate binders and calcitriol. However, patients using LCa must be carefully monitored for calcium homeostasis and bone turnover.
Well-Informed Patients with End-Stage Renal Disease Prefer Peritoneal Dialysis to Hemodialysis
Authors: Ahlmén Jarl , Carlsson Lisbeth , Schönborg Christina 
Published: February 2020

One hundred and one azotemic patients, from March 1988 to March 1992, expected to be in need of active treatment of uremia within the next 6 months, were invited to four information meetings concerning conservative treatment of uremia, hemodialysis, peritoneal dialysis, and transplantation. Eighty-three percent of the invited patients attended. Another 13 started active treatment of uremia after receiving individualized information. At the end of the observation period, 37 of 97 patients had chosen continuous ambulatory peritoneal dialysis (CAPD), and 23 hemodialysis. Twenty-nine had not yet decided which mode of active treatment of uremia they wanted, and 4 patients had died. Patients choosing CAPD had a mean age of 52 years, compared to 59 years for those choosing hemodialysis. Thirty-six of 37 patients who had chosen CAPD and 19 of 23 patients who had chosen hemodialysis had started treatment. The cumulative patient and technique survival at 12 months for CAPD was 92% and 66%, and for hemodialysis 700/0 and 70%, respectively. The patients were asked to give their views on their choice of active treatment of uremia and the information meetings once they had started treatment. Eighty-six percent of the patients did not want to change their chosen therapy, and 88% of the patients found the Information provided adequate. When patients with renal insufficiency are given adequate Information, the majority prefer peritoneal dialysis to hemodialysis and are very satisfied with their choice.
Urea Kinetics and Nitrogen Appearance Rates in Diabetic Patients on Peritoneal Dialysis
Authors: Prowant Barbara F. , Bernardini Judith Y. , 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.
Nasogastric Tube Feeding in Infants on Peritoneal Dialysis
Authors: Warady Bradley A. , Weis Lynette , Johnson Leslie 
Published: February 2020

Enteral nutritional support is an important component of the care provided to infants receiving long-term peritoneal dialysis. In the majority of published experiences on this subject, the use of the nasogastric tube has facilitated the provision of required calorie and protein intake and resulted in an improved patient outcome. Advantages of the nasogastric route of nutritional support include the ease of administration, while recurrent emesis remains the most troublesome and frequent shortterm complication associated with its use. Impaired oralmotor development may also result from nonoral feeding and should be addressed throughout the course of tube feeding. The outcome of infants with ESRD receiving CPD has markedly improved since the introduction of NG feedings as a regular component of dialysis patient care. While complications associated with NG feedings have been documented, the benefits associated with this route of nutritional supplementation have been great. Currently, an increasing number of infants/ young children on CPD are receiving supplemental nutrition with the use of the gastrostomy tube/button (31). However, the risks associated with this route of therapy in the CPD population, especially in terms of infection, are as yet not well defined (32). Once the risk/benefit ratio of gastrostomy tube/button placement is determined, future efforts should be directed towards better defining how the two routes of enteral nutritional support (e.g., NG tube, gastrostomy tube/button) may best complement one another.
Impaired Initial Cell Reaction in Capd-Related Peritonitis
Authors: Koopmans Julia G. , Boeschoten Elisabeth W. , Pannekeet Marja M. , Betjes Michiel G.H. , Zemel Désirée , Kuijper Ed J. , Krediet Raymond T. 
Published: February 2020

Our objective was to determine the incidence of peritonitis episodes with an impaired initial cell reaction (IICR: neutrophil number <100 x 1 061L) over a period often years, and to find possible explanations for this unusual presentation of peritonitis. A retrospective review of the files of continuous ambulatory peritoneal dialysis (CAPD) patients included in the CAPD program between 1984 and 1993 was done. Analysis of cytokine and prostanoid patterns during four peritonitis episodes with an IICR was compared to 12 episodes with a normal initial cell reaction (NICR). Dialysate cell numbers and immunoeffector characteristics of peritoneal cells were compared in 7 IICR patients in a stable situation and a control group of 70 stable CAPD patients. The setting was a CAPD unit in the Academic Medical Center in Amsterdam. Thirty-five CAPD patients who had one or more peritonitis episodes with an IICR and a control group of 249 CAPD patients were included in the study. The incidence of peritonitis with an IICR was 6%. These episodes occurred more than once in 51% of the patients who presented with IICR. In 72% the cell reaction was only delayed: a cell number exceeding 100 x 1 061L was reached later. Staphylococcus aureus was significantly more frequently the causative microorganism compared to all peritonitis episodes (PE) that occurred during the study period. Patients with IICR had lower dialysate cell counts in a stable situation, compared to a control group (p < 0.01). This was caused by a lower number of macro-phages and CD4 positive lymphocytes. The phagocytosis capacity of the macrophages appeared to be normal. In a comparison of four PE with an IICR and 12 episodes with an NICR, the tumor necrosis factor-α (TNF-α) response was similar and occurred on day 1, also pointing to normally functioning macrophages. However, the maximal appearance rates of interleukin-6 (IL-6) and IL-8 occurred later in the episodes with IICR compared to NICR (day 2 vs day 1, p < 0.05). No differences were found in vasodilating prostaglandins, mesothelial cell markers (cancer antigen 125, phospholipids, hyaluronan), and mesothelial cell numbers in the stable situation nor during peritonitis. Peritonitis can present as abdominal pain in the absence of a cloudy dialysate. In some of the patients this presentation occurred more than once. This impaired, most often delayed, cell reaction was associated with a delayed secondary cytokine response. As IL-6 and IL-8 can be synthesized by mesothelial cells, this suggests an impaired functioning mesothelium. This could not be confirmed, however, by a lower number of mesothelial cells in effluent or lower dialysate levels of mesothelial cell markers.
Calculation of 6-Hour Dip Creatinine Ratio from the 4-Hour Peritoneal Equilibration Test. The Effect of Dwell Duration on the Results
Authors: Mehrotra Rajnish , Khanna Ramesh , Yang Thomas C.K. , Kathuria Pranay , Moore Harold L. , Prowant Barbara F. , Nolph Karl D. , Twardowski Zbylut J. 
Published: February 2020

Objectives Since the introduction of the peritoneal equilibration test (PET), the 4-hour dialysatelplasma creatinine (DIP Cr) has been used by several authors for determining continuous ambulatory peritoneal dialysis (CAPD) prescriptions. However, the results have been unsatisfactory because the 4-hr DIP Cr does not accurately reflect the DIP Cr in 24-hr collections. The PET and the 24-hr dialysate collections differ in the duration of dwell and the tonicity and volume of dialysate, all of which influence the equilibrated DIP Cr. It can be assumed that the DIP Cr in 24-hr collections in these patients is closer to a 6-hr DIP Cr. Because a 6hr PET is inconvenient, we developed a mathematical model to calculate the 5 and 6-hr DIP using the results of a standard PET. Design In a retrospective analysis, DIP Cr ratios in 24-hr collections and DIP Cr ratios calculated from a mathematical formula were correlated. Using a mathematical model, the data collected fit an exponential relation of the type DIP = a(1 -e-t/τ). The values of a and τ are unique for a given patient and were determined using a nonlinear regression technique. The formula performed well on our published data -the true and predicted 6-hr DIP Cr being 0.696 and 0.71, respectively. Setting The University Hospital and Clinics, Dalton Cardiovascular Research Center and Dialysis Clinic, Inc., Columbia, Missouri. Patients All CAPD patients on four 2-L exchangeslday at the time of the 24-hr collections were included. Interventions None. Main Outcome Measures Closeness of 4-hr and 6-hr DIP Cr values to those of 24-hr ratios. Results The study group comprised 74 patients (age, mean ± SEM: 56.4 ± 1.8 yr) with 80 PETs and 145 (24-hr) collections. The interval between the two tests was 8. 3 ± 0.9 months (0 48.7 months). The median 24-hr DIP Cr of 0.760 did not differ significantly from the predicted median 6-hr DIP Cr of 0.755. A subgroup analysis, based on transport type, showed that this relationship was most precise in the high-average transporters. The predicted 6hr DIP Cr was within 100;0 of the 24-hr DIP Cr in 48% of patients and within 20% in 77% of patients. The margin of error was greatest in the low transporters. Conclusions To conclude, the 4-hr DIP Cr from a PET cannot be used interchangeably with the DIP Cr in the 24-hr dialysate collections, hence, the clearances calculated thereof will be inaccurate. Using the proposed model, it is feasible to use the 4 -hr PET results to obtain 5 and 6 -hr DIP Cr values. In our study, using this model, the extrapolated 6-hr DIP Cr is similar to the DIP Cr in 24-hr dialysate collections only in the high-average transporters. Hence, the best way to determine clearances in peritoneal dialysis patients is still by collecting 24-hr dialysates.
Reduced Glucose Degradation Products in Bicarbonate/Lactate-Buffered Peritoneal Dialysis Solutions Produced in Two-Chambered Bags
Authors: Cooker Laurinda A. , Luneburg Patricia , Faict Dirk , Choo Carolyn , Holmes Clifford J. 
Published: February 2020

Objectives The aims of the current study were: (1) to determine the effects of peritoneal dialysis (PD) solutions at different glucose concentrations on the growth of cultured cells; (2) to determine whether a bicarbonate/ lactate-based solution, as a result of the configuration of its components during heat sterilization in a two-chambered bag, was lower in glucose degradation products than a corresponding lactate-based PD solution; and (3) to determine whether lower glucose degradation corresponded to a decreased inhibition of cell growth. Design Growth inhibition of cells exposed to lactatebased PD solutions at three different glucose concentrations was determined. Bicarbonate/lactate-based and lactate-based solutions at high glucose concentration (3.86%) were further analyzed for presence of glucose degradation products and inhibition of cell growth. Methods Cell growth was determined by neutral red uptake, measured by optical density at 540 nm. Glucose degradation to acetaldehyde or fructose was determined by gas chromatographymass spectroscopy and highperformance liquid chromatography. Results Only 3.86% glucose lactate-based PD solution caused significant inhibition of cell growth (p < 0.05). The heat-sterilized, bicarbonate/lactate-based solution (3.86% glucose) had lower levels of fructose and acetaldehyde than a conventional heat-sterilized, lactatebased solution with the same glucose concentration. Growth of cultured cells exposed to the bicarbonate/ lactate-based solution was significantly improved (p < 0.05) over growth in the conventional solution. Conclusions The bicarbonate/lactate-based solutions, manufactured and heat-sterilized in two-chambered bags, were lower in glucose degradation products than the corresponding lactate-based PD solutions, and demonstrated improvedin vitrobiocompatibility as measured by the growth of cultured cells.
Safety and Efficacy of Total Dose Iron Dextran Administration in Patients on Home Renal Replacement Therapies
Authors: Sloand James A. , Shelly Mark A. , Erenstone Anne L. , Schiff Melissa J. , Talley Thomas E. , Dhakal Madhavendra P. 
Published: February 2020

Objective To determine the safety and efficacy of intravenous total dose iron (TDI) replacement in patients treated with home renal replacement therapy. Design Prospective open-label study on end points in the population studied. Setting Institutional outpatient home dialysis program. Patients The study included 20 end-stage renal disease (ESRD) patients, performing chronic peritoneal or home hemodialysis, with iron deficiency defined as ferritin < 100 ng/mL and/or an iron saturation < 20%. Intervention The total dose of iron dextran was calculated and infused at a rate not exceeding 6 mg/min. Hemoglobin, hematocrit, iron studies, and liver function tests (LFTs) were obtained before and 3 to 4 weeks after TDI infusion. Hematocrit of patients failing to achieve an increase in Hct over this period was re-examined 2 to 4 weeks later looking for a delayed response. Main Outcome Measures Primary end points for efficacy were changes in Hct, ferritin, and iron saturation. Toxicity was measured as reported immediate and delayed symptoms and elevated transaminases and/or alkaline phosphatase levels. Results A median iron dose of 1000 mg (range, 325 1500 mg) was administered. The infusions were generally well tolerated. Clinical adverse effects were seen in 2 patients weighing less than 50 kg. No increase in LFT results was seen. Hematocrit increased 2.2% (95% CI, 0.5% -3.9%) from 29.0% to 31.2% (p = 0.01) within 4 weeks of infusion. Significant increases also occurred in iron saturation (from 13% to 22%, p = 0.001) and ferritin (from 234 to 305 ng/mL, p = 0.008). Among the 9 patients who did not respond with a significant increase in Hct, 2 had a delayed response, increasing the overall response from 63% at 4 weeks to 71 %,8 weeks after TDI.lnadequate erythropoietin dosing and low-grade infectious/inflammatory disorders may have contributed to a poor response in several patients. Conclusion Total dose iron is a safe and effective means of restoring iron and erythropoietic response in ESRD patients weighing more than 50 kg who receive their renal replacement therapy at home.
Mast Cell Histamine-Induced Calcium Transients in Cultured Human Peritoneal Mesothelial Cells
Authors: Bird Stephen D. , Walker Robert J. 
Published: February 2020

Objective Peritoneal inflammation results from a complex interplay of events initiated by macrophage activity in response to infection, with the stimulation of mesothelial cell cytokine release amplifying the recruitment of blood-borne defense cells to the site of injury. Resident peritoneal mast cells may add to this complexity with mast cell derived cytokines released during this cascade. This study examined the influence of histamine, a mast cell derived inflammatory mediator, on the initial activation of human peritoneal mesothelial cells (HPMC) by intracellular free calcium (Cai2+) mobilization, and changes to the actin cytoskeleton. Design HPMC signal transduction was examined in response to histamine (1.0 mmol/L) compared to fetal bovine serum (FBS) (0.1 %) and 4-br-A23187 (1.0 μmol/L). Intracellular free calcium was measured in fura-2 loaded cells with and without external calcium (Ca2ex+t), or Ca2ex+t with verapamil (100 μmol/L). Following treatment with agonists, HPMC actin cytoskeleton was stained using direct immunocytochemistry. Results HPMC responded to histamine with a twofold transient rise in Cai2+ which returned to the baseline, in contrast with FBS and A23187–induced Cai2+ transients, which returned to elevated resting values. In the absence of Ca2ex+t’ all agents produced a calcium transient indicative of calcium release from intracellular stores. Histamine induced calcium -dependent changes to the cytoskeleton and cellular organization, including increased actin stress fibers. Conclusion Histamine produced large specific receptor-mediated calcium transients in HPMC, which included components of calcium release from intracellular stores and receptor -mediated calcium influx processes. The observed response to histamine raises the possibility that histamine derived from resident mast cells may modulate mesothelial cell function, in part by calciumdependent pathways, and influence the performance of the peritoneal membrane during peritoneal dialysis.