bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stability of Cefazolin Sodium in Four Heparinized and Non-Heparinized Dialysate Solutions at 38°C
Authors: Robinson Renee F. , Morosco Richard S. , Smith Charles V. , Mahan John D. 
Published: February 2020

Background Intraperitoneal administration of antibiotics is often required in the treatment of peritoneal dialysis-associated peritonitis. Extended use and heating may affect drug stability. The objective of our study was to determine the stability of cefazolin sodium (125 mg/L and 500 mg/L) in heparinized and non-heparinized dextrose-containing peritoneal dialysis solution (Dianeal PD-2; Baxter Healthcare, Deerfield, Illinois, USA) containing 1.5%, 2.5%, or 4.25% dextrose, or 7.5% icodextrin, the new colloid formulation (Extraneal; Baxter), at 38°C for 4 days. Methods Three poly-vinyl chloride containers of each dialysis fluid were stored at 38°C for 4 days. Samples were taken after the bags were mixed and allowed to stand for 2 minutes. Two 500-μL samples were collected from each bag at hours 0, 12, 24, 36, 48, 60, 72, 84, and 96. Samples were then analyzed by high-performance liquid chromatography (HPLC) in our laboratory. In order to establish the stability-indicating nature of the method, drugs 1.0 mg/mL, vehicles, and their mixtures were subjected to a forced degradation. This is done by acid (2.0 mol/L HCl) and base (2.0 mol/L NaOH) hydrolysis, oxidation (H2O2 0.3%), and heat at 80°C. Samples were analyzed every 30 minutes until approximately 25% of the drug's peak disappeared. The drug was considered stable if its concentration exceeded 90% of the original. Results For all Dianeal PD-2 peritoneal dialysis solution containing 1.5%, 2.5%, and 4.25% dextrose, cefazolin sodium was considered stable at 38°C for 60 hours at low cefazolin concentrations (125 mg/L), both with and without heparin, and for 48 hours at high cefazolin concentrations (500 mg/L). Cefazolin sodium was considered stable at 38°C in icodextrin for 48 hours at low cefazolin concentrations in heparinized and non-heparinized solutions, and at high concentrations only in non-heparinized dialysate, not in heparinized dialysate. Cefazolin sodium was considered stable at 38°C in icodextrin for 60 hours at high concentrations when heparinized. Conclusion Cefazolin sodium was stable in all four non-heparinized dialysate fluids for at least 48 hours at 38°C. In heparinized icodextrin dialysate, high concentrations of cefazolin sodium were not stable for extended periods of time. Extended use and heating of dialysate containing cefazolin may adversely affect patient outcome.
Ciprofloxacin and Cefazolin as a Combination for Empirical Initial Therapy of Peritoneal Dialysis-Related Peritonitis: Five-year Follow-up
Authors: Lima Renata C.S. , Barreira André , Cardoso Fernando L. , Lima Marcio H.S. , Leite Maurilo 
Published: February 2020

The treatment of peritoneal dialysis (PD)-related peritonitis has been a matter of extensive investigation, frequently generating therapeutic trials. Several combinations of antibiotics have served as newer protocols and tended to be efficacious, comfortable, and cost-effective. According to the more recent recommendations from the International Society for Peritoneal Dialysis, the rationale for empirical initial therapy of clinically detected peritonitis in PD patients has been to follow the bacterial profile derived from cultured specimens of PD effluents. The current study describes 5 year's experience with the use of a new antibiotic regimen for the treatment of peritonitis. We herein analyze the outcome of 95 episodes of peritonitis in 54 patients on either automated PD or continuous ambulatory PD at the dialysis unit of the Federal University of Rio de Janeiro. Peritoneal dialysis-related peritonitis was treated with the combination of oral ciprofloxacin and intraperitoneal cefazolin. The observed cure rate was 85.2% and the sensitivity test was observed to be positive for this combination of antibiotics in 88.9% of positive cultures. Of the 14 unsuccessful episodes, 7 were due to catheter colonization and the rest did not respond to the proposed therapy within 48 hours. These 7 cases were also related to peritoneal fluid cultures that were resistant to both ciprofloxacin and cefazolin. From this study, we propose this combination of oral ciprofloxacin and intraperitoneal cefazolin as a first choice for empirical initial therapy of PD-related peritonitis, given its efficacy and low cost. However, in order to apply the most adequate cost-effective therapy, careful examination of the bacterial profile and sensitivities to antibiotics used in each unit is strongly recommended.
Immediate Initiation of CAPD following Percutaneous Catheter Placement without Break-in Procedure
Authors: Jo Young-Il , Shin Sug Kyun , Lee Jong-Ho , Song Jong-Oh , Park Jung-Hwan 
Published: February 2020

Objective To evaluate the effect of a modified method of percutaneous catheter placement without a break-in procedure on the development of catheter-related complications in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A prospective, observational clinical study. Setting Peritoneal dialysis (PD) units of two university-based hospitals. Patients and Methods This study included 51 consecutive patients on CAPD. A straight double-cuffed Tenckhoff catheter with a straight intraperitoneal segment was used, and all catheters were inserted using a modified percutaneous placement method under local anesthesia. The catheter was introduced directly into the deep pelvis through an intramuscular tract, which had been created by tapered dilators. Peritoneal dialysis was initiated immediately after catheter insertion without a break-in procedure. Catheter-related complications were surveyed during the 12 months after initiation of CAPD. Results Within the first month, only 1 pericatheter leakage (1.9%) was detected. There were no cases of visceral perforation or severe hemorrhage during catheter insertions. Catheter malfunction due to catheter tip migration, exit-site infection, and peritonitis developed in only 1.9%, 3.9%, and 3.9% of patients, respectively. After 1 month following catheter insertion, no further incidences of pericatheter leakage occurred during the follow-up period. All catheters, except one that was reinserted due to tip migration, survived throughout the study period. Conclusion The rates of pericatheter leakage and other catheter-related complications are relatively low in CAPD patients using our percutaneous catheter placement method without a break-in procedure. This procedure is comparatively simple and less invasive than other catheter placement methods, and allows for immediate start of PD after catheter insertion, without a break-in procedure.
Peritoneal Dialysis in Croatia
Authors: Čala Svjetlana 
Published: February 2020

Objective To present the state of renal replacement therapy (RRT) in Croatia, assess the quality of dialytic treatment, verify the value of peritoneal dialysis (PD), and promote expansion of PD in Croatia based on results attained locally. According to the integrative care concept, PD is the best way to start life-long RRT. Croatian nephrologists have adopted the policy of increasing the use of PD. However, evidence for recommendations were obtained in specific circumstances and might not be relevant elsewhere. The aim of this observational study is to compare the outcome of PD with that of hemodialysis (HD), as practiced in Croatia. Methods Since 2000, the Croatian Registry for Renal Replacement Therapy has been collecting individual patient data for all patients on RRT, with complete coverage. Results As of 31 December 2004, there were 251 prevalent patients on PD (continuous ambulatory PD and automated PD) in Croatia, accounting for 7% of all patients on RRT and giving a prevalence of 57 patients per million population. From 1 January 2000 to 31 December 2004, 377 patients started PD and were followed from the first day of RRT. For 80% of them, PD was the first mode of RRT. The probability of staying on PD for 5 years was 31% [95% confidence interval (CI) 29 - 32]. Five-year technique survival (excluding transplanted, recovered, and deceased patients) was 68% (95%CI 65 - 70). For survival analysis and comparison between PD and HD, only patients on the same method from the start of their RRT were included. Patients changing treatment were censored after 60 days (intention-to-treat analysis). Unadjusted 5-year survival in the PD-first group (301 patients) was 60% (95%CI 54 - 65), which is significantly better than in the 2789 HD-first patients (42%, 95%CI 40 – 44; log-rank p < 0.0001). When data were stratified for age and diabetes, 5-year mortality rates on HD were higher in all strata. Only in patients ≥ 70 years old was the advantage of PD less impressive. Standardized mortality ratio was 1.85 ( p < 0.01) in favor of PD. Hazard ratio of HD versus PD was 2.1 (95%CI 1.6 – 2.8). After adjustments for age, gender, diabetes, and nephroangiosclerosis, the hazard ratio settled at 1.5 (95%CI 1.1 – 1.9). Conclusion In Croatia, PD is used mostly as the first RRT. Almost one third of patients continue PD for 5 years due to good patient and technique survival. Starting RRT with PD offers 50% superior 5-year survival in comparison to HD. Dialysis patients in Croatia would benefit from an expanded PD program.
Cost/Utility Study of Peritoneal Dialysis and Hemodialysis in Chile
Authors: Pacheco Alejandro , Saffie Antonio , Torres Rubén , Tortella Cristian , Llanos Cristian , Vargas Daniel , Sciaraffia Vito 
Published: February 2020

In Chile the reimbursement/patient/year for chronic peritoneal dialysis (PD) is US$14,654 and for chronic hemodialysis (HD) US$10,909. However, no study comparing global (direct plus indirect) costs has been performed in our country. Our research objective was to compare global costs and quality of life between the two therapies. Patients ( n = 159) from five selected dialysis units in Chile [57 patients on PD (50 on automated PD) and 102 on standard HD (3 x 4 hours weekly)] were retrospectively studied. No patient had previously received the alternate therapy. Items analyzed were quality of life, customer satisfaction, direct and indirect costs, annual global costs, and cost/utility index. Mean age on HD was 54.14 ± 16.01 years and on PD 49.76 ± 18.88 years ( p > 0.05). No differences in the distribution of diabetic patients between the therapies were found. Hemodialysis and PD groups did not have differences in the quality of life index, although there was better customer satisfaction with PD than with HD. Direct and indirect costs were calculated. We found significant differences in favor of PD in erythropoietin consumption (2.24 ± 1.57 vials/week on HD and 1.35 ± 0.85 vials/week on PD, p < 0.05) and working time (31.0 ± 13.3 hours/week on HD and 38.5 ± 12.2 hours/week on PD, p < 0.05). The quality life index (Health-Related SF-36 Health Survey) was 65.75 on HD and 66.88 on PD. Annual global costs were US$20,803 for HD and US$20,742 for PD. The cost/utility index was 3.16 for HD and 3.10 for PD. Patients on PD have an advantage related to erythropoietin consumption and working capacity compared with HD patients. Addition of related indirect costs to reimbursements gives a more accurate insight into treatment costs. Considering all these parameters, we did not find significant differences between HD and PD in quality life index, cost/utility index, or annual global cost in this Chilean end-stage renal disease population.
Blood Pressure, Volume, and Sodium Control in an Automated Peritoneal Dialysis Population
Authors: Boudville Neil C. , Cordy Peter , Millman Kristie , Fairbairn Laura , Sharma Ajay , Lindsay Robert , Blake Peter G. 
Published: February 2020

Objectives To examine the control of blood pressure and volume, and the role of sodium removal in a single, large, contemporary, automated peritoneal dialysis (APD) population where icodextrin is used liberally and there is a policy to avoid long duration glucose-based daytime dwells. Design Observational cross-sectional study. Setting A university hospital. Patients 56 APD patients, with a mean duration on peritoneal dialysis of 1.9 years; 50% were prescribed icodextrin. Main Outcome Measures Blood pressure, extracellular water volume (ECW)-to-intracellular water volume (ICW) ratio, and total (peritoneal and urinary) sodium removal. Results Sodium Removal: Mean total sodium removal, while low at 102.9 ± 64.6 mmol/day, showed a wide range, with 41% having a sodium removal of >120 mmol/day. Total sodium removal correlated with total body water, ECW, and ICW ( p < 0.001, p < 0.001, p < 0.025, respectively), as well as with height and weight ( p < 0.06, p < 0.01 respectively). On multivariate analysis, only ultra-filtration volume and urine volume were significantly associated with total sodium removal ( r2 = 0.67, p < 0.0001 for both). There was also a correlation between sodium removal and urea nitrogen appearance ( r2 = 0.31, p < 0.001), with urea nitrogen appearance in turn being closely correlated with ICW ( p < 0.001). Volume Status: The ECW/ICW ratio was 0.88 ± 0.17, which was not significantly different to that found in hemodialysis patients without clinical evidence of fluid overload, either predialysis (0.96 ± 0.16) or postdialysis (0.92 ± 0.16); p = 0.07 and 0.36 respectively. Blood Pressure: Mean ± standard deviation systolic blood pressure (BP) was 111.9 ± 18.2 mmHg and diastolic BP was 63.3 ± 11.9 mmHg, with only 4 (7%) patients having a systolic BP > 140 mmHg and 1 (2%) having a diastolic BP > 80 mmHg. Median number of antihypertensives was 1 per day. Blood pressure control and ECW/ICW ratio were similar in those with sodium removal >120 mmol/day compared to those with sodium removal ≤120 mmol/day ( p = 0.39 for SBP, p = 0.70 for diastolic B P, p = 0.24 for ECW/ICW). Conclusions We have shown that good blood pressure and volume control is achievable in a large contemporary APD population with liberal use of icodextrin and avoidance of long daytime glucose-based dwells. Neither low nor high sodium removal was associated with more frequent hypertension or volume expansion.
Does Previous Abdominal Surgery Increase Postoperative Complication Rates in Continuous Ambulatory Peritoneal Dialysis?
Authors: Chen Shih-Yi , Chen Teng-Wei , Lin Shih-Hua , Chen Cheng-Jueng , Yu Jyh-Cherng , Lin Chien-Hua 
Published: February 2020

Background This study was to compare the postoperative complication rates of continuous ambulatory peritoneal dialysis (CAPD) catheter insertion via open technique between two groups of patients, those with and those without a history of previous abdominal surgery. Methods A review was carried out in 122 patients over a 2-year period. The patients were divided into two groups: those with and those without previous lower abdominal surgery. All patient records were retrospectively analyzed until the time of catheter failure or to current time if alive and receiving CAPD. Patient characteristics, operative factors, and postoperative complications were recorded. Results Postoperative complications were reported as catheter malfunction in 16 patients and CAPD-related peritonitis in 36 patients. The complication rates in the group of patients with previous abdominal surgery were 16.7% catheter malfunction and 33.3% CAPD-related peritonitis. In patients without previous lower abdominal surgery, a catheter malfunction rate of 12.5% and a peritonitis rate of 28.8% were seen. The operation time in patients with previous abdominal surgery was longer than that in patients without previous abdominal surgery. However, no statistically significant difference in postoperative complication rates was detected between patients with and patients without previous lower abdominal surgery. Conclusion CAPD remains a reliable modality in the treatment of end-stage renal disease and does not increase postoperative complications in patients with previous abdominal surgery.
Short-Term Effects of a New Bicarbonate/Lactate-Buffered and Conventional Peritoneal Dialysis Fluid on Peritoneal and Systemic Inflammation in CAPD Patients: A Randomized Controlled Study
Authors: Pajek Jernej , Kveder Radoslav , Bren Andrej , Guček Andrej , Ihan Alojz , Osredkar Joško , Lindholm Bengt 
Published: February 2020

Objectives This study was designed to compare the local peritoneal and systemic inflammatory effects of a conventional lactate-based (Lac) peritoneal dialysis (PD) solution and a new biocompatible bicarbonate/lactate-based (Bic/ Lac) solution having low concentration of glucose degradation products. Methods 26 stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the Lac solution and 3 months with the Bic/Lac solution in a randomized order. Flow cytometry was used to measure the expression of inflammatory molecules on peritoneal cells in overnight effluent collected at the end of each study period. Results 21 patients successfully completed the study. Mean fluorescence intensity of human leukocyte antigen (HLA)-DR and CD14 expression by macrophages were not different between Lac and Bic/Lac. The peritoneal appearance rate of cancer antigen 125 (kU/minute) was 68 ± 37 with Lac and 133 ± 66 with Bic/Lac ( p < 0.001), and of interleukin (IL)-6 (ng/minute), 0.28 ± 0.2 with Lac and 0.18 ± 0.16 with Bic/Lac ( p = 0.014). HLA-DR macrophage expression and IL-6 peritoneal appearance rates did not correlate. Serum concentrations with Lac and Bic/Lac were, for IL-6, 3.49 ± 2.28 and 3.72 ± 2.46 ng/L ( p = 0.17), and for high-sensitivity C-reactive protein, 2.31 ± 2.98 and 2.71 ± 3.31 mg/L ( p = 0.32) respectively. The concentration of effluent macrophages (x106/L) with Lac was 1.6 ± 1.6 and with Bic/Lac 2.6 ± 3.3 ( p = 0.07). Conclusions We conclude that, although there was a significant reduction in peritoneal IL-6 in patients using Bic/ Lac solution, systemic levels of inflammatory markers did not differ between the two solutions and no changes were present in macrophage surface activation markers, suggesting perhaps a less important role of peritoneal macrophages in the intraperitoneal chronic inflammatory process. The number of effluent macrophages tended to be higher in patients using the Bic/Lac solution, possibly contributing to improved intraperitoneal defense.
Gastric Acid Suppression and the Risk of Enteric Peritonitis in Peritoneal Dialysis Patients
Authors: Nessim Sharon J. , Tomlinson George , Bargman Joanne M. , Jassal Sarbjit Vanita 
Published: February 2020

Objective Peritonitis caused by enteric organisms in peritoneal dialysis (PD) patients is associated with greater morbidity and mortality than peritonitis with non-enteric organisms. One reported risk factor for enteric peritonitis (EP) is gastric acid suppression, with two small studies providing conflicting results. The objective of this study was to determine, using a larger patient population, whether gastric acid suppressants are associated with an increased risk of EP. Patients and Methods Using a single-center case-control design, information on episodes of EP occurring between 2003 and 2006 was collected. Control episodes were all non-enteric episodes of peritonitis that occurred during the same time interval. Proton pump inhibitor (PPI) or H2-blocker (H2B) use prior to development of peritonitis was documented. Results A total of 228 peritonitis episodes among 137 patients met inclusion criteria. In 32% of episodes, the causative organism was enteric. Gastric acid suppressant use was documented in 46% of episodes, with the majority on PPIs. Overall, gastric acid suppression was not associated with a higher EP risk ( p = 0.17). In a post hoc analysis, PPIs were not associated with EP [odds ratio (OR) 1.3, 95% confidence interval (CI) 0.7 – 2.4; p = 0.42], whereas H2Bs were associated with a higher risk of EP (OR 2.9, 95% CI 1.1 – 7.7; p = 0.04), although the number of patients on H2Bs was small. Conclusion Overall, gastric acid suppression was not associated with an increased risk of peritonitis with enteric organisms. While PPI use appears to be safe for PD patients with appropriate indications, the potential risk of EP with H2Bs requires further investigation.
Contribution of Early Failure to Outcome on Peritoneal Dialysis
Authors: Descœudres Bernard , Koller Michael T. , Garzoni Daniela , Wolff Thomas , Steiger Juerg , Schaub Stefan , Mayr Michael 
Published: February 2020

Background The technique failure rate on peritoneal dialysis (PD) remains high despite technical progress. There are no data concerning the contribution of early failure to outcome on PD. Aim To analyze the importance of early treatment failure in PD and to compare early with late failures with respect to reasons and predictors of risk for failure. Methods We performed a retrospective study of all patients admitted for PD from October 1983 to June 2005. The end point was PD failure-free survival. Differences between reasons for failure with respect to early (within 6 months) and late failure were analyzed. Multivariate associations of baseline covariates with early and late failure were investigated. Results We included 279 patients. 153 (55%) patients experienced PD failure: 97 (63%) of them had technique failure; 56 (37%) patients died due to non-PD-related causes. 29% ( n = 44) of all PD failures and 40% ( n = 39) of all technique failures occurred within 6 months. Catheter and psychosocial problems contributed more often to early than to late failure, whereas infections, leakages, and hernias contributed equally to early and late failure. Death was the predominant reason for late failure. Female sex was a risk factor for early failure and older age a risk factor for late failure. Higher cholesterol levels were associated with a decreased risk for both early and late failure. Conclusion The contribution of early failure to outcome on PD is important, as one third of all PD failures and 40% of all technique failures may occur within the first 6 months, as shown in our study. Due to the retrospective nature and the single-center character, the results cannot be generalized. However, it is important to enhance recognition of patients at high risk for early PD failure prior to initiation of PD, in order to avoid unnecessary surgical interventions and medical complications, and for rational resource allocation.
Abdominal Wall Hernias in End-Stage Renal Disease Patients on Peritoneal Dialysis
Authors: Martínez-Mier Gustavo , Garcia-Almazan Eduardo , Reyes-Devesa Hugo E. , Garcia-Garcia Victor , Cano-Gutierrez Sergio , Fermin Reymundo Mora y , Estrada-Oros Jorge , Budar-Fernandez Luis F. , Avila-Pardo Sandro F. , Mendez-Machado Gustavo F. 
Published: February 2020

Objective To describe our experience with hernioplasty in peritoneal dialysis patients and to identify possible risk factors for surgical complications. Design A 4-year retrospective chart review of data. Setting Peritoneal dialysis unit of a university hospital. Patients and Methods 58 hernias in 50 patients were included. Detailed surgical technique and complications were recorded. Possible risk factors included age, gender, weight, height, body mass index, previous surgery, diabetes, time on dialysis, emergency surgery, hospital stay, type of hernia, mesh use, blood hemoglobin, and serum urea, creatinine, and potassium. Results Complications occurred in 12 hernioplasties (4 wound infections, 2 peritonitis, 4 catheter dysfunction, and 5 re-operations). Recurrence rate was 12% without mesh use and 0% with mesh hernioplasty. Dialysis was re-instituted in 96% of cases within 3 days postoperatively. Identified risk factors for complications were diabetes, low weight, low height, small body mass index, and low serum creatinine. Conclusions Mesh hernioplasty in peritoneal dialysis patients is advisable. Postoperative dialysis with low volume is feasible after surgery. Prospective studies will corroborate our risk factors for morbidity.