bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Peritoneal Membrane Permeability is Associated with Abnormal Peritoneal Surface Layer
Authors: Wang Tao , Cheng Hui-hong , Liu Si-ming , Wang Ying , Wu Jin-lang , Peng Wen-xing , Zhong Jian-hui , Lindholm Bengt 
Published: February 2020

Objectives We recently showed that the peritoneal surface layer may be an important barrier in modulating peritoneal membrane permeability. In the present study, we investigated the relationship between an increased peritoneal transport rate and the peritoneal surface layer. Methods Male Sprague–Dawley rats ( n = 8) received intraperitoneal injections of 4.25% glucose dialysate daily for 1 week. Forty-eight hours after the last injection, a 4-hour dwell study using 25 mL 4.25% glucose dialysate was performed in each rat. The results were compared with those from control rats that received no intraperitoneal injections ( n = 8). The peritoneal fluid and small-solute transport characteristics were evaluated. The peritoneal surface layer was studied using an electron microscope. The phospholipids content of the dialysate was also evaluated. Results Peritoneal fluid removal was significantly reduced in the daily injection group (30.6 ± 1.3 mL) as compared with the control group (38.2 ± 0.6 mL). The peritoneal fluid absorption rate and small-solute transport rate were also significantly higher in the daily injection group as compared with the control group. The amounts of phospholipids in the dialysate were significantly lower in the daily injection group—especially the quantity of phosphatidylcholine. However, lysophosphatidylcholine increased significantly in the daily injection group. Electron microscopy showed that the peritoneal surface layer was almost completely gone in the daily injection group, but that a dense and thick (average 4 μm) peritoneal surface layer was present on the top of the mesothelial cells in the control group. Conclusions Our results suggest that daily injection of hypertonic glucose dialysate significantly increased the peritoneal transport rate. The increased peritoneal transport rate was associated with a significant reduction in the peritoneal surface layer and the phospholipids content of the dialysis effluent.
Replacement of Glucose with N-Acetylglucosamine in Peritoneal Dialysis Fluid—Experimental Study in Rats
Authors: Breborowicz Andrzej , Pawlaczyk–Kuzlan Malgorzata , Pawlaczyk Krzysztof , Baum Ewa , Tam Paul , Wu George 
Published: February 2020

Background Glucose is still used as an osmotic solute in peritoneal dialysis fluids, despite evidence of its local (peritoneal) and systemic toxicities. However a constant search is underway for a new, more biocompatible osmotic solute for peritoneal dialysis fluids. Objective The present study evaluated N-acetylglucosamine (NAG) in a concentration of 220 mmol/ L as an alternative to glucose for the osmotic solute in peritoneal dialysis fluid, during chronic peritoneal dialysis in rats. Methods For 8 weeks, male Wistar rats were infused with glucose-based or NAG-based dialysis fluid. Intraperitoneal inflammation and peritoneal permeability and morphology were evaluated in all rats during the study. Results Repeated intraperitoneal infusion of the NAG-based dialysis fluid resulted in a weaker intra-abdominal inflammatory reaction as compared with the reaction in rats infused with glucose-based dialysis solution. At the end of the study, the concentration of hyaluronan in the peritoneal interstitium obtained from NAG-treated rats was higher than that found in the interstitium taken from animals exposed to dialysis fluid containing glucose. Also, peritoneal permeability to total protein was lower in NAG-treated rats. Conclusion As an alternative to glucose, NAG used for the osmotic solute in peritoneal dialysis solution decreases the intraperitoneal inflammatory reaction induced by the process of peritoneal dialysis and, indirectly (owing to the increased hyaluronan content in the peritoneal interstitium), diminishes peritoneal permeability to protein.
A Chronic Inflammatory Infusion Model of Peritoneal Dialysis in Rats
Authors: Margetts Peter J. , Kolb Martin , Yu Lisa , Hoff Catherine M. , Gauldie Jack 
Published: February 2020

Objectives Peritoneal membrane changes are related to daily exposure to non physiologic dialysate and recurrent acute inflammation. We modified a daily infusion and inflammation model and evaluated it for fibrotic and angiogenic features. The feasibility of adenovirus-mediated gene transfer in the model was also assessed. Methods Peritoneal catheters were implanted in rats. Over a period of 4 weeks, the animals received a daily infusion of Dianeal 4.25% (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.) with an initial three doses of lipopolysaccharide (LPS) or physiologic saline. Peritoneal fluid was assayed for transforming growth factor beta (TGFβ) and vascular endothelial growth factor (VEGF). Animals were humanely killed at week 5. Net ultrafiltration was then measured, and tissue samples were immunostained for factor VIII. Mesenteric tissue was assayed for hydroxyproline content. Adenovirus-mediated gene transfer of β-galactosidase was assayed by intraperitoneal administration of the virus, 4 days before the end of the experiment. Results Animals treated with either Dianeal or physiologic saline showed peritoneal membrane thickening and increased vascularity. Fibrosis was demonstrated by increased hydroxyproline concentration. Ultrafiltration was impaired. We found increased concentrations of VEGF and TGFβ in the peritoneal fluid of animals treated with LPS and daily infusion. Adenovirus-mediated gene transfer to the peritoneal membrane was demonstrated in the model. Conclusions Exposure to LPS and daily Dianeal or physiologic saline leads to peritoneal fibrosis and neoangiogenesis. Vascularization and glucose transport correlate with ultrafiltration failure. The present animal model mimics changes seen in humans on peritoneal dialysis and may be valuable for evaluating short-term interventions to prevent membrane damage.
Reformulating the Integrated Care Concept for the New Millennium
Authors: Mendelssohn David C. , Pierratos Andreas 
Published: February 2020

The concept of integrated care advocates a planned approach to predialysis care. Its components include timely referral to a renal care team, timely preparation for dialysis, and timely initiation of dialysis, with peritoneal dialysis (PD) as the initial therapy for suitable patients. This initial therapy may then be followed by timely transfer to hemodialysis (HD) when residual renal function declines or when other PD-related problems occur. We argue that at least three problems exist with the integrated care approach as it is currently being articulated. They are ( 1 ) an under emphasis on slowing the rate of progression of chronic kidney disease, aggressive management of cardiovascular risk factors and other comorbidities, and pre-emptive live donor transplantation; ( 2 ) a lack of consideration of home HD as an alternate initial therapy; and ( 3 ) a lack of discussion about patient choice. We propose a modified version of integrated care that we believe will optimize modality distribution and patient outcomes, while reducing the relative costs per patient treated, compared to the current situation in most countries.
Influence of Dialysate on Gastric Emptying Time in Peritoneal Dialysis Patients
Authors: Van Vlem Bruno A. , Schoonjans Renaat S. , Struijk Dirk G. , Verbanck Johan J. , Vanholder Raymond C. , Van Biesen Wim V. , Lefebvre Romain A. , De Vos Martine P. , Lameire Norbert H. 
Published: February 2020

Objective Peritoneal dialysis (PD) patients frequently suffer from dyspeptic complaints such as nausea, vomiting, abdominal distension, early satiety, and anorexia. Gastroparesis might be, at least partially, a source of dyspeptic complaints in PD patients. The aim of the present study was to determine the influence of the presence and composition of dialysate on gastric emptying in PD patients. Design Prospective study. Setting Renal Division, Department of Internal Medicine, Ghent University Hospital, Belgium. Patients Sixty-one PD patients using different dialysate solutions, and 27 healthy volunteers. Main Outcome Measure Gastric emptying of solids was assessed by the 13C-octanoic acid breath test. Results Gastric emptying was impaired in PD patients, regardless of the composition of dialysate and even if tested with an empty peritoneal cavity. Gastric emptying was significantly slower when glucose-containing dialysate was compared to an empty peritoneal cavity, or when glucose-containing dialysate was compared to icodextrin dialysate. No difference in gastric emptying could be demonstrated between glucose-containing dialysate and dialysate containing a mixture of glycerol and amino acids as osmotic agent. Conclusions These findings suggest that the delay in gastric emptying demonstrated in the presence of peritoneal dialysate is not the consequence of a mere volume or pressure effect, but of the absorption of substrate substances with caloric and/or metabolic activity, such as glucose or glycerol and amino acids.
Large Body Mass Index does not Predict Short-Term Survival in Peritoneal Dialysis Patients
Authors: Aslam Nabeel , Bernardini Judith , Fried Linda , Piraino Beth 
Published: February 2020

♦ Objective Higher than normal body mass index (BMI) is associated with an increased risk of death in the general population. We examined the effect of higher than normal BMI on patient and technique survival in peritoneal dialysis patients (PD), controlling for comorbidity, initial albumin, dialysate-to-plasma ratio of creatinine (D/PCr), and initial urea clearance (Kt/V). ♦ Design Registry database. ♦ Settings Four dialysis centers. ♦ Patients Incident PD patients. ♦ Methods All data were collected prospectively. Demographics, BMI, serum albumin, D/PCr, and comorbidity using the Charlson Comorbidity Index (CCI) were determined at the start of PD. 104 patients with a high BMI (> 27) were matched to a control group of 104 patients with normal BMI (20 – 27) for age, gender, presence of diabetes, and CCI. Patient and technique survival were compared using Cox proportional hazards model. ♦ Main Outcome Measures Patient and technique survival. ♦ Results The groups were of similar age (56.1 vs 56.7 years), sex (60% males in both groups), race (Caucasian 80% vs 86%), presence of diabetes (40% vs 37%), CCI score (5.4 in both groups), initial albumin (3.6 vs 3.5 g/dL), and D/PCr (0.65 in both groups). Kaplan–Meier survival analysis showed similar 2-year patient survival between large BMI (> 27) and control (20 – 27) groups (76.6% vs 76.1%). Two-year technique survival was also similar between the two groups (59.7% vs 66.8%). With Cox proportional hazards analysis, BMI was not a predictor of patient mortality or technique survival when controlling for initial albumin, D/PCr, and initial Kt/V. ♦ Conclusions We conclude that a BMI above normal is not associated with any increased or decreased risk of death in patients on PD for 2 years.
A Prospective Randomized Study of the Effect of a Subcutaneously “Buried” Peritoneal Dialysis Catheter Technique versus Standard Technique on the Incidence of Peritonitis and Exit-Site Infection
Authors: Danielsson Anders , Blohmé Linus , Tranæus Anders , Hylander Britta 
Published: February 2020

♦ Objective A new method for implantation of peritoneal dialysis (PD) catheters was described in 1991. The distal part of the catheter is buried subcutaneously and exteriorized at the start of PD. This study was designed to evaluate the effect of such a subcutaneous rest period on the incidence of peritonitis and exit-site infections (ESI). ♦ Design Sixty patients were randomized to either the new method (B group; n = 30) or to not having the distal part buried subcutaneously (NB group; n = 30). Sixty-five patients (NS group) were not randomized as they had to start PD within 1 – 2 weeks after implantation. The Moncrief–Popovich catheter was used in the B and NB groups and a standard Tenckhoff catheter was used in the NS group. ♦ Patients Patients scheduled for PD treatment, judged not in need of PD for at least 6 weeks after implantation. ♦ Results There was no statistically significant difference in the cumulative probability of not developing peritonitis during the first 6, 12, and 24 months. The incidence of the first episode of peritonitis was 1/40, 1/26, and 1/33 treatment-months in the B, NB, and NS groups, respectively. The incidence of ESI was 1/103 and 1/95 treatment-months in the B and NS groups, respectively. The cumulative probability of not developing ESI was similar in both groups. There were no episodes of ESI in the NB group. The difference in the number of ESI between the NB and NS groups was significant ( p < 0.05). ♦ Conclusions Subcutaneous burying of the distal catheter segment prior to starting PD does not reduce the risk of contracting peritonitis or exit-site infection.
Alterations in Lipoprotein Composition in Peritoneal Dialysis Patients
Authors: Moberly James B. , Attman Per-Ola , Samuelsson Ola , Johansson Ann-Cathrine , Knight–Gibson Carolyn , Alaupovic Petar 
Published: February 2020

♦ Objective Dyslipidemia is common among patients with end-stage renal disease, whether treated by hemodialysis (HD) or peritoneal dialysis (PD). To better understand the specific lipoprotein abnormalities in PD patients, we measured the lipid and apolipoprotein (Apo) composition of the four major classes of plasma lipoproteins in PD patients, HD patients, and healthy control subjects: very low density (VLDL), intermediate density (IDL), low density (LDL), and high density lipoproteins (HDL). ♦ Design Fasting plasma samples were obtained from 15 nondiabetic PD patients, 15 nondiabetic HD patients, and 16 healthy control subjects, all from a cross section of patients and subjects in the region of Göteborg, Sweden. Lipoproteins were isolated by preparative ultracentrifugation, and lipid and apolipoprotein concentrations were measured by gas chromatography and electroimmunoassay, respectively. ♦ Results Alterations in lipoprotein composition were apparent in all four lipoprotein density classes from PD and HD patients. VLDL contained a significantly higher concentration of ApoCIII in both HD and PD patients, and an elevation of free cholesterol, triglyceride, ApoB, ApoCII, and ApoE in PD patients. IDL from both PD and HD patients contained an excess of free and esterified cholesterol and triglyceride and significantly elevated levels of ApoB, ApoCII, ApoCIII, and ApoE. LDL had a higher concentration of ApoB in PD patients and elevated triglyceride and ApoCIII in both PD and HD patients. HDL isolated from PD patients had lower free cholesterol and ApoAI levels compared to control subjects, but these were not significantly different from HD patients. ♦ Conclusions An increase in lipid and apolipoprotein mass in IDL, and an enrichment of ApoCIII in VLDL, IDL, and LDL were observed in both HD and PD patients. The predominant alteration in lipoprotein composition distinguishing PD patients from HD patients was an elevation of ApoB in LDL. Further study of these alterations in lipoprotein composition in PD patients will be helpful in understanding the underlying causes of dyslipidemia and, ultimately, to the selection of hypolipidemic drugs or other treatments to reduce the cardiovascular risks associated with dyslipidemia in these patients.
Comparison of Vancomycin versus Cefazolin as Initial Therapy for Peritonitis in Peritoneal Dialysis Patients
Authors: Khairullah Quresh , Provenzano Robert , Tayeb Jukaku , Ahmad Aijaz , Balakrishnan Radhakrishnan , Morrison Linda 
Published: February 2020

The incidence of peritonitis ranges from 1 episode every 24 patient treatment months to 1 episode every 60 patient treatment months [Keane WF, et al. ISPD Guidelines/Recommendations. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20:396–411.]. Gram-positive organisms account for over 80% of continuous ambulatory peritoneal dialysis (PD)-associated peritonitis. Recent fear of vancomycin-resistant enterococci (VRE) has prompted suggestions of limiting vancomycin use. Fifty-one episodes of peritonitis in 30 patients studied over 2 years were evaluated. Cloudiness of the PD fluid and/or abdominal pain were considered suggestive of peritonitis and were confirmed by cell count and culture. Baseline cell count, Gram stain, and cultures were obtained, with periodic follow-up. Patients were randomized to receive either vancomycin 1 g/L intraperitoneally (IP) as loading dose, repeated on day 5 or day 8, depending on residual renal function, for 2 weeks, or cefazolin 1 g in the first PD bag and continued with 125 mg/L every exchange for 2 or 3 weeks, depending on culture results. All patients also received gentamicin 40 mg IP every day until the culture results were available. A similar randomized trial comparing vancomycin and cefazolin in the past used a lower concentration of cefazolin 50 mg/L [Flanigan MJ, Lim VS. Initial treatment of dialysis associated peritonitis: a controlled trial of vancomycin versus cefazolin. Perit Dial Int 1991; 11:31–7.]. Peritoneal dialysate fluid cultures revealed 31 (60.7%) gram-positive organisms, 7 (13.7%) gram-negative organisms, and 2 (3.9%) cultured yeast; 11 (21.5%) cultures yielded no growth. The incidence of peritonitis at our center was 1 episode every 42 patient treatment months. No case of VRE was noted. There was no statistical difference in clinical response or relapse rate for the two protocols. It was the authors’ and nurses’ observation that patient compliance and satisfaction was better with vancomycin, and the cost per treatment was 23% less than cefazolin. Based on these data we believe vancomycin should still be considered for first-line treatment of PD-associated peritonitis.
Treatment and outcome of Peritonitis in Automated Peritoneal Dialysis, using a Once-Daily Cefazolin-Based Regimen
Authors: Fielding Richard E. , Clemenger Michelle , Goldberg Lawrence , Brown Edwina A. 
Published: February 2020

Objective We determined the effectiveness of a once-daily cefazolin-based regimen in treating automated peritoneal dialysis (APD) peritonitis. Design We carried out a retrospective analysis of all APD peritonitis episodes treated with a once-daily cefazolin protocol. Setting The study was performed in a peritoneal dialysis unit in a tertiary care hospital. Patients and Methods We studied 60 episodes of primary peritonitis in 40 patients on APD. Each patient was treated with a vancomycin-free regimen consisting of intraperitoneal cefazolin (1.5 g IP) with gentamicin IP administered in the daytime exchange. The main outcome measures were successful treatment of peritonitis, removal of peritoneal catheter, relapse of peritonitis, and patient death. Results Gram-positive infections occurred in 35 episodes (58.3%), gram-negative infections in 10 episodes (16.7%), culture-negative infections in 14 episodes (23.3%), and a yeast infection in 1 episode (1.7%). Of the 60 episodes, 47 (78.3%) were successfully treated. In 10 episodes (16.7%), catheters were removed (9 for treatment failure, 1 for yeast infection). Four patients (8%) had a relapse of infection within 4 weeks of completing antibiotic therapy. One patient (1.7%) died. Conclusions Our results demonstrate that once-daily cefazolin with gentamicin IP is an effective treatment for APD peritonitis, with the advantage of being easy to administer and enabling patients to remain on APD during treatment.
Peritoneal Function and Adequacy Calculations: Current Programs versus PD Adequest 2.0
Authors: Teixidó–Planas Josep 
Published: February 2020

Objective Our current programs (CPs) were compared to PD Adequest 2.0 (PD-A) for calculations of peritoneal membrane transport and dialysis adequacy. Design Thirty peritoneal equilibration tests (PETs) and 24-hour balances (24hBs) were conducted and calculated using our CPs and PD-A. Patients and Methods Thirty hospital-controlled peritoneal dialysis (PD) patients were studied. The inclusion of correction factors (for glucose or plasmatic water) and of residual volume, and the use of 3 or 6 peritoneal samples were analyzed to discover the differences between programs. The main outcome measures were peritoneal permeability and adequacy parameters, evaluated by Student t-test (mean and paired comparisons) and linear regression for correlation. Results No significant differences were found in D/P values for small solutes. At the first step, mass transfer area coefficient (MTAC) urea and MTAC creatinine were significantly higher in DP-A than in CP, but MTAC glucose did not differ. The causes of differences were: ( 1 ) inclusion of a correction factor for aqueous plasmatic concentration of small solutes in CP; ( 2 ) lack of inclusion of residual volume in peritoneal volumes in CP; and ( 3 ) use of 6 peritoneal samples in CP versus 3 in PD-A. At the second step, when the input data were made equivalent for both programs, the differences disappeared for MTAC urea, creatinine, and glucose (mean comparison), but creatinine and glucose remained different by paired comparison. Similar results were obtained when a correction for plasmatic aqueous concentration was applied to the data in both programs [MTAC urea: 22.60 ± 4.27 mL/min (CP) vs 22.43 ± 4.61 mL/min (PD-A), nonsignificant, r = 0.97; MTAC creatinine: 9.76 ± 3.83 mL/min (CP) vs 10.61 ± 3.07 mL/min (PD-A), nonsignificant, r = 0.98; MTAC glucose: 13.30 ± 3.12 mL/min (CP) vs 11.87 ± 3.41 mL/min (PD-A), nonsignificant, r = 0.92]. Creatinine and glucose were different by paired t-test. No significant differences were found in Kt/V and urea generation rate. Weekly creatinine clearance [WCCr: 70.71±16.71 L (CP) versus 79.33±18.73 L (PD-A), p < 0.001] and creatinine generation rate [CrGR: 0.56 ± 0.18 mg/min (CP) versus 0.61±0.19 mg/min (PD-A), p < 0.001) were significantly higher in PD-A than in CP owing to the lack of creatinine correction according to glucose concentration in the PD-A adequacy program. Finally, normalized protein nitrogen appearance according to Bergström [1.09 ± 0.20 g/kg/d (CP) versus 1.03 ± 0.21 g/kg/d (PD-A), p = 0.01] was different owing to the different algorithms and normalization method: standardized body weight in CP and actual body weight in PD-A. Conclusions Provided that equivalent data are used, PD-A and CP yield similar results. The PD-A program needs external correction of data input: ( 1 ) for plasmatic water concentration in MTAC calculations, and ( 2 ) for peritoneal glucose interference with creatinine analysis (Jaffé method) in WCCr and CrGR calculations; otherwise, it may give falsely optimistic results.