bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glucose Degradation Products and Peritoneal Membrane Function
Authors: Witowski Janusz , Bender Thorsten O. , Gahl Gerhard M. , Frei Ulrich , Jörres Achim 
Published: February 2020

Background The bioincompatibility of peritoneal dialysis fluids (PDF) in current use has been partially attributed to the presence of glucose degradation products (GDPs), which are generated during heat sterilization of PDF. Several of the GDPs have been identified and we have recently demonstrated that these GDPs per se may impair the viability and function of human peritoneal mesothelial cells (HPMC) in vitro. It is also possible that GDP-related toxicity is further exacerbated by the milieu of PDF. We review the current literature on GDP and present the results of experiments comparing the impact of heat- and filter-sterilized PDF on the viability and function of HPMC. Methods Peritoneal dialysis fluids with low (1.5%) and high (4.25%) glucose concentrations were laboratory prepared according to the standard formula and sterilized either by heat (H-PDF; 121°C, 0.2 MPa, 20 minutes) or filtration (F-PDF; 0.2 μ). The buildup of GDP was confirmed by UV absorbance at 284 nm. Confluent HPMC monolayers were exposed to these solutions mixed 1:1 with standard M199 culture medium. After 24 hours, cell viability was assessed with the MTT assay, and interleukin-1β–stimulated monocyte chemotactic protein-1 (MCP-1) release with specific immunoassay. Results Exposure of HPMC to H-PDF resulted in a significant decrease in cell viability, with solutions containing 4.25% glucose being more toxic than 1.5% glucose-based PDF (27.4% ± 3.4% and 53.4% ± 11.0% of control values, respectively). In contrast, viability of HPMC exposed to F-PDF was not different from that of control cells. Moreover, treatment with H-PDF impaired the release of MCP-1 from HPMC to a significantly greater degree compared to F-PDF (17.4% and 24.9% difference for low and high glucose PDF, respectively). Conclusions Exposure of HPMC to H-PDF significantly impairs cell viability and the capacity for generating MCP-1 compared to F-PDF. This effect is likely to be mediated by GDPs present in H-PDF but not in F-PDF.
Importance of Blood Pressure and Volume Control in Peritoneal Dialysis Patients
Authors: Lameire Norbert , Van Biesen Wim 
Published: February 2020

Objectives To review the factors that impact control of blood pressure and euvolemia in peritoneal dialysis patients. Design Review of the most recent publications on this subject; inclusion of some personal data on the relation between plasma volume and evolution of blood pressure in short-term and long-term peritoneal dialysis patients. Setting Peritoneal dialysis program in a university hospital. Results The literature on circadian blood pressure and the role of the decreased compliance of the great vessels in uremia is reviewed. Analysis of the long-term evolution of plasma volume in peritoneal dialysis patients in correlation with the evolution of blood pressure indicates a positive correlation in 36 of 46 simultaneous determinations. The treatment of volume overload and hypertension in peritoneal dialysis includes the prescription of loop diuretics, preservation of residual renal function, reduction of dietary salt intake, and prevention and treatment of peritoneal ultrafiltration failure. Conclusions A reduction in the great cardiovascular mortality in peritoneal dialysis patients as nowadays observed can only be expected when more attention is paid to better control of hypervolemia and hypertension in these patients.
Monitoring of Long-Term Peritoneal Membrane Function
Authors: Davies Simon J. 
Published: February 2020

Objective Peritoneal membrane function influences dialysis prescription and clinical outcome and may change with time on treatment. Increasingly sophisticated tools, ranging from the peritoneal equilibration test (PET) to the standard permeability analysis (SPA) and personal dialysis capacity (PDC) test, are available to the clinician and clinical researcher. These tests allow assessment of a number of aspects of membrane function, including solute transport rates, ultrafiltration capacity, effective reabsorption, transcellular water transport, and permeability to macromolecules. In considering which tests are of greatest value in monitoring long-term membrane function, two criteria were set: those that result in clinically relevant interpatient differences in achieved ultrafiltration or solute clearances, and those that change with time in treatment. Study Selection Clinical validation studies of the PET, SPA, and PDC tests. Studies reporting membrane function using these methods in either long-term (5 years) peritoneal dialysis patients or longitudinal observations (> 2 years). Data Extraction Directly from published data. Additional, previously unpublished analysis of data from the Stoke PD Study. Results Solute transport is the most important parameter. In addition to predicting patient and technique survival at baseline, there is strong evidence that it can increase with time on treatment. Whereas patients with initially high solute transport drop out early from treatment, those with low transport remain longer on treatment, although, over 5 years, a proportion develop increasing transport rates. Ultrafiltration capacity, while being a composite measure of membrane function, is a useful guide for the clinician. Using the PET (2.27% glucose), a net ultrafiltration capacity of < 200 mL is associated with a 50% chance of achieving less than 1 L daily ultrafiltration at the expense of 1.8 hypertonic (3.86%) exchanges in anuric patients. Using a SPA (3.86% glucose), a net ultrafiltration capacity of < 400 mL indicates ultrafiltration failure. While there is circumstantial evidence that, with time on peritoneal dialysis, loss of transcellular water transport might contribute to ultrafiltration failure, none of the current tests is able to demonstrate this unequivocally. Of the other membrane parameters, evidence that interpatient differences are clinically relevant (permeability to macro-molecules), or that they change significantly with time on treatment (effective reabsorption), is lacking. Conclusion A strong case can be made for the regular assessment by clinicians of solute transport and ultrafiltration capacity, a task made simple to achieve using any of the three tools available.
Clinical Benefits and Tolerability of Increased Fill Volumes in Japanese Peritoneal Dialysis Patients
Authors: Fukatsu Atsushi , Komatsu Yasuhiro , Senoh Hachiro , Miyai Hironobu , Tanaka Yoshinori , Oiwa Takafumi , Nakauchi Miyuki , Kasori Ryoko , Takahashi Sumiko , Kawahara Hirohisa , Mayber Nicky , Yost Lawrence E. , Ogrinc Francis G. , Mujais Salim 
Published: February 2020

Background Increasing fill volume is an effective means of improving clearances in patients on peritoneal dialysis (PD). Since Japanese PD patients are physically smaller than their Western counterparts, there is some concern that PD patients in Japan may be unable to tolerate larger fill volumes. Objective To determine patient tolerance and changes in solute clearance and net ultrafiltration resulting from increased fill volumes in Japanese patients on PD. Design Prospective double-blind study, randomizing patients to three different fill volumes (2.5% dextrose solution: 1.5 L, 2.0 L, or 2.5 L) administered in random order on three different occasions separated by 1 week. Results Twenty-one patients with a mean age of 55.4 ± 2.1 years and a mean body surface area of 1.66 ± 0.03 m2 were studied. On a scale of 0 to 10, patients’ mean discomfort scores were 2.14 ± 0.59, 3.48 ± 0.54, and 3.81 ± 0.63 ( p = 0.047) at the end of the 1.5-L, 2.0-L, and 2.5-L dwells, respectively. There were no reports of cramps or shortness of breath with any fill volume. Patients were able to correctly guess the actual fill volume for only 34 of the 63 total exchanges (54.0%). Increasing fill volume resulted in an incremental improvement in peritoneal creatinine clearance, from 3.74 ± 0.16 to 4.49 ± 0.21 ( p < 0.001, 2.0 L vs 1.5 L) to 5.12 ± 0.20 mL/minute ( p < 0.001, 2.5 L vs 2.0 L) for 1.5-L, 2.0-L, and 2.5-L dwells, respectively. Peritoneal urea clearance also increased significantly, from 5.65 ± 0.13 to 7.04 ± 0.17 ( p < 0.001, 2.0 L vs 1.5 L) and 8.16 ± 0.29 mL/minute ( p < 0.001, 2.5 L vs 2.0 L), with incremental increases in fill volume. Similarly, net ultrafiltration in a 4-hour dwell increased significantly with fill volume, from 255.24 ± 24 mL with 1.5 L, to 356 ± 24 ( p < 0.004, 2.0 L vs 1.5 L) and 392 ± 29 mL ( p < 0.086, 2.5 L vs 2.0 L) in patients receiving 2.0 L and 2.5 L, respectively. Conclusion Increasing the fill volume results in improvement in solute clearance and net ultrafiltration in Japanese PD patients, with minimal increase in patient discomfort. A large percentage of patients were unable to identify the actual fill volume.
Expression of Cancer Antigen 125 by Peritoneal Mesothelial Cells is Not Influenced by Duration of Peritoneal Dialysis
Authors: Sanusi Abubakr A. , Zweers Machteld M. , Weening Jan J. , De Waart Dirk R. , Struijk Dirk G. , Krediet Raymond T. 
Published: February 2020

Objective To investigate the presence of cancer antigen 125 (CA125) on mesothelial cells in the effluent of peritoneal dialysis (PD) patients and to analyze the effect of duration of PD on the number of mesothelial cells in peritoneal effluent, the number of CA125-positive cells, and dialysate CA125 concentration. Design A cross-sectional study in which long-dwell peritoneal effluents were investigated for mesothelial cells and CA125. Setting A university hospital population of chronic PD patients. Patients 33 stable PD patients who were free of peritonitis during the investigation and during the 4 weeks prior to the study. Methods Examination of cytospin preparations of peritoneal effluent stained with May-Grünwald Giemsa, and also with an immunocytochemical double-staining method consisting of anticalretinin (pan-mesothelial cell marker) and OC125. Results A close relationship was present between the numbers of mesothelial cells counted with the two staining methods ( r = 0.998, p < 0.001). On average, 92% of mesothelial cells were positive for CA125, ranging between 75% and 100% in 80% of the patients. Correlations were found between the effluent CA125 concentration and the total number of mesothelial cells ( r = 0.64, p < 0.001), and also the number of CA125-positive cells ( r = 0.66, p < 0.001). A negative effect of time was seen on the effluent CA125 concentration, the total number of mesothelial cells, and the number of CA125-positive mesothelial cells. However, no effect of time was present on the percentage CA125-positive cells. Conclusions On average, 92% of mesothelial cells in peritoneal effluent are positive for CA125. This figure is not dependent on the duration of PD. Long-term PD is associated with low dialysate CA125 concentrations, a low number of mesothelial cells, and a low number of CA125-positive mesothelial cells in effluent. These results support the hypothesis that dialysate CA125 can be used as a marker of mesothelial cell mass in stable PD patients.
Expression of Defensin Antimicrobial Peptides in the Peritoneal Cavity of Patients on Peritoneal Dialysis
Authors: Zarrinkalam Krystyna H. , Leavesley David I. , Stanley Jodie M. , Atkins Gerald J. , Faull Randall J. 
Published: February 2020

Objective To investigate the expression and regulation of defensins in the peritoneal cavity of peritoneal dialysis (PD) patients. Design The presence of defensins in the peritoneal cavity was assessed using reverse transcription polymerase chain reaction (RT-PCR). In vivo defensin expression was analyzed in human peritoneal membrane biopsies and in peritoneal cavity leukocytes isolated from spent dialysate. Defensin expression in vitro was assessed in cultured human peritoneal mesothelial cells (HPMC) and confirmed with PCR Southern blot and DNA sequencing. The effect of tumor necrosis factor alpha (TNFa) and epidermal growth factor (EGF) on b2 defensin expression in HPMC was analyzed by Northern blot analysis and RT-PCR respectively. Results Both a and b classes of defensins are expressed in the peritoneal cavity of PD patients. Messenger RNA for the a-defensin human neutrophil peptide 3 and for b-defensin-1 (hbD-1) were found in preparations containing predominantly peritoneal leukocytes, whereas b-defensin-2 (hbD-2) is expressed by HPMC. HPMC isolated from different individuals displayed variability in both basal hbD-2 expression and in response to stimulation by TNFa. Conversely, EGF consistently downregulated the level of hbD-2 message in HPMC. Conclusion a- and b-defensins are expressed in the peritoneal cavity, and hbD-2 is the main defensin present in the peritoneal membrane. Variable levels of expression of hbD-2 by mesothelial cells were seen, with evidence of regulation by cytokines and growth factors. This provides evidence for a previously unknown mechanism of innate immunity at that site.
Local Anesthetic -Bupiv Acaine Increases the Transperitoneal Transport of Solutes. Part II: In Vitro Study
Authors: Breborowicz Andrzej , Knapowski Jall 
Published: February 2020

The local anesthetic, bupivacaine, alters the mesothelial permeability to urea and inulin. The effect is biphasic; an initial transient decrease is followed by an increase in permeability of the membrane to both solutes. Cytochalasill B and colchicine can mimic partially the action of bupivacaine, but without the initial decrease in the mesothelilal permeability. Similar to bupivacaine, verapamil also evokes a biphasic effect on the trallsmesothelial nux of urea and inulin. In conclusion bupivacaine induces changes both in trallscellular and intercellular pathways, due to its interaction with calcium ions and the cytoskeleton of the mesothelial cells. Mesothelium is one of the barriers detennining transfer of solutes from blood to the peritoneal cavity during peritoneal dialysis (1). It has been demonstrated that the function of the mesothelial cells may influence the efficiency of the peritoneal dialysis (2–4). Earlier we showed that bupivacaine added to the dialysis fluid in a concentration of 0.25 mmol/l increased the removal of urea and inulin via the peritoneum (5). Our findings suggest that the effect of bupivacaine depended primarily on its action on the mesothelium. We perfonned a series of in vitra experiments on the monolayer mesothelium taken from the ileal rabbit's mesentery in order to define the character of changes induced in this structure by bupivacaine. This paper describes our findings.
Augmentation of Peritoneal Hydraulic Permeability by Amphotericin B: Locus of Action
Authors: Maher John F. , Hirszel Przemyslaw , Bennett Robin R. , Chakrabarti Eva 
Published: February 2020

In normal rabbits, intraperitoneal instillation of amphotericin B increased peritoneal ultrafiltration rates without changing the osmotic gradient. Solute clearances were unaffected. When given intravenously the drug was ineffective, suggesting that amphotericin B acts on the serosal side of the vasculature or mesothelium, presumably creating channels through the membrane, thereby increasing hydraulic permeability. Peritoneal transport rates are much lower than those of hemodialysis (I). To circumvent this deficiency, continuous peritoneal dialysis is now employed in many patients (2). Nevertheless. a segment of patients undergoing continuous ambulatory peritoneal dialysis have, or develop, inadequate transport rates for solutes, or more often for water (3). Hence, their dialyses are not efficient enough for maintenance therapy. It is naive to consider that the peritoileum is inert like hemodialysis membranes. Accordingly, it has been observed that transport rates decrease with systemic vascular disease, or after vasoconstrictor drugs (4, 5) and increase when vasodilators are administered locally or have selective effects on the splanchnic vasculature (5 7). Also small number of studies have demonstrated that drugs, which affect membranes directly modulate peritoneal transport rates (8–10). A preliminary evaluation of the effects of amphotericin B on peritoneal transport rates showed that osmotically induced water flux increases when the drug was given intraperitoneally (11). No direct effect on solute transport was detected and, over the range of 0.5 to 25 mg/kg, we noted no dose effect. Although amphotericin B is so large a solute that its own transmembrane transport would be slow, the site of action could not be determined with confidence from these studies. Accordingly, we undertook to compare the effects of intraperitoneal instillation with those of intravenous administration of amphotericin B in the same experimental animals.
Does Hypercoagulability Exist in CAPD Patients?
Authors: Bertoli Massimo , Gasparotto Maria L. , Vertolli Ugo , Ruffatti Annamaria , Di Landro Domenico , Romagnoli Gian Franco 
Published: February 2020

Blood levels of fibrinogen degradation products (FDP), factor VIII (antigen and coagulant), plasminogen and antithrombin III, as well as fibrinogen half-life were studied in 15 patients on CAPD from 3–24 months; the daily loss of these factors in the dialysate was also determined. Fibrinogen and factor VIII levels were above (p < 0.05), fibrinogen half-life was below (p < 0.05) and AT III was within the normal range. The average daily protein loss in the dialysate was 7.74: t 2.42 g; fibrinogen loss was 48.14:t 41.66 mg;FDP241.37 :t 185.19 mg; plasminogen 11.16 :t 6.94, and AT IIl64.96 :t 37.67 mg. These findings suggest that patients on CAPD have a state of hypercoagulability similar to that observed in patients with the nephrotic syndrome. Continuous ambulatory peritoneal dialysis (CAPD) is accompanied by protein losses, which may lead to protein depletion (1). The situation is similar in the nephrotic syndrome (NS), which, in addition, has the features of a hypercoagulability state (2, 3). After observing the appearance of thrombotic events in some CAPD patients, we set out to determine whether patients undergoing continuous ambulatory peritoneal dialysis also have a hypercoagulability state and this paper presents our findings.
Renal Transplantation in Patients on Peritoneal Dialysis
Authors: Glass Neal R. , Miller Douglas T. , Sollinger Hans W. , Zimmerman Stephen W. , Simpson David , Belzer Folkert O. 
Published: February 2020

The authors reviewed the course of 56 peritoneal dialysis patients after renal transplantation to determine the influence of this mode of dialysis on the results of transplantation. Three subgroups were analyzed separately because of marked differences in results. Group 1 was a historical group of 13 diabetic and two nondiabetic recipients of cadaveric grafts transplanted before 1982 who received standard immunosuppression with steroids and azathioprine only, and antirejection therapy with steroids and/or antithymocytic globulin (ATG). In this group results were poor: only 100/o of grafts and 670/o of patients survived two years or more. Group 2, the current group of cadaveric recipients, consists of 11 diabetic and nine nondiabetic patients transplanted since 1982; these patients received standard immunosuppression with low-dose steroids, azathioprine, and a two-week course of prophylactic ATG beginning within one day of transplantation; rejection was treated with high doses of oral steroids. In this second group, results were good: 630/o of the grafts are functioning and 100% of patients have survived for up to two years. Group 3, consisting of 21 recipients of living donor kidneys, had excellent results with 1000/o graft and patient survival up to five years. Rejection (N = 11), death (N = 5) and renovascular problems (N = 3) caused the 19 graft losses. In most patients the dialysis catheters were removed three weeks to three months after transplantation when renal function was stable. There were two minor complications and no infections related to the catheters. We conclude that: a) excellent transplant results can be achieved in peritoneal dialysis patients, most of whom are diabetic and receive cadaveric grafts, b) the peritoneal dialysis catheter is not a significant source of peritransplant morbidity and therefore c) peritoneal dialysis is appropriate for patients awaiting renal transplantation and should not bias against their selection for transplantation. The published literature on kidney transplantation in patients on peritoneal dialysis is sparse, suggesting that it is not, and perhaps should not be common practice to transplant these patients. This study and review of the literature was undertaken 1) to characterize peritoneal dialysis patients undergoing renal transplantation at our center, 2) to determine the results of transplantation in this group, 3) to evaluate the risk to these patients from the peritoneal dialysis catheter itself and 4) to compare our experience with the literature concerning renal transplantation of peritoneal dialysis patients.
A New Treatment for Unilateral Recurrent Hydrothorax during CAPD
Authors: Vlachojannis Jannis , Boettcher Ivar , Brandt Lothar , Schoeppe Wilhelm 
Published: February 2020

A 46-year-old woman undergoing CAPD developed a recurring right sided hydrothorax. Instillation of tetracycline HCI and triamcinolone acetonide did not correct the condition. However application of a fibrin adhesive (Tissucol) made it possible to achieve permanent adhesion of the pleural layers. This paper descrubes the method in detail. The development of pleural effusions in patients undergoing peritoneal dialysis, although a rare complication, can lead to the interruption of CAPD (2,3). As treatment, several workers have provoked the adhesion of parietal and visceral pleura by instillation tetracycline HCI or triamcinolone acetonide into the pleural space (6). As this report shows, these approaches failed in one patient and we achieved pennanent correction of this hydrothorax by employing a non-invasive, fibrin-adhesion technique.
Transmesothelial Ultrafiltration IN VITRO
Authors: Breborowicz Andrzej , Knapowski Jan 
Published: February 2020

The authors created transmesothelial ultrafiltration in vitro by inducing an osmotic gradient (vasc-300 mOsm: meso-400 mOsm) across the membrane. Calculated value of hydraulic conductivity of the mesothelium is comparable with analogous value for endothelium of the microvessels. They propose that transperitoneal ultrafiltration develops in two phases: Transmesothelial ultrafiltration, which augments tonicity of the interstitial tissue which is followed by transendothelial ultrafiltration due to the osmotic gradient between the dehydrated interstitium and the vascular space. Hypertonic medium on the mesothelial side of the membrane modified its permeability to various solutes: transport rate of urea and inulin was increased whereas transport rate of albumin decreased. Transperitoneal ultrafiltration of fluid during peritoneal dialysis conditions the removal of water from the organism. According to Nolph et al, the endothelium of the peritoneal microvessels plays a crucial role in this process (I). Little is known about the role of the mesothelium in transperitoneal ultrafiltration but patients with damaged mesothelium show decreased removal of water across the peritoneal membrane (2). This paper describes the results of an in vitro study on the transmesothelial, osmotically induced ultrafiltration.