bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASPD: A Prospective Study of Adequacy in Asian Patients on Long Term, Small Volume, Continuous Ambulatory Peritoneal Dialysis
Authors: Lam Man Fai , Tang Colin , Wong Andrew K. , Tong Kwok Lung , Yu Alex W. , Li Chun Sang , Cheung King On , Lai Kar Neng 
Published: February 2020

Background The impact of small solute clearance on patient survival in continuous ambulatory peritoneal dialysis (CAPD) is not yet solidified. Previously, we demonstrated that CAPD using small volume (6 L) daily exchanges provides adequate dialysis for most Asian patients. Methods We conducted a prospective, long-term observational study to determine the optimal dialysis adequacy that may provide better patient survival for Asian patients who receive small-volume CAPD. We recruited 294 patients. The initial CAPD regime was 3 x 2-L exchanges daily. The same regime was maintained unless there was significant loss of ultrafiltration or fluid retention despite the use of hypertonic dialysate. Results Median study period was 38.9 (range 5 – 76.5) months, with 81% and 27% of patients remaining in the study at 24 and 48 months respectively. The overall survival rates at 2 and 4 years were 94.0% and 74.8% respectively. Our long-term data revealed that survival rate was related to Kt/V values. Survival rates were significantly higher for patients with total Kt/V > 2.0 than for patients with Kt/V < 1.7 ( p = 0.02). The former group had lower body mass index and higher residual renal function and peritoneal Kt/V than the latter group. On analysis using Cox proportional hazards regression models, cardiovascular disease (CVD), lower urine volume, and higher body mass index were independent predictors of mortality. Patients with higher renal Kt/V had a significantly lower risk of mortality (RR = 0.018, p = 0.01) after adjusting for the effects of CVD and diabetes mellitus. Conclusion Our data recommend that 1.7 be the minimal target for total Kt/V in patients on long-term CAPD. Patients with high body mass index, low residual urine volume, and significant CVD need close monitoring.
Modeling of Icodextrin in PD Adequest® 2.0
Authors: Vonesh Edward F. , Story Kenneth O. , Douma Caroline E. , Krediet Raymond T. 
Published: February 2020

Objective To validate the use of a modified three-pore model for predicting fluid transport during long dwell exchanges that use a 7.5% icodextrin solution. Design A nonrandomized, single group, repeated measures study. Patients Ten peritoneal dialysis patients underwent a single 8-hour exchange of a 7.5% icodextrin solution. All patients were naïve to icodextrin. Main Outcome Measures A modified three-pore model was used to model solute and fluid transport during each 8-hour exchange. Concordance correlation coefficients were used to estimate the level of agreement between modeled and measured values of net ultrafiltration (UF) and intraperitoneal volume. Methods Each patient underwent a modified 8-hour standard peritoneal permeability analysis using a 2-L 7.5% icodextrin exchange. Dextran 70 was added to the icodextrin solution as volume marker to estimate fluid transport kinetics. Transcapillary UF, fluid absorption, and intraperitoneal volumes were assessed via the volume marker at 0, 5, 15, 30, 60, 120, 240, 300, 360, 420, and 480 minutes. Results There was strong agreement (concordance correlation = 0.9856) between net UF as measured by the volume marker data and net UF as modeled using the modified three-pore model implemented in PD Adequest (Baxter Healthcare, Deerfield, Illinois, USA). Conclusions Net UF and intraperitoneal volumes for long dwell exchanges using a 7.5% icodextrin solution can be accurately modeled with a modified three-pore model. Steady state icodextrin plasma levels are needed to accurately predict net UF for chronic users of icodextrin.
How to Avoid Glucose Degradation Products in Peritoneal Dialysis Fluids
Authors: Erixon Martin , Wieslander Anders , Lindén Torbjörn , Carlsson Ola , Forsbäck Gunita , Svensson Eva , Jönsson Jan Åke , Kjellstrand Per 
Published: February 2020

Objective The formation of glucose degradation products (GDPs) during sterilization of peritoneal dialysis fluids (PDFs) is one of the most important aspects of biocompatibility of glucose-containing PDFs. Producers of PDFs are thus trying to minimize the level of GDPs in their products. 3,4-Dideoxyglucosone-3-ene (3,4-DGE) has been identified as the most bioreactive GDP in PDFs. It exists in a temperature-dependent equilibrium with a pool of 3-deoxyglucosone (3-DG) and is a precursor in the irreversible formation of 5-hydroxymethyl furaldehyde (5-HMF). The aim of the present study was to investigate how to minimize GDPs in PDFs and how different manufacturers have succeeded in doing so. Design Glucose solutions at different pHs and concentrations were heat sterilized and 3-DG, 3,4-DGE, 5-HMF, formaldehyde, and acetaldehyde were analyzed. Conventional as well as biocompatible fluids from different manufacturers were analyzed in parallel for GDP concentrations. Results The concentrations of 3-DG and 3,4-DGE produced during heat sterilization decreased when pH was reduced to about 2. Concentration of 5-HMF decreased when pH was reduced to 2.6. After further decrease to a pH of 2.0, concentration of 5-HMF increased slightly, and below a pH of 2.0 it increased considerably, together with formaldehyde; 3-DG continued to drop and 3,4-DGE remained constant. Inhibition of cell growth was paralleled by 3,4-DGE concentration at pH 2.0 – 6.0. A high glucose concentration lowered concentrations of 3,4-DGE and 3-DG at pH 5.5 and of 5-HMF at pH 1. At pH 2.2 and 3.2, glucose concentration had a minor effect on the formation of GDPs. All conventional PDFs contained high levels of 3,4-DGE and 3-DG. Concentrations were considerably lower in the biocompatible fluids. However, the concentration of 5-HMF was slightly higher in all the biocompatible fluids. Conclusion The best way to avoid reactive GDPs is to have a pH between 2.0 and 2.6 during sterilization. If pHs outside this range are used, it becomes more important to have high glucose concentration during the sterilization process. There are large variations in GDPs, both within and between biocompatible and conventionally manufactured PDFs.
Compatibility of Insulin over 24 Hours in Standard and Bicarbonate-Based Peritoneal Dialysis Solutions Contained in Bags Made of Different Materials
Authors: Voges Markus , Divino-Filho Jose C. , Faict Dirk , Somers Fabian , Vermeulen Pierre 
Published: February 2020

Background The purpose of this study was to evaluate potency changes in insulin in different solutions and bag materials used for peritoneal dialysis (PD). One of the PD solutions (Physioneal) tested is available in two different solution containers, PVC and Clear-Flex. Four insulin concentrations (4 IU/L, 10 IU/L, 20 IU/L, and 40 IU/L) were evaluated. This range of concentrations was defined in accordance with standard medical practice. All PD solutions made by Baxter, Castlebar, Ireland. Methods Insulin determination was performed by immunoassay (ELISA). Results In Dianeal, more than 90% of the initial dose of insulin remained available up to 24 hours for all concentrations tested. In Physioneal, for the higher concentrations tested (10 IU/L, 20 IU/L, and 40 IU/L), more than 90% of the initial dose of insulin remained available up to 6 hours, and more than 80% up to 24 hours. For the lowest concentration of insulin tested in Physioneal (4 IU/L), more than 90% of the initial dose of insulin remained available up to 3 hours, and more than 70% up to 24 hours. Also for the lowest concentration of insulin, recovery correlated with the pH of the tested solutions. This effect became apparent over the storage time. Conclusions The data show that insulin adsorption is less than 10% during the first 3 hours for every PD solution tested. Insulin recovery tends to be stable or to decrease slightly over time for the lower insulin concentrations tested. The results for insulin recovery show a correlation with insulin concentration and with pH for the lowest insulin dose tested. From a solution–container interaction perspective, Clear-Flex is an equivalent alternative to standard PVC material.
Adenovirus-Based Transient Expression Systems for Peritoneal Membrane Research
Authors: Hoff Catherine M. , Margetts Peter J. 
Published: February 2020

Background Peritoneal membrane research has provided important insights into the physiology and pathophysiology of this tissue that is of vital importance for peritoneal dialysis patients. Among the various tools and methodologies used to study the peritoneum, we have extensively used adenovirus-mediated gene transfer. Methods A literature review was carried out. Information from reviewed papers was combined with the authors’ experience and results. Results We have used first-generation adenoviruses that are simple to construct and can infect a wide range of dividing and nondividing cell types. These vectors are restricted, however, in that they provide only a short duration of transgene expression and may elicit an inflammatory response. Modifications to this technology with helper-dependent adenovirus may circumvent these problems but with increased complexity of construction. Adenovirus-mediated gene transfer has been used to evaluate the effect of several cytokines and growth factors on peritoneal membrane physiology. We have used intraperitoneal delivery of transforming growth factor-β to generate an experimental model system of resolving peritoneal fibrosis and epithelial mesenchymal transdifferentiation. We have studied the effects of the inflammatory cytokines interleukin-1β and tumor necrosis factor alpha on the peritoneum, and have shown that antiangiogenic factors such as sFLT-1 and angiostatin can reduce the damaging effects of exposure to peritoneal dialysis solutions in an animal model. Conclusions The use of recombinant adenoviruses to genetically modify cells and tissues is now a common laboratory research tool. This technique has provided important advances in our understanding of the peritoneal membrane.
Improved In Vitro Biocompatibility of Bicarbonate-Buffered Peritoneal Dialysis Fluid
Authors: Grossin Nicolas , Wautier Marie-Paule , Wautier Jean-Luc , Gane Pierre , Taamma Redouane , Boulanger Eric 
Published: February 2020

Background Conventional peritoneal dialysis fluids (PDFs) have been shown to damage the mesothelial layer and are associated with the development of peritoneal fibrosis and neoangiogenesis. New-generation PDFs have therefore been developed with physiological pH and reduced levels of glucose degradation products (GDPs), precursors of advanced glycation end products (AGEs). In this work, we evaluated and compared the improved biocompatibility of two new-generation PDFs (Balance and bicaVera) using mesothelial cell biology; we also compared them to a standard PDF (stay·safe) (all PDFs by Fresenius Medical Care, Fresnes, France). Methods stay·safe, Balance, and bicaVera were tested for their effect on human peritoneal mesothelial cell (HPMC) viability by measuring cell proliferation and apoptosis, and oncosis induction. The formation of AGEs was evaluated by immunoassay. Transforming growth factor beta-1 and vascular endothelial growth factor (VEGF) were immunoassayed in HPMC supernatants exposed to the above PDFs. Results At 15 g/L glucose concentration, HPMC exposure to bicaVera resulted in higher cell proliferation compared to Balance ( p < 0.001) and stay·safe ( p < 0.001). Compared to the lactate-buffered PDFs (Balance and stay·safe), oncosis was significantly lower in cells exposed to bicaVera ( p < 0.05). bicaVera, containing lower amounts of GDPs, generated less AGE formation ( p < 0.05) and VEGF production ( p < 0.05) than either Balance or stay·safe. Conclusions New-generation PDFs with physiological pH and lower GDP levels, especially if bicarbonate-buffered (bicaVera), have fewer in vitro toxic effects on mesothelial cells and may contribute to peritoneal preservation, thus improving long-term treatment of PD patients.
Perioperative Management of Peritoneal Dialysis Patients Undergoing Hernia Surgery without the use of Interim Hemodialysis
Authors: Shah Hemal , Chu Maggie , Bargman Joanne M. 
Published: February 2020

Objective To review the feasibility of undertaking elective hernia repair in peritoneal dialysis (PD) patients without converting them to hemodialysis. Design A 10-year retrospective review of prospectively collected data. Setting PD unit of a university-based hospital. Patients and Methods All patients received regular exchanges until the morning of the surgery and remained off dialysis for the first 48 hours postoperatively. After that, PD was gradually reintroduced. The patients on continuous ambulatory PD (CAPD) received intermittent PD (IPD) 3 times per week for 10 hours per day for 2 weeks, followed by 5 exchanges of low volume (1 – 1.5 L) CAPD for 2 weeks, returning to the pre-surgery prescription by 4 weeks. Patients on continuous cycling PD (CCPD) received 1 week of IPD followed by 4 weeks of nocturnal IPD and returned to the original dose in 5 weeks. Between 1 April 1995 and 31 March 2005, 50 consecutive patients were managed by this protocol. Average age was 65 years and 67.7% were males. The original disease was diabetes mellitus (19 patients), hypertension ( 6 ), chronic glomerulonephritis (13), polycystic kidney disease ( 6 ), and others ( 6 ). The types of abdominal hernias included umbilical (25 patients), inguinal (18), incisional ( 5 ), and epigastric ( 2 ). 42 patients were on CAPD and 8 on CCPD. Average duration of PD prior to development of hernia was 16.4 months. Results Average pre-surgery creatinine was 673 μmol/L, increasing to 968 μmol/L on IPD. Serum potassium increased from 3.4 to 4.7 mmol/L. No episodes of hyperkalemia were noted. The average total follow-up was 33.4 months. None of the patients had leakage or early hernia recurrence due to early resumption of PD; 13 patients had recurrence of the same hernia after a median 19.9 months; 4 patients had hernias at different sites after an average of 55 months. Conclusions Based on this experience, we recommend that PD patients undergoing elective abdominal hernia surgery should continue PD according to the prescribed protocol. Interim hemodialytic support does not appear to be necessary in most patients.
Resting Energy Expenditure in Peritoneal Dialysis Patients
Authors: Bazanelli Ana P. , Kamimura Maria A. , da Silva Camila Barbosa , Avesani Carla M. , Lopes Miriam G. Garcia , Manfredi Silvia R. , Draibe Sergio A. , Cuppari Lilian 
Published: February 2020

Objectives This study aimed to evaluate whether resting energy expenditure (REE) of patients undergoing peritoneal dialysis (PD) therapy differs from that of healthy individuals, as well as to investigate the factors associated with REE in this sample of patients. Design Cross-sectional study. Setting Dialysis Unit of the Nephrology Division, Federal University of Sao Paulo–Oswaldo Ramos Foundation, Brazil. Subjects and Methods The study examined the REE of 37 patients (20 males, age 44.5 ± 13 years) undergoing PD therapy. Only patients older than 18 years, on PD for at least 3 months, without catabolic illness, and with normal thyroid function were included. Patients were pair matched for age and gender with 37 healthy individuals. REE was measured by indirect calorimetry. Body composition was assessed by dual-energy x-ray absorptiometry in the patients and by bioelectrical impedance in the healthy individuals. Results The REE of PD patients was similar to that of pair-matched controls (1372 ± 266 and 1453 ± 252 kcal/day respectively, p = 0.13) even when adjusted for lean body mass and gender ( p = 0.56). The REE of PD patients was positively correlated with lean body mass ( r = 0.60, p < 0.01), fat mass ( r = 0.43, p < 0.01), body mass index (r = 0.60, p < 0.01), serum glucose (r = 0.36, p < 0.05), and protein equivalent of nitrogen appearance (PNA; r = 0.42, p < 0.01). There were no correlations between REE and glucose absorption, dialysis-related parameters, C-reactive protein, and energy or protein intake by 3-day food diary. In the multiple linear regression analysis, using REE as the dependent variable, the final model showed that lean body mass and female gender were determinants of REE in PD patients ( R2 = 0.44). When separate analysis by gender was performed, REE correlated directly with body fat in female patients (r = 0.70, p < 0.01) but not in male patients ( r = 0.29, p = 0.21). On the other hand, lean body mass was significantly correlated with REE in male patients ( r = 0.78, p < 0.01) but not in female patients ( r = 0.47, p = 0.06). Conclusions This study showed that REE of PD patients did not differ from that of healthy individuals. The strong association between body fat and REE in female patients remains to be further investigated.
Malnutrition–Inflammation Score is a Useful Tool in Peritoneal Dialysis Patients
Authors: Afşar Bariş , Sezer Siren , Ozdemir Fatma Nurhan , Celik Huseyin , Elsurer Rengin , Haberal Mehmet 
Published: February 2020

Background Malnutrition–Inflammation Score (MIS) is a quantitative assessment tool based on Subjective Global Assessment (SGA) and predicts mortality and morbidity in maintenance hemodialysis patients. However, there are not enough data about the use of MIS in peritoneal dialysis (PD). In this study, relationships between MIS and prospective hospitalization indices, risk of developing peritonitis, anemia indices, and laboratory and anthropometric parameters were analyzed and compared with SGA in PD. Methods 50 PD patients (M/F 26/24, age 45.2 ± 14.9 years, mean PD duration 30.8 ± 23.1 months) were included. The same physician performed the SGA and MIS evaluations. Clinical, laboratory, and anthropometric parameters were measured. Results 18 patients were classified as SGA-A (without malnutrition), 24 as SGA-B (with moderate malnutrition), and 8 as SGA-C (with severe malnutrition). Increment in MIS was concordant with SGA groups A to C ( p < 0.0001). Peritonitis rate, number of hospitalizations, total number of hospitalization days, erythropoietin requirements, C-reactive protein (CRP), and ferritin levels were positively correlated with MIS ( p < 0.0001). Midarm muscle circumference ( p = 0.04), albumin ( p < 0.0001), prealbumin ( p = 0.001), creatinine ( p = 0.04), hemoglobin ( p = 0.003), transferrin ( p < 0.0001), and cholesterol ( p = 0.009) were negatively correlated with MIS. Correlation coefficients of hospitalization indices, peritonitis rate, anemia indices, erythropoietin requirements, albumin, prealbumin, CRP, and anthropometric parameters were higher with MIS than with SGA. In logistic regression analysis, a higher MIS was independently associated with a higher risk of future hospitalization ( p = 0.029, odds ratio 2.14, confidence interval 1.082 – 4.146). Conclusions This study demonstrated that MIS significantly correlated with clinical, nutritional, inflammatory, and anthropometric parameters and anemia indices in PD patients, and that those correlations were stronger than those with SGA.
Plasma Ghrelin Levels in Children with Chronic Renal Failure on Peritoneal Dialysis
Authors: Szczepańska Maria , Szprynger Krystyna , Mazur Bogdan , Zwolińska Danuta , Kilis-Pstrusińska Katarzyna , Makulska Irena 
Published: February 2020

Objectives Malnutrition and loss of appetite represent a serious problem in children with chronic renal failure. Ghrelin is a newly described hormone involved in control of growth hormone secretion, stimulation of food intake, and regulation of energy balance. Methods Plasma ghrelin levels were compared between 12 children on automated peritoneal dialysis (APD) and 9 children on conservative treatment of chronic renal failure. Eight healthy children matched for age and body mass index (BMI) served as a control group. Results Plasma ghrelin levels were similar in children on APD (698.3 ± 59.7 pg/mL) and children on conservative treatment (675.4 ± 41.9 pg/mL) compared to healthy controls (700.1 ± 24.7 pg/mL). There was no difference in plasma ghrelin levels in children with chronic renal failure regardless of the method of treatment (peritoneal dialysis vs conservative treatment). The plasma ghrelin index was similar in all three investigated groups: APD 40.2 ± 8.7 vs conservative treatment 39.1 ± 5.6 vs controls 41.0 ± 7.8 (pg/mL)/BMI (kg/m2). Plasma ghrelin levels did not correlate with age, duration of dialysis treatment, height, weight, BMI, creatinine and urea levels, adequacy parameters, or nightly glucose load. Conclusion Plasma ghrelin levels in children on APD were not different from levels in children on conservative treatment or healthy controls with comparable BMI. The persistent state of toxic influence of uremic end-products could be responsible for such a lack of correlation with anthropometrical parameters. Further studies on a larger group of children on APD are needed to clarify the effect of ghrelin on nutritional status in children with chronic renal failure.
Sen Virus Infection in Patients on Peritoneal Dialysis
Authors: Hsu Bang-Gee , Wang Li-Yu , Hu Chi-Tan , Wang Chih-Hsien , Fang Te-Chao , Lin Hans Hsienhong 
Published: February 2020

Background Many reports have demonstrated SEN virus (SEN-V) infection rates in hemodialysis patients, but the SEN-V infection rate in peritoneal dialysis (PD) patients has never been reported. In this study, we determined the prevalence rate of SEN-V viremia in a PD population. Methods Serum samples from 47 PD patients and a control group of 43 subjects from the general population at their health examination were assayed for SEN-V-D and -H viremia using polymerase chain reaction. Results The proportions of female gender ( p = 0.001), previous transfusion ( p < 0.0001), and higher mean serum AST level ( p = 0.012) were significantly higher in PD patients. The prevalence rates of SEN-V-D and/or -H viremia were not significantly different between PD patients and controls (27.7% vs 32.6%). SEN-V-D(+) patients had lower mean duration of PD than SEN-V(–) patients. Mean ALT level was significantly lower in SEN-V-H(+) than in SEN-V(–) patients (12.8 ± 5.8 vs 19.6 ± 12.1 (IU/L), p = 0.025). None of the SEN-V-infected PD patients had overt clinical or biochemical signs of liver disease. There were no statistically significant differences in prevalence of SEN-V-D and/or -H viremia between automated PD (APD) patients and continuous ambulatory PD (CAPD) patients. Conclusions These results indicate that the SEN-V infection rate is not different between healthy individuals and PD patients. Infection with SEN-V is not associated with evident liver disease in PD patients and SEN-V infection rate is not different between APD patients and CAPD patients.