bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Toxic Degradation Products during Heat Sterilization of Glucose-Containing Fluids for Peritoneal Dialysis: Influence of Time and Temperature
Authors: Kjellstrand Per , Martinson Evi , Wieslander Anders , Holmquist Björn 
Published: February 2020

Objective Fluids for peritoneal dialysis (PD) cause cytotoxic reactions in many different in vitro systems. The low pH, the high osmolality of the fluids, and the glucose degradation products formed during heat sterilization have been considered responsible. In the present study, we investigate the influence of temperature and time during heat sterilization of PD fluids and glucose solutions on glucose degradation and cytotoxicity of the solutions. Design Ampoules containing PD-fluid or glucose solution were heated in an oil bath to predetermined F o values (combinations of time and temperature giving equal energy/bacteriallethality). Cytotoxicity of the solutions was measured as groWth inhibition of cultured L-929 fibroblasts. Glucose degradation was measured as UV absorbance at 228 and 284 nm. Results The same general pattern was seen in both PD fluid and glucose solution. Cytotoxicity decreased from 90% to 15% when the sterilization temperature was increased from 115° to 140°C and concomitantly the length of time shortened in order to maintain equal bacteriallethality. Under the same conditions, degradation products, measured as UV absorbance at 284 nm, decreased from 0.2 to 0.02. Conclusion To minimizethe development of cytotoxic breakdown products, high temperatures over short periods of time should be used to heat-sterilize PD fluids. Even as small an increase as 5°C at around 120°C will improve the quality of the solutions.
Successful Self-Care Home Dialysis in the Elderly: A Single Center's Experience
Authors: McDonald Maree , McPhee Patricia D. , Walker Robert J. 
Published: February 2020

Objective This study was designed to prospectively review our experience with self-care home dialysis in the 60-years-and-older age group since the commencement of continuous ambulatory peritoneal dialysis (CAPD) in our center in 1989. Design Data on mortality, morbidity, dialysis technique and complications, quality of life, and rehabilitation were collected prospectively. Setting A regional dialysis unit providing full renal replacement services for a population of 292 000. Patients Twenty-five patients (16 male) with an average age of 64.4 years (range: 58.25-76.5 years) at commencement of dialysis. Results All patients were on self-care home dialysis. Patient survival rates were comparable with the national average at 12 months (90% vs 89%) and two years (84% vs 80%). Dialysis therapy was well tolerated and technique survival rates were comparable for both hemodialysis and CAPD. There was a very low peritonitis rate of 1 episode per 28.5 patient-months. Conclusions Self-care home dialysis is a viable therapeutic option with a high degree of technique success and a good quality of life in the older population.
Does Impaired Transcellular Water Transport Contribute to Net Ultrafiltration Failure during CAPD?
Authors: Monquil Margje C.J. , Imholz Alexander L.T. , Struijk Dirk G. , Krediet Raymond T. 
Published: February 2020

Objectives To assess the contribution of transcellular water transport in net ultrafiltration failure during continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective. Setting Renal Unit, Academic Medical Center, Amsterdam. Patients One group of 6 patients with clinical severe ultrafiltration loss and a group of 10 stable CAPD patients without ultrafiltration problems. Intervention In all patients, two peritoneal permeability tests were done within one week, using glucose 1.36% dialysate on one day and glucose 3.86% on the other day. Dextran 70 was used as a volume marker. Results The difference in net ultrafiltration between 3.86% glucose and 1.36% glucose dialysate was 569±51 mL (control) and 153±1 03 mL (poor ultrafiltration group; p < 0.005). The dialysatelplasma (DIP) concentration ratios increased in both groups with glucose 1.36%. When using 3.86% glucose, the DIP ratio decreased in the control group with a median minimum value one hour after completion of inflow. It is possible that sieving of sodium was due to transcellular water transport by crystalloid osmosis during the hypertonic dwell, as a dissociation between the transport of water and sodium is unlikely to occur in transport through the much larger intercellular pores. The DIP sodium ratio after one hour was related to the mass transfer area coefficient (MTC) of creatinine and the percentage of glucose absorption in the control group. No decrease in DIP ratio was found in the poor ultrafiltration group. This suggests impairment of transcellular water transport. No significant differences were present between both groups with regard to MTC creatinine (10.2 and 14.0 mL/min), glucose absorption (71% and 71%), effective lymphatic absorption rate (1.34 and 1.01 mL/min), and residual volume (248 and 178 mL). Only 1 patient in the ultrafiltration loss group continued with CAPD. The others had to be transferred to hemodialysis; 1 of them developed sclerosing peritonitis. Conclusion The sieving of sodium during CAPD may be caused by transcellular water transport. Deficient sieving as assessed by the absence of a decreased DIP ratio after one hour of a hypertonic dwell suggests impairment of transcellular water transport. This is asso ciated with severe ultrafiltration failure. It indicates that failure of transcellular water transport, possibly by glycosylation of specific proteins on the cell membrane, may be considered one of the causes of ultrafiltration failure during CAPD.
Subcutaneous Epoetin Beta in Renal Anemia: An Open Multicenter Dose Titration Study of Patients on Continuous Peritoneal Dialysis
Authors: Bárány Peter , Clyne Naomi , Hylander Britta , Johansson Ann-C. , Simonsen Ole , Larsson Rutger , Frisenette-Fich Carsten , Svensson Birgitta , Helmers Claes 
Published: February 2020

Objective To establish dose requirements (target hemoglobin >100 g/L) and safety of subcutaneously administered epoetin beta. Design Open multicenter study. Patients Forty-five anemic patients (21 female, 24 male; mean age 55 years; range 20 79 years) who had been on continuous peritoneal dialysis for 1-157 months (mean 24 months). Thirty patients required blood transfusions during the year prior to the study. Mean hemoglobin concentration pretreatment was 75 g/L (range 57 –89 g/L). Intervention After a pretreatment period of two weeks, 60 IU kg-1 week-1 divided into three weekly doses of epoetin beta was administered subcutaneously. The dose was increased by 60 IU kg-1 week-1 after ten weeks, and when necessary, every fourth week in patients with hemoglobin levels below 100 g/L. Main Outcome Measures Hemoglobin concentration. Analysis of factors affecting the response to epoetin beta. Safety of epoetin beta. Results Thirty-eight of the 45 patients completed six months and 21 patients completed one year in the study. Twenty-six patients reached hemoglobin 100 g/L within six months and 8 patients did later on. The mean hemoglobin concentration after three months was 93 g/L (range 64 –144 g/L) and after six months was 99 g/L (range 59 –130 g/L; mean epoetin beta dose 1221U kg-1 week-I). During the second six-month period of the study, hemoglobin levels were stable in most patients. After one year, the mean hemoglobin was 110 g/L (range 84 –153 g/L) and the mean epoetin beta dose was 1071U kg-1 week-l. Prolonged correction time and impaired response to epoetin were observed in patients with infections or hemorrhages and in patients with low hemoglobin concentration before starting epoetin treatment. Iron deficiency was controlled by iron supplementation, either orally or, in 10 patients, intravenously. Increased blood pressure, requiring intensified antihypertensive treatment, was observed in 13 patients. Conclusions Continuous peritoneal dialysis patients with moderate anemia (Hb 75 –90 g/L) and without complicating disorders can be managed with subcutane0usdoses of ep0etin<1201U kg-lweek-l. Theepoetin beta dose should be adjusted after the first month of treatment since most patients required higher doses than the initial 60 IU kg-1 week-l.
Effect of Oral Calcidiol Treatment on Its Serum Levels and Peritoneal Losses
Authors: Martinez María E. , Del Campo Maria T. , Sánchez-Cabezudo Maria J. , Balaguer Gloria , Rodriguez-Carmona Ana , Selgas Rafael 
Published: February 2020

Objectives To evaluate calcidiol serum levels in a group of continuous ambulatory peritoneal dialysis (CAPO) patients and the effect of oral calcidiol treatment on serum levels and peritoneal losses. Study design Twenty patients (13 female, 7 male) were studied for 12 –60 months. Their ages ranged 22 72 years (mean 46±15). Serum calcidiol, total protein and urea were determined at baseline and after the administration per os of 0.133 mcg/day of calcidiol for 10 days. At the same time, calcidiol and total protein were measured in peritoneal effluent at baseline and at 5,10, and 40 days after starting this treatment. Results A significant and direct correlation between the calcidiol dialysis/plasma ratio and the peritoneal protein losses was found, both before and 40 days after calcidiol administration when calcidiol serum levels were the lowest. As calcidiol serum levels rose to the normal range in the course of the study, peritoneal losses of this metabolite increased slightly and correlated with calcidiol serum levels and urea mass transfer coefficient (MTC); the significant correlation between calcidiol serum levels and peritoneal protein losses disappeared. Conclusions When serum calcidiol levels are low, calcidiol peritoneal losses in patients on CAPO correlate with protein peritoneal losses. However, when serum calcidiollevels rise, the calcidiol peritoneal losses correlate with calcidiol serum levels and urea MTC, and not with protein peritoneal losses.
Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable CAPD
Authors: Pannekeet Marja M. , Zemel Désirée , Koomen Ger C.M. , Struijk Dick G. , Krediet Raymond T. 
Published: February 2020

Objective To investigate whether dialysate concentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue. Design We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation. Setting CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam. Patients Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied. Results All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur. Conclusions Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in CAPD
Authors: Gokal Ram , Mistry Chandra D. , Peers Elizabeth M. ,   The MIDAS Study Group
Published: February 2020

Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patient year, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patient year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
Bioelectrical Impedance Analysis and Dual Energy X-Ray Absorptiometry to Monitor Nutritional Status
Authors: Stall Sharon , Ginsberg Nancy S. , Lynn Robert I. , Zabetakis Paul M. 
Published: February 2020

There exists an imperative to monitor changes in body composition in all dialysis patients on a regular basis to avoid overt malnutrition. In this regard, the absolute measurement of the fat-free mass assessment may not be as crucial as the serial measurement of fat-free mass with the same modality. A significant difference in measured fat and fat-free mass should be expected if different techniques are employed. Therefore, when attempting to monitor patients over time or to assess the effects of changes in therapeutic regimens, a single methodology should be employed. Our data validate the use of BIA in the stable PD patient, indicating that BIA can predict the DXA results. Considering the ease with which BIA measurements can be obtained and the lack of dependency on operator interpretation, BIA is an ideal technique for use in the clinical setting. The applicability of this technique for use in monitoring longitudinal changes in body composition has, in fact, been well established (25,30,31). BIA appears to be an excellent method for routine fat-free mass measurement in dialysis patients. In as much as malnutrition continues to remain a significant problem in PD patients, measuring and monitoring body composition is strongly recommended.
Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable Capd
Authors: Pannekeet Marja M. , Zemel Désirée , Koomen Ger C.M. , Struijk Dick G. , Krediet Raymond T. 
Published: February 2020

Objective To investigate whether dialysateconcentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue. Design We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation. Setting CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam. Patients Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied. Results All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur. Conclusions Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
Fractional Urea Clearance Estimates Using Two Anthropometric Formulas in Continuous Peritoneal Dialysis: Sex, Height, and Body Composition Differences
Authors: Tzamaloukas Antonios H. , Dombros Nicholas V. , Murata Glen H. , Nicolopoulou Nicoletta , Dimitriadis Athanasios , Kakavas John , Malhotra S Deepak , Antoniou Stavros , Balaskas Elias V. , Voudiklaris Sonia 
Published: February 2020

Objective To compare estimates of urea volume (V) and KT/V obtained by the Watson and Hume anthropometric formulas, and to identify the similarities and differences between these estimates. Design Theoretical analysis applying wide variations in the determinants of anthropometric V (age, height, weight) in hypothetical women and men. Analysis of urea kinetic studies performed in patients on continuous peritoneal dialysis (CPD). Setting Four dialysis units in Albuquerque, two in Athens, and two in Thessaloniki. Participants Three hundred and two CPD patients who had 440 urea kinetic studies. Intervention Standard urea clearance was performed by 24-hour collections of urine and drained dialysate followed by blood sampling. V was estimated by both the Watson and Hume formulas. Main Outcome Measures Estimates of V and KT/V were compared separately in women and men by Student's t-test, linear regression, and limits of agreement (mean difference±2 SD). The agreement of the KT/V estimates was also tested by the kappa ratio using a value of 1.70 weekly as the lowest acceptable KT/V. Results The theoretical analysis indicated important disagreement only in extreme variations from the ordinary in height and, to a lesser extent, weight. Differences due to height variation were pronounced only in hypothetical women. CPD patient findings were as follows: in women, Watson V and weekly KT/V were 30.4±4.4 L and 2.10±0.61, respectively. Corresponding Hume estimates were 30.3±5.4 L and 2.12±0.66, respectively. Corresponding estimates for men were 40.5±5.7 L and 1.92±0.57 (Watson) plus 41.4±5.6 L and 1.88±0.57 (Hume), respectively. By linear regression, KT/VHume = -0.083 + 1.052 (KT/Vw8tson), r = 0.961 (women); and KT/VHume = -0.026 + 0.992 (KT/Vwatson), r = 0.985 (men). Limits of agreement were -1.41 L and 2.10 L for V, and -0.15 and 0.14 weekly for KT/V. In 94.3% of the cases, KT/Vw8tson and KT/VHume agreed (both >1.70 or both <1.70 weekly). Kappa ratio was 0.875 (excellent agreement). The concordant and discordant groups differed in height and degree of obesity, in agreement with the theoretical analysis. Conclusion The Watson and Hume formulas provide similar estimates of V and KT/V in CPD patients. Differences may be noted only if women's height or, to a lesser extent, both sexes’ weight is at a great variance with the ordinary values.
Comparison of Measured and Predicted Creatinine Excretion is An Unreliable Index of Compliance in Pd Patients
Authors: Blake Peter G. , Spanner Evelyn , McMurray Susan , Lindsay Robert M. , Ferguson Evelyn 
Published: February 2020

Objective To evaluate the use of the ratio of measured to predicted creatinine excretion as an index of compliance in peritoneal dialysis (PD) patients. Design A prospective analysis. Setting Academic teaching hospital dialysis unit. Patients Forty-three patients on PD. Measurements Creatinine excretion in daily dialysate and urine collections was measured on one occasion in 10 patients and on two occasions in 33 patients, and, after adding an estimate for extrarenal creatinine degradation, was divided by predicted creatinine excretion to give a creatinine excretion ratio, which has been proposed as an index of compliance with exchanges in PD patients. Values above 1.24 have been suggested to indicate non-compliance. Lean body mass was also estimated from creatinine excretion. Results The mean creatinine excretion ratio was 1.12, and 30% of patients had a value above 1.3. Only one patient admitted noncompliance. Studies on four consecutive days of guaranteed compliance in 7 patients with high ratios showed that creatinine excretion remained constant, suggesting that the patients were high creatinine producers rather than noncompliant. Creatinine excretion was stable when measured at intervals of days, but over months it tended to change markedly in many patients. Lean body mass estimations using creatinine excretion were low in most patients. Conclusion Comparison of measured and predicted creatinine excretion is not a reliable indicator of noncompliance because many compliant patients consistently excrete more creatinine than predicted. The standard formulas were not validated in dialysis patients and underestimate creatinine excretion significantly in many PD patients. Existing estimates in the literature of non-compliance, using this methodology, may not be accurate. Better methods of detecting this problem are required.
Igg Subclasses in Capd Patients
Authors: Krediet Raymond T. , Koomen Ger C.M. , Vlug Arjen , Struijk Dirk G. , Buis Barbara , Van Olden Rudolf W. , Imholz Alexander L.T. 
Published: February 2020

Objective To make a comparison of serum levels of immunoglobulin G (lgG) subclasses in adult continuous ambulatory peritoneal dialysis (CAPD) patients with those in age-and sex-matched hemodialysis patients and healthy volunteers, and to analyze the contribution of removal of these proteins in peritoneal effluent to their plasma values. Design A cross-sectional study. Setting A renal unit of a university hospital. Patients Twenty-three CAPD patients, 21 hemodialysis patients, and 21 healthy volunteers. Peritoneal transport studies were done in 8 of the 23 CAPD patients. Methods IgG subclasses were measured in serum by nephelometry. For the peritoneal transport studies an ELISA method on ethylenediamine tetracetic acid plasma was used. The same method was used in seven-to ten-fold concentrated peritoneal dialysate. Results CAPD patients had lower IgG2 and IgG4 1evels than hemodialysis patients and healthy volunteers (p < 0.01). lgG2 values below 1.5 glL were present in 43% of the CAPD patients (p < 0.001 compared to healthy volunteers). Peritonitis incidence was not different between CAPD patients with low or normal IgG2 plasma levels. Peritoneal clearance of IgG3 was lower than that of the other subclasses. Evidence was obtained for a depressed synthesis of IgG2 and IgG4 in CAPD patients. The hypothesis that interleukin-2 may be involved in the low synthesis rate of IgG2 is discussed. Conclusion Low serum IgG2 and IgG4 1evels are present in stable, adult CAPD patients. These were not caused by increased peritonealloss, but by decreased synthesis.