bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis
Authors: Warady Bradley A. , Bahl Vicki , Alan Uri , Hellerstein Stanley 
Published: February 2020

Objective To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification. Design Prospective case evaluation. Setting The Home Peritoneal Dialysis Unit, Children's Mercy Hospital. Patient Seven-year-old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum. Intervention Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months. Results The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months. Conclusion Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.
Effects of 3-Month Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Qamar Izhar U. , Levin Leo , Balfe J. Williamson , Balfe Judith A. , Secker Donna , Zlotkin Stanley 
Published: February 2020

Objectives To compare the nutritional and biochemical effects of amino acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized crossover study. Setting Pediatric Nephrology Unit in a tertiary care, teaching hospital of the University of Toronto. Patients Seven children aged 0.7–16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit. Interventions Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months. Main Outcome Measures Nutritional and biochemical data were obtained on each patient during each dialysis regimen. Results Analysis of the patients’ nutritional data showed comparable weight gain with both regimens but no significant improvement in lean body mass with either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tendency to higher plasma potassium and urea levels with no clinical side effects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma albumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino acid dialysis did not show any significant change. An interesting phenomenon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the amino acid dialysis period. This newly described phenomenon could have been due to tolerance or hepatic enzyme induction. Conclusions Overall amino acid dialysis was comparable to dextrose dialysis with no additional proven nutritional benefit, was equally effective in ultrafiltration and creatinine clearance, and produced no adverse clinical or biochemical effects.
Measurement of Peritoneal Fluid Handling in Children on Continuous Ambulatory Peritoneal Dialysis Using Autologous Hemoglobin
Authors: Reddingius Roel E. , Schröder Cornelis H. , Willems Hans L. , Van Den Brandt Frans C.A. , Koomen Gerardus C.M. , Krediet Raymond T. , Monnens Leo A.H. 
Published: February 2020

Objective Previous measurements of peritoneal fluid handling in children treated by continuous ambulatory peritoneal dialysis (CAPD) were performed with human albumin as a fluid marker. A major disadvantage of this substance is that endogenous patient albumin enters the peritoneal cavity during the dwell period. For this reason perito neal fluid kinetics were measured in a group of children on CAPD, using autologous hemoglobin as a volume marker. Design Autologous hemoglobin was added to dialysate containing 1.36% glucose as a volume marker. Marker clearance (MC), which is presently the best available approximation of lymphatic absorption in the clinical setting, and transcapillary ultrafiltration (TCUF) were measured during a 4-hour dwell. Setting University hospital. Patients Children on CAPD (N=9), with a median age of 8.1 years (range 2.1–13.2 years). Results MC was 521±166 mL/4 hour/1.73 m2, which is high compared to the literature data on adult CAPD patients. TCUF was 519±92 mL/4 hour/1.73 m2, which is similar to data concerning adult patients. TCUF reached no maximum during the 4-hour dwell, and the deviation of the TCUF curve from linear was markedly less than usually seen in adult patients. Conclusions MC in children treated with CAPD is higher when compared to the literature data on adults. Difficulties to achieve sufficient ultrafiltration in children could be caused by relatively small differences between MC and TCUF from the beginning to the end of the dwell.
Minimizing the Drainage Period for Continuous Ambulatory Peritoneal Dialysis
Authors: Kumano Kazuo , Yokota Shinji , Sakai Tadasu , Kazama Haruki , Sofue Katsuyoshi 
Published: February 2020

Objectives To examine features of drainage flow and to determine whether the drainage period could be safely reduced in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Open nonrandomized prospective study in CAPD patients. Setting The kidney center in a tertiary care university hospital. Patients Fourteen CAPD patients with good catheter function. Interventions Drainage flow pattern was studied using a 2-L dialysate. The drainage period was reduced from 28 minutes (mean) to 10 minutes throughout a short-term, 2-month study period and a long-term, 6-month study period for 10 patients. Main Outcome Measures Ultrafiltration volume, body weight, and peritoneal clearance. Results A kinetics analysis of the drainage period and volume indicated a positive linear correlation with two different slopes: one for rapid drainage for the first 5–7 minutes and one for subsequent slow drainage. The effluent exceded 80% in the former period. Ultrafiltration volume and body weight showed no change due to the reduction. Improved peritoneal clearance of small molecular substances could not be confirmed despite a 5% increase in the effective dialysis period. Nearly all patients were satisfied with the reduction and desired its continuation. Conclusions Ten minutes is a sufficient drainage period for most CAPD patients with a 2-L dialysate volume. This may possibly allow an increase in daily activities and an effective peritoneal membrane dialysate contact period.
Magnesium and Parathyroid Hormone Changes to Magnesium-Free Dialysate in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Takahashi Susumu , Okada Kazuyoshi , Yanai Mitsuru 
Published: February 2020

Objective For the normalization of serum magnesium (Mg) concentration, dialysate Mg concentration tends to be reduced in continuous ambulatory peritoneal dialysis (CAPD) patients. The aim of this study was to evaluate the influence of Mg on parathyroid hormone (PTH). Design Prospective study of the utilization of Mg-free dialysate for 8 weeks. Setting Dialysis service, Itabashi Hospital, Nihon University School of Medicine. Patients Five stable CAPD patients (1 male; 4 female; age 49.7±1.3 years; duration of CAPD 27±9 months). Main Outcome Measures Serum Mg, serum high sensitive PTH, and Mg content in mononuclear cells were measured at 4-week intervals. Results In comparison to baseline, serum Mg concentration was significantly reduced at week 4 (p<0.01) and week 8 (p<0.01), and serum PTH was significantly increased at week 4 (p<0.05) and at week 8 (p<0.05). However, the PTH level at week 8 was lower than that at week 4. Furthermore, the Mg content in mononuclear cells was significantly decreased at week 4 (p<0.01) and at week 8 (p<0.01). Serum -ionized calcium and phosphate concentrations did not change. Conclusions The removal of Mg by Mg-free dialysate leads to Mg depletion in CAPD patients. In addition, Mg depletion stimulates PTH synthesis or secretion at 4 weeks, but at 8 weeks PTH synthesis or secretion is also influenced by other factors.
Risk Factors for Peritoneal Dialysis-Related Infections
Authors: Oxton Lisa L. , Zimmerman Stephen W. , Roecker Ellen B. , Wakeen Maureen 
Published: February 2020

Objective To identify factors associated with peritoneal dialysis-related infections at one center. Design The study was a retrospective study of a 3 year time period with relatively stable treatment patterns. Setting A single center experienced academic peritoneal dialysis program. Patients Patients (N = 163) receiving peritoneal dialysis (PD) from January 1989 to December 1991 who had received treatment at home for at least one month. Interventions None. Main Outcome Measures Catheter-related infection and peritonitis were the main outcome measures. Variables affecting infection rates that were assessed included age, time on PD, prior end-stage renal disease (ESRD) therapy, diabetic status, catheter type, exchange device, nasal carriage of S. aureus, and prophylactic rifampin therapy. Data were analyzed with univariate as well as with a fixed-effects and a mixed-effects gamma Poisson multiple regression model. Results Variables associated with an increased risk of new peritonitis included age under 20 years (p < 0.009; rate ratio 4.54) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.75). Decreased new peritonitis risk was associated with the ULTRA Set exchange system (p < 0.008; risk ratio 0.38) and intermittent prophylactic rifampin therapy (p < 0.001; rate ratio 0.99 for each 1% time on therapy). Catheter-related infections were increased in patients who had double-cuff catheters (p < 0.003) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.82). Decreased catheter-related infections were noted in older patients (p < 0.02; rate ratio 0.983/year) and increasing months of study follow - up (p < 0.03; rate ratio 0.97/month). Conclusion In our program nasal carriage of S. aureus increased the risk of peritonitis and catheter-related infection. Prophylactic rifampin significantly decreased peritonitis, as did use of the UL TRA Set. Single-cuff opaque catheters had the lowest catheter infection rate. Analysis of the relationships between clinical and demo graphic variables and peritoneal dialysis-related infection rate can identify significant contributing or protective variables and allow peritoneal dialysis programs to develop preventive strategies to minimize the risk of infection.
A Comparison of Clearances on Tidal Peritoneal Dialysis and Intermittent Peritoneal Dialysisa
Authors: Piraino Beth , Bender Filitsa , Bernardini Judith 
Published: February 2020

Objectives To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate. Design Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 Llexchange for a total of 30 Lltreatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 Lltreatment. Patients Six patients, with a mean dialysatelplasma (DIP) creatinine as determined by the peritoneal equilibration test (PET) of 0.64±0.1 0, were studied. Four had a low -average DIP creatinine, while 2 had a high-average DIP creatinine. Measurements Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test. Results The dialysate flow rates were 3.7±0.1 Llhour for IPD and 3.8±0.2 Llhour for TPD. The mean dialysate dextrose was 1.9±0.5 gldL for both. The creatinine clearances were 9±2 versus 10±3 mLlminute, the urea nitrogen clearances 19±3 versus 20±3 mLlminute, and phosphate clearances 10±3 versus 11±3 mLlminute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9±0.9 mLlminute on IPD and 3.3±1.6 mLI minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average DIP creatinine were higher than for the 4 patients with low -average DIP creatinine. Conclusions When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.
Careful Patient Selection and Dialysis Prescription are Required for Effective Nightl Y Intermittent Peritoneal Dialysis
Authors: Holley Jean L. , Piraino Beth 
Published: February 2020

Objective To evaluate the adequacy of dialysis in patients on nighttime intermittent peritoneal dialysis (NIPD). Design Retrospective review of prospectively collected data. Patients Seven patients on NIPD. Measurements The fast peritoneal equilibration test (PET) was used to determine peritoneal membrane permeability for small solutes. Adequacy of dialysis measured by 24hour collections of dialysate and urine for weekly KT/V and creatinine clearance in liters/week/1.73 m2 was assessed in patients with (n=3) and without (n=4) residual renal function and evaluated in concert with the patient's clinical status. Outcome for each patient was also noted. Results Five of the patients had a high-average dialysate/serum creatinine by PET (>0.66). Despite a weekly KT/V of 1.7 or more, four of the seven patients on NIPD were uremic and either transferred to hemodialysis or continuous cycling peritoneal dialysis (CCPD). A fifth patient had a KT/V of 1.4 and was also uremic on NIPD. The patient who was clinically well and continued on NIPD had significant residual renal function. Conclusions NIPD should be restricted to patients with high-average dialysate/serum creatinine as determined by PET and residual renal function or those with high dialysate/serum creatinine. Extended dialysis time and large volumes of dialysate are required for successful NIPD in patients without residual renal function. Accepted parameters of dialysis adequacy used for patients on continuous peritoneal dialysis are not appropriate for intermittent forms of peritoneal dialysis.
Cytogenetic Analyses Reveal “Atypical Cells” in the Peritoneal Dialysis Effluent
Authors: Dimkovic Nada B. , Barjaktarovic Nada M. , Kostic Vitana M. , Jovanovic Dragan R. , Radovanovic Ljiljana T. , Radmilovic Aleksandar V. 
Published: February 2020

Cytogenetic analyses were performed on dividing cells from the peritoneal effluent of 26 patients undergoing chronic peritoneal dialysis (CPD). Numerical and structural abnormalities of karyotype served as the diagnostic criteria for “atypical cells.” The following cytogenetic abnormalities were observed in 7 patients: hyperdiploidy (in 6 patients), hypodiploidy (in 2 patients), and marker chromosomes (in 2 patients). In 3 patients more than one chromosome abnormality was present. Dividing cells with normal mitoses were observed in 11 patients, while in the remaining 8 patients no dividing cells could be found. There were no differences in age, sex, duration of dialysis, and peritonitis incidence between patients with pathological mitoses and those without it. The question whether this unexpected finding is a consequence of immunosuppressed uremic status, dialysis procedure, or some other factor remains to be elucidated.
Excellent Technique Survival on Home Peritoneal Dialysis: Results of a Regional Program
Authors: Jindal Kailash K. , Hirsch David J. 
Published: February 2020

Objective To examine peritoneal dialysis technique survival in our regional, continuous ambulatory peritoneal dialysis (CAPD) program. Design Retrospective analysis. Setting Tertiary care dialysis programatan academic medical center. Patients 155 patients representing all those in the peritoneal dialysis program between October 1, 1987 and October 1,1990. Outcome measures The study analyzed patient and technique survival as well as the reasons for discontinuation of dialysis. In addition, the incidence and type of peritonitis and exit-site infection were also analyzed. Results Three-year actuarial patient survival was 66% and three-year technique survival was 86%, with data censored for death and transplant patients. Fiftyseven percent of transfers to hemodialysis were due to peritonitis, usually fungal or multiorganism bacterial. Only 1 patient failed due to exit-site and tunnel infection, and 1 due to inadequate dialysis. The catheter removal rate was 0.04 per patient-year. Conclusions Excellent CAPD technique survival can be achieved if exit-site and tunnel infection rates are low.
Bidirectional Solute Transport in Peritoneal Dialysis
Authors: Waniewski Jacek , Heimbürger Olof , Park Min Sun , Werynski Andrzej , Lindholm Bengt 
Published: February 2020

Objective Three transport components are involved in solute transport in peritoneal dialysis: diffusion, convective transport, and peritoneal reabsorption of dialysate (fluid and solutes). The relative impact of these components on measurable transport characteristics (dialysateto-plasma concentration ratio, diffusive mass transport coefficient, unidirectional clearances) may depend on the direction of solute transport, that is, from blood to dialysate or vice versa. The application of the bidirectional characteristics for the assessment of fluid and solute transport in peritoneal dialysis is reviewed and evaluated. Data Sources Theoretical analysis as well as computer simulations were applied to discuss available data from our own studies on peritoneal transport as well as from published clinical, experimental, and theoretical studies in the same field. Study Selection Thirty-three relevant clinical and experimental studies as well as theoretical analyses derived from the literature were reviewed. Data Extraction Data were extracted to highlight current controversies in the literature concerning the assessment of peritoneal reabsorption rate based on transport of macromolecules, middle molecules, and small solutes. Results Peritoneal reabsorption is the main component of the transport of macromolecules infused into the peritoneal cavity, and these solutes are currently being used for the assessment of the rate of reabsorption. In contrast, diffusive transport and peritoneal reabsorption cannot be experimentally discriminated for small solutes which exhibit negligible sieving through the membrane in convective transport (i.e., solutes with sieving coefficient equal to 1). For middle molecules each transport component may be of importance and may have an independent impact on bidirectional transport characteristics. Conclusions Middle molecules, with sieving coefficients substantially less than 1, may be applied for estimation of peritoneal reabsorption rate using bidirectional transport characteristics, as apparent diffusive mass transport coefficients or unidirectional clearances. However, an independent measurement of sieving coefficient is necessary for this method.
Viscus Perforation in Peritoneal Dialysis Patients: Diagnosis and Outcome
Authors: Wakeen Maureen J. , Zimmerman Stephen W. , Bidwel Denise 
Published: February 2020

Objective To determine the incidence and outcome of spontaneous viscus perforation in peritoneal dialysis (PD) patients and which factors could facilitate early diagnosis. Design A retrospective chart review was done on all patients with viscus perforation and on a control group with peritonitis secondary to gram-negative organisms. Setting A tertiary care University Hospital Peritoneal Dialysis program. Patients All patients with surgically proven spontaneous viscus perforation from 1978 to June 1992 (n = 15). A group of control patients (n = 15) with gram-negative bacterial peritonitis was also reviewed for comparison. Interventions None. Main Outcome Measures Hospital days, patient survival after perforation, and return to peritoneal dialysis were the main outcomes measured. Peripheral white blood cell (WBC) count, PD fluid WBC count with differential, PD fluid cultures, radiologic information, and surgical intervention were also evaluated. Data were analyzed using the Mann-Whitney test to determine significant differences between the two groups. Results Viscus perforation occurred in 15 of the 431 patients on PD from 1978 to June 1992 (3.5%). In comparison to the control group, patients with viscus perforation had a significantly higher peripheral WBC count (p = .016), a higher mean PD fluid WBC count (p = .006), and a higher mean percentage of polymorphonuclear cells in the PD effluent (p = .038). Multiple organisms on PD fluid cultures were noted in 12 of 15 patients with perforation and in only 3 control patients. Pneumoperitoneum was seen on abdominal or chest radiograph or computerized tomographic (CT) scan in 10 of 15 patients with perforation and in only 1 of 15 patients in the control group. All patients with viscus perforation required surgery and 6 expired. Only 1 death occurred in the control group. Only 1 of the 9 patients surviving perforation was able to resume PD, in contrast to 13 of 14 surviving control patients. Conclusion We conclude that viscus perforation is associated with high morbidity, mortality, and technique failure. Diagnosis may be made by repeatedly searching for intraperitoneal free air on radiograph or CT scan in patients with persistently elevated peripheral and PD fluid WBC count, and for multiple organisms on PD fluid culture.
Albumin and Amino Acid Levels as Markers of Adequacy in Continuous Ambulatory Peritoneal Dialysis
Authors: Heimbürger Olof , Bergström Jonas , Lindholm Bengt 
Published: February 2020

Similar to previous findings in HD patients, a markedly decreased serum albumin level has been found to be a strong predictor of morbidity and mortality in CAPD patients. However, a slight decrease in serum albumin levels (to about 30 g/L if measured with nephelometry or the bromcresol purple method) does not always seem to reflect impaired nutritional status or to be associated with an increased morbidity or mortality in CAPD patients. A low serum albumin level among CAPD patients is related to dialysate albumin loss, comorbidity, age, and a low dietary protein intake. The possible relation between the dialysis dose (as assessed by small solute clearances) and serum albumin levels among CAPD patients is much less established and needs further study, although serum albumin tends to increase in prospective studies of increased peritoneal dialysis dose. Although the plasma levels of amino acids seem to be lower in CAPD patients compared to HD patients, this does not reflect the intracellular amino acid pattern in muscle which is less abnormal in CAPD patients, possibly because of the sustained hyperinsulinemia during CAPD, resulting in an in creased intracellular to extracellular gradient. It is at present not established to what extent the amino acid abnormalities are related to the dialysis dose. Malnourished and hypoalbuminemic CAPD patients should be recommended to increase the protein intake, and if this is not effective, the dialysis dose should be increased. Furthermore, the use of amino acid-based peritoneal dialysis solutions is a promising new tool for the treatment of malnourished CAPD patients and may become an important component of CAPD therapy in the future. On the other hand, if the nutritional status deteriorates in spite of these efforts, the patient should be transferred to hemodialysis if possible.