bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Polymeric Diets in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Galindo Beatriz A. Aguirre , Fierro Jorge G. Prieto , Cano Pedro , Abularach Leonor , Rentería Armando Nieves , Navarro Maricela , Del Río Jesús 
Published: February 2020

Objective To determine if a diet complemented with calcium caseinate is better than a natural high protein diet for increasing serum albumin levels in patients on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods A 4-month clinical trial involving 100 patients older than 18 years was performed. Patients were randomized into two groups: group A, high protein diet (1.4 g natural protein/kg target weight/day and 35 kcal/kg target weight/day); and group B, calcium caseinate (0.7 g calcium caseinate plus 0.7 g natural protein diet/kg target weight/day and 35 kcal/kg target weight/day). Serum levels of albumin, total proteins (TP), BUN, creatinine, glucose, urea, sodium, and potassium, and hematocrit, leukocytes, erythrocytes, and hemoglobin were analyzed at baseline and every 30 days. Results The final mean albumin value was, for group A, 3.04 ± 0.39 g/dL, and for group B, 3.1±2 0.41 g/dL ( p < 0.05); TP for group A, 6.29 ± 0.47 g/dL, and for group B, 6.49 ± 0.51 g/dL ( p < 0.05); leukocytes for group A, 688 ± 8 1282/mm3, for group B, 7288 ± 1878/mm3 ( p = 0.05); BUN for group A, 47 ± 11 mg/dL, for group B, 50 ± 16 mg/dL ( p = 0.05). Regression analysis showed a treatment effect in serum albumin and TP levels from the third month in both groups. In group B, a constant elevation of serum albumin of 0.19 mg/dL and TP of 0.27 mg/dL was observed in every month of treatment with calcium caseinate. In the regression analysis of group A we observed a smaller increase in serum albumin, 0.06 mg/dL, and in TP, 0.11 mg/dL, in each month of treatment with the high protein diet. Both differences are significant ( p < 0.05). Conclusion Calcium caseinate used in CAPD patients suffering from malnutrition increases serum albumin levels.
Incidence and Significance of Peritoneal Eosinophilia during Peritoneal Dialysis-Related Peritonitis
Authors: Fontán Miguel Pérez , Rodríguez-Carmona Ana , Galed Ignacio , Iglesias Pilar , Villaverde Pedro , García-Ureta Ernesto 
Published: February 2020

Objective To determine the incidence and significance of peritoneal eosinophilia (PEo) during peritoneal dialysis (PD)-related peritonitis. Design Retrospective observational study. Setting Tertiary-care public hospital. Patients and Method We performed a cytological study of dialysate at the start of 465 cases of peritonitis diagnosed between January 1987 and May 2002. Cases associated with PEo (> 10% eosinophils) were classified according to their infectious or seemingly noninfectious origin. We compared the two groups, trying to disclose differentiating patterns of presentation. Results We found PEo in 42 cases. Infectious peritonitis was the final diagnosis in 22 of the 42 cases; a diagnosis of idiopathic eosinophilic peritonitis was finally established in 20 cases. The etiologic spectrum of infectious peritonitis with PEo did not differ markedly from the global spectrum of peritonitis in our unit. Infectious peritonitis with PEo tended to appear later in the course of PD therapy, presented with more severe clinical symptoms, displayed higher total peritoneal leukocyte and neutrophil counts, and showed lower degrees of PEo than idiopathic eosinophilic peritonitis, but overlap between the groups was significant. Conclusions Peritoneal eosinophilia is infrequent but not rare during infectious PD-related peritonitis. Our findings agree with established concepts on idiopathic eosinophilic peritonitis, but overlap in presentation with infectious eosinophilic peritonitis is significant, which should be taken into consideration at the time of planning therapy for this condition.
An Exploratory Study of a Novel Peritoneal Combination Dialysate (1.36% Glucose/7.5% Icodextrin), Demonstrating Improved Ultrafiltration Compared to Either Component Studied Alone
Authors: Jenkins Sarah B. , Wilkie Martin E. 
Published: February 2020

Objective Concerns regarding the impact of ultrafiltration failure on peritoneal dialysis and the effect of hypertonic glucose on the peritoneal membrane have lead to a search for alternative dialysates. Computer simulations based on the three-pore theory suggest that a combination of 1.36% glucose and 7.5% icodextrin (glucose polymer) offers an improved ultrafiltration profile. The aim of the present study was to investigate the ultrafiltration profile of this combination fluid. Design Prospective open study comparing 1.36% glucose, 3.86% glucose, 7.5% icodextrin, and the combination fluid (1.36% glucose/7.5% icodextrin). Setting Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK. Patients 11 patients currently using peritoneal dialysis not previously exposed to icodextrin. Main Outcome Measure Intraperitoneal volume was measured using a radioisotope dilution method. Results The combination fluid showed a biphasic ultrafiltration profile, with a steep initial increase in intraperitoneal volume, then a maintained plateau phase for the duration of the study dwell (7 hours). The final volume was greater than that with the 1.36% glucose dwell and the 7.5% icodextrin dwell. The fluid was well tolerated by the patients. Conclusions These findings are in keeping with computer simulations using the three-pore model. The combination fluid offers an improved ultrafiltration profile, with a final volume similar to 3.86% glucose, while avoiding exposing the peritoneal membrane to high glucose concentrations. It may have a role as a long dwell to optimize ultrafiltration and possibly prolong peritoneal dialysis technique survival.
Influence of Climate on the Incidence of Peritoneal Dialysis-Related Peritonitis
Authors: Szeto Cheuk-Chun , Chow Kai-Ming , Wong Teresa Yuk-Hwa , Leung Chi-Bon , Li Philip Kam-Tao 
Published: February 2020

Objective The use of peritoneal dialysis has expanded in many developing subtropical countries; however, the role of climatic factors in dialysis-related peritonitis has not been studied in detail. Design Retrospective study. Setting A single regional dialysis unit in a university teaching hospital. Patients We reviewed all cases of dialysis-related peritonitis treated in our dialysis unit from January 1995 to December 2001. Information was collected on demographic data, microbiologic etiology, associated catheter exit-site infection, and clinical response. Results In 24 059 patient-months of follow-up, 1344 episodes of peritonitis were recorded. There were significantly more peritonitis episodes in July and August [odds ratio 1.17, 95% confidence interval (CI) 1.03 – 1.32], and fewer peritonitis episodes in December (odds ratio 0.79, 95% CI 0.61 – 0.98). There was also a trend of more peritonitis in March (odds ratio 1.18, 95% CI 0.97 – 1.41), but the difference was not statistically significant. When the incidence of peritonitis caused by individual bacterial species was further analyzed, we found a significant seasonal variation in the rate of peritonitis caused by gram-negative bacteria, except Pseudomonas (overall chi-square test, p = 0.002). A similar trend of seasonal variation was also observed in gram-positive peritonitis, but the result was not statistically significant. There was significant seasonal variation in the rate of peritonitis that had coexisting exit-site infection (overall chi-square test, p = 0.02), with peak incidence in July. However, the proportion of peritonitis that had coexisting exit-site infection did not have significant seasonal variation. There was significant correlation between monthly peritonitis rate and average humidity ( r = –0.346, p < 0.002) and temperature ( r = –0.264, p = 0.015). Conclusions There is substantial seasonal variation in the incidence of dialysis-related peritonitis, with peak incidence in the months that are hot and humid. Keeping a cool and dry living environment may help to reduce peritonitis in peritoneal dialysis patients in tropical countries.
Adverse Prognostic Indicators in Continuous Ambulatory Peritoneal Dialysis Patients without Obvious Vascular or Nutritional Comorbidities
Authors: Wong Ping-Nam , Mak Siu-Ka , Lo Kin-Yee , Tong Gensy M.W. , Wong Yuk , Wong Andrew K.M. 
Published: February 2020

Objectives Factors that predict the occurrence of vascular events and poor patient survival in continuous ambulatory peritoneal dialysis (CAPD) patients have not been clearly defined. Previous studies have focused on nonselective CAPD patients, in whom pre-existing comorbidity or poor health might complicate interpretation of the significance of individual factors. The present study was conducted with CAPD patients without severe vascular and nutritional comorbidity. Patients and Methods This single-center, prospective, observational study was conducted with 66 prevalent CAPD patients without co-existing severe vascular or nutritional problems. The patients were enrolled in January 1999. We monitored baseline demographic data and clinical and laboratory characteristics including average clinic blood pressure (BP), hemoglobin (Hb), serum albumin, intact parathyroid hormone (iPTH), serum cholesterol, triglycerides, dialysate-to-plasma (D/P) creatinine, dialysis adequacy [Kt/V and creatinine clearance (CCr)], and protein equivalent of nitrogen appearance. We followed the patients for 3 years. Outcome measures were actuarial patient survival, time to occurrence of cerebrovascular accident (CVA) and acute myocardial infarction (AMI), technique survival, and hospitalization rate. Results Mean age of the patients was 56.7 ± 10.3 years. Mean duration on CAPD at the time of enrollment was 36.4 ± 21.7 months. Nineteen of the patients (28.8%) had diabetes. Most of the patients [ n = 55 (83.3%)] were using three 2-L exchanges daily. Mean body weight was 56.3 ± 12.2 kg. Mean total weekly Kt/V was 1.91 ± 0.47, and mean total weekly CCr was 75.3 ± 30.6 L/1.73 m2. Actuarial patient survival was 96.9% at 1 year, 90.5% at 2 years, and 75.3% at 3 years. Overall technique survival was 96.9% at 1 year, 95.1% at 2 years, and 89.1% at 3 years. Multivariate analysis showed that age, diabetes mellitus (DM), and body size (weight or surface area) were independent predictors of patient survival. We estimated that a 1-kg increase in body weight was associated with a 6% increase in the relative risk of death ( p = 0.015; 95% confidence interval: 1.013 to 1.126). Patients with a body weight of 60 kg or less showed a significantly better 3-year survival as compared with patients with body weight greater than 60 kg (88.1% vs 58.3%, p = 0.0042). No significant predictors were identified for technique failure or occurrence of a major vascular event. High BP and DM were independent predictors for hospitalization. Dialysis adequacy indices and serum albumin showed no significant effect on any outcome measure. Conclusions Our study showed that, in addition to age and DM, body size could also be a significant factor affecting survival of CAPD patients. However, the underlying causative mechanisms remain unclear and require further study.
Risk Factors for Poor Outcome of Fungal Peritonitis in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Lo Stanley H.K. , Chan Ching-kit , Shum Hoi-ping , Chow Vincent C.C. , Mo Ka-leung , Wong Kin-shing 
Published: February 2020

Objective Fungal peritonitis is rare among end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD), but when it occurs, it is associated with a high risk of mortality and peritoneal membrane failure. In the present study, we identified risk factors for poor outcome and examined the effect of treatment profile on outcome in fungal peritonitis. Patients and Methods We identified cases of fungal peritonitis in CAPD patients in a regional dialysis center and analyzed the possible risk factors for poor outcome in fungal peritonitis. To estimate the amount of dextrose presented to the peritoneum, we scored the dextrose content of the peritoneal dialysis fluid used by the patient at the time of admission to hospital (1 point to each bag of 1.5% fluid, 2 points to each bag of 2.3% or 2.5% fluid, and 3 points to each bag of 4.25% fluid daily). Results Among 471 episodes of CAPD-related peritonitis in 7.8 years, we identified 22 episodes of fungal peritonitis (4.7%). The ratio of men to women in the fungal peritonitis group was 1.4:1. Seventeen patients (77.3%) practiced dialysis without a helper. Within the 3 months preceding the fungal peritonitis, 12 patients (55%) had had bacterial peritonitis. Among the cases of fungal peritonitis, we identified 9 cases of Candida parapsilosis and 13 cases of non C. parapsilosis. All of the patients received fluconazole, and 7 patients (31.8%) also received flucytosine. The Tenckhoff catheter was removed in 17 patients (77.3%). Eight patients (36.4%) either died or lost peritoneal function. The risk of mortality was increased if the fungal organism was C. parapsilosis [odds ratio (OR): 4.25; 95% confidence interval (CI): 1.8 to 10.0; p = 0.002], if a helper was involved (OR: 11.3; 95% CI: 1.1 to 114; p = 0.024), or if CAPD duration was more than 26 months (OR: 2.2; 95% CI: 1.3 to 3.5; p = 0.034). Addition of flucytosine to fluconazole did not significantly improve the mortality rate in either the C. parapsilosis or non C. parapsilosis group. Multivariate analysis showed that C. parapsilosis was an independent factor associated with mortality ( p = 0.013). A dextrose score greater than 5 was associated with a trend toward increased risk of peritoneal failure (OR: 3.4; 95% CI: 1.6 to 7.1; p = 0.021). Conclusion C. parapsilosis is an independent risk factor for mortality in fungal peritonitis.
Training of Peritoneal Dialysis Nurses
Authors: Tan Poh-choo , Morad Zaki 
Published: February 2020

Clinical disciplines in which the nurse plays as preeminent a role in total patient care as in peritoneal dialysis (PD) are few. The PD nurse is readily identified by the patient as the principal source of advice on day-to-day aspects of treatment, as a resource manager for supplies of PD disposables and fluids, and as a general counselor for all kinds of advice, including diet, rehabilitation, and medication, among others. The PD nurse is thus the key individual in the PD unit, and most activities involve and revolve around the nursing staff. It is therefore not surprising that most nephrologists pay considerable attention to the selection of PD nurses, particularly in long-term PD programs such as continuous ambulatory peritoneal dialysis (CAPD). The appointment of a PD nurse depends on finding an individual with the right attributes, broad general experience, and appropriate training.
Independent Effects of Renal and Peritoneal Clearances on the Mortality of Peritoneal Dialysis Patients
Authors: Szeto Cheuk-Chun , Wong Teresa Yuk-Hwa , Chow Kai-Ming , Leung Chi-Bon , Law Man-Ching , Li Philip Kam-Tao 
Published: February 2020

Objective Previous studies show that peritoneal Kt/V is an independent predictor of survival in anuric patients receiving continuous ambulatory peritoneal dialysis (CAPD). We studied whether peritoneal Kt/V has the same effect in CAPD patients with residual renal function. Design Observational cohort study. Setting Single dialysis center in a university teaching hospital. Patients New and prevalent CAPD patients. Methods We examined the 5-year follow-up results of our prospective study previously reported ( Kidney Int 2000; 58:400–7). A total of 270 CAPD patients were followed for up to 6 years. Dialysis adequacy indices, residual renal function, and nutritional data were monitored. Outcome Measures Primary outcomes included mortality and technique failure. Peritoneal Kt/V rather than total Kt/V was used for multivariate survival analysis. Results Average duration of follow-up was 35.1 ± 22.0 months. Average peritoneal Kt/V throughout the study was 1.59 ± 0.37; median residual glomerular filtration rate (GFR) 0.82 mL/minute. Five-year actuarial patient survival was 41.5%, and technique survival was 23.1%. Multivariate analysis showed that sex, age, duration of dialysis, presence of diabetes, serum albumin, dialysate-to-plasma creatinine ratio at 24 hours, peritoneal Kt/V, residual GFR, and normalized protein nitrogen appearance were independent factors of both actuarial patient survival and technique survival. For every 0.1 unit higher peritoneal Kt/V, relative mortality risk was 0.94 (95% CI 0.89 – 0.99, p = 0.03). When prevalent and new CAPD cases were analyzed separately, peritoneal Kt/V predicted survival only for prevalent CAPD patients. Conclusion We conclude that, in prevalent CAPD patients with relatively low levels of peritoneal clearance and residual renal function, a higher peritoneal Kt/V is associated with better survival. Peritoneal clearance below 1.6 – 1.7 likely has a major detrimental effect on the clinical outcome of CAPD patients with little residual renal function.
Catabolism of Newly Synthesized Decorin in vitro by Human Peritoneal Mesothelial Cells
Authors: Yung Susan , Hausser Heinz , Thomas Gareth , Schaefer Liliana , Kresse Hans , Davies Malcolm 
Published: February 2020

Objective Previous studies have shown that decorin and biglycan account for over 70% of the proteoglycans (PGs) synthesized by human peritoneal mesothelial cells (HPMCs). Since these PGs are involved in the control of cell growth, cell differentiation, and matrix assembly, we investigated their turnover in cultured HPMCs. Methods Confluent HPMCs were metabolically labeled with [35S]-sulfate and the labeled products isolated from the cell medium and the cell layer characterized by sensitivity to bacterial eliminases. Experiments were undertaken with exogenous labeled decorin, and its metabolic state was studied. Results In a 24-hour labeling period, 75% of the newly synthesized chondroitin sulfate/dermatan sulfate (CS/DS) PGs appeared in the culture medium, the majority of which (90%) was decorin. In the cell layer, protein-free glycosaminoglycan (GAG) chains accounted for 21% of the total CS/DS at 24 hours and exhibited constant specific activity at 12 – 16 hours. The latter material was turned over with a half-life of approximately 2.5 hours. Exogenous decorin underwent receptor-mediated endocytosis and subsequent intracellular degradation. Uptake but not degradation could be inhibited by heparin. Conclusions HPMCs are distinguished by a rapid turnover of decorin. A characteristic metabolic feature is the existence of a large intracellular pool of protein-free DS-GAGs. Understanding the control of decorin turnover in HPMCs might lead to delineation of its potential role in both the physiology and pathophysiology of the membrane in PD patients.
The Effect of Depressive Symptoms on Survival in Peritoneal Dialysis Patients
Authors: Einwohner Rebecca , Bernardini Judith , Fried Linda , Piraino Beth 
Published: February 2020

Objective There is little information on the relationship between depressive symptoms and survival in peritoneal dialysis (PD) patients. We examined whether a single measurement of depressive symptoms using a simple self-administered tool predicts survival. Design Screening test of depressive symptoms as a predictor of outcome. Setting Three dialysis centers in Southwestern Pennsylvania. Participants 66 adult PD subjects were screened in 1997–1998 for depression using the Zung scale. Main Outcome Measures Baseline data collection included assessments of comorbidity, residual renal function, total Kt/V, nPNA, previous renal transplant, and serum albumin. Outcomes were collected prospectively after completion of the depression survey to 12/01. Cox regression analysis of patient survival was performed using all cofactors with p < 0.05 on univariate analysis. Results One third of patients had depressive symptoms. Compared to nondepressed patients, depressive symptom patients were older (62.5 vs 52.5 years, p = 0.012), had borderline lower serum albumin levels (3.47 vs 3.70 g/dL, p = 0.058), and were more disabled (Karnofsky score 70 vs 90, p < 0.001), but had similar Kt/V, residual renal function, and previous time on PD at the point of the testing. Using multivariate analysis and controlling for comorbidity (using a measurement that includes diabetes mellitus and age) and serum albumin, the survival of patients with depressive symptoms was significantly reduced compared to nondepressed patients. Conclusion A single measurement of depressive symptoms using a simple self-administered test was an independent predictor of death in a cohort of PD patients, which extends observations in hemodialysis patients. Screening for depressive symptoms should be routine for dialysis patients, and those depressed should have thorough assessment and treatment. Whether treating depression will have an impact on survival is unclear and needs to be studied.
Exercise Capacity in Pediatric Patients with End-Stage Renal Disease
Authors: Pattaragarn Anirut , Warady Bradley A. , Sabath Richard J. 
Published: February 2020

Objective To evaluate the correlation between exercise capacity and hemoglobin in pediatric patients with end-stage renal disease (ESRD) treated with automated peritoneal dialysis (APD) and hemodialysis. Design Prospective case-control study and retrospective review. Setting Dialysis summer camp and Children's Mercy Hospital exercise laboratory. Participants Prospective evaluation conducted with 14 patients (9 males, mean age 14.5 ± 2.5 years) who received either home APD (5 patients) or in-center hemodialysis (9 patients), and 8 healthy age-matched controls. Retrospective data derived from 10 children (7 males, mean age 12.3 ± 3.3 years), all of whom received APD. Intervention Maximal treadmill evaluation conducted with each patient and control. The hemoglobin value of each patient was also assessed. Main Outcome Measures Comparison of the following data generated during treadmill protocol: peak heart rate, blood pressure, oxygen saturation, treadmill time, oxygen consumption (VO2), ventilation (Ve), oxygen consumption at anaerobic threshold (VO2 AT), and respiratory exchange ratio. Results The hemoglobin value of the current patient group (12.8 ± 1.6 g/dL) was significantly greater than the previously studied patients (10.5 ± 1.1 g/dL) ( p = 0.001). Treadmill time, VO2, and VO2 AT were significantly lower in both groups of dialysis patients compared to the control subjects ( p < 0.05). No differences were noted in any of these variables when comparing these two groups of dialysis patients only. Conclusion The exercise capacity of pediatric dialysis patients is significantly poorer than that of healthy children, an outcome apparently related to factors other than normalization of the hemoglobin value.