bluuebunny/crossref_metadata_2025_split huggingface dataset:
Semipermeability Imparted by Surface-Active Phospholipid in Peritoneal Dialysis
Authors: Chen Yi , Burke John R. , Hills Brian A. 
Published: February 2020

Objective It has previously been demonstrated that a lining of surface-active phospholipid (SAPL) is reversibly bound (adsorbed) to normal peritoneal mesothelium. The lining acts as a boundary lubricant and release (anti-stick) agent preserving mechanical integrity of the epithelial surface. In a review of clinical trials on the use of SAPL (akin to “surfactant”) to restore ultrafiltration (UF) in patients on peritoneal dialysis (PD), speculation is that, by adsorption, the SAPL lining might also be imparting the semipermeability vital for UF. Design To evaluate the hypothesis, SAPL harvested from the spent dialysate of 5 patients with normal UF was deposited onto a porous, inert medium, and the resulting 7 “membranes” were clamped in an Ussing chamber used as an osmometer. Results With every “membrane,” a clinical concentration of glucose (2.5%) was able to induce a statistically significant osmotic pressure when dialyzed against saline. We also demonstrated how synthetic SAPL—in the form of dipalmitoyl phosphatidylcholine (DPPC) and an admixture of DPPC with phosphatidylglycerol (PG) called artificial lung-expanding compound (ALEC)—imparts greater osmotic pressure in proportion to an increasing glucose gradient. Our findings prove that human peritoneal SAPL has the physical capability to impart semipermeability when adsorbed to a surface. Comment As a lipid lining, adsorbed SAPL could also explain the high permeability of the natural membrane to lipophilic substances in PD. Administered as a very fine powder or as a solution in a lipid solvent, ALEC offers a potential treatment for restoring UF, if applied during the interdialytic interval. In various physical forms, ALEC and DPPC have both been widely used for two decades with complete safety in the treatment of respiratory distress syndrome in newborns. The question of formulation of exogenous SAPL in restoring UF is discussed as a complex physicochemical compromise between the higher surface activity of saturated phosphatidylcholine and its lower solubility in water.
Association of Anion Gap with Thyroid Dysfunction and Nodular Goiter in Capd Patients
Authors: Lin Chih Ching , Yang Wu Chang , Ng Yee Yung , Chou Yi Hong , Tarng Der Cherng , Chen Tzen Wen 
Published: February 2020

Objective To investigate the association of clinical parameters and serum anion gap with thyroid dysfunction and nodular goiter in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Cross-sectional study. Setting Single dialysis unit and outpatient clinic. Patients This study included 89 uremic patients on CAPD. Gender ratio was 50 males to 39 females (M/F = 1.28); mean age was 54.8 years. Main Outcome Measures We investigated the prevalence of nodular goiter and thyroid dysfunction with a 10-MHz high-frequency ultrasound scanner and immunoassay kits. Results Nodular goiter was detected in 52.8% (47/89) of the CAPD patients. Patients with nodular goiter were older than those without goiter (57.7 vs 51.5 years, p < 0.05). Nodular goiter was found more frequently in females than in males (66.7% vs 44.0%, p < 0.05). Patients with nodular goiter had longer duration of CAPD than patients without goiter (51.6 ± 42.9 vs 31.0 ± 28.1 months, p < 0.02). In addition, CAPD patients with goiter had a higher serum anion gap (AG) (16.8 ± 3.3 vs 14.0 ± 4.5 mEq/L, p < 0.02) and a lower weekly creatinine clearance (55.9 ± 12.6 vs 64.6 ± 21.1 L/week/1.73 m2, p < 0.05) than patients without goiter. As serum AG gradually increased, significant alteration of thyroid parameters developed in the following sequence: ( 1 ) reduction of total T3 level at an AG level of 15, ( 2 ) elevation of thyrotropin (TSH) and increased prevalence of goiter at an AG of 18, and ( 3 ) reduction of free T4 and total T4 levels and elevation of TSH, with further increased frequency of goiter at an AG of 20 mEq/L. Conclusion According to this study, age, gender, dialysis duration, serum AG, and weekly creatinine clearance are correlated with prevalence of goiter in CAPD patients. Sequential alteration of thyroid function and increasing frequency of nodular goiter correlated with higher serum AG. There are two explanations for this correlation: the level of serum AG may be an indirect index of the level of serum goitrogens, and higher serum AG and increased frequency of nodular goiters might be a reflection of loss of residual renal function. Therefore, thyroid function screening and goiter detection using ultrasound should be considered when examining CAPD patients with progressively elevating serum anion gap.
Low Calcium Dialysate Increases Cardiac Relaxation in CAPD Patients
Authors: Tuncer Murat , Ermiş Cengiz , Süleymanlar Gültekin , Yakupoglu Gülşen , Ersoy F. Fevzi 
Published: February 2020

Objective To establish whether changes in serum calcium affect left ventricular (LV) function in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This study was conducted on 28 clinically stable CAPD patients (11 females, 17 males). Left ventricular relaxation and systolic function were echocardiographically examined in all patients during standard dialysate (containing 1.75 mmol/L calcium) treatment. All patients were then changed to low calcium dialysate (1.25 mmol/L calcium) for 1 month and all patients were re-examined echocardiographically. Decrement in isovolumic relaxation time (IVRT) and deceleration time (DT), and increment in the ratio of peak early to peak late diastolic velocities (E/Amax) were admitted as indexes showing improvement in LV relaxation. 17 age- and sex-matched controls were also echocardiographically examined. Results Deceleration time, interventricular septal thickness at systole (IVSTS) and diastole (IVSTD), and posterior wall thickness at systole (PWS) and diastole (PWD) were higher in CAPD patients using standard dialysate than in normal controls. With the use of low calcium dialysate, DTs were similar but IVSTS, IVSTD, PWS, and PWD values remained higher. In normal controls, E/Amax values were higher than those in CAPD patients using standard dialysate ( p < 0.001) and low calcium dialysate ( p = 0.009). Serum intact parathyroid hormone level, weight, clinical volume status, and blood pressure were similar throughout the study period. Serum ionized calcium levels were decreased significantly during low calcium dialysate treatment. The changes in IVRT, DT, and E/Amax suggest improvement in LV relaxation during low calcium dialysate treatment. Conclusion Left ventricular relaxation is increased with the use of low calcium dialysate compared with standard dialysate treatment. The idea of possible beneficial effects of increment in LV relaxation on cardiovascular morbidity and mortality deserves further studies.
Intranasal Mupirocin does not Prevent Exit-Site Infections in Children Receiving Peritoneal Dialysis
Authors: Araki Yoshinori , Hataya Hiroshi , Ikeda Masahiro , Ishikura Kenji , Honda Masataka 
Published: February 2020

← Objective Exit-site infections (ESI) in patients receiving peritoneal dialysis (PD) often progress to tunnel infections and peritonitis, sometimes requiring PD catheter removal. Staphylococcus aureus (SA) is the commonest cause of ESI. In this study, we evaluated the efficacy of mupirocin nasal ointment in preventing ESI in children receiving PD. ← Design A single-center study. ← Setting Tokyo Metropolitan Kiyose Children's Hospital. ← Patients 47 outpatients [33 males; age 11.7 ± 4.9 years (mean ± SD)] participated in this study between April 1998 and March 1999 at Tokyo Metropolitan Kiyose Children's Hospital. The total study period comprised 399 patient-months. Nasal cultures were performed every month. Nasal carriers of SA applied intranasal mupirocin ointment twice per day for 7 days. We compared the incidence of ESI in the intervention group to 77 historical controls (48 males; age 7.6± 5.1 years); the total control period comprised 2802 patient-months. ← Results 32 patients were identified as SA nasal carriers on one or two occasions (32/47 or 68%). The total period of SA nasal carriage was 95 patient-months (95/399 or 24%). The incidence of ESI caused by SA among all ESI cases was 20/28 (71%) in the study group and 115/151 (76%) in the control. There was no significant difference. The incidence of peritonitis caused by SA among all peritonitis cases was 3/6 (50%) in the study group and 17/42 (40%) in the control group, showing no significant difference. There was no significant difference in the overall incidence of ESI, peritonitis, or replacement of PD catheters between the study group and the control group. ← Conclusion Intranasal mupirocin ointment did not prevent ESI. Further study is needed to develop an effective method of preventing ESI in pediatric PD patients.
Viability of Home Peritoneal Dialysis: Experience with 100 Patients from an Arab Population
Authors: Al-Hilali Nabieh , Nampoory Mangalathillam R.N. , Ninan Thomas V. , Ali Jaber H. , Gawish Alaa , Johny Kaivilayil V. 
Published: February 2020

Background The viability of home peritoneal dialysis (HPD) is being debated in Arab countries. We therefore undertook the present study to assess the viability of HPD in the Arab culture. Patients and Methods A total of 100 patients with end-stage renal failure were treated with HPD during the period January 1996 to October 2001. Results Continuous ambulatory peritoneal dialysis (CAPD) was performed in 81 patients (81%), and nightly intermittent peritoneal dialysis (NIPD) in 19 patients (19%). The patient group included 54 men (54%) and 46 women (46%) with a mean age of 54.94 ± 14.58 years. They were followed for a total of 2118.3 patient–treatment months and had a mean dialysis duration of 21.2 ± 9.97 months. Peritonitis occurred at the rates of 1 episode every 18.5 patient–treatment months (Bieffe L3 double-bag system: Bieffe Medital, Grosotto, Italy), 1 episode every 22.5 patient–treatment months (ANDY Plus system: Fresenius Medical Care, Bad Homburg, Germany), and 1 episode every 23.7 patient–treatment months (NIPD system Fresenius PD-Night: Fresenius Medical Care, Bad Homburg, Germany). Recurrent peritonitis was the main reason (70.6%) for transfer to hemodialysis. A good level of social well-being and rehabilitation was achieved in 49 patients on CAPD (60.5%) and 13 patients on NIPD (68.4%). Conclusions We conclude that HPD is a viable modality of renal replacement therapy in Arab countries. By adopting a strict training model, the peritoneal dialysis team can train even patients or caregivers with limited education, preventing peritonitis and promoting the general well-being of patients.
Transmigration of Blood Leukocytes into the Peritoneal Cavity is Related to the Upregulation of ICAM-1 (CD54) and MAC-1 (CD11b/CD18) Adhesion Molecules
Authors: Liberek Tomasz , Chmielewski Michal , Lichodziejewska–Niemierko Monika , Lewandowski Krzysztof , Rutkowski Boleslaw 
Published: February 2020

Background Migration of blood leukocytes into the peritoneal cavity of patients treated with peritoneal dialysis appears to be an important mechanism to prevent and fight peritonitis. To study the role of adhesion molecules in the process of leukocyte transmigration, we compared the expression of several adhesion receptors between peripheral blood monocytes and macrophages isolated from overnight dwell effluents. Methods The study was performed in 12, stable, infection-free patients treated with continuous ambulatory peritoneal dialysis (CAPD) and in 9 patients during peritonitis. In another set of experiments, we analyzed the expression of these molecules on blood leukocytes in 10 predialysis chronic renal failure (CRF) patients and 9 healthy controls. Peritoneal cells from an 8-hour dwell were isolated by centrifugation. Expression of adhesion receptors CD11a, CD11b, CD18, CD49d, and CD54 on blood and peritoneal leukocytes was measured using flow cytometry. Results In macrophages from the uninfected effluents, expression of both subunits of Mac-1 integrin receptor (CD11b and CD18) and intercellular adhesion molecule (ICAM)-1 receptor (CD54) was upregulated compared to peripheral blood monocytes from the same patients. The median value of mean fluorescence intensity in blood and effluent was 760.3 versus 1085.8 for CD11b ( p = 0.013), 288.8 versus 448.6 for CD18 ( p = 0.003), and 186.1 versus 365.7 for CD54 ( p = 0.001). The same adhesion receptors were also significantly upregulated on peritoneal macrophages and neutrophils during peritonitis compared to blood leukocytes. Blood leukocytes from CAPD and CRF patients showed higher expression of CD54 and CD49d molecules compared to leukocytes from healthy controls. Conclusions These data suggest that transmigration of blood leukocytes into the peritoneal cavity during uncomplicated dialysis and in peritonitis is related to selective upregulation of ICAM-1 (CD54) and Mac-1 (CD18/CD11b) receptors.
Comparing the Incomparable: Hemodialysis versus Peritoneal Dialysis in Observational Studies
Authors: Foley Robert N. 
Published: February 2020

A randomized trial comparing survival in hemodialysis and peritoneal dialysis remains a utopian aspiration. Dialysis is still relatively rare on a population basis, and a natural tension exists between desirability and feasibility in terms of quality of evidence. In practice, it is very difficult to perform prospective comparisons with large groups of contemporary representative subjects, and much of the literature comes from retrospective national registries. This article considers several questions to address when trying to compare the outcomes of peritoneal dialysis and hemodialysis. Prognostic similarity at baseline is a fundamental issue. Traditionally, adjustment for known prognostic factors has been used in an attempt to minimize the bias caused by nonrandom treatment assignment. Propensity scores have been suggested to be superior, and matched-case analysis may also be a useful method for comparison. Other questions include, when, in relation to starting dialysis, to start the observation clock; the definition and handling of switches of dialysis therapy; and the decision to censor at transplantation. Finally, comparisons are complicated by hazards ratios that vary over time, and time-segmented analysis is obligatory. Many types of analytical approaches are needed to begin to appreciate outcome disparities between dialysis therapies.
Ossification of the Peritoneal Membrane
Authors: Di Paolo Nicola , Sacchi Giovanni , Lorenzoni Paola , Sansoni Enrico , Gaggiotti Enzo 
Published: February 2020

Background Peritoneal dialysis (PD) patients rarely develop sclerosing peritonitis (SP), a severe, life-threatening condition of unknown pathogenesis. Ossification of the peritoneum (PO) is a rare occurrence, which has, however, been reported in PD patients with SP. Objective To investigate etiopathogenetic correlations between PO and SP by histopathological examination. Method We examined biopsy specimens, obtained by laparoscopy or during surgery from 36 patients with SP, from all parts of Italy in the past 8 years for evidence of peritoneal calcification or ossification. Other studies were performed on a sample of dense white material found under the parietal peritoneum of 1 patient during laparoscopy. Results Ossification of the peritoneum was found in 4/16 patients with calcifications. In addition to PO, we also found bone marrow in two specimens and arterial ossification in one case. In specimens with calcifications, and especially those with ossification, there was evidence of peritoneal inflammation with infiltration of lymphocytes, multinuclear giant cells, macrophages, and mast cells. The chemical composition of the whitish material was 85% calcium chloride and 15% hydroxyapatite. Conclusions Calcifications alone were found in 33% (12/36) of cases of SP; 11% of SP cases were complicated by both peritoneal calcification and ossification (4/36), which indicates great availability of calcium under conditions of inflammation. Where does this calcium come from? In 1 patient with PO, the quantity of calcium was enormous and its unusual composition suggested a link with the calcium contained in dialysis solution.
Acute Systemic Inflammation is Associated with an Increase in Peritoneal Solute Transport Rate in Chronic Peritoneal Dialysis Patients
Authors: Kim Soon Bae , Chang Jai Won , Lee Sang Koo , Park Jung Sik 
Published: February 2020

Background This study was performed to evaluate the effects of acute systemic inflammation on peritoneal solute transport rate (PSTR) in chronic peritoneal dialysis (CPD) patients. Methods A baseline standard peritoneal equilibration test (PET) was performed on each patient every 6 months, and blood concentration of high-sensitivity C-reactive protein (hs-CRP) was assayed every 2 months in our peritoneal dialysis clinic. Acute systemic inflammation was defined as a greater than 10-fold increase in hs-CRP concentration compared with baseline value, in the absence of peritonitis, and returning to baseline level in 2 months. In patients with acute systemic inflammation, PET and hs-CRP concentration assays were performed during inflammation and after recovery. Ten patients with acute systemic inflammation were enrolled in the inflammation group and 42 other patients served as controls. Results There were no significant changes in hs-CRP and dialysate-to-plasma ratio of creatinine (D/Pcreat) in the control group during the study period. In the inflammation group, median hs-CRP levels at baseline, during acute inflammation, and at recovery were 2.3 mg/L (range 0.3 – 4.5 mg/L), 39.2 mg/L (range 15.1 – 117.4 mg/L), and 3.7 mg/L (range 0.9 – 8.9 mg/L), respectively. Median D/Pcreat increased significantly from baseline (0.64; range 0.55 – 0.98) to time of acute inflammation (0.72; range 0.60 – 0.96) ( p < 0.05). The D/Pcreat at recovery was 0.67 (range 0.52 – 0.94), which decreased significantly from time of acute inflammation ( p < 0.05). There was no correlation between changes in log (hs-CRP) and changes in D/Pcreat. Conclusion We have shown here that acute systemic inflammation is associated with a temporary increase in PSTR in CPD patients.
Superior Patient Survival for Continuous Ambulatory Peritoneal Dialysis Patients Treated with a Peritoneal Dialysis Fluid with Neutral pH and Low Glucose Degradation Product Concentration (Balance)
Authors: Lee Ho Yung , Park Hyeong Cheon , Seo Bo Jeung , Do Jun Young , Yun Sung Ro , Song Hyun Yong , Kim Yeong Hoon , Kim Yong Lim , Kim Dae Joong , Kim Yong Soo , Ahn Curie , Kim Moon Jae , Shin Sug Kyun 
Published: February 2020

Background In recent years, laboratory and clinical research has suggested the need for peritoneal dialysis fluids (PDFs) that are more biocompatible than the conventional PDFs commonly used today. Bioincompatibility of PDF has been attributed to low pH, lactate, glucose, glucose degradation products (GDPs), and osmolality. PDFs with neutral pH and low GDPs are now available commercially. In vitro and early clinical studies suggest that these solutions are indeed more biocompatible but, as of now, there is no evidence that their use improves patient outcome. Methods Using a dedicated database of over 2000 patients treated with PD in Korea, we were able to conduct a retrospective observational study comparing outcomes for incident continuous ambulatory PD patients treated with a standard, conventional, heat-sterilized PDF to the outcomes for patients treated with a novel, low GDP, neutral-pH PDF prepared in a dual-compartment, double-bag PD system (Balance; Fresenius Medical Care, St. Wendel, Germany). In an intention-to-treat analysis, patient and technique survival, peritonitis-free survival, and peritonitis rates were compared in 611 patients treated with Balance for up to 30 months and 551 patients with a standard PDF (stay·safe; Fresenius Medical Care) treated in the same era and with equivalent follow-up. Results The patients were well matched for most relevant characteristics except older age distribution for the patients treated with the standard PDF. Patients treated with Balance had significantly superior survival compared to those treated with the standard PDF (74% vs 62% at 28 months, p = 0.0032). In a multivariate Cox regression model including age, diabetes, and gender, the survival advantage persisted (relative risk of death for Balance 0.75, 95% confidence interval 0.56 – 0.99, p = 0.0465). Modality technique survival was similar in Kaplan–Meier analysis for both PDFs. No differences were detected in peritonitis-free survival or in peritonitis rates between the two solutions. Conclusion This study, for the first time, suggests that treatment with a novel biocompatible PDF with low GDP concentration and neutral pH confers a significant survival advantage. The exact mechanisms for such a survival advantage cannot be determined from this study. The usual criticisms of observational studies apply and the results reported here strongly warrant the undertaking of appropriately designed, randomized, controlled clinical trials.
Nephrologists Should Voluntarily Divulge Survival Data to Potential Dialysis Patients: A Questionnaire Study
Authors: Fine Adrian , Fontaine Bunny , Kraushar Maryann M. , Rich Beverly R. 
Published: February 2020

Background For many dialysis patients, survival is no different than with certain cancers. Yet, it appears that most nephrologists do not give detailed information about survival prior to obtaining informed consent for chronic dialysis. There are no published data on whether patients wish to be so informed. Objective To assess whether patients would want voluntary disclosure by their physician of their survival should they need dialysis, and if so, why? Method A questionnaire was completed by 100 general nephrology patients during their first visit to a nephrologist. Results The vast majority of patients (97%) would want to be given life-expectancy information, and for the physician to do so without having to be prompted. Furthermore, the majority of patients would want as much information as possible, both good and bad. Conclusions Virtually all patients want, and therefore should receive from their physician, prognostic information about dialysis to facilitate informed decision-making. This is in accordance with current practice guidelines.