bluuebunny/crossref_metadata_2025_split huggingface dataset:
Azithromycin: An Assessment of Its Pharmacokinetics and Therapeutic Potential in CAPD
Authors: Kent James R. , Almond Michael K. , Dhillon Soraya 
Published: February 2020

Background Azithromycin is an azalide antibiotic with a similar antibacterial spectrum to erythromycin but with greater gram-negative activity. Azithromycin displays a favorable pharmacokinetic profile, with improved absorption and higher sustained tissue concentrations compared with erythromycin. This results in a prolonged elimination half-life, suggesting a potential for treating continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Objective This study aimed to define the potential role of azithromycin in treating CAPD peritonitis. Design The pharmacokinetics and peritoneal dialysis (PD) clearance of azithromycin were studied following a single 500-mg oral dose of azithromycin. Blood and dialysate samples were taken over a 10-day period and assayed using high-pressure liquid chromatography. Setting The study took place within the Renal Unit at Southend Hospital NHS Trust, a district general hospital in the United Kingdom. Patients Eight patients with oliguric end-stage renal failure without peritonitis maintained on CAPD (3 x 2 L/day). Results Peak plasma concentrations occurred at 2 -3 hours with 0.35 - 1.35 mg/mL (mean 0.75). The mean elimination half-life was 84.55 hrs, and plasma clearance was 21.93 L/hour. This compares with values of greater than 40 hours and 40.8 L/hour reported in healthy volunteers. After 8 hours, the mean dialysate concentration was 0.07 mg/mL; PD clearance was 0.06 L/hr. Conclusion Azithromycin is not substantially removed by CAPD in the absence of peritonitis and cannot be recommended for widespread use in this setting at present. However, the successful use of azithromycin in CAPD peritonitis, due possibly to an intracellular drug transport mechanism, has been reported. Future research should address this possibility.
Intravenous Vancomycin Pharmacokinetics in Automated Peritoneal Dialysis Patients
Authors: Manley Harold J. , Bailie George R. , Frye Reginald F. , McGoldrick M. Donald 
Published: February 2020

The pharmacokinetics of intravenous (IV) vancomycin was studied in automated peritoneal dialysis (APD) patients who received a single IV dose of vancomycin (15 mg/kg total body weight). Dialysate samples were collected at the beginning, middle, and end of dwells 1 – 3 (on-cycler), and at the end of dwells 4 and 5 (off-cycler), for a 24-hour period. Blood samples were collected at the beginning, middle, and end of dwells 1 – 3 (on-cycler), and at the end of dwell 5 (off-cycler) for a 24-hr period. Pharmacokinetics parameters were calculated assuming a one-compartment model. Glomerular filtration rate (GFR) and vancomycin clearance (Cl) values were normalized to 1.73 m2. Ten patients [4 males, 6 females; 47.4 ± 9.9 years of age (mean ± SD)] who had received PD for a median 3.5 months (range 2 – 66 months) were studied. Dwell times were 2.3 ± 0.1 hours on cycler and 7.3 ± 0.1 hours off cycler. Vancomycin half-life was significantly different on-cycler than off-cycler (11.6 ± 5.2 hr vs 62.8 ± 33.0 hr; p < 0.001). Vancomycin total Cl (ClT) was 7.4 ± 2.0 mL/min. Renal Cl (ClR) and PD Cl (ClPD) accounted for 23.6% and 28.0% of ClT, respectively. ClR correlated with GFR (ClR = 0.90 GFR – 1.01; r2 = 0.79; p = 0.008). Mean vancomycin serum and dialysate end-of-dwell concentrations were above minimum inhibitory concentration of susceptible organisms (5 mg/mL) for the first cycler and the second ambulatory exchanges only. The results of this study suggest that, to provide adequate concentrations for susceptible organisms over a 24-hour period, current intermittent vancomycin dosing recommendations for PD-related peritonitis need to be changed to 35 mg/kg intraperitoneally on day 1, then 15 mg/kg IP thereafter ( i.e., once daily) in APD patients.
Impact of Dialysis Adequacy on Cardiac Function in Pediatric CAPD Patients
Authors: Bakkaloąlu Sevcan A. , Ekim Mesiha , Koçak Gülendam , Atalay Semra , Tümer Necmiye 
Published: February 2020

Background Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies. Objective To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD). Design Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital. Patients Eighteen children, aged 13.3 ± 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study. Main Outcome Measures Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group. Results Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects ( p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 ± 0.71 and mean TCCr was 58 ± 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions ( p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V ( p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI ( r = 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr ( r = -0.555 and r = -0.520) were detected. Conclusion These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic findings and dialysis adequacy indices suggest that adequate dialysis has a beneficial effect on cardiac function via effective removal of toxic substances.
Pediatric Peritoneal Dialysis Training: Characteristics and Impact on Peritonitis Rates
Authors: Holloway Margaret , Mujais Salim , Kandert Marianne , Warady Bradley A. 
Published: February 2020

Objective Peritonitis is the leading cause of technique failure in pediatric patients on peritoneal dialysis. A survey was developed to determine what impact, if any, training practices and staffing patterns have on peritonitis rates in pediatric patients. Design A survey developed by the International Society for Peritoneal Dialysis Advisory Committee on Peritonitis Management in Pediatric Patients. Patients The survey was distributed to 168 centers and was completed by 76 (45%) centers. A total of 597 children younger than 21 years of age received peritoneal dialysis in these centers. Results The peritonitis rate was significantly lower (1 episode/19.9 months vs 1 episode/13.5 months; p < 0.05) in programs characterized by larger patient numbers (≥ 15 patients vs < 15 patients) and longer training time dedicated to theory and practical/technical skills ( p < 0.01). Conclusion Peritoneal dialysis training is an important factor that influences the rate of peritonitis. The results of this survey reinforce the value of the time committed to this effort.
Effects of Two Simplified Methods of Dialysate Sampling on Estimations of Adequacy Indices in Automated Peritoneal Dialysis
Authors: Rodríguez–Carmona Ana , Pérez–Fontán Miguel 
Published: February 2020

Objective To assess the effects of two simplified methods of dialysate sampling on the estimation of adequacy markers in automated peritoneal dialysis (APD). Design Cross-sectional noninterventional study. Setting Tertiary-care hospital. Patients Forty-nine patients undergoing standard APD therapy (36 nontidal, 13 tidal with low reserve volume). Intervention We estimated creatinine clearance (CCr), Kt/V urea, sodium removal, and peritoneal protein loss using two simplified methods. We calculated separate diurnal and nocturnal adequacies. Nocturnal concentrations of urea, creatinine, sodium, and proteins were extrapolated from dialysate samples taken after the first (method A) or the last (method B) cycle of the night. For the reference method, we estimated adequacy from a complete 24-hour dialysate collection. Results Spearman correlations versus the reference method were, for CCr, 0.82 for method A and 0.87 for method B; and for Kt/V, 0.78 (A) and 0.72 (B). Method A overestimated CCr by 19.6% (4.5 L/week)(median values) and Kt/V by 8.8% (0.12). Method B overestimated CCr by 5.0% (1.7 L/week) and Kt/V by 4.4% (0.06). Both methods estimated sodium removal accurately, but estimated protein loss poorly. Tidal APD was associated with a clear overestimation of adequacy indices with both methods. In fact, when only nontidal patients were considered, method B slightly underestimated CCr and Kt/V. Conclusions In APD, estimation of nocturnal adequacy from dialysate samples taken after the first cycle is inaccurate. Estimation from samples taken after the last cycle yields suboptimal but acceptable results; the deviation is small and the dose of dialysis delivered to the patients is not overestimated.
Patient and Technique Survival on Capd in Turkey
Authors:   for The Turkish Multicenter Peritoneal Dialysis Study Group (TULIP), Utaş Cengiz 
Published: February 2020

Objective To analyze the status of continuous ambulatory peritoneal dialysis (CAPD) in 12 centers in Turkey. Design Retrospective study of CAPD technique and patient outcome. Setting University hospital renal units. Patients 334 patients [205 males (61%), 129 (39%) females; mean age 42.2 ± 13.8 years; mean follow-up time 23.5 ± 18.3 months] beginning CAPD between March 1992 and December 1999, and having a minimum follow-up of 3 months. Outcome Measure Patient survival, technique survival, and duration of hospitalization. Results Mean weekly Kt/V urea was 1.9 ± 0.8, weekly creatinine clearance was 62.9 ± 8.5 L/1.73 m2, and mean serum albumin level was 3.7 ± 0.6 g/dL. 93 patients (28%) were withdrawn from peritoneal dialysis due to death (12.6%), transplantation (3.9%), transfer to hemodialysis (8.7%), patient failure to adapt (1.5%), and other reasons (1.2%). The major causes of death were cardiovascular disease (60%), infection (19%), malignancy (2%), and others (19%). Cox proportional hazard model analysis indicated age, serum albumin levels, comorbidity, and functional status affected survival and hospitalization ( p < 0.05), whereas gender and Kt/V did not ( p > 0.05). Estimation of patient survival by Kaplan–Meier analysis showed 94.2%, 88.6%, 84.5%, and 68.9% at 1, 2, 3, and 5 years respectively. Technique survival estimate by Kaplan–Meier analysis was 96.6%, 91.1%, 90.4%, and 77.4% at 1, 2, 3, and 5 years respectively. Conclusion Peritoneal dialysis is an acceptable method of renal replacement therapy in Turkey. There is controversy regarding the usefulness of Kt/V in predicting mortality and morbidity.
High Glucose Dialysis Solutions Increase Synthesis of Vascular Endothelial Growth Factors by Peritoneal Vascular Endothelial Cells
Authors: Seo Moon Jeong , Oh Suk Joong , Kim Sung Il , Cho Kye Won , Jo Inho , Schaub Thomas , Schilling Holger , Passlick–Deetjen Jutta , Han Dong Choel 
Published: February 2020

♦ Objective Increased peritoneal vasculature has been reported in long-term peritoneal dialysis (PD), and vascular endothelial growth factors (VEGFs) have been found in dialysate. High concentrations of glucose or lactate, glucose degradation products (GDPs), and low pH of dialysis solutions are all possible factors in increased peritoneal VEGF synthesis. In this study, we investigated the effects of high glucose dialysis solutions on VEGF synthesis by peritoneal vascular endothelial cells (PVECs). ♦ Methods The PVECs were isolated from rat omentum and were incubated for 4 hours in three different culture media [M199 media (control), conventional dialysis solutions containing 4.25% glucose diluted with an equal volume of M199 media (HGD), and M199 media containing 118 mmol/L mannitol as an osmolar control (mannitol)]. Levels of VEGF protein in the culture supernatant were measured by ELISA, and mRNA expression was determined by Northern blot analysis. Data are presented as percent of control. ♦ Results After incubation for 4 hours, the number of cells did not differ between the 3 groups. Levels of VEGF in culture supernatant were significantly higher in the HGD group (124% ± 19%, p = 0.006) as compared with the control and mannitol (85% ± 10%) groups. The mRNA expression of VEGF appeared to be higher in the HGD group (128% ± 49%) than in the control and mannitol (94% ± 18%) groups. ♦ Conclusion High glucose dialysis solutions increased VEGF synthesis by PVECs. The relationship between VEGF synthesis by PVECs and neovascularization of the peritoneum observed in long-term peritoneal dialysis patients has to be studied further.
Aspirin Protected the Nitric Oxide/Cyclic Gmp Generating System in Human Peritoneum
Authors: Arriero Maria M. , Celdran Angel , Jimenez Petra , García–Mendez Antonio , De La Pinta Juan C. , Manzarbeitia Felix , Muñoz–Alameda Luis , Reyero Ana , Escribano Marta , Casado Santos , López–Farré Antonio 
Published: February 2020

♦ Objective Changes in the expression of endothelial nitric oxide synthase (eNOS) in the peritoneum could be involved in the peritoneal dysfunction associated with peritoneal inflammation. The aim of the present study was to analyze the effect of Escherichia coli lipopolysaccharide (LPS) on eNOS expression in samples of human peritoneum. The effect of aspirin, a drug with anti-inflammatory properties, was also determined. ♦ Results The eNOS protein expressed in human peritoneal tissue was reduced by LPS (10 μg/mL) in a time-dependent manner. The eNOS was expressed mainly in capillary endothelial cells and mesothelial cells. Anti-inflammatory doses of aspirin (1 – 10 mmol/L) restored eNOS expression in LPS-stimulated human peritoneal tissue samples. The main intracellular receptor of NO, soluble guanylate cyclase (sGC), was also downregulated by LPS. This effect was prevented by aspirin (5 mmol/L). ♦ Conclusion Protein expression of the eNOS–sGC system in the peritoneal tissue was downregulated by LPS. High doses of aspirin protected both eNOS protein expression and sGC in human peritoneum. These findings suggest a new mechanism of action of aspirin that could be involved in the prevention of peritoneal dysfunction during inflammation.
Mesothelial Paracrystalline Inclusions in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Stojimirovic Biljana B. , Obradovic Miljana M. , Trpinac Dusan P. , Milutinovic Drago D. , Obradovic Dragan I. , Nesic Vidosava B. 
Published: February 2020

♦ Objective Uremia is known to be followed by changes in the serous membranes of pleura, pericardium, and peritoneum. During continuous ambulatory peritoneal dialysis (CAPD), the peritoneum is exposed to altered body conditions as well as to the influence of dialysate. The aim of the present study was to examine the ultrastructure of the mesothelial cells in CAPD patients, and to compare the findings with those from studies of the peritoneum in uremic controls. Paracrystalline intracytoplasmic inclusions in mesothelial cells were objects of special interest. ♦ Methods Biopsies of human parietal peritoneum were studied. These were taken from 12 uremic patients during catheter implantation before the start of CAPD, and from 7 CAPD patients during catheter removal for infection or malfunction. The samples were prepared in the standard way to be studied by transmission electron microscopy (TEM). ♦ Results Paracrystalline intracytoplasmic inclusions were seen in mesothelial cells only by TEM. They appear as filamentous structures at the outer part of the inclusions, and as pearl-like structures at the core of the inclusions. Sacculate dilatations of rough endoplasmic reticulum cisternae with partly destroyed membranes and only few ribosomes were also seen, with and without densely osmiophilic filaments within the cisternae. We have found paracrystalline intracytoplasmic inclusions in mesothelial cells from uremic and CAPD patients both. According to the literature, these changes are present in one third of biopsies from uremic patients. Until now, however, they have not been mentioned in CAPD patients.
Encapsulating Peritoneal Sclerosis in Japan: Prospective Multicenter Controlled Study
Authors: Kawanishi Hideki ,   Long-Term Peritoneal Dialysis Study Group, Fukui Hiroyoshi , Shigeko Hara , Imada Akio , Kawaguchi Yoshindo , Kawanishi Hideki , Kim Masao , Kubo Hitoshi , Nakamoto Masahiko , Ohira Seiji , Shoji Takao 
Published: February 2020

♦ Objective Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis. The aim of this study was to determine the incidence, clinical features, and variation in mortality rates for EPS. ♦ Design A prospective multicenter design was used, in which peritoneal dialysis patients were pre-registered by facilities across Japan and the incidence of EPS was observed in the registrants. The registrants were followed for a total of 4 years to accurately observe the onset of EPS. ♦ Results As of April 1999, 2216 peritoneal dialysis patients from 64 facilities were registered. By the end of March 2001, 332 patients had dropped out, and 17 of the dropouts had developed SEP. The incidence was 0.77%. After excluding 110 patients who died, the incidence in 2106 patients was 0.81%. The incidence of EPS increased with the duration of peritoneal dialysis. Of the 17 patients with EPS, 12 developed the condition after discontinuing peritoneal dialysis and changing to hemodialysis. During the 2-year survey period, 6 of the 17 EPS patients died. The interval from onset to death was 10.8 ± 5.8 months (range: 3 – 19.5 months). ♦ Conclusions From this prospective multicenter study, the current incidence of EPS is 0.77% (0.81% when dropout owing to death is censored). After a follow-up of 2 years, we conjecture that the incidence of EPS will increase. The incidence, etiology, and prognosis of EPS will be further clarified by periodic observation of dropouts until the end of March 2003.
The Measurement of Total Body Potassium in Patients on Peritoneal Dialysis
Authors: Woodrow Graham , Oldroyd Brian , Wright Antony , Coward W. Andrew , Turney John H. , Brownjohn Aleck M. , Truscott John G. , Smith Michael A. 
Published: February 2020

♦ Objectives To assess the validity of measuring total body potassium (TBK) to estimate fat-free mass (FFM) and body cell mass (BCM) in patients on peritoneal dialysis (PD). ♦ Methods We studied 29 patients on PD (14 men, 15 women) and 30 controls (15 men, 15 women). We calculated TBK by using a whole-body counter to measure 1.46 MeV gamma-ray emissions from naturally occurring 40K. We measured total body water (TBW) by deuterium oxide dilution, and extracellular water (ECW) from bromide dilution. These measurements allowed us to estimate intracellular water (ICW), fat-free mass dilution (FFMDilution), and body cell mass dilution (BCMDilution). ♦ Results The FFMTBK in male PD patients (55.7 ± 7.0 kg) did not differ from that in male controls (57.0 ± 10.9 kg). The FFMTBK in female PD patients (38.4 ± 6.8 kg) was less than that in female controls (44.7 ± 4.5, p < 0.01). The FFMDilution did not differ from the FFMTBK. Correlation of FFMTBK and FFMDilution was r = 0.90, p < 0.0001 for all subjects; r = 0.90, p < 0.0001 for PD patients; and r = 0.90, p < 0.0001 for controls. Bland–Altman comparison of FFMDilution with FFMTBK in individuals showed bias 0.6 kg, range –8.5 kg to 9.7 kg for the whole group; bias 1.4 kg, range –7.9 kg to 10.7 kg for PD patients; and bias –0.2 kg, range –9.0 kg to 8.6 kg for controls. The BCMTBK in male PD patients (30.1 ± 4.5 kg) did not differ from that in male controls (31.9 ± 6.2 kg). The BCMTBK in female PD patients (19.0 ± 4.4 kg) was less than that in female controls (23.1 ± 2.9 kg, p < 0.01). The BCMDilution results did not differ from those for the BCMTBK. Correlation of BCMTBK and BCMDilution was r = 0.90, p < 0.0001 for all subjects; r = 0.87, p < 0.0001 for PD patients; and r = 0.93, p < 0.0001 for controls. Bland–Altman comparison of BCMDilution with BCMTBK in individuals showed bias 0.1 kg, range –5.9 kg to 6.1 kg for the whole group; bias 0.0 kg, range –6.9 kg to 6.9 kg for PD patients; and bias 0.1 kg, range –5.0 kg to 5.2 kg for controls. The [K+]ICW did not differ between PD patients and controls (148.0 ± 25.1 mmol/L vs 148.1 ± 14.3 mmol/L, p = nonsignificant). ♦ Conclusions Total body potassium is a valid, noninvasive technique for measuring FFM and BCM in PD patients. In our PD patient group, depletion of FFM and BCM as compared with controls was identified in the women but not in the men.
Tuberculous Peritonitis in a Cohort of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Abraham Georgi , Mathews Milly , Sekar Lena , Srikanth Aparajitha , Sekar Uma , Soundarajan P. 
Published: February 2020

Among 155 patients who were initiated on continuous ambulatory peritoneal dialysis (CAPD), 4 patients (2 men, 2 women) developed tuberculous peritonitis. They had been on PD for between 2 months and 84 months when they developed the peritonitis. The Mantoux test was negative in all of them. The diagnosis was made by a variety of means in the various cases: demonstration of Mycobacterium tuberculosis in the peritoneal cavity; presence of caseating granuloma in a peritoneal biopsy; Mycobacterium tuberculosis in a cold abscess adjacent to the peritoneal cavity; and demonstration of IS6110 and MPB64 genes of Mycobacterium tuberculosis by polymerase chain reaction (PCR) technique. Two of the patients developed ultrafiltration failure. Among 3 patients who were switched to hemodialysis, 2 died and 1 continues on maintenance dialysis. The last patient, whose catheter was removed, was reimplanted with a new catheter and continues on PD without ultrafiltration failure. Any patient with peritonitis unresponsive to conventional therapy should be investigated for tuberculous peritonitis. Institution of chemotherapy without delay will preserve peritoneal membrane integrity.