bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peritonitis Prevention in Continuous Ambulatory Peritoneal Dialysis: Long Term Efficacy of a Y-Connector and Disinfectant
Authors: Cantaluppi Alberto , Scalamogna Antonio , Castelnovo Claudia , Graziani Giorgio 
Published: February 2020

We have already described (Lancet 1983, ii, 642) the results of a controlled study in two centres showing the efficacy of a Y-shaped connector, filled with sodium hypochlorite during the dwelling time, for the reduction of peritonitis: one episode every 33 patient-months in the treated group versus one episode every 11.3 patient-months in the control group using the standard method. During the past 2.5 years we have continued to use the Y-connector. All new patients referred to our hospital for initiation of CAPD program were trained to use the Y-connector, while those patients already on the standard Y-connector continued on it. From January 1983 to June 1985, among 18 non-diabetic patients using the standard bag-exchange method, there were 23 peritonitis episodes in 14 patients (78%) over a cumulative period of 257 months -one episode every 11.2 patient-months. In contrast, among the 92 patients using the Y-connector, there were 30 peritonitis episodes in 21 patients (22.8%) during 1354 months -one episode every 45.1 patient-months. When we exclude from this group the 10 diabetic patients adding insulin to the bags, the incidence of peritonitis fell to one episode every 92.2 patientmonths. These results confirm that the Y-connector is extremely effective in reducing the rate of peritonitis in patients on CAPD. The most widely accepted technique for prevention of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is that described by Oreopoulos et al (I). However, to reduce further the risk of dialysis-fluid
Red-Cell Survival in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Erve Norbert Lameire , De Paepe Matthys Marc , Karel Emiel Sys , Schelstraete  , Ringoir Severin 
Published: February 2020

An early rise in hematocrit due to an increase in red cell mass (RCM) and a decrease in plasma volume (PV) has been noted after six months of continuous ambulatory peritoneal dialysis (CAPD). The present study measured red-cell survival (RCS) together with RCM and PV at the beginning and after six months of CAPD in paired observations in 15 patients. RCM increased from 890 ± 98 to 1089 ± 142 ml (p < 0.05) and plasma volume decreased from 3026 ± 295 to 2936 ± 178 ml. Mean red-cellsurvival half life at the start was 22.3 ± 1.06 days and rose to 25.2 ± 1.15 days after six months (p < 0.05). The same results were observed in four diabetic patients on a non-glucose, glycerol-containing dialysate. This study demonstrates that, after six months of CAPD, not only do hematocrit and red cell mass improve but also the red-cell survival is prolonged. However, a correlation could not be demonstrated between the increase in red-cell mass and prolongation of red-cell survival.
The Pharmacokinetics of Bezafibrate in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Williams Anthony J. , Walls John 
Published: February 2020

Patients on CAPD often have hyperlipidemia -a known risk factor for morbidity and mortality from cardiovascular disease. We have defined the pharmacokinetic properties of bezafibrate, a new hypolipidemic agent, in CAPD patients. Its serum half-life was prolonged approximately 10 times that of normal subjects, and less than 2% of an oral 200 mg dose appears in the dialysate after 48 hours. If indicated, an appropriate dose for the treatment of hyperlipidemia in the CAPD population would be 200 mg bezafibrate every third day. Cardiovascular disease remains one of the main causes of morbidity and mortality among patients with end stage renal disease (I). Hyperlipidemia, a known risk factor in the normal population, may be involved in the progression of arterial disease in such patients (2). The hyperlipidemia associated with CAPD is related to the absorption of large quantities of glucose during dialysis (3), and attempts to treat the hyperlipidemia by low-dose intraperitoneal insulin (4) and dietary carbohydrate restriction (3), have met with only limited success. Bezafibrate, a new hypolipidemic agent, is effective in reducing elevated serum triglyceride and cholesterol levels in various hyperlipidemic conditions (5). However, because its pharmacokinetic properties are altered in patients with renal impairment (6), it is necessary to adjust the dose to compensate for the significant proportion of the drug that is excreted in the urine. This study was done to define the pharmacokinetics of bezafibrate in patients receiving CAPD in order to establish a safe dosage.
Renal Function Recovery and Maintenance of Residual Diuresis in CAPD and Hemodialysis
Authors: Cancarini Giovanni C. , Brunori Giuliano , Silvia Corrado Camerini , Manili Brasa Luigi , Maiorca Rosario 
Published: February 2020

During 1981–1984, at our center 6/75 patients on CAPD and 1/86 on HD demonstrated a recovery of renal function. This and the observation that diuresis was maintained on CAPD, led us to study urine output (UO) and creatinine clearance (CrCI) in 41 patients on CAPD (CAPDp) and 45 on HD (HDp) without the use of diuretics. CAPDp had a decline in diuresis from 1201 ± 379 mI/day to 731 ± 572 (p < 0.01). HDp diuresis decreased from 1233 ± 439 to 438 ± 568 (p < 0.01). Creatinine clearance: HDp 5.8 ± 1.6 ml/min before, 1.3 ± 1.5 after; CAPDp 6.4 ± 2.0 before, 3.9 ± 2.9 after. After one year, HDp showed a significant drop in diuresis; three years passed before CAPDp had significant drop. Patients with glomerulonephritis showed the same trend on HD and CAPD. CAPDp with interstitial nephropathy had a smaller mean annual decrease in UO and CrCI, compared to HDp. CAPDp with nephroangiosclerosis showed less decrease in diuresis compared to HDp. These data confirm that, com pared to HD, CAPD treatment maintains residual renal function even in patients not using diuretics, and suggest that CAPD is a treatment of choice for those considered likely to recover renal function. Some workers have reported a slow decline in residual renal function and diuresis in patients on CAPD (1,2,3). Rottembourg (1), in particular, suggests that diuretics may have helped his patients to maintain diuresis. In 161 dialyzed patients (75 on CAPD, 86 on HD) who started dialysis between 1981 and 1984, six CAPD patients recovered renal function but only one HD patient. This disparity led us to inquire whether when compared to HD, CAPO enables us to maintain satisfactory, long-term diuresis, without the use of diuretics.
Risk Factors for Hyperaluminemia in Continuous Ambulatory Peritoneal Dialysis
Authors: Mactier Robert A. , Nolph Karl D. , Khanna Ramesh , Twardowski Zbylut 
Published: February 2020

The authors evaluated risk factors for hyperaluminemia and aluminum toxicity in 51 CAPD patients, who received aluminum-containing phosphate binders. Serum aluminum correlated with total intake of elemental aluminum after starting CAPD (p = 0.001), with aluminum intake in the previous six months (p = 0.001), with duration of CAPD (p = 0.003), and with serum phosphate (p = 0.05). Eight patients had elevated serum aluminum, but only one had clincial evidence of aluminum toxicity (he had been on hemodialysis with untreated water until he was changed to CAPD 30 months before the study). Although the incidence of clinical aluminum toxicity appears to be low, we conclude that the aluminum intake from aluminum-containing phosphate binders is a major factor in the evolution of hyperaluminemia and, potentially, aluminum toxicity in CAPD patients. We believe that alternative effective, phosphate binders are much needed. It has been shown that tissue accumulation of aluminum in brain, bone and blood in uremic patients causes encephalopathy (I. 2), osteomalacia (3, 4), and anemia (5, 6). Clinically aluminum toxicity has been observed mainly in hemodialysis patients (1–6), although it has been reported in few cases before dialysis (7–9) and in those on continuous ambulatory peritoneal dialysis (10. II). The major cause of aluminum toxicity during hemodialysis has been transfer of aluminum from untreated water in the dialysate (1–5); this mechanism has tended to obscure the contribution of other factors, such as diet and drugs. Peritoneal dialysate contains a low concentration of aluminum (less than 15 μg/L) and there is a net removal of aluminum in the dialysate in those with serum aluminum levels within the reference range for dialysed uremics (11–13). Serial aluminum levels in CAPD patients not receiving aluminum -containing phosphate binders (ACPB) showed no significant change during a two-year follow-up (12, 14); this suggests that aluminum removal in the dialysate compensates for the failure of the kidney to excrete absorbed dietary aluminum in end-stage renal disease. Since the combination of CAPD and diet appears to have minimal influence on serum aluminum, this study was done to identify those factors which determine serum aluminum levels in CAPD patients, receiving aluminum-containing phosphate binders.
Endogenous Sympathetic Activity in CAPD Patients: Its Relationship to Peritoneal Diffusion Capacity
Authors: Selgas Rafael , Munoz Isabel M. , Conesa Jose , Madero Rosario , Gancedo Pilar G. , Carmona Ana R. , Martinez M.Eugenia , Huarte Emma , Fontan Miguel P. , Sicilia Luis S. 
Published: February 2020

Endogenous agents, as catecholamines, may influence peritoneal mass transport by modifying peritoneal blood flow. Such endogenous mechanisms could explain certain functional peculiarities of the peritoneum in CAPD patients. In 27 randomly selected patients on CAPD we calculated peritoneal mass-transfer coefficient (MTC) for urea, creatinine, uric acid and parathormone (PTH) using mathematical modelling techniques. Also we measured simultaneously the renin-angiotensin and catecholamine levels in blood and dialysate. The dialysate level of catecholamines and especially noradrenaline was significantly higher than the blood levels. Most of these patients had higher renin and aldosterone blood levels than the controls; we found no renin activity in the dialysate of any of these patients; (Plasma) aldosterone values correlated directly with renin activity. Multivariant analysis provided no evidence that the MTCs values were affected by two or more variables. Linear regression analysis of all variables studied showed direct correlation between dialysate noradrenaline and MTCs, and negative relationship between noradrenaline and ultrafiltration capacity. The catecholamine plasma levels, which were within the normal range, did not correlate with MTCs or with ultrafiltration. Our findings suggest that, in some cases, noradrenaline produced in the peritoneum may influence peritoneal mass transport through a vasoactive effect. Dialysate catecholamine levels correlate with that of plasma, but the latter does not influence peritoneal transport.
Mechanism of Phosphatidylcholine Action during Peritoneal Dialysis
Authors: Breborowicz Andrzej , Sombolos Kostas , Rodela Helen , Ogilvie Raymond , Bargman Joanne , Oreopoulos Dimitrios 
Published: February 2020

We studied the effect of phosphatidyl- choline (PDC) (50 mg/L) on the peritoneal ultrafiltration and permeability in vivo and in vitro. Our in vivo studies with normal rabbits confirmed previous observations of increased ultrafiltration mainly by decreasing the reabsorption phase. We observed no effect on glucose absorption rate. In in vitro studies, using isolated section of rabbit's mesentery, phosphatidylcholine increased the permeability of the mesothelium to water, urea and glucose from the vascular to the mesothelial side but not in the opposite direction. Following exposure of the peritoneal membrane to Alcian blue, a positively charged dye, phosphatidylcholine had no effect on mesothelial permeability. Our observations suggest that necessary for the action of phosphatidylcholine is its attachment to the anionic sites of the mesothelium. We speculate that improvement in UF is achieved by diminishing the thickness of the stagnant fluid layers trapped between the microvilli.
A Comparison of Intraperitoneal and Intravenous/Oral Antibiotics in CAPD Peritonitis
Authors: Bennett-Jones David , Penny Val Wass , Taube Mawson David , Chisholm Guy Neild , Cameron Ogg J Stewart , Williams D Gwyn 
Published: February 2020

Eighty patients with CAPD peritonitis were randomised to receive either intraperitoneal (IP) vancomycin and tobramycin, or intravenous (IV) van-comycin and tobramycin followed by oral antibiotics, depending on the results of culture and sensitivity. Five patients were withdrawn, and, of the remaining patients, 39 were in the IP group and 36 in the IV group. When all episodes of bacterial peritonitis are considered, the treatment failure rate was higher in the IV group (34.1%), than in the IP group (10.3%) (p < 0.02). This was also the case when gram-positive organisms resistant to tobramycin were considered separately (p < 0.05), but not for vancoinycin-resistant organisms. We conclude that vancomycin should be administered by the intraperitoneal route: the case for intraperitoneal tobramycin is “not proven”.
The Antimicrobial Implications of the Pharmacokinetics of Cotrimoxazole in CAPO Patients
Authors: Ojo Otegbola , Jones Colina , Stevens Donald L. 
Published: February 2020

Cotrimoxazole (TMP/SMX) has been used to treat continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis. It is considered bactericidal for some species. The most common single organism responsible for this type of peritonitis is Staph. epidermidis (SE). When the drug is given orally, the typical ratio of TMP to SMX achieved in the peritoneal fluid is 1:5, which is different from the optimal combination for antimicrobial synergy of 1:19. This study investigated the antimicrobial activity of TMP alone and TMP/SMX by agar dilution at ratios of 1:19, 1:10 and 1:5 against 99 strains of Staphylococcus epidermis (SE). The majority of strains were susceptible to TMP and to all ratios of TMP/SMX by the routine agar dilution methods. We studied the bactericidal activity of TMP/SMX against one strain each of SE and of Staph. aureus (SA) in pooled uninfected spent dialysate by killing curve experiments. TMP at concentrations of 0.5 to 2.0 μg/ml was bacteriostatic. TMP/SMX became slowly bactericidal when 5 % lysed horse blood, a source of thymidine phosphorylase, was added to the dialysate. It is concluded that susceptibility tests of inhibition do not predict bactericidal activity of TMP/SMX in recovered dialysate. Inhibition of TMP/ SMX is most likely due to thymidine present in dialysate. TMP alone was as effective against SE as TMP/ SMX. Until it is shown that bactericidal activity is not required for cure of CAPD-related peritonitis, cotrimoxazole should not be used routinely for its treatment.
Effects of Intraperitoneal Captopril on Peritoneal Transport in Rats
Authors: Lal Sunder M. , Moore Harold L. , Nolph Karl D. 
Published: February 2020

We studied the effects of various doses of intraperitoneal (I.P.) captopril, (an angiotensin-converting enzyme inhibitor) during peritoneal dialysis, on urea dialysate/plasma (DIP) ratios, dialysate protein (Dpo), dialysate glucose (DG), and drainage volume (VD) in 19 Sprague-Dawley male rats with normal renal function. Similarly, these parameters were measured in five control rats. Among the study group, 14 rats received 20 to 100 mg/kg of intraperitoneal captopril without effect. Following a larger intraperitoneal dose (75 mg/exchange (ex)) five rats had delayed increases in urea D/P ratios and dialysate protein losses by 30% (p < 0.05) and by 286% (p < 0.025), respectively. During and following intraperitoneal captopril the rats showed enhanced glucose absorption and consequently significant decreases in dialysate glucose concentration. The rats receiving IP captopril, 75 mg/ex remained hypotensive throughout the drug exchanges and three subsequent exchanges. Increases in dialysate protein concentration and decreases in the dialysate glucose concentration seen with captopril (75 mg/ex) returned to near baseline values only after four to five hours of drug-free exchanges. These changes, despite systemic hypotension, may reflect an increase in blood flow, capillary permeability and/or surface area subsequent to blockade of the renin-angiotensin system, suggesting some angiotensin II modulation of the peritoneal microcirculation and solute transport during peritoneal dialysis.
Transperitoneal Calcium and Magnesium Transfer during an 8-Hour Dialysis
Authors: Kwong Mary B.L. , Lee Joseph S.K. , Chan Man Kam 
Published: February 2020

The authors studied transperitoneal calcium and magnesium transfer during an eight-hour dialysis in 13 CAPD patients with both 1.5% dextrose and 4.25% dextrose solutions with a Ca concentration of 1.75 mM/L and Mg 0.75 mM/L. The mean mass transfer of calcium was 0.733 mmol with 1.5% dextrose exchanges, and - 0.151 mmol with 4.25% dextrose solutions. The mean mass transfer of magnesium was negative with both 1.5% and 4.25% dextrose solutions. Mass transfer of both calcium and magnesium correlated inversely with the initial peritoneal fluid: blood osmotic gradient and positively with the initial peritoneal fluid/blood calcium or magnesium gradients. The ionic calcium gradient was dissipated rapidly because of the disappearance of pH gradient. Peritoneal fluid ionic calcium concentrations correlated positively with peritoneal fluid pH. It is suggested that calcium traverses the peritoneal membrane in the forms of ionic and chelated calcium. Transperitoneal transfer of calcium and magnesium during peritoneal dialysis has been the subject of a few studies (1–4), which were concerned with intermittent peritoneal dialysis (1,2) or with continuous peritoneal dialysis (CAPD) involving four 2-litre exchanges daily (3, 4). Because three exchanges per day is our usual practice (15) and because there is a paucity of data on calcium and magnesium transfer during an eight-hour peritoneal dialysis, we undertook to determine transperitoneal transfer of calcium and magnesium, and to examine in detail the various factors affecting these trans peritoneal fluxes.
Peritoneal Equilibration Test
Authors: Karl Zbylut J. Twardowski , Khanna O. Nolph Ramesh , Leonor Barbara F. Prowant , Ryan P. , Moore Harold L. , Nielsen Marc P. 
Published: February 2020

Peritoneal transfer rates of urea, creatinine, glucose, protein potassium, and sodium as well as drain and residual volumes were measured during 103 equilibration tests performed in 18 diabetic and 68 nondiabetic patients. Equilibration test was performed over a 4-hour dwell exchange with 2 L of 2.5% Dianeal solution. Excellent reproducibility was seen after tests were standardized for length of preceding exchange, times of inflow and drainage, patient position, methods of obtaining and processing samples and laboratory assays. Diabetics did not have lower peritoneal solute transfers than nondiabetics. Wide variations were found in the study population. Measurements of creatinine, glucose and sodium transfer were particularly useful in predicting the patient's response to the standard CAPO. The patients with highaverage peritoneal solute transport did well on standard CAPO even after losing residual renal function. Patients with high peritoneal solute transfer rates were likely to have inadequate ultrafiltration on standard CAPO. These patients did much better on dialysis modalities with short dwell exchanges, i.e. nightly peritoneal dialysis (NPO) or daytime ambulatory peritoneal dialysis (OAPO). Patients with low average, and particularly low peritoneal transport rates were likely to develop symptoms and signs of inadequate dialysis as their residual renal function became negligible, particularly in individuals with high body surface area. Repeated tests were helpful in evaluating causes of insufficient ultrafiltration and/or inadequate dialysis.
Pseudoporphyria Cutanea Tarda and Non-A Non-S Hepatitis in a CAPD Patient
Authors: Zeier Martin , Doss Manfred , Ziegler Traugott , Ritz Eberhard , Rambausek Michael 
Published: February 2020

A 47-year-old man was treated by continuous ambulatory peritoneal dialysis (CAPD) because of chronic glomerulonephritis. One year later he developed skin friability and bullous dermatosis resembling porphyria cutanea tarda. The skin lesions were associated with an elevation of serum aminotransferases, most probably due to a blood transfusion-induced, non-A non-B hepatitis. Urinary, fecal and blood porphyrins including the activity of red cell uroporphyrinogen decarboxylase were normal. Thus we accepted the diagnosis of pseudoporphyria cutanea tarda in view of the relatively frequent association of cutaneous disease with maintenance dialysis.
Hydrothorax as a Complication of Pediatric Peritoneal Dialysis
Authors: Bunchman Timothy E. , Wood Ellen G. , Lynch Robert E. 
Published: February 2020

Hydrothorax is a known complication of peritoneal dialysis (PD) but there is very little in the pediatric literature concerning this complication. From 1982 to 1984 seven of 29 of our patients who underwent peritoneal dialysis, developed pleural effusions as a complication of PD. These patients varied in respect to age, technique and duration of PD. Four of the seven developed respiratory symptoms at the time when effusions were discovered, while the other three were recognized during evaluation of loss of ultrafiltration. Five of the seven had right-sided effusions, one had a left-sided effusion, and one had bilateral effusions. No technical factors could be identified as causative agents. We have concluded that pediatric patients may be particularly likely to develop hydrothorax as a complication of peritoneal dialysis. This may present as a pulmonary emergency or as a subtle loss of ultrafiltration ability. The possibility of congenital potential communicating pathways seems more likely than any other single explanation for this phenomena. Hydrothorax as a complication of peritoneal dialysis (PD) is reported chiefly in the adult PD literature. The first reports were associated with trauma but in most subsequent cases, there was no explanation. We are aware of only two accounts of this complication in children covering a total of eight cases. Several of these may have been related to surgical trauma (1). However, in our own patient population, we observed seven who developed hydrothorax while on various forms of PD. Review of individual cases did not demonstrate common factors which would explain the hydrothorax. Thus, hydrothorax developed during PD in a significant number of infants over a short period and under a variety of clinical circumstances. This suggests the existence of potential anatomical channels which may open under a variety of circumstances.
Vancomycin Tolerance in Staphylococcus Aureus Isolated during Treatment of CAPD Peritonitis
Authors: Freeman Derek , Cryan Elizabeth M.J. , Falkiner Frederick R. , Keogh J.A. Brian , Keane Conor T. 
Published: February 2020

The susceptibility to vancomycin of nine staphylococcal strains responsible for nine episodes of peritonitis in patients on continuous ambulatory peritoneal dialysis was correlated with outcome of therapy. All strains examined had MIC values indicating sensitivity (MIC.:; 4 μg/ml). Tolerance was observed in one strain of Staphylococcus aureus (MIC = 1 μg/ml., MBC = 64 μg/ml). Time-kill studies using three different media demonstrated this organism's reduced susceptibility to vancomycin and suggested that testmedium composition may also affect the result. The patient with the tolerant strain, required an extended period of treatment.