bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyporesponsiveness to Anemia Therapy—What are we Doing Wrong?
Authors: Macdougall Iain C. 
Published: February 2020

Most patients receiving anemia therapy respond well, with a significant rise in hemoglobin concentration. However, approximately 5% – 10% of patients fail to show a satisfactory response despite high doses of erythropoietin. The definition of hyporesponsiveness to anemia therapy is somewhat arbitrary, but it is generally regarded as a failure to achieve a hemoglobin concentration of 10 – 11 g/dL despite a dose of erythropoietin in excess of 200 U/kg weekly. The condition has many causes, the most important ones being iron deficiency, infection or inflammation, and underdialysis. Investigating a patient's poor response to erythropoietin should begin with a check for compliance, followed by screening for iron deficiency. If doubt exists about the presence of iron deficiency, then a trial of intravenous iron may be given. A reticulocyte count may be helpful. A significantly elevated count suggests the presence of blood loss or hemolysis. The level of C-reactive protein (CRP) may be useful as an indicator of underlying inflammation, and underdialysis may be corrected by increasing the dialysis prescription. If other, minor causes of hyporesponsiveness to erythropoietin have been excluded, then a bone marrow biopsy should be performed. Some patients may require higher doses of erythropoietin, and it is not unreasonable to increase the dose to 10,000 U thrice weekly. Some causes of hyporesponsiveness to erythropoietin, such as iron deficiency and underdialysis, are easily corrected; but others, such as primary bone marrow disorders and hemoglobinopathies, are not possible to overcome.
Oral versus Intravenous Iron Supplementation in Peritoneal Dialysis Patients
Authors: Johnson David W. , Herzig Karen A. , Gissane Ruth , Campbell Scott B. , Hawley Carmel M. , Isbel Nicole M. 
Published: February 2020

The vast majority of erythropoietin (EPO)–treated peritoneal dialysis (PD) patients require iron supplementation. Most authors and clinical practice guidelines recommend primary oral iron supplementation in PD patients because it is more practical and less expensive. However, numerous studies have clearly demonstrated that oral iron therapy is unable to maintain EPO-treated PD patients in positive iron balance. Once patients become iron-deficient, intravenous iron administration has been found to more effectively augment iron stores and hematologic response than does oral therapy. We recently performed a prospective, cross-over trial in 28 iron-replete PD patients and showed that twice-monthly outpatient iron polymaltose infusions (200 mg) were a practical and safe alternative to oral iron. That treatment produced significant increases in hemoglobin concentration and body iron stores. The additional expense of intravenous iron therapy was completely offset by reductions in EPO dosage. Careful monitoring of iron stores is important in patients receiving intravenous iron supplementation in view of epidemiologic links with infection and cardiovascular disease. Nevertheless, a growing body of evidence suggests that, as has been found for hemodialysis patients, intravenous iron therapy is superior to oral iron supplementation in EPO-treated PD patients.
Morphologic Aspects of Chronic Peritoneal Dialysis in a Rat Model
Authors: Wieczorowska–Tobis Katarzyna , Brelinska Renata , Breborowicz Andrzej , Oreopoulos Dimitrios G. 
Published: February 2020

Objective We previously put forward an experimental model for evaluating peritoneal function in chronically dialyzed rats. In the present paper, we show the morphologic alterations detected by electron microscopy in the peritonea of chronically dialyzed rats. Materials and Methods The study was done in male Wistar rats. Animals were divided into two groups: control (non dialyzed) rats and dialyzed rats [intraperitoneally exposed to Dianeal 3.86% (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.) for 1 month]. At the end of the study, the rats were humanely killed by bleeding, and samples of the visceral peritoneum covering the liver were taken from 3 rats in each group. The samples were examined by transmission electron microscopy (TEM). Results In control rats, the peritoneum was composed of flattened mesothelial cells covering the thin layer of the submesothelial connective tissue (ST), containing few fibroblasts. In dialyzed animals, a dramatic expansion of the ST was found. We saw compartmentalization of the ST, with changed morphology of the fibroblasts, altered organization of collagen fibers, and changes in the cells infiltrating the ST. Apart from the fibroblasts, mast cells were relatively numerous. Conclusions Our work underlines the capabilities of morphology studies in an animal model for assessing peritoneal dialysis fluid biocompatibility.
Adequacy Targets of Peritoneal Dialysis in the Asian Population
Authors: Li Philip K.T. , Szeto Cheuk-Chun 
Published: February 2020

End-stage renal disease affects a large number of patients in Asia. The percentage of patients utilizing PD varies significantly in Asian countries. Continuous ambulatory peritoneal dialysis (CAPD) accounts for about 80% of the dialysis population in Hong Kong. In this review, we address several questions related to adequacy targets in Asians: Are Asians different? Is dialysis adequacy important for Asians? What is the magnitude of the benefit and the optimal dose of dialysis prescription? Is the adequacy target realistic? The current international recommendations, including the Dialysis Outcomes Quality Initiative guidelines, are compared with some of our own data for Asian patients. Our published data on dialysis adequacy, nutrition, residual renal function, and peritoneal membrane transport showed that those factors have a significant impact on the morbidity and mortality of PD patients in Hong Kong. Our results show that solute clearance as measured by Kt/V has a significant impact on the outcome of Asian CAPD patients. Although Chinese PD patients have excellent medium-term patient and technique survival despite an apparently lower Kt/V as compared with the CANUSA standard, that favorable outcome should not prevent nephrologists from providing adequate dialysis to Asian patients. From our own data and analysis, we propose a target Kt/V of 1.9 in Asian CAPD populations. Small-volume dialysis (6 L daily) may be an acceptable compromise in some Asian populations with a smaller body size, especially with residual renal function, given the financial constraints in some developing countries. Dialysis adequacy means more than a Kt/V value; other clinical parameters are equally if not more important. Thus we should also aim at achieving adequate fluid removal and volume homeostasis, blood pressure control, good nutrition, normal acid–base balance, normal mineral metabolism, minimal anemia, and normal lipid metabolism.
Methodological Issues in Assessing the Incidence of Peritoneal Dialysis-Associated Peritonitis in Children
Authors: Schaefer Franz , Kandert Marianne , Feneberg Reinhard 
Published: February 2020

♦ Objectives To evaluate the distribution of peritonitis incidence and assess the usefulness of patient-specific peritonitis rates in children. ♦ Design 49 children on automated peritoneal dialysis (PD) followed during a 2-year observation period. ♦ Setting Single-center, academic children's hospital. ♦ Patients 49 children aged 2 months to 18 years; 24 prevalent, 25 incident during the observation period. Cumulative observation time was 639 patient-months. ♦ Main Outcome Measures Cohort-specific peritonitis incidence, median patient-specific peritonitis incidence, mean peritonitis incidence by gamma-Poisson (negative binomial) modeling, peritonitis-free survival by Kaplan–Meier life-table analysis. ♦ Results 68 new peritonitis episodes and 21 relapses occurred in 27 patients. The distribution of patient-specific peritonitis incidence was bimodal, with a large group experiencing no or very few episodes, and another cluster around 1 episode per 6 – 9 months. Overall cohort-specific peritonitis incidence was 1.28, median subject-specific incidence 0.99, and mean incidence according to negative binomial modeling 1.04 (95% confidence interval 1.02 – 1.06) episodes per patient-year. Median peritonitis-free survival time was 6.9 months. In those patients who developed peritonitis, subject-specific peritonitis incidence was inversely correlated with patient age ( r = –0.42, p < 0.05) and duration of chronic PD at last observation ( r = –0.42, p < 0.05). ♦ Conclusions Since the distribution of peritonitis in children is non-Gaussian, the average risk of peritonitis is more accurately expressed by the median of the individual subject-specific peritonitis rates or by the mean incidence estimate obtained by the negative binomial distribution model. The assignment of a personal peritonitis risk to each patient permits risk factor analysis by routine statistical methods, even in smaller populations.
By Reducing Production of Vascular Endothelial Growth Factor Octreotide Improves the Peritoneal Vascular Alterations Induced by Hypertonic Peritoneal Dialysis Solution
Authors: Günal Ali Ihsan , Celiker Hüseyin , Akpolat Nusret , Üstündag Bilal , Duman Soner , Akcicek Fehmi 
Published: February 2020

Objective Chronic peritoneal dialysis (PD) may eventually result in vascular alterations of varying degree, which lead to progressive reduction in dialytic efficacy. Although the pathogenesis has not been elucidated yet, vascular endothelial growth factor (VEGF) has been proposed to play a central role in the process leading to vascular alterations. Design Rats were allocated to three groups: no treatment, intraperitoneal introduction of hypertonic PD solution alone, and intraperitoneal introduction of hypertonic PD solution plus octreotide. After 4 weeks, a 1-hour peritoneal equilibration test (PET) was performed. Dialysate-to-plasma urea ratio (D/P urea), glucose reabsorption (D1/D0 glucose), ultrafiltration volume (UF), and levels of dialysate protein and VEGF were determined. Peritoneal membrane histology was evaluated by light microscopy. Results Compared with the control group, rats treated with hypertonic PD solution showed dramatically deranged peritoneal function tests (UF: 5.8 ± 0.9 mL vs 1.3 ± 0.6 mL; D/P urea: 0.49 ± 0.1 vs 0.74 ± 0.04; D1/D0 glucose: 0.55 ± 0.05 vs 0.34 ± 0.06) and morphology (thickness: 4.6 ± 0.4 μ vs 62 ± 12 μ; neovascularisation: 0.1 ± 0.3 vessels per field vs 2.2 ± 0.3 vessels per field). Similarly, a higher level of VEGF was found in the rats treated with hypertonic PD solution. In rats treated with hypertonic solution plus octreotide, peritoneal thickness was not completely reduced (25 ± 5 μ), but peritoneal functions were protected (UF: 4.0 ± 0.5 mL; D/P urea: 0.58 ± 0.02; D1/D0 glucose: 0.51 ± 0.02). Moreover, VEGF level and neoangiogenesis were significantly less in the octreotide group than in the group treated with hypertonic dextrose alone. Conclusion Our data document that, by increasing the production of VEGF, a high glucose concentration can cause vascular alterations within the peritoneal membrane. Octreotide can protect against the vascular alterations and preserve peritoneal function by inhibiting overexpression of VEGF and regulating the inflammatory response in the peritoneum.
Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients
Authors: Ariano Robert E. , Franczuk Christine , Fine Adrian , Harding Godfrey K.M. , Zelenitsky Sheryl A. 
Published: February 2020

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.
Comparison of a 2.5% and a 4.25% Dextrose Peritoneal Equilibration Test
Authors: Pride Eric T. , Gustafson Joan , Graham Angie , Spainhour Linda , Mauck Vicki , Brown Paige , Burkart John M. 
Published: February 2020

Background Ultrafiltration (UF) failure develops over time in some patients on peritoneal dialysis. The workup of UF failure can be difficult and the 4.25% peritoneal equilibration test (PET) has been suggested to be more useful than the 2.5% PET for the workup of UF failure. It is unknown how a 4.25% PET compares to a 2.5% PET in individual patients. Objectives To assess the differences in drain volumes and sodium sieving using a 4.25% PET compared to a 2.5% PET, and to determine whether peritoneal transport rates, in terms of dialysate-to-plasma (D/P) ratios, are comparable between the two. Design Pilot study with each patient serving as his or her own control. Setting Outpatient dialysis facility of Wake Forest University Baptist Medical Center. Patients 47 patients, all of whom had a 2.5% PET and a 4.25% PET performed within 1 week of each other. Outcome Measures Dialysate-to-plasma ratios of urea and creatinine, dialysate total protein, and dialysate glucose compared to time zero (D/D0) at 0, 2, and 4 hours. Four-hour drain volumes and sodium sieving at 2 hours were also measured. Results There was reproducibility between the 2.5% and 4.25% PET for D/P ratios of urea and creatinine and for dialysate total protein. There were expected differences in drain volume, sodium sieving, and D/D0 glucose between the two methods. Conclusions The use of a 4.25% PET may be more useful for the workup of UF failure because of the accentuation of drain volume and sodium sieving, while remaining useful for prescription management.
Metallothionein and Dendritic Cells in Skin of End-Stage Renal Disease Patients not on Dialysis, or on Hemodialysis or Peritoneal Dialysis
Authors: Alscher Dominik M. , Bruckner Andreas , Fritz Peter , Kimmel Martin , Stoeltzing Hartmut , Kuhlmann Ulrich , Mettang Thomas 
Published: February 2020

♦ Objective Renal failure leads to a variety of defects in immune function. The skin, as a major player in the immune system network, also exhibits multiple derangements. The pathogenesis of these defects and derangements are poorly understood; therefore, we studied immune competent cells, dermal dendrocytes (DC), and a special proinflammatory protein, metallothionein (MT), in the skin of these patients. ♦ Design 22 patients with end-stage renal disease (ESRD) but not on dialysis, 18 patients on hemodialysis (HD), 14 patients on peritoneal dialysis (PD), and 35 healthy controls were included in the study. Immunohistochemical staining of skin biopsies for DC and MT was performed with the following antibodies: for DC, antibody against factor XIIIa; and for MT, Dako-MT, E9 (Dako, Carpinteria, California, USA). Measurements were made by counting stained DC per square millimeter, and by optical density (OD) for MT (mean ± SEM). ♦ Results Metallothionein was increased in the skin of HD (OD 0.42 ± 0.05, p < 0.01) and PD patients (OD 0.33 ± 0.04, p < 0.05) compared to controls (OD 0.23 ± 0.02) and ESRD patients not on dialysis (OD 0.22 ± 0.05). In contrast, numbers of DC were reduced in patients on PD compared to controls (59 ± 13 vs 96 ± 59 DC/mm2, p < 0.01) and increased in patients with ESRD prior to dialysis (141 ± 13 DC/mm2, p < 0.05). Patients on HD were in-between (105 ± 20 DC/mm2), with a significant difference versus patients on PD ( p < 0.05). ♦ Conclusions Our data show that the mode of dialysis influences the number of antigen-presenting cells in the dermis. However, in both dialysis modes, a proinflammatory immune status of the skin (MT) was present and, therefore, other regulatory elements for dermal dendrocytes apart from proinflammation exist.
Clinical outcomes and Quality of Life in Elderly Patients on Peritoneal Dialysis versus Hemodialysis
Authors:   for the North Thames Dialysis Study (NTDS) Group, Harris Susan A.C. , Lamping Donna L. , Brown Edwina A. , Constantinovici Niculae 
Published: February 2020

♦ Objective To compare clinical outcomes and quality of life (QOL) in elderly patients on peritoneal dialysis (PD) and hemodialysis (HD) in the North Thames Dialysis Study. ♦ Design A 12-month prospective cohort study. ♦ Setting Four hospital-based renal units in London, UK. ♦ Patients 174 patients that were 70 years or older at the start of dialysis, separated into two cohorts: 78 new patients (36 PD, 42 HD) that were recruited after 90 days of chronic dialysis; and 96 stock patients (42 PD, 54 HD) that were already on dialysis during the recruitment period. ♦ Main Outcome Measures 12-month survival and hospitalization rate, and QOL assessed at baseline and at 6 and 12 months by the SF-36 and the Symptoms/Problems scale of the Kidney Disease Quality of Life Questionnaire (KDQOL). ♦ Results Peritoneal dialysis and HD patients were similar for sociodemographic and clinical characteristics. Annual mortality and hospitalization rates in PD versus HD patients were 26.1 versus 26.4 deaths/100 person–years and 1.9 versus 2.0 admissions/person–year, respectively. Adjusted relative risks showed no effect of modality on clinical outcomes. Multiple linear regression analyses of QOL at baseline showed similar SF-36 scores between PD and HD patients, but higher KDQOL scores in PD patients (3.5 points higher, 95% confidence interval 0.3 – 6.6). There was, however, no effect of dialysis modality on QOL at 6 or 12 months. ♦ Conclusions Clinical outcomes and QOL are similar in elderly people on PD and HD. Peritoneal dialysis is a viable option for more than a carefully selected minority of elderly people requiring dialysis.
Apolipoprotein(a) Phenotype and Lipoprotein(a) Level Predict Peritoneal Dialysis Patient Mortality
Authors: Iliescu Eduard A. , Marcovina Santica M. , Morton Alexander R. , Lam Miu , Koschinsky Marlys L. 
Published: February 2020

♦ Objective To examine the associations between lipoprotein(a) [Lp(a)] level, apolipoprotein(a) [apo(a)] phenotype, and patient mortality in peritoneal dialysis (PD) patients. ♦ Design Observational prospective study of prevalent PD patients. ♦ Setting Tertiary-care health sciences center. ♦ Patients 54 prevalent PD patients were followed prospectively for 24 months. ♦ Main Outcome Measures The exposures were Lp(a) level and apo(a) phenotype, designated by the apo(a) isoform size (number of kringle 4 repeats). Outcome was death from any cause. ♦ Results There were 24 deaths in 77.9 patient–years’ follow-up. The independent predictors of death in the multivariate survival analysis were age [relative risk (RR) = 1.03, p = 0.23], diabetes (RR = 3.00, p = 0.03), diastolic blood pressure ≤ 70 mmHg (RR = 2.94, p = 0.03), serum albumin (RR = 0.87, p < 0.01), and Lp(a) level (RR = 1.004, p < 0.01). There was strong inverse correlation of Lp(a) with apo(a) isoform size ( r = –0.62, p < 0.01). With Lp(a) removed from the model, apo(a) isoform size was a significant predictor of death (RR = 0.91, p = 0.0497). ♦ Conclusions Lipoprotein(a) level and apo(a) phenotype are associated with PD patient mortality. Measurement of Lp(a) level and apo(a) phenotype may be useful in clinical practice to identify patients at high risk for cardiovascular disease. Large prospective studies are needed to determine if a reversal of the increase in Lp(a) level associated with renal disease and dialysis is feasible and beneficial in reducing the risk of cardiovascular disease and mortality.
The Effects of Heparin Administration in an Animal Model of Chronic Peritoneal Dialysate Exposure
Authors: De Vriese An S. , Mortier Siska , Cornelissen Maria , Palmans Els , Vanacker Nele J. , Leyssens Anne , Faict Dirk , De Ridder Leo , Lameire Norbert H. 
Published: February 2020

Diverse modes of heparin administration have been used in animal models of chronic peritoneal dialysate exposure to maintain catheter patency and prevent fibrinous adhesions. Heparin has biological actions independent of its well-known anticoagulant activity, including the ability to modulate extracellular matrix synthesis, cellular proliferation, angiogenesis, and inflammation. These actions may interfere with peritoneal membrane homeostasis. The present study evaluated the influence of the mode of heparin administration on technique survival and infection rate in a rat model of chronic dialysate exposure. Further, the incorporation of heparin in the peritoneal membrane was examined. A 3.86% glucose dialysate was injected twice daily into Wistar rats with a heparin-coated catheter (group A1), or with a standard catheter with heparin injections during the entire exposure time (group A2) or only during 1 week (group A3). Sham manipulations were performed in a fourth group and a fifth group was left untreated. Technique survival was 80% in group A1, 60% in group A2, and 40% in group A3. The rate of infection was highest in group A1 and lowest in group A2. Intraperitoneally administered heparin accumulated in the peritoneal membrane, whereas dextran, with a molecular weight similar to that of heparin, was not incorporated in the peritoneum. In conclusion, intraperitoneal heparin reduced the incidence of infection in an animal model of chronic dialysate exposure. The best technique survival was, however, obtained using a heparin-coated catheter. Heparin is incorporated in the peritoneal membrane, where it may exert diverse biological actions and thus bias study results. The use of a heparin-coated catheter in combination with antibiotics may be the optimal approach to obtaining peritoneal access in animal models of chronic dialysate exposure.