bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timely Initiation of Dialysis — Single-Exchange Experience in 39 Patients Starting Peritoneal Dialysis
Authors: Foggensteiner Lukas , Baylis Julia , Moss Heather , Williams Paul 
Published: February 2020

♦ Objective To establish the effectiveness and patient acceptability of initiating peritoneal dialysis (PD) according to published guidelines. ♦ Setting A university teaching hospital and a neighboring district general hospital. ♦ Design Nonrandomized prospective pilot study. ♦ Patients 39 patients with a Kt/V > 2.0 attending predialysis clinics at both hospitals agreed to participate in this study. ♦ Methods Patients were started on a single exchange of dialysate overnight. Dialysis adequacy was monitored at least every 2 months and incremental increases in dialysis were used to maintain combined urinary and dialysis Kt/V above 2.0. Routine laboratory parameters and complications of dialysis were monitored during the follow-up period. ♦ Results The mean weekly Kt/V at initiation of dialysis was 2.09. Median actuarial survival on a single exchange before requiring incremental dialysis was 297 days. At the end of the study period, all patients were still alive: 8 remained on 1 exchange, 18 were on more than 1 exchange, 8 had switched to hemodialysis, and 5 had received renal transplants. During the 12 665 patient-days on single-exchange dialysis, there were 14 hospital admissions of 12 patients. This resulted in a mean of 1.64 hospital days per patient–year for the whole group. During the follow-up period there were 2 episodes of bacterial peritonitis, 3 pleural leaks, 1 patent processus vaginalis, and 1 inguinal hernia that required surgical intervention. The use single daily icodextrin exchanges was associated with a 46% incidence of culture-negative peritonitis. ♦ Conclusions This pilot study has shown that a timely start of dialysis with a single overnight PD exchange is acceptable to patients. Incremental dialysis as residual renal function falls is easily managed and patients also find this acceptable. Complication and hospitalization rates were low. The presence of residual renal function often allows complications to be managed without the need for hemodialysis. The use of icodextrin as a single-exchange dialysate is associated with sterile peritonitis in a significant proportion of cases.
Nutrition Indices in Obese Continuous Peritoneal Dialysis Patients with Inadequate and Adequate Urea Clearance
Authors: Tzamaloukas Antonios H. , Servilla Karen S. , Murata Glen H. , Hoffman Richard M. 
Published: February 2020

♦ Objective To test whether better nutrition is associated more with adequate urea clearance than with inadequate urea clearance in obese patients on continuous peritoneal dialysis (CPD). ♦ Design Retrospective analysis of clearance and nutrition indices in obese CPD patients. Only obese patients were analyzed. Obesity was defined as a ratio of actual weight to desired weight (W/DW) ≥ 1.2. The dose of dialysis was considered adequate at weekly Kt/V urea ≥ 2.0. Small solute clearances and nutrition indices were compared between patients with weekly Kt/V urea < 2.0 and patients with weekly Kt/V urea ≥ 2.0 at the first clearance study. ♦ Setting Four university-affiliated and two private dialysis units in Canada and the United States. ♦ Patients A total of 270 CPD patients with W/DW ≥ 1.2 at the first clearance study. ♦ Results Among the 270 obese CPD patients, 157 (58.1%) were underdialyzed (weekly Kt/V urea 1.66 ± 0.22) and 113 (41.9%) had adequate dialysis (weekly Kt/V urea 2.51 ± 0.47) at the first clearance study. Creatinine clearance values also differed between the underdialyzed and adequately dialyzed obese groups (55.6 ± 15.2 vs 87.6 ± 29.8 L/1.73 m2 weekly, respectively, p < 0.001). The underdialyzed group contained fewer women (39.5% vs 60.2%, p < 0.001) and more patients with anuria (35.0% vs 8.8%, p < 0.001), and had higher serum urea (20.7 ± 6.9 vs 18.2 ± 5.3 mmol/L, p = 0.001) and serum creatinine (974 ± 283 vs 734 ± 275 μmol/L, p < 0.001), marginally lower serum albumin (35.8 ± 5.2 vs 37.2 ± 6.4 g/L, p = 0.082), lower urea nitrogen excretion (5778 ± 2290 vs 7085 ± 2238 mg/24 hr, p < 0.001) and indices derived from urea nitrogen excretion (protein nitrogen appearance and normalized protein nitrogen appearance), and lower creatinine excretion (1034 ± 349 vs 1217 ± 432 mg/24 hr, p < 0.001) and indices derived from creatinine excretion (lean body mass normalized to actual or desired weight) than the adequately dialyzed group. ♦ Conclusion Nutrition indices derived from urea nitrogen and creatinine excretion are worse in underdialyzed than in adequately dialyzed obese CPD patients. This finding may have clinical importance, despite the mathematical coupling between small solute clearances and excretion rates in cross-sectional studies, because of evidence from other studies that small solute excretion rate in cross-sectional studies is a robust independent predictor of outcome in CPD.
Predictors of Outcome following Bacterial Peritonitis in Peritoneal Dialysis
Authors: Krishnan Murali , Thodis Elias , Ikonomopoulos Dimitrios , Vidgen Ed , Chu Maggie , Bargman Joanne M. , Vas Stephen I. , Oreopoulos Dimitrios G. 
Published: February 2020

Objective No studies have been done to examine factors that predict the outcome of bacterial peritonitis during peritoneal dialysis (PD), beyond the contribution of the organism causing the peritonitis, concurrent exit-site or tunnel infection, and abdominal catastrophes. Design In this study we examined several clinical and laboratory parameters that might predict the outcome of an episode of bacterial peritonitis. Between March 1995 and July 2000, we identified 399 episodes of bacterial peritonitis in 191 patients on dialysis. Results There were 260 episodes of gram-positive peritonitis, 99 episodes of gram-negative peritonitis, and 40 episodes of polymicrobial peritonitis. Gram-positive peritonitis had a significantly higher resolution rate than either polymicrobial peritonitis or gram-negative peritonitis. Staphylococcus aureus episodes had poorer resolution than other gram-positive infections. Nonpseudomonal peritonitis had a better outcome than Pseudomonas aeruginosa episodes. Among all the gram-negative infections, Serratia marcescens had the worst outcome. Episodes associated with a purulent exit site had poor outcome only on univariate analysis. For those peritonitis episodes in which the PD fluid cell count was > 100/μL for more than 5 days, the nonresolution rate was 45.6%, compared to a 4.2% nonresolution rate when the cell count returned to 100/μL or less in less than 5 days. Those patients that had a successful outcome had been on continuous ambulatory PD for a significantly shorter period of time than those patients that had nonresolution. The nonresolution rate for those patients that had been on PD for more than 2.4 years was 24.4%, compared to 16.5% for those that had been on PD for less than 2.4 years ( p = 0.05). Conclusion The duration of PD and the number of days the PD effluent cell count remained > 100/μL were the only factors that independently predicted the outcome of an episode of peritonitis. Caucasians seem to have a higher nonresolution (failure) rate compared to Blacks. Other variables, such as the number of peritonitis episodes before the episode in question, vancomycin-based initial empiric treatment, serum albumin level, total lymphocyte count and initial dialysate white blood cell count, age, sex, diabetes, previous renal transplantation, and the use of steroids did not affect the outcome of peritonitis.
A Comprehensive Study on Hemostasis in CAPD Patients Treated with Erythropoietin
Authors: Malyszko Jolanta , Suchowierska Ewa , Malyszko Jacek S. , Mysliwiec Michal 
Published: February 2020

Objective Bleeding diathesis and simultaneous thrombotic complications may be seen in dialyzed patients. Erythropoietin (EPO) may shift the precarious balance of the hemostatic system toward thrombosis. Platelets and tissue factor (TF) play a major role in plug formation. Tissue factor pathway inhibitor (TFPI) appears to play a primary role in regulating TF-induced coagulation. Thrombin activatable fibrinolysis inhibitor (TAFI) is a key protein linking coagulation and fibrinolysis. The aim of the study was to assess whether 6 months of EPO therapy affects platelet function, that is, platelet aggregation and P-selectin level; moieties of the extrinsic coagulation pathway: TF, TFPI, and TFPI/Xa complexes, and factors VII and X; markers of ongoing coagulation: thrombin–antithrombin complexes (TAT) and prothrombin fragments 1+2; a marker of ongoing fibrinolysis: plasmin–antiplasmin complexes (PAP); fibrinolytic activity: euglobulin clot lysis time (ECLT); and markers of endothelial cell injury: von Willebrand factor, thrombomodulin, E-selectin, and TAFI, in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods 22 patients on CAPD were given EPO 6000 U/week. 12 patients with chronic renal failure and 12 healthy volunteers served as control groups. All parameters were studied before, and after 1, 3, and 6 months of EPO therapy. Setting Department of Nephrology and Internal Medicine, Medical Academy of Bialystok, Poland. Results Platelet aggregation in whole blood did not change significantly during EPO treatment. A significant rise in arachidonic acid-induced platelet aggregation in platelet-rich plasma was observed after 3 and 6 months, and in collagen-induced platelet aggregation after 6 months of EPO therapy, compared to the baseline values. The TFPI concentration decreased significantly after 6 months of EPO therapy. The activity of factor VII increased transiently after 1 month of EPO therapy, compared to the baseline values. The TAFI concentration and activity in the CAPD group were significantly higher than in the control group. Erythropoietin therapy resulted in a significant decrease in TAFI concentration and activity after 6 months of EPO treatment. The ECLT was shortened significantly as early as after 1 month of EPO therapy. Thrombomodulin, von Willebrand factor concentration and activity, PAP, TAT, TFPI/Xa complexes, prothrombin fragments 1+2, factor X activity, P-selectin, E-selectin, and lipoprotein(a) did not change significantly during EPO treatment. Conclusion Erythropoietin treatment has a minimal effect on hemostasis in CAPD patients. A tendency toward a decline in TAFI is of unknown clinical relevance so far, and awaits further research.
Factors Associated with Sleep Disorders in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Lui Sing Leung , Ng Flora , Lo Wai Kei 
Published: February 2020

Objective This study aimed at identifying factors that are associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis (CAPD). Study Design Questionnaire survey. Setting Renal dialysis unit of a tertiary-care hospital. Patients 179 Chinese patients on CAPD. Main Outcome Measures The quantity and quality of sleep were compared between CAPD patients with and without self-reported sleep disorders. Demographic variables, personality traits, behavioral factors, somatic symptoms, and clinical parameters were correlated with the presence of sleep disorders. Results The mean age of the patients was 61 ± 12 years and the male-to-female ratio was 1:1.3. The mean duration of CAPD was 47 ± 42 months. 110 patients (61%) had self-reported sleep disorders. Among patients with self-reported sleep disorders, difficulty falling asleep was the most frequent complaint (74.5%), followed by frequent awakening (68%) and early morning waking (68%). The mean duration of sleep among these patients was 4.6 ± 2.2 hours, versus 7.3 ± 1.4 hours in patients without self-reported sleep disorders. Three personality traits (anxiety, worry, and sadness) and two somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders. Patients with sleep disorders also more frequently reported certain symptoms suggestive of sleep apnea. Demographic variables, behavioral factors ( e.g., caffeine or alcohol intake), and clinical parameters ( e.g., adequacy of dialysis, body mass index, hemoglobin, albumin, parathyroid hormone levels) did not differ between patients with and without sleep disorders. Conclusions Sleep disorders are prevalent among Chinese CAPD patients. Personality traits (anxiety, worry, and sadness) and somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders in this patient population. Behavioral factors, demographic variables, and clinical parameters did not appear to predict sleep disorders. Further studies evaluating the impact of various psychological factors on sleep disorders among CAPD patients are warranted.
Sodium Removal in Patients Undergoing CAPD and Automated Peritoneal Dialysis
Authors: Rodríguez–Carmona Ana , Fontán Miguel Pérez 
Published: February 2020

Objectives To compare sodium removal in continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) patients, and to identify the main factors that modify Na removal in clinical practice in these patients. Design Study in three steps. Cross-sectional observational (Study A), and longitudinal interventional (Studies B and C). Patients and Methods First (Study A) we carried out a cross-sectional survey of Na removal in 63 patients on CAPD and 78 patients on APD. Second (Study B), we studied Na removal in 32 patients before and after changing from CAPD to APD therapy. Finally (Study C), we analyzed the impact on Na removal of introducing icodextrin for the long dwell in 16 patients undergoing CAPD or APD. Results In Study A, total Na removal averaged 210 mmol/day for CAPD patients and 91 mmol/day for APD patients ( p < 0.001); Na removal was < 100 mmol/day in 7.1% of CAPD patients and 56.4% of APD patients. Multivariate analysis identified ultrafiltration [B = 125 mmol/day, 95% confidence interval (CI) 110, 140], CAPD therapy (B = 60 mmol/day, 95%CI 37, 83), and residual diuresis (B = 51 mmol/L, 95%CI 34, 69) as independent predictors of Na removal (adjusted r2 = 0.76). For APD patients, longer nocturnal dwell times and performing a supplementary diurnal exchange were also independently associated with higher Na removal rates. In Study B, Na removal decreased from 192 to 92 mmol/day (median) after the change to APD ( p = 0.02). In Study C, peritoneal Na removal increased from 98 to 148 mmol/day (median) ( p = 0.04) after introducing icodextrin. Conclusions Standard APD schedules are frequently associated with poor Na removal rates. For any degree of ultrafiltration, Na removal is better in CAPD than in APD. Icodextrin, supplementary diurnal exchanges, and longer nocturnal dwell times improve Na removal in APD. Sodium removal can be estimated from ultrafiltration in patients on CAPD, but must be specifically monitored in patients on APD.
Capd Peritonitis Induces the Production of a Novel Peptide, Daintain/Allograft Inflammatory Factor-1
Authors: Brauner Annelie , Hertting Olof , Alkstrand Eva , Sandberg Elvi , Chromek Milan , Chen Zheng-Wang , Östenson Claes-Göran 
Published: February 2020

← Objectives To study the occurrence of a novel macrophage-derived peptide, daintain/allograft inflammatory factor-1 (AIF-1), in dialysate from continuous ambulatory peritoneal dialysis (CAPD) patients at commencement and after a follow-up period of therapy and during peritonitis. In addition, we studied peptide production in response to bacterial stimulation of monocytes and macrophages. ← Design Peritoneal fluid and supernatants from cells stimulated with different bacteria were analyzed for daintain/AIF-1. ← Patients and Setting Peritoneal fluid was obtained from 5 patients at commencement of CAPD therapy and during 8 weeks follow-up, and from 14 patients (10 males, 4 females) during CAPD peritonitis and during the noninfected steady state. All patients were admitted to the Karolinska Hospital. A human monocyte cell-line, THP-1 was differentiated to macrophages, and both monocytes and macrophages were stimulated with live and heat-inactivated Escherichia coli, Staphylococcus aureus, and S. epidermidis Cells were also stimulated with interleukin (IL)-1β and interferon gamma (IFNγ). Daintain/AIF-1 was analyzed with radioimmunoassay technique and IL-8 with enzyme immunoassay technique. ← Results An increased production of daintain/AIF-1 was observed in the first spent dialysate in the newly started CAPD patients, with a decrease during the follow-up period ( p < 0.05). During peritonitis, the first spent dialysate revealed significantly higher levels of daintain/AIF-1 (3.9 ng/mL) compared to the noninfected state (0.8 ng/mL), with production normalizing after 9 – 12 days. Bacterial stimulation with E. coli, S. aureus or S. epidermidi sinduced higher daintain/AIF-1 response in monocytes compared to macrophages ( p < 0.05). Live bacteria induced higher production of the peptide compared to heat-inactivated bacteria ( p < 0.05). Interleukin-1β and IFNγ were used to stimulate monocytes and macrophages; however, no daintain/AIF-1 production was found, although increased IL-8 levels were detected. ← Conclusion CAPD peritonitis induces a high and prominent daintain/AIF-1 response. Bacteria are able to induce a response of the peptide from monocytes and macrophages, and it is likely that the virulent parts of the bacteria are heat-labile structures. The early rise in daintain/AIF-1 might be used as a marker of CAPD peritonitis.
Improvement in Clinical Outcome by Early Nephrology Referral in Type Ii Diabetics on Maintenance Peritoneal Dialysis
Authors: Wu Mai-Szu , Lin Chun-Liang , Chang Chiz-Tzung , Wu Ching-Herng , Huang Jeng-Yi , Yang Chih-Wei 
Published: February 2020

← Objectives To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance peritoneal dialysis (PD). ← Design This is a retrospective study in a single University Hospital in Taiwan. ← Patients This study analyzed the type II diabetic patients entering our PD program from February 1988 to June 2000. Patients that were presented to a nephrologist more than 6 months before starting dialysis were defined as early referrals (ER). Patients were considered late referrals (LR) if they were transferred to the nephrology department within 6 months before initial dialysis. ← Main Outcome Measures Patient survival and technique survival curves were derived from Kaplan–Meier analysis and were compared using the Cox–Mantel log rank test. Covariates were analyzed with Cox proportional hazards model. ← Results 52 type II diabetic patients were enrolled in this study: 16 in the ER group and 36 in the LR group. Patient survival was better in the ER group than in the LR group {relative risks [exp(coef)] 0.42; 95% confidence interval 0.152 – 0.666; p < 0.05}. The improved survival in the ER group was independent of age at dialysis, good glycemic control, and residual renal function, as indicated in the multivariate analysis with stepwise regression by Cox proportional hazards model. The ER group was also associated with better technique survival. ← Conclusions These results suggest that early nephrology referral before initiating dialysis is associated with improved long-term clinical outcome in type II diabetics on maintenance PD.
Changes in Peritoneal Dialysis Practices in Canada 1996 – 1999
Authors: Perez Rafael A. , Blake Peter G. , Jindal Kailash A. , Badovinac Kimberly , Trpeski Lilyanna , Fenton Stanley S.A. ,   on behalf of the Canadian Organ Replacement Register–EPREX Study Group a, Barre Paul , Blake Peter , Cartier Pierre , Churchill David , Dyck Roland , Farah Antoine , Fay William , Fenton Stanley , Fine Adrian , Handa Paul , Harnett John , Jeffery John , Jindal Kailash , Jobin Jacques , Kates David , Kappel Joanne , Langlois Serge , Levin Adeera , Liu Tom , McCready William , Nolin Linda , Toffelmire Edwin , Turcot Richard , Ulan Raymond 
Published: February 2020

← Objective Over the past decade, clinical studies and clinical practice guidelines have suggested the use of higher small solute clearance targets for patients on peritoneal dialysis (PD). This study asks whether these recommendations have translated into changes in clinical prescription of PD. ← Study Design Data were collected annually from 1996 to 1999 on all prevalent dialysis patients in 24 Canadian centers, accounting for approximately 40% of the Canadian chronic dialysis population. Approximately a third of these patients were on PD. Full details of each patient's prescription were recorded, with particular attention to dwell volumes and frequency of exchanges for continuous ambulatory PD (CAPD) and to total treatment volumes and day dwells for automated PD (APD). The most recent Kt/V and creatinine clearance values available were recorded for each patient and the overall results for each year were compared to present treatment recommendations. ← Setting 24 university- and community-based hospitals. ← Results From 1996 to 1999, the use of APD, relative to CAPD, grew from 14% to 28% of all PD patients. Among CAPD patients, the proportion using dwell volumes greater than 2 L rose from 14% to 32%, and the proportion doing more than 4 dwells per day rose from 16% to 28%. The mean daily volume of prescribed fluid for CAPD patients increased from 8.3 to 9.1 L. As a result, the proportion of patients achieving a weekly Kt/V above 2.0 rose from 54% to 72%, and those receiving a Kt/V less than 1.7 fell from 22% to 10%. For creatinine clearance, those exceeding 60 L per week rose from 63% to 73%. For APD, the mean treatment volume rose from 11.8 L in 1996 to plateau at about 13.4 L in 1998 and 1999. However, the proportion of patients receiving more than 1 day dwell grew from 31% in 1998 to 40% in 1999, and the proportion that were “day dry” fell from 25% to 17%. For APD, the proportion of patients with a Kt/V above 2.0 rose from 67% to 77%, and with a creatinine clearance above 60 L, from 62% to 70%. The proportion with no recent clearance value recorded fell during the course of the study, from 45% to 27%. ← Conclusion There was a marked change in PD prescription practices in Canada during the second half of the 1990s. This occurred in response to clinical studies and publication of guidelines. There is room for further improvement, especially with respect to the proportion of patients that did not have regular clearance measurements made.
Inhibition of Caspases Improves Bacterial Clearance in Experimental Peritonitis
Authors:   Grupo de Estudios Peritoneales de Madrid-FRIAT/IRSIN, Catalan Marina Penélope , Esteban Jaime , Subirá Dolores , Egido Jesús , Ortiz Alberto 
Published: February 2020

Background Inhibition of caspases improves the antibacterial capacity of leukocytes cultured with peritoneal dialysis solutions, and improves the prognosis of septic, polymicrobial experimental peritonitis. Objective To test whether inhibition of caspases alters the evolution of peritonitis in the presence of peritoneal dialysis solution. Design 32 mice were assigned to therapy with either the pan-caspase inhibitor zVAD or vehicle for 48 hours following infection with Staphylococcus aureus, in the presence of lactate-buffered, 4.25% glucose peritoneal dialysis solution. 16 mice received vehicle in phosphate-buffered saline. Main Outcome Measure Number of bacteria recovered from the peritoneum at 48 hours. Results Peritoneal dialysis solution accelerated leukocyte apoptosis. zVAD decreased the number of apoptotic peritoneal leukocytes and the number of bacteria recovered from the peritoneum at 48 hours (zVAD 2.8 ± 0.3 vs vehicle 3.9 ± 0.2 log colony forming units of S. aureus, p = 0.007). Conclusions Inhibition of caspases accelerates peritoneal bacterial clearance in the presence of peritoneal dialysis solutions in vivo in the experimental setting. Inhibition of caspases should be explored as a mean to accelerate recovery following peritonitis in the clinical setting.