bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peritoneal Dialysis in Children under 5 Years of Age
Authors: Hölttä Tuula M. , Rönnholm Kai A.R. , Jalanko Hannu , Ala-Houhala Marja , Antikainen Marjatta , Holmberg Christer 
Published: February 2020

Objective We report our experience with maintenance peritoneal dialysis (PD) in small children. Design This is a retrospective analysis of the patient records of all children under the age of 5 years treated with continuous peritoneal dialysis (CPD) between 1986 and 1994 in Finland. Setting Treatment was started and the patients were seen at the outpatient clinic at the Hospital for Children and Adolescents, University of Helsinki, every 3 months. Between these visits, they had controls at their local hospital every 2 -4 weeks. Patients The most common primary renal disease in these 34 patients was congenital nephrotic syndrome of the Finnish type (27 patients). Others were: congenital nephrotic syndrome (3 patients), polycystic kidney disease (1), urethral valve (1), neuroblastoma (1), and renal dysplasia (1). Results Mean age at onset was 1.6 years and median treatment time 9.3 months. Time spent in hospital decreased from 270 days/year in the 1980s to 150 days/year in the 1990s. Two children died (5.9%). The peritonitis rate on continuous cyclic peritoneal dialysis was 1:11.5 patient-months. Hernias were diagnosed in 29% of the patients. After 3 months half of the patients were on antihypertensive medication. Pulmonary edema was diagnosed once in 12 patients and twice in 2 patients. During the first 6 months on PD the mean height standard deviation score (hSDS) increased from -2.13 to -1.66 (p < 0.0001). The 6-month change in hSDS before initiation and 6 months after the start of CPD increased from -0.12 ± 0.68 to +0.59 ± 0.64 (p = 0.0008). Conclusions Our results indicate that peritoneal dialysis is feasible and safe in small children. Mortality was low and growth was good. The major challenges presented by CPD therapy were maintenance of optimal nutrition, avoidance of peritonitis, and control of volemia.
Surfactant Barrier Lining Peritoneal Mesothelium: Lubricant and Release Agent
Authors: Hills Brian A. , Burke John R. , Thomas Kristen 
Published: February 2020

Objective Five studies are described to determine whether there is an outermost lining of surface-active phospholipid (SAPL) adsorbed to the peritoneum and to quantify its ability to act as a release (antistick) agent and boundary lubricant by standard tests. Methods Using a hydrophobic probe (phosphin E), epifluorescence microscopy was used to demonstrate an outermost lining of oligolamellar SAPL by spectral analysis of the emitted light, a finding consistent with the appreciable hydrophobicity demonstrated on canine peritoneal mesothelium and its virtual elimination by incubation with bile salt. Good release and excellent lubricating capabilities of human peritoneal SAPL have been quantified as the release factor and coefficient of friction, respectively, by standard tests from the physical sciences. Results A well-defined outermost layer was clearly visible on peritoneal mesothelium whose color spectrum was identical to that produced by pure phosphatidylcholine ultrasonicated into its oligolamellar state. Further evidence for a SAPL lining was demonstrated by a parietal contact angle of 43° (47° visceral) on this surface and its virtual elimination by incubation with dilute bile salt. Human SAPL from continuous ambulatory peritoneal dialysis (CAPD) effluent proved an effective release agent, reducing adhesion by 67%, and an excellent lubricant as quantified by a coefficient of friction of 0.091 under load (1.9 kg/cm2). Conclusions The good release and excellent lubricating properties of SAPL adsorbed to mesothelial surfaces are highly desirable in reducing wear and exfoliation of epithelial cells. In spanning epithelial cells, the same lining might also serve to render tight junctions tight and reduce macromolecular escape while compatible with many aspects of CAPD, including lipid permeability and conflicting results obtained from administering exogenous SAPL.
Intraperitoneal Pulse Calcitriol in the Treatment of Secondary Hyperparathyroidism in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Chan Hilda W.H. , Tsang Wai-Kay , Chan Chor-Man , Fung Samuel K.S. , So Sheung-On , Tang Hon-Lok , Tong Matthew K.L. , Lee Kam-Cheong , Chan Albert Y. W. 
Published: February 2020

Objective To determine whether it is practicable to use intraperitoneal calcitriol to treat continuous ambulatory peritoneal dialysis (CAPD) patients with secondary hyperparathyroidism and whether this form of therapy is effective and safe. Design A prospective, nonrandomized study. Setting Division of Nephrology, Tertiary Hospital. Method Eight patients from our CAPD population were recruited (5 F,3 M), aged 24 to 63 years (mean 38.9 ± 7.6 yr). They had been on CAPD for 8 to 84 months (mean 47.6 ± 24.6 months). All the patients had bone biopsy -proven secondary hyperparathyroidism with 2 patients showing mixed lesions. The CAPD system was changed to the twinbag system (Ultrabag, Baxter Healthcare, McGaw Park, IL, U.S.A.) in all 8 patients, who were taught to inject the calcitriol directly through the short transfer set and the Tenckhoff catheter into the peritoneal cavity, twice per week before bedtime. Calcium carbonate or calcium acetate was used as the main phosphate binder. Intact parathyroid hormone level (iPTH), serum ionized calcium (iCa), serum phosphate, and serum total alkaline phosphatase (alk. phos.) levels were measured at baseline and then every 4 weeks. The mean duration of follow-up was 10.5 months ± 1.9 months. Results There was a significant drop of iPTH level from the pretreatment level of 100.6 ± 35.8 pmoll L to a level of 63.8 ± 48.7 pmoll L at 24 weeks (p = 0.036). The lowest level of iPTH attained was 43.4 ± 27.0 pmol/L at 48 weeks. Serum total alk. phos. also dropped from 232.4 ± 83.3 lUlL pretreatment to 147.9 ± 52.0 lUlL at 24 weeks (p = 0.017). The decrease in alk. phos. level paralleled the decrease in iPTH level. The mean serum iCa level did not show any significant rise throughout the study period. The maximum dose of calcitriol used was 6.6 ± 1.5 μg/week and the average dose of calcitriol was 5.4 ± 1.2 μg/week. One patient did not respond satisfactorily and she subsequently had a parathyroidectomy. Two episodes of peritonitis occurred during the study period, giving a peritonitis rate of one episode per 42 patient-months. There was no significant change in the urea clearance tests or the peritoneal equilibration tests before and after the study. Conclusion Intraperitoneal calcitriol is practicable, effective, and safe in the treatment of secondary hyperparathyroidism in CAPD patients.
Pharmacokinetics of Clodronate in Peritoneal Dialysis Patients
Authors: Saha Heikki H.T. , Ala-Houhala Ilpo O. , Liukko-Sipi Sirpa H. , Ylitalo Pauli , Pasternack Amos I. 
Published: February 2020

Objective To study the pharmacokinetics of clodronate in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A single intravenous dose pharmacokinetic study. Setting University hospital. Patients Ten CAPD patients (3 female, 7 male, age 39 79 year, median 55). Methods Clodronate disodium in serum, urine, and dialysate was collected for 24 hours and analyzed by capillary gas chromatography with mass-selective detection. Results Only 7% of the infused dose of clodronate was eliminated through peritoneal dialysis during 24 hours. Clearance via CAPD (CLCAPD) was 2.4 ± 0.6 mL/min, which was less than 10% of the total serum clearance (CLtot’ 26.0 ± 19.3 mL/min). Even the kidneys were a more important route of elimination than CAPD in those patients with residual diuresis of more than 500 mL/24 hr. However, in all patients most of the clodronate serum clearance (77% ± 13%) took place via routes other than peritoneal dialysis or kidneys, that is, via nonrenal-non-CAPD clearance (CLNRD). CLNRD most likely represents the part of the drug deposited in the skeleton. There was a positive correlation between CLNRD and the plasma intact parathyroid hormone concentration. Conclusions CAPD removed clodronate poorly from the circulation. Most clearance took place via routes other than CAPD or kidneys. This CLNRD most likely represents the skeletal deposition of the drug, and this is related to the severity of hyperparathyroidism. When treating CAPD patients with hyperparathyroid bone disease, the administration of clodronate should be adjusted as in those subjects with severe renal failure.
Repair of Chronic Peritoneal Dialysis Catheter
Authors: Usha Kumari , Ponferrada Leonor , Prowant Barbara F. , Twardowski Zbylut J. 
Published: February 2020

Background Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement. Objective and Design Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.). Results The life of these seven catheters was extended by a mean of 26 months (range 1 -87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site. Conclusions and Recommendations Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.
Serum Leptin Correlates with Fat Mass but not Dietary Energy Intake in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Parry Robin G. , Johnson David W. , Carey David G. , Hibbins Mark , Chang Wendy , Purdie David , Rigby Russell J. 
Published: February 2020

Objectives In view of previous studies demonstrating hyperleptinemia in uremic and hemodialysis patients, the aims of the present study were to determine whether serum leptin levels are elevated in peritoneal dialysis (PD) patients, to establish whether leptin is significantly removed by PD, and to elucidate the relationship of plasma leptin to body composition, dietary intake, nutritional indices, and dialysis adequacy. Design Cross-sectional analysis of PD patients and matched healthy controls. Setting Tertiary-care institutional dialysis center. Participants The study included 49 PD patients [35 women and 14 men; median age 63 years, interquartile range (IQR) 49.5 -68.5 yr; body mass index (BMI) 25.5: I: 0.8] and 27 controls (11 men and 16 women; median age 42 years, IQR 34.8 51; BMI 27.2: I: 0.9). For evaluation of leptin clearance, 8 patients receiving nocturnal intermittent PD were also evaluated. Main Outcome Measures The primary outcome measure was plasma leptin concentration. Dialysate leptin concentration was also measured in 7 patients. Results Serum leptin levels were significantly higher (p < 0.01) in patients (males: median 11 nglmL, IQR 9 19 ng/mL; females: 53 ng/mL, 19.5 -128 ng/mL) compared with controls (males: 5.5 nglmL, 4 9.5 nglmL; females: 12 ng/mL, 9.8 17.3 ng/mL). Leptin levels in both groups correlated positively with BMI (r = 0.64 and 0.60, respectively; p < 0.0001) and with percentage body fat determined by dual-energy x-ray absorptiometry (r = 0.86 and 0.82, respectively; p < 0.01). Dialysis patients exhibited a greater increase in serum leptin for any given increase in BMI. No significant correlation was observed between leptin concentration and residual renal function, dialysis adequacy (Kt/V), dietary protein or caloric intake, or serum levels of albumin, prealbumin, C-reactive protein, glucose, and insulin-like growth factor-1. Although leptin was detectable in peritoneal dialysate after a 6-hour dwell (median 4.2 ng/ mL, IQR 1.1 -8.5 ng/mL, n = 8), serum leptin levels were not appreciably lowered following intermittent PD via an automated cycler (63.9: I: 19.3 ng/mL vs 57.6: I: 20.5 ng/mL, p = NS, n = 8). Conclusions Serum leptin levels are elevated in PD patients and are not appreciably cleared by PD. Although hyperleptinemia correlates poorly with dialysis adequacy and protein intake, a strong and significant relationship was maintained between serum leptin and fat mass. Serum leptin could therefore serve as a useful clinical marker of body fat content in PD patients.
Clinical Evaluation of a Peritoneal Dialysis Solution with 33 mmol/L Bicarbonate
Authors: Cancarini Giovanni C. , Faict Dirk , De Vos Catherine , Guiberteau Robert , Tranæus Anders , Minetti Luigi , Maiorca Rosario 
Published: February 2020

Objective To evaluate the efficacy and safety of a new peritoneal dialysis solution with 33 mmol/L bicarbonate. Design In an acute, prospective, randomized crossover study, 8 patients were randomized in two groups of 4. On the first study day, the first group performed two consecutive 4-hour exchanges with a dialysis solution containing 35 mmol/L lactate: the first exchange with 13.6 g/L and the second with 38.6 g/L dextrose. On the second study day, the same type of exchanges were performed with bicarbonate. The second group underwent the same treatment, but used bicarbonate solutions on the first day and control solutions on the second study day. Thirty-three patients participated in a 2-month prospective and randomized study. After a 4-week baseline period using solutions containing 40 mmol/L lactate, the patients were dialyzed with either 33 mmol/L bicarbonate solutions or 40 mmol/L lactate solutions. Setting Peritoneal dialysis units at the University Hospital of Brescia and the Niguarda Hospital of Milan, Italy. Results Acute study: Control and bicarbonate solutions had similar effects on blood chemistries and peritoneal transport. Chronic study: Mean venous bicarbonate concentrations remained unchanged in the control group (26.6 -27.2 mmol/L), but decreased significantly in the bicarbonate group from 28.8 mmol/L at the start of the study to 23.0 mmol/L after 2 months of bicarbonate administration. Other biochemical parameters remained unchanged. Conclusion A peritoneal dialysis solution with a bicarbonate level of 33 mmol/L does not adequately correct uremic acidosis.
Pseudomonas Exit-Site Infections in CAPD Patients: Evolution and Outcome of Treatment
Authors: Lo Chi Yuen , Chu Wai Ling , Wan Kit Mui , Ng Suk Yi , Lee Wai Ling , Chu Mui Fun , Cheng Suk Wai , Lo Wai Kei 
Published: February 2020

Objective To examine the natural history of Pseudomonas aeruginosa (PSA) exit-site infections (ESI) in patients treated with antibiotics with or without surgical interventions. Design Retrospective record review from May 1994 to April 1997. Setting A single dialysis unit in a district hospital. Patients The review included 353 patients who had undergone continuous ambulatory peritoneal dialysis (CAPD). Outcome Measures The prevalence and etiology of ESI, the treatment regimen for PSA ESI, and the outcome of treatment. Results The prevalence of ESI was 55%. A total of 131 episodes (range 1 -5) of PSA ESI occurred in 78 (40.2%) of the 194 patients who experienced ESI. Among these 78 patients, 4 groups with different outcomes were identified.ln group 1,35 patients (44.9%) were treated successfully with antibiotic therapy alone. Among these 35 patients, 4 developed PSA peritonitis at a mean of 5 months (range 2 -10 mth) after apparent clinical resolution of PSA ESI. Two of the 4 patients switched to long-term hemodialysis (HD) because of peritoneal failure. In group II, 8 patients (10.3%) responded to a combination of antibiotics and shaving of the external cuff. In group III, 21 patients (26.9%) with recurrent ESI underwent elective Tenckhoff catheter removal and reinsertion. One of the 21 patients had relapse of PSA ESI 14 months after the operation. In group IV, 14 patients (17.9%) had recurrent PSA ESI that failed to respond to multiple courses of antibiotics and shaving of the external cuff. Consent for Tenckhoff catheter removal was not obtained and 4 of these 14 patients subsequently developed PSA peritonitis. One of the 4 patients changed to permanent HD due to peritoneal failure. Conclusions Considering the increased risk and the poor outcome of PSA peritonitis in patients with persistent PSA ESI, early Tenckhoff catheter removal is recommended if the patient fails to respond to antibiotics with or without externalization of the external cuff.
Tranexamic Acid Increases Peritoneal Ultrafiltration Volume in Patients on Capd
Authors: Kuriyama Satoru , Nakayama Masaaki , Tomonari Haruo , Kawaguchi Yoshindo , Hosoya Tatsuo 
Published: February 2020

Objective The preservation of ultrafiltration (UF) capacity is crucial to maintaining long-term continuous ambulatory peritoneal dialysis (CAPD). The aim of the present study was to investigate whether the antiplasmin agent tranexamic acid (TNA) increases UF volume in CAPD patients. Patients and Methods Fifteen patients on CAPD, 5 with UF loss and 10 without UF loss, were recruited for the study. The effect of TNA was evaluated with respect to changes in UF volume, peritoneal permeability, peritoneal clearance, bradykinin (BK), and tissue plasminogen activator (tPA) concentration. Setting Dialysis unit of the Saiseikai Central Hospital. Results In patients with UF loss, 2 weeks of treatment with oral TNA produced a significant increase in UF volume in all subjects (5/5). TNA also produced a significant increase in peritoneal clearances of urea and creatinine (Cr). However, the peritoneal equilibration test (PET) revealed that TNA had no effect on dialysate/plasma (D/P) Cr, Kt/V, or the protein catabolic rate (PCR). TNA also had no effect on net glucose reabsorption. In contrast, significant decreases in BK and blood tPA concentrations in response to TNA treatment were noted. BK concentration in drainage fluid was also reduced. In the case of patients without UF loss, TNA produced an increase in UF volume in 70% (7/10). However, no differences were found in blood and drainage BK and tPA concentrations between the TNA treatment and nontreatment periods in these patients. A comparison of basal BK and tPA concentration showed that there were no differences in these parameters between patients with UF loss and those without loss of UF. Furthermore, TNA given intraperitoneally to a patient also produced a marked increase in UF volume. Conclusion The present study suggests that TNA enhances UF volume in patients both with and without UF loss. Since TNA did not affect peritoneal permeability and glucose reabsorption, the mechanism by which TNA exerts an enhancing action on UF is largely unknown. We speculate that it may be associated with suppression of the BK and/or tPA system, at least in patients with UF loss.
Characterization of Subtypes of Hypertension in Capd Patients by Cyclic Guanosine Monophosphate
Authors: Lang Susanne M. , Wolfram Gernot , Gerzer Rupert , Schiffl Helmut 
Published: February 2020

Objective While most hypertensive patients with endstage renal disease normalize high blood pressure with fluid removal by continuous ambulatory peritoneal dialysis (CAPD), there is a significant proportion of CAPD patients whose blood pressure can be controlled only by antihypertensive drugs. Method and Patients To study the hypothesis that such patients are still volume overloaded, we used plasma cyclic guanosine monophosphate (cGMP) as a marker for hydration status. Thirty-two CAPD patients were divided into 3 groups: group 1, normotensive patients (n = 12); group 2, hypertensive patients who normalized their blood pressure with fluid removal (n = 12); group 3, hypertensive patients whose blood pressure was refractory to intensified fluid removal (n = 8). Results Mean cGMP levels were significantly higher in dialysis-sensitive hypertension (27 ± 5 pmol/mL) than in dialysis-refractory hypertension (15 ± 2 pmol/mL), or in normotensive patients (13 ± 4 pmol/mL). Reduction of excess fluid in volume overloaded hypertensive CAPD patients resulted in a normalization of cGMP levels (14 ± 8 pmol/mL), but did not affect this volume marker in patients with dialysis-resistant hypertension (10 ± 4 pmol/mL). Conclusion Plasma cGMP levels are elevated in volume overload-induced hypertension complicating CAPD. Hypertensive CAPD patients whose plasma cGMP levels are within normal limits have raised blood pressure refractory to volume removal. Our findings are consistent with the hypothesis that inadequate removal of excess volume plays a major role in a subset of patients with CAPD hypertension.
Gender Differences in Normalized Clearances in Capd: Role of Body Size and Normalizing Parameters
Authors: Tzamaloukas Antonios H. , Murata Glen H. , Bernardini Judith , Malhotra Deepak , Rao Panduranga , Piraino Beth , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To compare raw (not normalized) and normalized urea and creatinine clearances between women and men on continuous ambulatory peritoneal dialysis (CAPD). To study whether potential gender differences are due to the normalization process. Design Retrospective analysis of clearance studies. Setting Dialysis units of four academic medical centers. Participants The study included 302 subjects (135 women and 167 men) on CAPD with four daily exchanges and a 2-L exchange volume. Intervention Measurement of urea and creatinine clearances (261 in women, 352 in men) by standard methods. Body water (the volume of distribution, V, for both urea and creatinine) was estimated by the Watson anthropometric formulas. Main Outcome Measures Comparison of raw and normalized clearances between women and men. Urea clearance was normalized by V (Kt/Vur), while creatinine clearances was normalized by both V (Kt/Vcr) and body surface area (BSA) (Ccr). Results Mean values of weekly total (peritoneal plus renal) raw clearances were higher in men (urea clearance: women 67.1 L, men 77.4 L; Ccr: women 61.7 L, men 78.3 L). Raw renal clearances were higher in men, while raw peritoneal clearances were comparable. Mean weekly total Kt/Vur was higher in women (2.19 vs 1.94 in men), mean weekly total Kt/Vcr did not differ between the genders (women 2.01, men 1.95), while mean weekly Ccr was higher in men (73.0 vs 64.7 L/1.73 m2 in women). When clearances differed, the differences were significant at p < 0.001. Men had greater height and weight, while women had greater body mass index. On the average, V in men exceeded V in women by 31%, while BSA in men exceeded BSA in women by only 12%. Conclusions Normalization of clearances by V creates relatively higher clearance values in women, while normalization by BSA creates relatively higher clearance values in men. Thus the normalization process may create artificial differences in the normalized clearances between genders.