bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transplantation in Patients Undergoing CAPD
Authors: Tsakiris Dimitrios , Bramwell Stephen P. , Briggs J. Douglas , Junor Brian J.R. 
Published: February 2020

Between May 1980 and December 1983, 39 patients on continuous ambulatory peritoneal dialysis (CAPD) received renal allografts, which represents 18% of the 212 transplants done during this period. The remaining 173 allografts were transplanted into 162 patients who to the time of operation had been maintained on hemodialysis. For the CAPD and hemodialysis patients respectively, the one-year graft survival for first cadaveric transplants was 61% and 59%, while, for the two groups, the one-year patient survival was identical-95%. In five of the 14 patients (36%) in whom CAPD was used immediately after the transplant peritonitis developed, but in none of the 25 patients who did not have CAPD at this time. The Tenckhoff catheters were left in situ for a mean period of 12.7 weeks after the transplant without leading directly to any complications. However, at catheter removal, organisms grew on cultures from 11 of 25 catheter tips (44%). In conclusion, graft and patient survival is as high in CAPD patients as in those maintained by hemodialysis. In patients in whom the transplant does not function immediately we now use hemodialysis because CAPD at this time is associated with peritonitis and wound infection in some of the patients. Only a few centres have described their experience with renal transplantation in CAPD patients and most have not considered CAPD to be a contraindica tion to transplantation (1–5). However, based on one case report Cramer et al (6) suggested that CAPD provides a suboptimal preparation for transplantation, and Gelfand et al (7) reported that compared with hemodialysis, patients on CAPD had inferior transplant results. The small numbers of patients and varying selection criteria in most of these studies may explain the differences of opinion. This paper describes our experience with 39 CAPD patients who received renal allografts between May 1980 and Dec. 1983.
Procedures Used to Demonstrate a Pleuroperitoneal Communication: A Review
Authors: Kennedy Juanita M. 
Published: February 2020

A variety of procedures are used to demonstrate transdiaphragmatic transport of peritoneal fluid. Ideally, the procedure should be safe, reliable and generally available. At present, three procedures are used for this purpose: I) The study of dialysate, serum and pleural fluid for glucose, protein and LDH compoDents, 2) the intraperitoneal instillation of methylene blue dye, and 3) radionuclide scanning. Our study of five patients with hydrothorax suggests that these three procedures differ in risk factors, availability and reliability. Radionuclide scanning made the correct diagnosis in three of three cases where it was performed; the other two procedures were associated with false negative and positive results and a high incidence of side effects. We have concluded that radionuclide scanning is a safe and reliable procedure by which to demonstrate a pleuroperitoneal communication. Methylene blue test should be abandoned because of its toxic side effects and inconclusive results.
Effect of the Peritoneal Dialysate Buffer on UL TRafil Tration: Studies in Normal Rabbits
Authors: Kwong Mary B.L. , Wu George G. , Rodella Helen , Brandes Lidia , Oreopoulos Dimitrios G. 
Published: February 2020

We studied an animal model to test the ultrafiltration capability of three different peritoneal dialysis solutions: Brand A, containing lactate and manufactured in Canada, Brand B, containing acetate and manufactured in U.S.A. and Brand C also containing acetate and manufactured in France. Solutions with 1.5 g0/o and 4.25 g0/o glucose concentrations were tested. We found no significant difference in the amount of ultrafiltration produced with the three brands when glucose concentration was 1.5 g0/o. However with glucose concentration of 4.25 g 0/o ultrafiltration was significantly lower with the Brand C-French acetate solution comparing to Brand A-Iactate solution. Brand B (acetate U.S.A.) solution produced ultrafiltration volumes that were between the other two and were not statistically significantly different from either Brand A (acetate) nor from Brand C (acetate). We concluded that the lower ultra-filtration produced by Brand C is not due to the presence of acetate buffer but to other factors operating alone or in combination with acetate. Adequate peritoneal ultrafiltration for fluid balance is one of the main factors in the success of continuous ambulatory peritoneal dialysis (CAPD). Ultrafiltration failure associated with the use of acetate buffered dialysis solution has been described frequently in France (I, 2, 3), but only occasionally in North American centres (4,5,6). It is still controversial whether acetate or some other element(s) is the factor responsible for the ultrafiltration failure observed in French patients. The first report of an international co-operative study revealed that ultrafiltration is significantly lower in patients using acetate, compared to those using lactate dialysis solutions (7). However, the second report of this study, which contained results from patients using a larger number of brands, showed that acetate may not be a responsible factor because there were patients using acetate-solutions manufactured outside France who had an ultrafiltration similar to that produced with lactate brands (8). Because of this, we chose to study in an animal model the ultrafiltration produced with solutions containing different buffers during acute experiments. This paper reports our findings.
Coronary Artery Bypass Surgery in Peritoneal Dialysis Patients
Authors: McNamee Peter T. , Sombolos Kostas I. , David Tyrone E. , Oreopoulos Dimitrios G. 
Published: February 2020

Over the last two years, in the Toronto Western Hospital, five chronic renal failure patients suffering from severe symptomatic ischemic heart disease, who had been maintained on peritoneal dialysis underwent coronary artery bypass surgery. One of the five had simultaneous mitral valve replacement. Of the five, four survived with substantial improvement in symptoms, the fifth died soon after the operation. This paper describes the management of these patients and the dialysis technique used in the preand postoperative periods. Coronary artery bypass surgery (CABG) is effective in the treatment of symptoms of ischemic heart disease and under some circumstances it seems to improve life expectancy (1–4). Cardiovascular disease, which frequently is associated with chronic renal failure (CRF) remains the most common cause of death in dialysis patients (5, 6). Several workers have reported successful cardiac surgery in hemodialysis patients (7–10); however, we know of no relevant literature on similar operations in those maintained on peritoneal dialysis. During the last 5 years there has been a considerable increase in the number of CRF patients receiving peritoneal dialysis (11), and this paper describes five of our patients who underwent bypass operations while maintained on this fonn of therapy.
Closter: A New Connection for a Double-Bag System to Prevent Exogenous Peritonitis
Authors: Coli Giorgio Bazzato Ugo , Landini Silvano , Fracasso Agostino , Morachiello Paolo , Righetto Flavio , Scanferla Flavio , Genchi Rosangela 
Published: February 2020

Although CAPD has been widely accepted as routine treatment for uremic patients, recurrent peritonitis still remains a limiting factor. Since 1978 to reduce the incidence of the peritonitis mainly due to exogenous origin, we have used a doublebag system with satisfactory results. To make easier the connection and to reduce the chances of contamination during the bag-exchange manoeuvre, we designed “Closter”, a new closed sterile connection. This device consists of a needle mounted on a Luer cap, and protected by a folding plastic cover. A thin diaphragm at the end of the needle closes the entire system. During the connecting manoeuvre, the cap is first locked to a branch of the Y adaptor connected to the Tenckhoff catheter, then the needle, driven with a slight pressure through the diaphragm and the antiseptic chamber, puts the system in line.
Effectiveness of Single Daily Intraperitoneal Administration of Aztreonam and Cefuroxime in the Treatment of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Fuiano G. , Sepe V. , Viscione M. , Nani E. , Conte G. 
Published: February 2020

To discover if the management of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) may be effectively simplified by single daily i.p. administration of aztreonam (A) and cefuroxime (C), 10 adult CAPD patients (pts) with peritonitis were trained to start the following treatment procedure: a) sterile collection of dialysate effluent for cultures; b) 4 rapid in-and-out exchanges with antibiotic free dialysate; c) addition of 2 g C and 2 g A to a 2-L exchange for 6-h dwell time (the same dosage was repeated once a day in the overnight exchange); d) routine CAPD exchanges. Concentrations of C and A were measured in dialysate and serum of the patients 2, 12, 18, and 21–23 h after the i.p. administration: C remained within therapeutic range in all samples, while serum and dialysate A levels fell below such range 16 h after the i.p. administration. Seventeen peritonitis episodes occurred during the observation period (12 months): initial dialysate cultures grew Staph. aureus in 6 episodes, Staph epidermidis in 6, Pseudomonas aer. in 2, Streptococcus faecalis in 1, Citrobacter in 1, and Candida in 1. All patients but 1 (with Candida-positive culture) responded to this treatment with no relapse in 2 months. We conclude that once a day i.p. administration of 2 g aztreonam plus 2 g of cefuroxime is an effective and simple way of treating CAPD pts with gram-positive and gram-negative peritonitis.
Vitamin D and Vitamin-D-Binding Protein Kinetics in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Joffe Preben , Heat James G. 
Published: February 2020

Serum and dialysate levels of 25-hydroxycholecalciferol (25-0HD3), 1,25 dihydrox ycholecalciferol (1,25(0H)2D3), and vitamin-D-binding protein (DBP) were measured in 14 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Serum levels of 25-0HD3 and DBP were within normal range (29.1 ± 22.9 nmollL and 5.9 ± 1.1 μmol/L, respectively). Serum levels of 1,25-(0H)2D3 were subnormal in all «16 pmol/L) but one. In 5 patients, dialysate concentrations of 25-0HD3 were 2.3 ± 0.9 nmol/L, the rest had levels <1.0 nmol/L. Small quantities of 1,25-(0H)2D3 were found in the dialysate effluents. DBP could be detected in the dialysate in all patients (0.24 ± 0.06 μmol/L). Mass transfer (MT) of 25-0HD3 and DBP were respectively -10.4 ± 8.3 nmol/24 h and -1.46 ± 0.46 μmol/24 h. Peritoneal clearances of 25-0HD3 and DBP were low (0.40 ± 0.37 mL/min and 0.18 ± 0.06 mL/ min, respectively. We conclude that CAPD leads to losses of 25-0HD3 and DBP. However, the peritoneal loss of DBP is well compensated and does not result in serum deficiency. Serum 25-0HD3 levels did not correlate with time on CAPD.
Evaluation of Nutritional Status in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD)
Authors: Buchwald Raquel , Peña Jose Carlos 
Published: February 2020

We designed this study to evaluate the nutritional conditions of 16 continuous ambulatory peritoneal dialysis (CAPD) patients. In all these patients we did a monthly 1-day clinical, anthropometrical, biochemical, and nitrogen balance evaluation: a minimum of 3 and a maximum of 9 monthly evaluations in all patients. The results were analyzed in two groups: Group I (N = 8) with neutral or positive nitrogen balances, and Group II (N = 8) with one or more negative nitrogen balances. The sex distribution, mean age in years, time on CAPD, and period of study in this protocol were similar in both groups. Group I maintained a positive nitrogen balance and steady values in the anthropometric measurements (triceps fat fold, upper-arm circumference, body weight). Group II showed a significant decrease in both the anthropometric values and the nitrogen balance during the episodes of peritonitis. In this same group, when peritonitis subsided, the protein intake increased, nitrogen balance became positive, and the anthropometric values improved. When all the nutritional evaluations were analyzed we found a significant and direct linear correlation between nitrogen intake and nitrogen balance in g/kg/day (N = 60; nitrogen balance = nitrogen intake X 0.75 -0.101; r = 0.71; p < 0.001). We also contrasted the presence of peritonitis with the nitrogen balance and the anthropometric values using Spearman rank correlation coefficient and obtained a very high correlation (0.997 to 0.999). Blood values (blood urea, serum creatinine, serum phosphate, serum potassium, and hemoglobin) were not very sensitive to detect differences within or between groups along the study. The serum proteins and the serum albumin were good markers of the changes in the nutritional conditions of our patients. With the use of the monthly 1-day evaluation, we were able to estimate the initial nutritional conditions at the time of the first assessment and the clinical and nutritional course with the monthly evaluations. The low caloric and proteic intake, during the episodes of peritonitis, were the main cause of malnutrition in this group of CAPD patients and not the peritoneal membrane protein losses as reported in the literature.
Changes in Activity of Selected Lysosomal Enzymes in Peritoneal Macrophages of Renal Failure Patients on Peritoneal Dialysis
Authors: Sulowicz Wladyslaw , Cichocki Tadeusz , Hanicki Zygmunt 
Published: February 2020

Activity of acid phosphatase (AP), beta-glucuronidase (GR), N-acetyl-beta-D-glucosaminidase (GZ), and peroxidase (P) was assessed using a semiquantitative cytochemical method in peritoneal macro phages of 30 patients with end-stage renal failure treated by intermittent peritoneal dialysis and of 30 control patients with normal renal function. The dialysed patients showed a significantly higher activity of GR and P at the beginning of the treatment as compared with the respective activities observed in the control group and a further significant rise of these activities after 4 months of dialysis. Activity of AP at the beginning of the treatment was insignificantly lower than in the control group and the difference became significant at the end of the investigated period. There was no significant difference between the dialysed patients and the control group in the activity of GZ assessed at the beginning of the dialytic treatment and after 4 months of dialysis. A significant decrease in that activity was, however, observed in the course of dialysis.
A Comparison of Peritoneal Dialysis-Related Infections in Black and White Patients
Authors: Holley Jean L. , Bernardini Judith , Piraino Beth 
Published: February 2020

Objective To determine if black patients in our peritoneal dialysis (PD) program had higher rates of PD-related infections. The outcomes of black patients versus white patients were also reviewed. Design A review of prospectively collected patient demographic and PD-related infection data and out comes, from 1979 to 1991. Patients The 68 black patients in our PD program were matched with white control patients for age, sex, insulin dependence, time on dialysis, and mode of dialysis (CAPD or CCPD). The infection, demographic, and outcome data from the two groups were compared. Results Black patients had higher peritonitis rates (1.10 vs 0.82 episodeslyear, p=0.001) and exit-site infection rates (1.13 vs 0.95 episodeslyear, p=0.02) than the white control patients. Tunnel infection rates were 0.21 episodeslyear in both groups. S. epidermidis peritonitis was more common in black patients (48% of episodes vs 21% of episodes in whites, p=0.005), and S. aureus peritonitis was more common in white patients (29% vs 11% in blacks, p=0.005). The subset of black patients (n=13) on a disconnect system (Y-set) had a peritonitis rate similar to their white controls on the Y-set (0.41 vs 0.74 episodes/year, p=0.27). There were no episodes of S. epidermidis peritonitis in this subset of black patients. Black patients had fewer S. aureus exit-site infections than white patients (21% vs 41%, p=0.005). Peritonitis was the leading cause of transfer to hemodialysis in the black patients but not in the white patients. Conclusion The susceptibility to S. aureus and S. epidermidis infections differs in black and white patients on peritoneal dialysis for unclear reasons. Peritonitis rates in black patients can be reduced to that of white patients if a disconnect system is used.
Poor Response to Oral Ciprofloxacin in the Treatment of Peritonitis in Patients on Intermittent Peritoneal Dialysis
Authors: Waite Nancy M. , Johnson Michael D. , Webster Nancy R. , Fong Ignatius W. 
Published: February 2020

Objectives To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population. Design Open nonrandomized prospective study. Setting Nephrology Peritoneal Dialysis Unit in a tertiary care, teaching hospital of the University of Toronto. Patients Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following: 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of >100!IJl, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria. Interventions Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days. Main Outcome Measures Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration. Results Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured. Conclusions Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis related Gram-positive bacterial peritonitis.
Evaluation of Short-Chain Polypeptides as An Osmotic Agent in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Imholz Alexander L.T. , Lameire Norbert , Faict Dirk , Koomen Gerardus C.M. , Krediet Raymond T. , Martis Leo 
Published: February 2020

Objectives To assess whether dialysate containing short-chain polypeptides is well tolerated in continuous ambulatory peritoneal dialysis (CAPD) patients and to determine its effect on fluid and solute transport, plasma amino acid levels, and biochemical parameters. Design Two -treatment, two-period cross -over design. Setting Renal Unit, Academic Medical Center, Amsterdam and Renal Unit, University Hospital, Gent. Patients Two groups of 10 stable CAPD patients. Intervention All patients received a trial solution (1.36% glucose and 1% peptides, 381 mOsm/kg) and a control solution (2.27% glucose, 404 mOsm/kg) in randomized order. The patients were examined on four consecutive days in which two dwell periods on days 1 and 3 of either 4 (Group I) or 8 hours (Group II) were performed. Results The peptide solution was well tolerated in all patients. In addition, no differences were found in the parameters for the effective peritoneal surface area and the intrinsic permeability, implying that no irritating effect of the peptide solution was present. Net ultrafiltration was not different in Group I: -43±125 versus 86±125 mL (mean±SEM) and marginally lower in Group II: -94±64 versus 51±64 mL, despite the lower osmolality of the trial solution compared to the control solution. Glucose absorption was higher than the peptide absorption in all patients: Group I: 66±10% versus 57±13% (p = 0.0003); Group II: 80±5% versus 72±11% (p = 0.006). No differences in plasma amino acid profiles could be detected. Conclusion Short-chain polypeptides are absorbed less than glucose and can be used as an osmotic agent in CAPD patients. However, longer-term studies are needed to evaluate possible additional effects of peptides on the nutritional status of CAPD patients.
Positive Nitrogen Balance after Intraperitoneal Administration of Amino Acids in 3 Patients
Authors: Rubin Jack , Garner Tina 
Published: February 2020

Objective To determine whether intraperitoneal (IP) administration of amino acids improves nitrogen balance during continuous ambulatory peritoneal dialysis (CAPD). Design Nitrogen balance studies of CAPD patients comparing periods of peritoneal dialysis using dialysate with nitrogen added from a commercial amino acid solution, versus standard dialysate. Setting Clinical research center in a tertiary facility. Patients Patients on CAPD who volunteered. Interventions One 4-day balance period was carried out with conventional dialysate and one 4-day period with conventional dialysate to which amino acids were added. The study periods were separated by a 3-day washout period. Main Outcome Measures Nitrogen accumulation or loss during each period. Results The mean (SD) daily control period balances (grams per day) were 0.2, 1.9, and -3.4; during the amino acid period the balances were 5.4, 2.7, -0.7. The mean daily control effluent dialysate volumes (milliliters) were 11 350±443, 10 052±449, and 10 165±154; during the amino acid period the volumes were 10345±50, 12325±1021, and 10 220±655. Conclusions The IP addition of amino acids diminishes the amount of nitrogen lost from dialysate while maintaining effluent dialysate volume. Nitrogen balances improved in al13 patients during the period with IP amino acids, compared to control.
Higher Incidence of Peritonitis in Native Canadians on Continuous Ambulatory Peritoneal Dialysis
Authors: Fine Adrian , Cox Darlyne , Bouw Maria 
Published: February 2020

Objective To determine if the rate of peritoneal dialysis (PD)-related infections in our large Native population was higher than in non-Natives. Design Prospective study of PD-related infections, 1987 to 1993. Patients Forty-eight Natives and 136 non-Natives were studied. Comparisons of infection rates were made as well as determinations of the effect of diabetes and of dialysis techniques on infection rate. Results The chance of remaining free of peritonitis was far lower at 6 and 12 months in Natives versus nonNatives, 40% versus 76% at 6 months, and 24% versus 54% at 12 months (p < 0.01). Having diabetes or adding intraperitoneal insulin did not confer additional risk of peritonitis. The Y-Iine reduced the risk of peritonitis in non-Natives only. Exit-site infection (ESI) was significantly higher in Natives versus non-Natives, 0.42 versus 0.19 episodes per patient year (p < 0.01) mainly due to Staph. aureus. However, less than 30% of episodes of peritonitis were due to that organism. Staph. epidermidis peritonitis episodes were not more common in Native patients, whereas infections due to most other organisms were. Conclusion The susceptibility to both peritonitis and exit-site infection is increased in Native Canadians compared to non-Natives. The non protective effect of the Yline combined with increased peritonitis due to most organisms except Staph. epidermidis in Natives suggests that host factors could be important in these patients.